PeaceHealth End of Life Policy

Status

Active

PolicyStat ID

14835878

Origination 10/14/2015 Owner

Hilary Walker:

Last 11/17/2023

Approved

Mgr Advance

Care Planning

Effective 12/15/2023

Area

Administration

Applicability

PeaceHealth

Systemwide

Tags

Policy

Advance Directives Policy

SCOPE

This policy applies to all PeaceHealth settings and services in the location(s) checked below:

Ambulatory Surgery Center PeaceHealth Medical Group

Cottage Grove Medical Center Sacred Heart RiverBend

Ketchikan Medical Center Southwest Medical Center

Ketchikan Long Term Care St. J ohn Medical Center

Peace Harbor Medical Center St. J oseph Medical Center

Peace Island Medical Center System Services Center

PeaceHealth Home & Community United General Medical Center

PeaceHealth Laboratories

PURPOSE

The purpose of this policy is to:

• Provide care consistent with the mission and values of PeaceHealth, in recognition of the

intrinsic worth and inherent dignity of those for whom we provide care.

• Ensure our patients are able to provide guidance to their loved ones, physicians, and

Caregivers, regarding their wishes for healthcare treatments in the future, should they be

unable to make these decisions for themselves.

• Ensure the implementation of the Federal Patient Self-Determination Act (PSDA) of 1991,

affirming a competent patient's right to make decisions about their healthcare, to accept or

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refuse medical treatment, and to complete an advance healthcare directive.

• Offer education and assistance to patients and the public in the documentation of their

preferences for medical treatment; including their right to accept or refuse treatment; and

• Ensure PeaceHealth is in compliance with state laws and regulatory body standards regarding

formulation, documentation, and implementation of advance directives.

DEFINITIONS

•

Advance Directives:

A voluntary formal document written in advance which provides direction

to the health care team when an adult Patient loses decisional capacity. Living Wills, Directives

to Physicians, Durable Power of Attorney for Healthcare, are all forms of advance directives.

•

Caregiver:

An employee of PeaceHealth.

•

Directive to Physicians:

A Living Will or Health Directive used in Alaska, Washington and

Oregon.

•

Healthcare Representative:

A person appointed by the patient in a Durable Power of Attorney

document to make decisions for the patient when they lose decisional capacity.

•

Patient:

Both the patient and/or the patient's legal personal representative.

•

Surrogate Decision-Maker:

A patient's legal decision-maker according to the laws of the State

where the patient is receiving medical care. Generally, the order is as follows: (varies by state.

please see state specific hierarchy on ACP team crossroads page)

◦

Legal Guardian appointed by the Courts

◦

Durable Power of Attorney for Health Care

◦

Legal Spouse

◦

Adult children over the age of 18

◦

Parents

◦

Adult siblings over the age of 18

◦

Please see your state laws for specifics, i.e. majority vs. unanimous consent within

groups where there is more than one member, etc.

POLICY

It is the policy of PeaceHealth, that in keeping with our mission and values, PeaceHealth supports

patients and their surrogates right to participate in healthcare decision making and advance care

planning. PeaceHealth offers assistance in formulating and documenting advance directives per

Patient's wishes and ensures those wishes and directives are followed in accordance with standard

medical practice and state and federal law.

• In the event a caregiver is unable to comply with a Patient's advance directives for legal,

religious or cultural reasons, they must inform the patient (or surrogate) and arrange for

transfer of care as per federal and state law.

• Formulation of advance directives is entirely voluntary, and a Patient with decisional capacity

may change or revoke an advance directive at any time, verbally or in writing. All PeaceHealth

medical centers and clinics have procedures for the implementation of this policy within their

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facilities.

• Note: Alaska, Washington and Oregon state law requires Advanced Directives to be witnessed

by two people or an acknowledgment by a notary public. See PeaceHealth Witness/Notary

Policy.

• In the event a patient has not completed advance directives naming a healthcare

representative; state law designating the order of legal decision-makers will be followed. See

State Hierarchies on ACP crossroads page.

• In the event the patient has completed an Advanced Directive but does not have it with them,

there is a process for follow up reflected in the procedure.

HELP

Further information may be obtained by contacting the Advance Care Planning team

RELATED MATERIAL

Policies & Procedures:

• Advance Directives for Patient Access in CareConnect

• Witnessing and Notarizing Medical Advance Directives Policy

Laws & Regulations:

• Patient Self-Determination Act of 1991

• RCW 70.122 Natural Death Act

• RCW 70.122.030 Directive to Withhold or Withdraw Life Sustaining Treatment

• RCW 11.94 Power of Attorney

• ORS 127

• Alaska:

◦

AS 13.52.010 et seq.

◦

AS 12.65.007

◦

7 ACC 16.010

• 42 U.S.C. §300a-7 (d)

Advance Directives Policy. Retrieved 7/24/2024. Official copy at http://peacehealth-system-services.policystat.com/policy/

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Status

Active

PolicyStat ID

15012312

Origination 12/1/1992 Owner

Erica Torres: Sys

Last 7/16/2024

Approved

VP Mission

Integration

Effective 7/16/2024

Area

Mission Services

Applicability

PeaceHealth

Systemwide

Tags

Policy and

Procedure

Physician Assisted Suicide Policy

SCOPE

This policy and procedure applies to all PeaceHealth settings and services in the location(s) checked

below:

Ambulatory Surgery Center PeaceHealth Medical Group

Cottage Grove Medical Center Sacred Heart RiverBend

Ketchikan Medical Center Southwest Medical Center

Ketchikan Long Term Care St. J ohn Medical Center

Peace Harbor Medical Center St. J oseph Medical Center

Peace Island Medical Center System Services Center

PeaceHealth Home & Community United General Medical Center

PeaceHealth Laboratories

PURPOSE

The purpose of this policy and procedure is to provide the requirements for appropriate support of dying

persons and families while respecting PeaceHealth's position as set forth in its policy.

DEFINITIONS

•

Death with Dignity:

Defined under Oregon and Washington State laws, as when a terminally ill,

informed adult voluntarily chooses to obtain a physician prescription for drugs to end his or

her life and

self-administers

the drugs, thereby hastening his or her death following

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confirmation of a prognosis of dying in less than six (6) months. Prior to receiving this

prescription, a patient must have a second physician's opinion regarding their terminal

diagnosis, make an oral and a written request, and reiterate the oral request to his or her

attending physician no less than seven (7) days after making the initial oral request. The

patient must also have counseling if either physician believes the patient has a mental

disorder, or impaired judgment from depression, and be cleared of these by the person

providing the counseling. Patients also have the choice whether to notify next of kin or not.

Health care providers are immune from civil and criminal liability for good faith compliance.

•

PeaceHealth's Statement of Common Values:

A document curated by PeaceHealth's Board of

Directors which identifies PeaceHealth as a Catholic health system and offers ethical guidance

to be followed by any and all who conduct patient care and/or business on behalf of

PeaceHealth.

•

Physician Assisted Suicide:

A volitional choice – deemed wrong according to the moral

teachings of the Roman Catholic Church – to hasten one's death via the self-administration of

lethal medication obtained from a physician which directly causes one's death.

POLICY

As a Catholic health system, PeaceHealth does not promote or participate in physician assisted suicide

(PAS, known by some as Death with Dignity or DWD). (See PeaceHealth's Statement of Common Values)

Patients wanting information on PAS should consult their provider.

OVERVIEW

According to PeaceHealth's Statement of Common Values, "Any act done with the explicit intent of

ending a patient's life may not be performed in PeaceHealth owned or leased facilities. A patient's

decision to refrain from aggressive or curative treatment will be respected, even when such a decision

may result in the person's death. Medicines capable of relieving pain and suffering may be given to a

person even if such therapy may indirectly shorten the person's life."

PROCEDURE

1. Make an initial determination that a patient has a terminal disease and inform the patient of

the medical prognosis.

Providers, pharmacists, and other Caregivers may not provide drugs that allow patients to end

their own lives in PeaceHealth facilities or as an employee of or an independent contractor

with PeaceHealth.

2. Patients voicing an interest in pursuing PAS should be asked about the reasons for their

interest to determine if modalities offered by PeaceHealth may help, and receive a palliative

care consult, a spiritual care consult, a hospice eligibility intake assessment, and/or

information from their provider about relevant community resources as appropriate.

3. Patients pursuing PAS independently who are also hospice eligible may be admitted to a

PeaceHealth hospice program with the intent of receiving hospice care consistent with

PeaceHealth's mission and values.

4. Patients in the hospital voicing an interest in pursuing PAS who are not hospice eligible should

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receive a palliative care consult, a referral for spiritual care, and/or information from their

provider about relevant community resources as appropriate.

5. Provide the patient with information about appropriate and allowable end-of-life resources as

well as the link to the Washington Death with Dignity Act website or similar websites in other

states with DWD or similar laws upon the request of the patient.

6. Providers should enter a chart note with the smartphrase, .firstoralrequest, which states:

“@name@ has made a first oral request today to pursue the option of obtaining life-ending

medications for self-administration under applicable state Death with Dignity statutes. I

provided resources for end-of-life support (palliative care, hospice, online resources for Death

with Dignity) excluding medication prescribed with the intention of helping patient end their

own life.”

7. While PeaceHealth does not restrict freedom of provider speech, providers may not use

facilities or medical records to aid in DWD requests.

8. In home hospice settings, Caregivers may not provide life ending medications or be in the

patient’s room when they ingest life-ending medications. However, after ingestion, Caregivers

may provide nursing, spiritual, social, and other supports as needed.

9. All normal support services for the family, including bereavement coordination should be

provided to the family when and where applicable.

10. PeaceHealth caregivers or providers with conscience objections should follow the process

outlined in the Objections of Conscience Policy.

HELP

Further gudiance may be obtained by contacting Mission Services.

REFERENCES

• Oregon Health Authority, https://www.oregon.gov/oha/ph/providerpartnerresources/

evaluationresearch/deathwithdignityact/pages/index.aspx

• Washington State Department of Health, https://www.doh.wa.gov/youandyourfamily/

illnessanddisease/deathwithdignityact

• Ethical and Religious Directives for Catholic Health Care Services (ERDs), 6th Edition, United

States Conference of Catholic Bishops. 2018.

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Status

Active

PolicyStat ID

14889519

Origination 6/8/2020 Owner

Erica Torres: Sys

Last 12/12/2022

Approved

VP Mission

Integration

Effective 12/15/2023

Area

Mission Services

Applicability

PeaceHealth

Systemwide

Tags

Policy and

Procedure

Voluntarily Stopping Eating and Drinking Policy

SCOPE

This policy applies to all PeaceHealth settings and services in the location(s) checked below:

Ambulatory Surgery Center PeaceHealth Medical Group

Cottage Grove Medical Center Sacred Heart RiverBend

Ketchikan Medical Center Southwest Medical Center

Ketchikan Long Term Care St. J ohn Medical Center

Peace Harbor Medical Center St. J oseph Medical Center

Peace Island Medical Center System Services Center

PeaceHealth Home & Community United General Medical Center

PeaceHealth Laboratories

PURPOSE

The purpose of this policy is to clarify the PeaceHealth position on "voluntarily stopping eating and

drinking" (aka VSED).

DEFINITIONS

•

Ethical and Religious Directives for Catholic Health Care Services (ERDs):

A document

published by the United States Conference of Catholic Bishops that provides ethical and

religious guidance to be followed by any and all Catholic healthcare systems wishing to

maintain a Catholic identity.

Voluntarily Stopping Eating and Drinking Policy. Retrieved 7/24/2024. Official copy at http://peacehealth-system-

Page 1 of 3

•

Voluntarily Stopping Eating and Drinking

: A volitional choice – deemed wrong according to the

moral teachings of the Roman Catholic Church – to refuse oral food and fluids for the purpose

of hastening death via the process of terminal dehydration.

POLICY

As a Catholic health system, PeaceHealth does not promote or participate in voluntarily stopping eating

and drinking (VSED) to hasten death. (See ERDs 58 and 60.) Patients wanting information on VSED

should consult their provider.

OVERVIEW

VSED is a volitional choice – deemed wrong according to the moral teachings of the Roman Catholic

Church – to refuse oral food and fluids for the purpose of hastening death via the process of terminal

dehydration. VSED is distinct from the withdrawal of burdensome medical treatment (such as a feeding

tube) or deciding to stop eating and drinking due to an inability to receive oral food and fluids because of

burdens related to a medical condition. Individuals who successfully complete VSED die from

dehydration brought on by the voluntary choice to refuse to take oral food and fluids. Individuals deciding

to pursue VSED may or may not have a terminal medical condition. As a Catholic health system,

PeaceHealth understands the intake of oral food and fluids under normal circumstances to be ordinary

or proportionate means of preserving human life. (See ERD 56.) Exceptions to this may occur when in

the judgment of the patient (or their health care representative) the intake of oral food and fluid

themselves become excessively burdensome

due to an underlying medical condition

. (See ERDs 57 and

58.)

PROCEDURE

1. Patients voicing an interest in pursuing VSED should be asked about the reasons for their

interest in VSED to determine if modalities offered by PeaceHealth may help, and receive a

palliative care consult, a spiritual care consult, a hospice eligibility intake assessment, and/or

information from their provider about relevant community resources as appropriate.

2. Patients pursuing VSED independently who are also hospice eligible may be admitted to a

PeaceHealth hospice program with the intent of receiving hospice care consistent with

PeaceHealth's mission and values.

3. Patients in the hospital voicing an interest in pursuing VSED who are not hospice eligible

should receive a palliative care consult, a referral for spiritual care, and/or information from

their provider about relevant community resources as appropriate.

4. PeaceHealth caregivers or providers with conscience objections should follow the process

outlined in the

Objections of Conscience Policy

HELP

Further information may be obtained by contacting Mission Services by phone at (360) 729-1295, or the

System Director of Hospice and Palliative Care at (360) 729-1681.

Voluntarily Stopping Eating and Drinking Policy. Retrieved 7/24/2024. Official copy at http://peacehealth-system-

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REFERENCES

• United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic

Health Care Services.

• J ansen, I.A., & Sulmasy, D.P. (2002). "Sedation, alimentation, hydration, and equivocation:

Careful conversation about care at end of life." Annals of Internal Medicine, 136, 845-849.

Voluntarily Stopping Eating and Drinking Policy. Retrieved 7/24/2024. Official copy at http://peacehealth-system-

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