More than a quarter of the patients in palliative care have a primary diagnosis of cancer, according to the Center to Advance Palliative Care.

A survey of 351 palliative care programs showed that 27% of their patients had been diagnosed with cancer in 2016, more than twice as many patients who had a cardiac (13%) or pulmonary (12%) diagnosis. The next most common primary diagnosis category in 2016 was neurologic at 8%, with a tie at 6% between diagnoses classified as infectious or complex chronic, followed by patients with dementia at 5%, Maggie Rogers and Tamara Dumanovsky, PhD, of the CAPC reported.

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More than a quarter of the patients in palliative care have a primary diagnosis of cancer, according to the Center to Advance Palliative Care.

A survey of 351 palliative care programs showed that 27% of their patients had been diagnosed with cancer in 2016, more than twice as many patients who had a cardiac (13%) or pulmonary (12%) diagnosis. The next most common primary diagnosis category in 2016 was neurologic at 8%, with a tie at 6% between diagnoses classified as infectious or complex chronic, followed by patients with dementia at 5%, Maggie Rogers and Tamara Dumanovsky, PhD, of the CAPC reported.

[email protected]

More than a quarter of the patients in palliative care have a primary diagnosis of cancer, according to the Center to Advance Palliative Care.

A survey of 351 palliative care programs showed that 27% of their patients had been diagnosed with cancer in 2016, more than twice as many patients who had a cardiac (13%) or pulmonary (12%) diagnosis. The next most common primary diagnosis category in 2016 was neurologic at 8%, with a tie at 6% between diagnoses classified as infectious or complex chronic, followed by patients with dementia at 5%, Maggie Rogers and Tamara Dumanovsky, PhD, of the CAPC reported.

[email protected]

The Food and Drug Administration announced a safety alert on Aug. 10, 2017, for liquid-filled intragastric balloon systems, as they have caused five reports of unanticipated deaths that occurred from 2016 to present in patients.

The cause or incidence of patient death is still unknown, and the FDA has not been able to definitively attribute the deaths to the devices or the insertion procedures for these devices. All five reports show that patient deaths occurred within a month or less of balloon placement. In three of the reports, death occurred as soon as 1-3 days after balloon placement. The FDA has also received two additional reports of deaths in the same time period related to potential complications associated with balloon treatment.

[email protected]

The Food and Drug Administration announced a safety alert on Aug. 10, 2017, for liquid-filled intragastric balloon systems, as they have caused five reports of unanticipated deaths that occurred from 2016 to present in patients.

The cause or incidence of patient death is still unknown, and the FDA has not been able to definitively attribute the deaths to the devices or the insertion procedures for these devices. All five reports show that patient deaths occurred within a month or less of balloon placement. In three of the reports, death occurred as soon as 1-3 days after balloon placement. The FDA has also received two additional reports of deaths in the same time period related to potential complications associated with balloon treatment.

[email protected]

The Food and Drug Administration announced a safety alert on Aug. 10, 2017, for liquid-filled intragastric balloon systems, as they have caused five reports of unanticipated deaths that occurred from 2016 to present in patients.

The cause or incidence of patient death is still unknown, and the FDA has not been able to definitively attribute the deaths to the devices or the insertion procedures for these devices. All five reports show that patient deaths occurred within a month or less of balloon placement. In three of the reports, death occurred as soon as 1-3 days after balloon placement. The FDA has also received two additional reports of deaths in the same time period related to potential complications associated with balloon treatment.

[email protected]

Results of a large cohort study in Denmark found that adults with atopic dermatitis (AD) were significantly more likely to be affected by certain ocular conditions, compared with those who did not have AD.

“Keratitis, conjunctivitis, and keratoconus as well as cataracts in patients younger than 50 years occurred more frequently in patients with AD and in a disease severity–dependent manner,” concluded the authors, who wrote that as far as they know, this is the largest study conducted to date of ocular disorders in adults with AD.

Results of a large cohort study in Denmark found that adults with atopic dermatitis (AD) were significantly more likely to be affected by certain ocular conditions, compared with those who did not have AD.

“Keratitis, conjunctivitis, and keratoconus as well as cataracts in patients younger than 50 years occurred more frequently in patients with AD and in a disease severity–dependent manner,” concluded the authors, who wrote that as far as they know, this is the largest study conducted to date of ocular disorders in adults with AD.

Results of a large cohort study in Denmark found that adults with atopic dermatitis (AD) were significantly more likely to be affected by certain ocular conditions, compared with those who did not have AD.

“Keratitis, conjunctivitis, and keratoconus as well as cataracts in patients younger than 50 years occurred more frequently in patients with AD and in a disease severity–dependent manner,” concluded the authors, who wrote that as far as they know, this is the largest study conducted to date of ocular disorders in adults with AD.

Three strategies to correct vaccination hesitancy failed in a small study, supporting findings in the literature that misinformation tends to linger in the memory and efforts to dislodge it may in fact reinforce it.

In a study of 120 students recruited from diverse departments of the University of Edinburgh, the Suor Orsola Benincasa University of Naples, and the Second University of Naples, 61% were women, and the mean age was 25 years. Most students had a bachelor’s (38%) or master’s degree (53%), while 11 were PhD students, reported Sara Pluviano, PhD, of the University of Edinburgh, and her associates.

The participants completed a baseline questionnaire assessing their beliefs and attitudes about immunization, and twice completed a questionnaire that had focused on general misperceptions about vaccines causing autism, vaccine side effects, and how likely they would be to give MMR vaccine to their children – immediately after an intervention and after a 7-day delay.

Students were exposed to one of four correction interventions.

In the first, participants were given a booklet confronting 10 “myths” with a number of “facts” about vaccines (myths vs. facts group). In the second, students were presented with a series of tables comparing the potential problems caused by measles, mumps, and rubella with the potential side effects caused by the MMR vaccine (graphics group). In the third intervention, participants were shown photos of unvaccinated children with measles, mumps, and rubella, in addition to the symptoms of each disease and warnings about vaccinating one’s own child (fear group). The fourth was the control condition, where participants were given two unrelated fact sheets with tips to help prevent medical errors and get safer health care (control group).

“The myths vs. facts format, at odds with its aims, induced stronger beliefs in the vaccine/autism link and in vaccines side effects over time, lending credit to the literature showing that countering false information in ways that repeat it may further contribute to its dissemination,” the researchers said. Also, “the exposure to fear appeals through images of sick children led to more increased misperceptions about vaccines causing autism. Moreover, this corrective strategy induced the strongest beliefs in vaccines side effects.

“The usage of fact/icon boxes resulted in less damage but did not bring any effective result,” they said.

“Our pattern of results thus confirms that there should be more testing of public health campaign messages,” Dr. Pluviano and her associates cautioned. “This is especially true because corrective strategies may appear effective immediately, yet backfire even after a short delay when the message they tried to convey gradually fades from memory, allowing common misconceptions to be more easily remembered and identified as true.”

Read more in PLOS One (2017 Jul 27. doi: 10.1371/journal.pone.0181640).

Three strategies to correct vaccination hesitancy failed in a small study, supporting findings in the literature that misinformation tends to linger in the memory and efforts to dislodge it may in fact reinforce it.

In a study of 120 students recruited from diverse departments of the University of Edinburgh, the Suor Orsola Benincasa University of Naples, and the Second University of Naples, 61% were women, and the mean age was 25 years. Most students had a bachelor’s (38%) or master’s degree (53%), while 11 were PhD students, reported Sara Pluviano, PhD, of the University of Edinburgh, and her associates.

The participants completed a baseline questionnaire assessing their beliefs and attitudes about immunization, and twice completed a questionnaire that had focused on general misperceptions about vaccines causing autism, vaccine side effects, and how likely they would be to give MMR vaccine to their children – immediately after an intervention and after a 7-day delay.

Students were exposed to one of four correction interventions.

In the first, participants were given a booklet confronting 10 “myths” with a number of “facts” about vaccines (myths vs. facts group). In the second, students were presented with a series of tables comparing the potential problems caused by measles, mumps, and rubella with the potential side effects caused by the MMR vaccine (graphics group). In the third intervention, participants were shown photos of unvaccinated children with measles, mumps, and rubella, in addition to the symptoms of each disease and warnings about vaccinating one’s own child (fear group). The fourth was the control condition, where participants were given two unrelated fact sheets with tips to help prevent medical errors and get safer health care (control group).

“The myths vs. facts format, at odds with its aims, induced stronger beliefs in the vaccine/autism link and in vaccines side effects over time, lending credit to the literature showing that countering false information in ways that repeat it may further contribute to its dissemination,” the researchers said. Also, “the exposure to fear appeals through images of sick children led to more increased misperceptions about vaccines causing autism. Moreover, this corrective strategy induced the strongest beliefs in vaccines side effects.

“The usage of fact/icon boxes resulted in less damage but did not bring any effective result,” they said.

“Our pattern of results thus confirms that there should be more testing of public health campaign messages,” Dr. Pluviano and her associates cautioned. “This is especially true because corrective strategies may appear effective immediately, yet backfire even after a short delay when the message they tried to convey gradually fades from memory, allowing common misconceptions to be more easily remembered and identified as true.”

Read more in PLOS One (2017 Jul 27. doi: 10.1371/journal.pone.0181640).

Three strategies to correct vaccination hesitancy failed in a small study, supporting findings in the literature that misinformation tends to linger in the memory and efforts to dislodge it may in fact reinforce it.

In a study of 120 students recruited from diverse departments of the University of Edinburgh, the Suor Orsola Benincasa University of Naples, and the Second University of Naples, 61% were women, and the mean age was 25 years. Most students had a bachelor’s (38%) or master’s degree (53%), while 11 were PhD students, reported Sara Pluviano, PhD, of the University of Edinburgh, and her associates.

The participants completed a baseline questionnaire assessing their beliefs and attitudes about immunization, and twice completed a questionnaire that had focused on general misperceptions about vaccines causing autism, vaccine side effects, and how likely they would be to give MMR vaccine to their children – immediately after an intervention and after a 7-day delay.

Students were exposed to one of four correction interventions.

In the first, participants were given a booklet confronting 10 “myths” with a number of “facts” about vaccines (myths vs. facts group). In the second, students were presented with a series of tables comparing the potential problems caused by measles, mumps, and rubella with the potential side effects caused by the MMR vaccine (graphics group). In the third intervention, participants were shown photos of unvaccinated children with measles, mumps, and rubella, in addition to the symptoms of each disease and warnings about vaccinating one’s own child (fear group). The fourth was the control condition, where participants were given two unrelated fact sheets with tips to help prevent medical errors and get safer health care (control group).

“The myths vs. facts format, at odds with its aims, induced stronger beliefs in the vaccine/autism link and in vaccines side effects over time, lending credit to the literature showing that countering false information in ways that repeat it may further contribute to its dissemination,” the researchers said. Also, “the exposure to fear appeals through images of sick children led to more increased misperceptions about vaccines causing autism. Moreover, this corrective strategy induced the strongest beliefs in vaccines side effects.

“The usage of fact/icon boxes resulted in less damage but did not bring any effective result,” they said.

“Our pattern of results thus confirms that there should be more testing of public health campaign messages,” Dr. Pluviano and her associates cautioned. “This is especially true because corrective strategies may appear effective immediately, yet backfire even after a short delay when the message they tried to convey gradually fades from memory, allowing common misconceptions to be more easily remembered and identified as true.”

Read more in PLOS One (2017 Jul 27. doi: 10.1371/journal.pone.0181640).

MADRID – Outpatient oral antibiotics were more successful than outpatient parenteral antibiotic therapy at treating children with community-acquired pneumonia complicated by empyema, in a study presented at the annual meeting of the European Society for Paediatric Infectious Diseases.

Thirty-five percent of the patients were culture positive, a typically low rate that makes treatment of this disease particularly challenging, Lauren Kushner, a medical student at the University of California, Irvine, and one of the study’s authors, said at the meeting.

The treatment success rates, which were defined as improvement with no change in treatment, were 93% for the patients taking oral antibiotics and 58% in the patients on outpatient parenteral antibiotic therapy.

This retrospective observational study included 149 patients under age 18 years hospitalized for community-acquired pneumonia complicated by empyema, at Children’s Hospital of Orange County, Calif. Only 12 of the patients were treated with parenteral antibiotic therapy and none of the study participants had comorbid chronic medical conditions. As in other studies, Streptococcus pneumoniae was the most commonly identified pathogen.

Laboratory markers of inflammation are useful in guiding oral antibiotic therapy for children with CAP complicated by empyema, reported Ms. Kushner.

“A rapid drop in C-reactive protein [CRP] in combination with a decrease in white blood cell count [WBC] can be used acutely in the hospitalization phase to tell you the patient is improving on the selected antibiotic and also to help dictate when the patient might be able to go home, whereas improvement in the erythrocyte sedimentation rate [ESR] does not happen until much later in the course of treatment but can be used to tell you when a patient has been adequately treated,” said Ms. Kushner.

One hundred thirty-seven patients were discharged on oral antibiotic therapy, as is strongly recommended in Infectious Diseases Society of America guidelines for postdischarge treatment of complicated pneumonia, even though there are no randomized clinical trials demonstrating it to be superior or even noninferior to outpatient parenteral antibiotics. An aminopenicillin was the most frequently prescribed type of oral antibiotic, while ceftriaxone was the top choice for outpatient parenteral therapy.

The average total duration of antibiotic therapy, inpatient plus outpatient, was similar in the two groups: 30.4 days in the oral antibiotic group and 33.2 days in children on outpatient IV therapy.

The transition to oral therapy occurred a median of 6 days after admission. At that point, CRP levels had dropped sharply by a mean of 204 mg/L from a baseline of more than 250 mg/L at admission. In the same time frame, mean WBC dropped by 6,400 cells/mcL from close to 20,000/mcL at admission. Thus, sharp declines in these two inflammatory markers while a patient is still in the hospital provide reassurance that antibiotic therapy is on the right track. Their rate of decline slowed considerably after the switch to oral therapy: for example, mean CRP decreased by only another 44 mg/L from switch to discharge, and by a further 19 mg/L from discharge to end of treatment.

In contrast, the mean ESR remained elevated at a level approaching 100 mm/hour with little fluctuation from admission through discharge. Weekly monitoring of ESR post discharge showed that this inflammatory marker improved only late in the course of oral therapy. A drop to less than 30 mm/hour indicates the infection has resolved, Ms. Kushner said.

She noted that in contrast to her study findings, a recent multicenter, 2,123-patient study by the Pediatric Research in Inpatient Settings Network found that treatment failure rates didn’t differ significantly between the two treatment strategies (Pediatrics. 2016 Dec;138[6]. pii: e20161692). Similarly, a retrospective study of 391 children with empyema admitted to Primary Children’s Hospital in Salt Lake City found closely similar rates of treatment failure and other complications regardless of whether the patients were placed on outpatient oral or parenteral antibiotic therapy (Hosp Pediatr. 2015 Dec;5[12]:605-12).

Ms. Kushner reported having no financial conflicts of interest regarding the study.

[email protected]

MADRID – Outpatient oral antibiotics were more successful than outpatient parenteral antibiotic therapy at treating children with community-acquired pneumonia complicated by empyema, in a study presented at the annual meeting of the European Society for Paediatric Infectious Diseases.

Thirty-five percent of the patients were culture positive, a typically low rate that makes treatment of this disease particularly challenging, Lauren Kushner, a medical student at the University of California, Irvine, and one of the study’s authors, said at the meeting.

The treatment success rates, which were defined as improvement with no change in treatment, were 93% for the patients taking oral antibiotics and 58% in the patients on outpatient parenteral antibiotic therapy.

This retrospective observational study included 149 patients under age 18 years hospitalized for community-acquired pneumonia complicated by empyema, at Children’s Hospital of Orange County, Calif. Only 12 of the patients were treated with parenteral antibiotic therapy and none of the study participants had comorbid chronic medical conditions. As in other studies, Streptococcus pneumoniae was the most commonly identified pathogen.

Laboratory markers of inflammation are useful in guiding oral antibiotic therapy for children with CAP complicated by empyema, reported Ms. Kushner.

“A rapid drop in C-reactive protein [CRP] in combination with a decrease in white blood cell count [WBC] can be used acutely in the hospitalization phase to tell you the patient is improving on the selected antibiotic and also to help dictate when the patient might be able to go home, whereas improvement in the erythrocyte sedimentation rate [ESR] does not happen until much later in the course of treatment but can be used to tell you when a patient has been adequately treated,” said Ms. Kushner.

One hundred thirty-seven patients were discharged on oral antibiotic therapy, as is strongly recommended in Infectious Diseases Society of America guidelines for postdischarge treatment of complicated pneumonia, even though there are no randomized clinical trials demonstrating it to be superior or even noninferior to outpatient parenteral antibiotics. An aminopenicillin was the most frequently prescribed type of oral antibiotic, while ceftriaxone was the top choice for outpatient parenteral therapy.

The average total duration of antibiotic therapy, inpatient plus outpatient, was similar in the two groups: 30.4 days in the oral antibiotic group and 33.2 days in children on outpatient IV therapy.

The transition to oral therapy occurred a median of 6 days after admission. At that point, CRP levels had dropped sharply by a mean of 204 mg/L from a baseline of more than 250 mg/L at admission. In the same time frame, mean WBC dropped by 6,400 cells/mcL from close to 20,000/mcL at admission. Thus, sharp declines in these two inflammatory markers while a patient is still in the hospital provide reassurance that antibiotic therapy is on the right track. Their rate of decline slowed considerably after the switch to oral therapy: for example, mean CRP decreased by only another 44 mg/L from switch to discharge, and by a further 19 mg/L from discharge to end of treatment.

In contrast, the mean ESR remained elevated at a level approaching 100 mm/hour with little fluctuation from admission through discharge. Weekly monitoring of ESR post discharge showed that this inflammatory marker improved only late in the course of oral therapy. A drop to less than 30 mm/hour indicates the infection has resolved, Ms. Kushner said.

She noted that in contrast to her study findings, a recent multicenter, 2,123-patient study by the Pediatric Research in Inpatient Settings Network found that treatment failure rates didn’t differ significantly between the two treatment strategies (Pediatrics. 2016 Dec;138[6]. pii: e20161692). Similarly, a retrospective study of 391 children with empyema admitted to Primary Children’s Hospital in Salt Lake City found closely similar rates of treatment failure and other complications regardless of whether the patients were placed on outpatient oral or parenteral antibiotic therapy (Hosp Pediatr. 2015 Dec;5[12]:605-12).

Ms. Kushner reported having no financial conflicts of interest regarding the study.

[email protected]

MADRID – Outpatient oral antibiotics were more successful than outpatient parenteral antibiotic therapy at treating children with community-acquired pneumonia complicated by empyema, in a study presented at the annual meeting of the European Society for Paediatric Infectious Diseases.

Thirty-five percent of the patients were culture positive, a typically low rate that makes treatment of this disease particularly challenging, Lauren Kushner, a medical student at the University of California, Irvine, and one of the study’s authors, said at the meeting.

The treatment success rates, which were defined as improvement with no change in treatment, were 93% for the patients taking oral antibiotics and 58% in the patients on outpatient parenteral antibiotic therapy.

This retrospective observational study included 149 patients under age 18 years hospitalized for community-acquired pneumonia complicated by empyema, at Children’s Hospital of Orange County, Calif. Only 12 of the patients were treated with parenteral antibiotic therapy and none of the study participants had comorbid chronic medical conditions. As in other studies, Streptococcus pneumoniae was the most commonly identified pathogen.

Laboratory markers of inflammation are useful in guiding oral antibiotic therapy for children with CAP complicated by empyema, reported Ms. Kushner.

“A rapid drop in C-reactive protein [CRP] in combination with a decrease in white blood cell count [WBC] can be used acutely in the hospitalization phase to tell you the patient is improving on the selected antibiotic and also to help dictate when the patient might be able to go home, whereas improvement in the erythrocyte sedimentation rate [ESR] does not happen until much later in the course of treatment but can be used to tell you when a patient has been adequately treated,” said Ms. Kushner.

One hundred thirty-seven patients were discharged on oral antibiotic therapy, as is strongly recommended in Infectious Diseases Society of America guidelines for postdischarge treatment of complicated pneumonia, even though there are no randomized clinical trials demonstrating it to be superior or even noninferior to outpatient parenteral antibiotics. An aminopenicillin was the most frequently prescribed type of oral antibiotic, while ceftriaxone was the top choice for outpatient parenteral therapy.

The average total duration of antibiotic therapy, inpatient plus outpatient, was similar in the two groups: 30.4 days in the oral antibiotic group and 33.2 days in children on outpatient IV therapy.

The transition to oral therapy occurred a median of 6 days after admission. At that point, CRP levels had dropped sharply by a mean of 204 mg/L from a baseline of more than 250 mg/L at admission. In the same time frame, mean WBC dropped by 6,400 cells/mcL from close to 20,000/mcL at admission. Thus, sharp declines in these two inflammatory markers while a patient is still in the hospital provide reassurance that antibiotic therapy is on the right track. Their rate of decline slowed considerably after the switch to oral therapy: for example, mean CRP decreased by only another 44 mg/L from switch to discharge, and by a further 19 mg/L from discharge to end of treatment.

In contrast, the mean ESR remained elevated at a level approaching 100 mm/hour with little fluctuation from admission through discharge. Weekly monitoring of ESR post discharge showed that this inflammatory marker improved only late in the course of oral therapy. A drop to less than 30 mm/hour indicates the infection has resolved, Ms. Kushner said.

She noted that in contrast to her study findings, a recent multicenter, 2,123-patient study by the Pediatric Research in Inpatient Settings Network found that treatment failure rates didn’t differ significantly between the two treatment strategies (Pediatrics. 2016 Dec;138[6]. pii: e20161692). Similarly, a retrospective study of 391 children with empyema admitted to Primary Children’s Hospital in Salt Lake City found closely similar rates of treatment failure and other complications regardless of whether the patients were placed on outpatient oral or parenteral antibiotic therapy (Hosp Pediatr. 2015 Dec;5[12]:605-12).

Ms. Kushner reported having no financial conflicts of interest regarding the study.

[email protected]

SAN DIEGO – The Veterans Health Administration has issued strict rules forbidding clinicians from doing anything to help patients kill themselves via physician-assisted suicide, which is now legal in certain cases in California, according to a psychiatrist who updated colleagues at the annual meeting of the American Psychiatric Association.

The VHA says clinicians may not make referrals to physicians who help patients commit suicide, said Kristin Beizai, MD, who is affiliated with the VA San Diego Healthcare System. Nor can they provide information about patient diagnoses outside of medical records or complete forms to support physician aid-in-dying (PAD), she said.

The VA San Diego system received queries from patients about assisted suicide even before the law in mid-2016 allowed physicians to provide deadly medications to some patients, said Dr. Beizai, who’s also with the University of California, San Diego.

“There was a lot of attention coming before the law was active,” she said, and more questions from patients arose after that time.

In addition to California, four other states (Colorado, Oregon, Vermont, and Washington) – and the District of Columbia – allow terminally ill people who meet certain conditions to commit suicide with the assistance of physicians. In addition, a court ruling in Montana appears to allow PAD there.

California’s law allowing PAD took effect after Gov. Jerry Brown in 2015 signed a bill passed by the legislature.

According to a recent report from the state of California, 111 people killed themselves during June-December 2016 by taking deadly medication prescribed by physicians. The patients must self-administer the medications. Of those 111 people, 90% were white, and most had college degrees. The majority had cancer.

The report also said 173 physicians had written 191 total lethal prescriptions, suggesting some patients – perhaps dozens – had not taken the drugs by the end of 2016.

In response to a query from Dr. Beizai about policies regarding PAD, VHA ethics officials sent word that clinicians must butt out when it comes to assisted suicide: “No practitioner functioning within his or her scope of duty may participate in fulfilling requests for euthanasia or PAD,” they said, regardless of what state law allows.

According to the VHA:

• Clinicians may not support PAD through any means, including referrals and evaluations, and federal funds may not be used for PAD.
• Clinicians cannot fill out forms supporting PAD. However, they must not hinder the release of medical records when requested by an outside provider.
• Patients can seek PAD outside of the VHA system if they wish. Patients who ask about PAD must be told that the VHA doesn’t offer the service. “We need to inform them very directly that we do not provide it and are not allowed to participate,” Dr. Beizai said.
• If a patient makes a request regarding PAD, the VHA clinician “must explore the source of the patient’s request and respond with the best possible, medically appropriate care that is consistent with legal standards and is legally permissible.”

Clinicians are encouraged to explore issues like pain, depression, fears, and anxiety, Dr. Beizai said. The VHA has set up a six-step protocol on this front.

But the VHA is making it clear that patients who seek PAD elsewhere must not be abandoned. “Don’t disconnect from the patients if they determine they want to go that route,” said Dr. Beizai, who gave that message to VA San Diego staffers during an educational outreach program regarding PAD.

Dr. Beizai reported no relevant disclosures.

[email protected]

SAN DIEGO – The Veterans Health Administration has issued strict rules forbidding clinicians from doing anything to help patients kill themselves via physician-assisted suicide, which is now legal in certain cases in California, according to a psychiatrist who updated colleagues at the annual meeting of the American Psychiatric Association.

The VHA says clinicians may not make referrals to physicians who help patients commit suicide, said Kristin Beizai, MD, who is affiliated with the VA San Diego Healthcare System. Nor can they provide information about patient diagnoses outside of medical records or complete forms to support physician aid-in-dying (PAD), she said.

The VA San Diego system received queries from patients about assisted suicide even before the law in mid-2016 allowed physicians to provide deadly medications to some patients, said Dr. Beizai, who’s also with the University of California, San Diego.

“There was a lot of attention coming before the law was active,” she said, and more questions from patients arose after that time.

In addition to California, four other states (Colorado, Oregon, Vermont, and Washington) – and the District of Columbia – allow terminally ill people who meet certain conditions to commit suicide with the assistance of physicians. In addition, a court ruling in Montana appears to allow PAD there.

California’s law allowing PAD took effect after Gov. Jerry Brown in 2015 signed a bill passed by the legislature.

According to a recent report from the state of California, 111 people killed themselves during June-December 2016 by taking deadly medication prescribed by physicians. The patients must self-administer the medications. Of those 111 people, 90% were white, and most had college degrees. The majority had cancer.

The report also said 173 physicians had written 191 total lethal prescriptions, suggesting some patients – perhaps dozens – had not taken the drugs by the end of 2016.

In response to a query from Dr. Beizai about policies regarding PAD, VHA ethics officials sent word that clinicians must butt out when it comes to assisted suicide: “No practitioner functioning within his or her scope of duty may participate in fulfilling requests for euthanasia or PAD,” they said, regardless of what state law allows.

According to the VHA:

• Clinicians may not support PAD through any means, including referrals and evaluations, and federal funds may not be used for PAD.
• Clinicians cannot fill out forms supporting PAD. However, they must not hinder the release of medical records when requested by an outside provider.
• Patients can seek PAD outside of the VHA system if they wish. Patients who ask about PAD must be told that the VHA doesn’t offer the service. “We need to inform them very directly that we do not provide it and are not allowed to participate,” Dr. Beizai said.
• If a patient makes a request regarding PAD, the VHA clinician “must explore the source of the patient’s request and respond with the best possible, medically appropriate care that is consistent with legal standards and is legally permissible.”

Clinicians are encouraged to explore issues like pain, depression, fears, and anxiety, Dr. Beizai said. The VHA has set up a six-step protocol on this front.

But the VHA is making it clear that patients who seek PAD elsewhere must not be abandoned. “Don’t disconnect from the patients if they determine they want to go that route,” said Dr. Beizai, who gave that message to VA San Diego staffers during an educational outreach program regarding PAD.

Dr. Beizai reported no relevant disclosures.

[email protected]

SAN DIEGO – The Veterans Health Administration has issued strict rules forbidding clinicians from doing anything to help patients kill themselves via physician-assisted suicide, which is now legal in certain cases in California, according to a psychiatrist who updated colleagues at the annual meeting of the American Psychiatric Association.

The VHA says clinicians may not make referrals to physicians who help patients commit suicide, said Kristin Beizai, MD, who is affiliated with the VA San Diego Healthcare System. Nor can they provide information about patient diagnoses outside of medical records or complete forms to support physician aid-in-dying (PAD), she said.

The VA San Diego system received queries from patients about assisted suicide even before the law in mid-2016 allowed physicians to provide deadly medications to some patients, said Dr. Beizai, who’s also with the University of California, San Diego.

“There was a lot of attention coming before the law was active,” she said, and more questions from patients arose after that time.

In addition to California, four other states (Colorado, Oregon, Vermont, and Washington) – and the District of Columbia – allow terminally ill people who meet certain conditions to commit suicide with the assistance of physicians. In addition, a court ruling in Montana appears to allow PAD there.

California’s law allowing PAD took effect after Gov. Jerry Brown in 2015 signed a bill passed by the legislature.

According to a recent report from the state of California, 111 people killed themselves during June-December 2016 by taking deadly medication prescribed by physicians. The patients must self-administer the medications. Of those 111 people, 90% were white, and most had college degrees. The majority had cancer.

The report also said 173 physicians had written 191 total lethal prescriptions, suggesting some patients – perhaps dozens – had not taken the drugs by the end of 2016.

In response to a query from Dr. Beizai about policies regarding PAD, VHA ethics officials sent word that clinicians must butt out when it comes to assisted suicide: “No practitioner functioning within his or her scope of duty may participate in fulfilling requests for euthanasia or PAD,” they said, regardless of what state law allows.

According to the VHA:

• Clinicians may not support PAD through any means, including referrals and evaluations, and federal funds may not be used for PAD.
• Clinicians cannot fill out forms supporting PAD. However, they must not hinder the release of medical records when requested by an outside provider.
• Patients can seek PAD outside of the VHA system if they wish. Patients who ask about PAD must be told that the VHA doesn’t offer the service. “We need to inform them very directly that we do not provide it and are not allowed to participate,” Dr. Beizai said.
• If a patient makes a request regarding PAD, the VHA clinician “must explore the source of the patient’s request and respond with the best possible, medically appropriate care that is consistent with legal standards and is legally permissible.”

Clinicians are encouraged to explore issues like pain, depression, fears, and anxiety, Dr. Beizai said. The VHA has set up a six-step protocol on this front.

But the VHA is making it clear that patients who seek PAD elsewhere must not be abandoned. “Don’t disconnect from the patients if they determine they want to go that route,” said Dr. Beizai, who gave that message to VA San Diego staffers during an educational outreach program regarding PAD.

Dr. Beizai reported no relevant disclosures.

[email protected]