{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"The Interior Experience of Prescribing Medical Aid in Dying: Carly Zapata and Dani Chammas","description":"I had the privilege of learning from fellow Greenwall Faculty Scholar Lisa Harris about a term she termed, \u201cdangertalk.\u201d  As an ob\/gyn and abortion provider, Lisa found the debate around the legality of abortion so polarizing that it created a false dichotomy: you\u2019re either for or against.  Any talk about misgivings, uncertainty, ambiguity, or ambivalence was silenced.  Talking about these issues in the face of polarization was deemed dangerous and undermining to one side or another. \u201cHow could you?\u201d For Lisa\u2019s work in finding common ground and embracing nuance she was awarded the 2023 Bernard Lo Award for forging connections across divisions. In today\u2019s podcast we focus on the equivalent experience of moral uncertainty, distress, and residue among prescribers of medical aid in dying.  We are joined by Carly Zapata and Dani Chammas, prescribers of medical aid in dying in California. We discuss: Their journey prescribing medical aid in dying, and reasons for choosing to prescribe The legality of prescribing in California.  We compare California to Canada, as we have previously on this podcast. We discuss new limited survey data suggesting that legal barriers may not explain the remarkable 20 fold differences in use of medical aid in dying between California and Canada; rather, Canada has 6x the number of providers per capita as California, and much greater awareness of the legality of medical aid in dying. We talk about cases that are not as clear - e.g. people who have voluntarily stopped eating and drinking.   Moral issues, including ambiguity and ambivalence, distress and residue. For example the moral distress created when a patient requests medical aid in dying due to what is clearly a systems failure (see this Atlantic article for clear examples from Canada).  We ask if they sometimes feel frustrated that more people who are in favor of medical aid in dying are not prescribing, instead leaving prescribing responsibility to a relatively small group of clinicians.   How core ethical ideas might lead to very different conclusions about medical aid in dying, and ways Dani teaches ethics to trainees.   Psychological models that can help navigate this complex terrain with patients and families, including formulations and countertransference.   And I can\u2019t believe I haven\u2019t played, \u201cI will follow you into the dark\u201d previously - but google couldn\u2019t find it - really?  In 400+ GeriPal podcasts?  Great song.  So fitting.  My son Renn plays guitar on the audio only version. -Alex Smith   Additionally, some take home points, sent by Dani after recording: (1) Holding the dialectic: On one hand, people deserve the highest level of attention to their personhood and their suffering\u2014an effort that, at times, can soften or even resolve a desire for hastened death. And on the other hand, some people will authentically experience this as the most values-aligned way of dying, given their circumstances. (2) Learning to accept that while laws create the safety rails, within those boundaries, morality is pluralistic. Both patients and clinicians bring deeply held moral frameworks to these decisions\u2014and those frameworks deserve to be acknowledged and respected. (3) We have to be willing to ask the hard questions\u2014and to show up for one another as we do. Because this work, more than almost any other, has taught us the profound impact of not feeling alone when navigating grey terrain. I view the discussion as an invitation for our field to not necessarily to become more certain, but to be willing to wrestle with the hard questions\u2014while still showing up with rigor and compassion. And to remember that our patients are people before they are cases. If we can stay close enough to truly know them, we\u2019re much more likely to respond in ways that honor both their suffering and their dignity\u2014whatever path that ultimately leads to. ","author_name":"GeriPal - A Geriatrics and Palliative Medicine Podcast","author_url":"http:\/\/www.geripal.org","html":"