Cathy Perri

I am a registered nurse who graduated in 1983. I have seen many changes in healthcare over the years. I feel privileged to care for dying patients. They give me more than I can ever give them. I did not become a nurse to kill my patients but to journey with them to their natural end & I know many physicians feel the same way. I, hereby, I propose the following revisions to the draft standard:  Section 1.f. could be revised as “Proactively maintain a non-judgmental approach and be aware of resources to provide for frequently requested services they are unwilling to provide.”  Section 2.c. should be removed due to lack of clarity. o Specifically, “adverse clinical outcomes” and “delayed” are not objectively defined and are open to wide subjective interpretation. If a patient were to experience pain while waiting for MAID, this could be claimed an adverse clinical outcome. Although the procedure sought out should not be impeded as in 2c, there are a lot of subjective possibilities that could emerge from so-called "exposures" from "delayed effective referral." o "Delayed" is not clearly defined either and in many ways the seeking of care is dependent on what the patient decides to do after visiting a provider. o Many psychiatrists have warned that it will be extremely difficult for physicians to discern which patients are making a fully informed, consensual decision to pursue MAID and which are not. Trust in nurses and doctors is declining, Many patients, me included, want providers whose values fit with theirs, and a large group of patients want to be served by providers who decline to offer certain procedures like MAID. Finding the right physician fit requires a diverse medical system with a variety of different providers with different opinions. Healthcare professionals should NEVER have to violate their conscience in providing care to their patients.

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