1. 169 Front Street South, Orillia, ON, L3V 4S8 Phone: 705.325.0505 Fax: 705.325.7328 www.nsmhpcn.ca 2014 Palliative Care Conference, Huntsville Faculty/Presenter Disclosure: Panel Presentation Presenters: Kelly Hubbard, Dr. Pam McDermott, Maureen O’Connell, Amy Pritzker, Dr. Glenn Robitaille, Ken Smith, Catherine Wallis-Smith, Rebecca Woodall Relationships with commercial interests: Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: None Other: None

2. Case 1: Mr X, 43 years old Mr X is 43 years old Fiancée, two daughters 8+10, supportive family (mom, dad, sister, friends) 6 week diagnosis of aggressive ca lung, with mets to brain, liver. No treatment offered/provided. Admitted to residential hospice care.

3. Case 1, continued: PPS 20%, condition deteriorating quickly. No advanced directives. Non verbal, moans and facial grimacing present when repositioned and when care provided. Mr X is described by his family to be “very healthy” Only ate organic food, ran 5 km /day and never took any chemical medication. He visited a naturopathic physician regularly (prior to illness). Family is devastated. Fiancée suffering from Post Traumatic Stress Disorder (PTSD)

4. Family refuses to allow pain medication to be given “states he has never taken a chemical drug!” Nurses gave morphine subq after ++ health teaching with family; they agreed for one dose, then refused additional doses. Died in pain Was this in the best interest of the person? Case 1, continued:

5. Mrs Y is 82 years old, one daughter, one son. Daughter is SDM. In acute care facility Treated for CHF, is now stable, history of depression, short periods of confusion PPS 30%, discharge plans to LTC Resident “Capable” (as per CCAC) to make placement/discharge decisions. Suspect of emotional and financial abusive relationship between son and mother - “elder abuse?” Case 2: Mrs Y, 82 years old

6. Staff encouraging DC to LTC- son insisting DC home. Staff “unsettled to discharge plans home” Resident refuses to go to LTC. States “wants to go home with son”. Discharged home. Died two weeks after discharge Was this in the best interest of the resident? Case 2: Mrs R – 69 years old female

7. 36 year old female, newly diagnosed breast CA History of depression, anxiety and OCD. Supportive spouse, two young children 2+3. Spouse unable to go to work, on LOA. Refuses to have treatment as concerned that she can’t leave her children at home. Feels she has to look after the children. Spouse feels helpless, but feels he needs to respect her decision. Discuss Case 3: Mrs K – 36 years old

8. A big thank you to all of our expert panel members.