Dec 2017

Medical Assistance in Dying (MAID) Resource

Introduction

The Medical Assistance in Dying (MAID) Resource summarizes requirements outlined in federal and provincial legislation and guidelines by various provincial regulatory colleges, and presents them in a logical, sequential order to support medical and nurse practitioners with patient requests for MAID.

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About the Tool

ATTENTION: While this resource is based on the best available information to date, there may be gaps to the process that cannot be addressed at this time. Every effort will be made to update this resource as new information becomes available.

New federal reporting requirements for medical assistance in dying are in effect as of November 1, 2018. This resource will be updated to reflect the new reporting requirements. For information about the new reporting requirements, please refer to the federal regulations, Health Canada’s website, and the Ministry of Health and Long-Term Care website.

UPDATE: The CEP has revised the MAID Resource based on established provincial legislation and services regarding MAID. In 2017, Ontario passed Bill 84, Medical Assistance in Dying Statute Law Amendment Act 2017 which amended six provincial laws. The province also established a Care Coordination Service (CCS) to improve accessibility and referrals to MAID. The revised MAID Resource: includes in-document hyperlinks for easier and more intuitive use; incorporates the CCS as a referral, information and support service for clinicians providing MAID, clinicians with conscientious objections and patients; and incorporates the amendment to the Coroners Act that an investigation into the provision of MAID is no longer mandatory and is up to the discretion of the Coroner.

On June 16, 2016, the federal government passed legislation to amend Canada’s Criminal Code and established a framework for medical assistance in dying (MAID) for individuals who meet pre-defined eligibility criteria.

MAID, as defined by the Government of Canada, refers to:

  • The administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death.
  • The prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person, at their request so that they may self-administer the substance, and in doing so, cause their own death.

As part of its efforts to implement a consistent approach to the MAID process in Ontario, the Ministry of Health and Long-Term Care (MOHLTC) has engaged the Centre for Effective Practice (CEP) to develop a resource to support clinicians (physicians and nurse practitioners) with the provision of MAID.

This resource is intended to supplement, not circumvent, existing regulatory body requirements or institutional processes that have been implemented.

The CEP’s MAID Resource is comprised of the following sections:

  • Introduction
  • Full pathway outlining process for the provision of MAID.
  • Section One: Patient Inquiry
  • Addresses the patient’s inquiry about MAID and exploring the reasoning behind their request; details clinician requirements with respect to conscientious objections & patient referral.
  • Section Two: Assessment of Patient Eligibility for MAID
  • Defines eligibility criteria & provides resources to support eligibility assessments; provides considerations when preparing for the provision of MAID.
  • Section Three: Provision of MAID
  • Outlines key steps for the provision of MAID, certification of death, and reporting.
  • Section Four: Documentation Checklist
  • Highlights significant steps of the MAID process and associated documentation.
  • Section Five: Supporting Material & References
  • Includes a list of relevant resources, guidance documents, policy statements and tools for clinicians.

While this resource is based on the best available information to date, there may be gaps to the process that cannot be addressed at this time. Every effort will be made to update this resource as new information becomes available.

Definition of terms*

For the purpose of this resource in particular, the following terms are defined as:

  • Medical Practitioner — A physician who is entitled to practise medicine in Ontario.
  • Nurse Practitioner — A registered nurse who is entitled to practise as a nurse practitioner in Ontario.
  • Clinician — The medical or nurse practitioner that is overseeing the provision of MAID for an individual patient. This role may include, but is not limited to, receiving a patient request for MAID, conducting the first eligibility assessment, and administering or prescribing the drug protocol for the provision of MAID. It is recommended that this Clinician be responsible for ensuring that all relevant documentation is obtained and included in the patient’s medical record. In instances where the Clinician responsible for the provision of MAID is not the Most Responsible Provider (MRP) (e.g., in cases of conscientious objection and patient referral), the MRP will remain involved to direct coordination of care for the patient (excluding the provision of MAID).
  • Second Clinician — The medical or nurse practitioner that conducts the second, independent eligibility assessment of the patient. This role may also include administering or prescribing the drug protocol for the provision of MAID.

*The MRP and the Clinician OR Second Clinician may have overlapping roles and responsibilities or may be the same individual.

The Medical Assistance in Dying resource was developed using the CEP’s integrated knowledge translation approach. This approach ensures that providers are engaged throughout development processes through the application of user-centered design methodology. Clinical leadership of the resource was provided by Dr. Sandy Buchman. Clinical experts, policy advisors, hospitals and faith-based organizations were also engaged to provide feedback on key processes and components relevant to Medical Assistance in Dying.

The Medical Assistance in Dying resource is one of several resources developed as part of the 2014 to 2017 Knowledge Translation in Primary Care Initiative. This multi-year initiative was a collaboration between the Centre for Effective Practice(CEP), Ontario College of Family Physicians (OCFP), and Nurse Practitioners’ Association of Ontario (NPAO). Funded by the Ministry of Health and Long-Term Care, this initiative supported primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.

As part of this initiative, the CEP has developed a Medical Assistance in Dying resource for all providers in order to help clinicians understand the legislation and be able to act accordingly in practice.

The project team conducted a comprehensive literature search, and developed guidance based on current legislation and policy frameworks in partnership with the clinical lead and working group. Healthcare providers and other stakeholders were also engaged throughout the development process.

Clinical Lead

  • Sandy Buchman

    BA, MD, CCFP, FCFP

    Dr. Sandy Buchman is an associate professor in the Department of Family and Community Medicine at the University of Toronto and practices palliative medicine, providing home-based palliative and end-of-life care. He practiced comprehensive family medicine for many years with special interest in primary care, cancer care, palliative care, HIV/AIDS and global health – including volunteer experiences in South America and Africa. He is the education lead at the Temmy Latner Centre for Palliative Care, Mount Sinai Hospital. He was President of the College of Family Physicians of Canada in 2011 – 2012 and the Ontario College of Family Physicians in 2005 – 2006. He received his MD degree from McMaster University and completed his Family Medicine Residency training at the University of Toronto.

Stakeholder Organizations

For the development of this resource, we consulted with many stakeholder organizations and regulatory bodies, including:

  • Catholic Health Association of Ontario
  • Canadian Medical Association
  • Canadian Medical Protective Association
  • Central East LHIN – MAiD Working Group
  • College of Nurses of Ontario
  • College of Physicians and Surgeons of Ontario
  • Joint Centre for Bioethics
  • Nurse Practitioners’ Association of Ontario
  • Office of the Chief Coroner of Ontario
  • Ontario Medical Association
  • Ontario College of Family Physicians
  • Ontario College of Pharmacists
  • Ontario Hospital Association
  • Ontario Ministry of Health and Long-Term Care
  • Mount Sinai Support Services and Bridgepoint
  • Thunder Bay Hospital MAID Committee
  • Trillium Gift of Life Network
  • Clinical experts and target end-users

Thank you to all providers and stakeholders who participated in the development of this clinical resource.

Target End User Feedback and Expert Opinion


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