Medical Assistance in Dying
Since June 2016, Ross Memorial Hospital has been accommodating patients’ wishes for Medical Assistance in Dying (MAiD) in accordance with legislative, ethical and professional obligations.
Medical Assistance in Dying is a medical treatment that could potentially be provided in any area of the Hospital or in a person’s home. It is not the same as palliative care, which focuses on the control of pain and suffering in a patient with a life threatening illness, maximizing quality of life leading to a natural death.
RMH has a MAiD Steering Committee, which has studied the legislation and directions from the professional colleges, and has prepared policy and procedure guidelines, as well as information for patients and their families.
Understandably, the Hospital’s policy involves many steps to ensure a patient is eligible to receive the service and capable of understanding the implications. It includes safeguards to protect the patient and those involved in providing the service.
Information that RMH has prepared for patients and their families emphasizes that people who choose to have a medically assisted death may change their minds at any point. It also provides a list of questions to consider and recommendations including discussions with legal counsel and insurance representatives.
The RMH Steering Committee is pleased to work with all community healthcare partners in an attempt to ensure that local patients’ wishes are respected and they receive coordinated care wherever they choose to receive Medical Assistance in Dying. This area of treatment will continue to evolve as further direction and guidance is provided from provincial bodies, including the Ministry of Health & Long Term Care.
Anyone with questions about this service is encouraged to speak to his or her physician or nurse practitioner, or contact Anne Overhoff, RMH Vice President Patient Care & Chief Nursing Officer at 705-328-6074 or firstname.lastname@example.org.
What is Medical Assistance in Dying?
Medical Assistance in Dying (MAiD) is a medical procedure. It involves the administration of medications to safely end the life of an adult patient who meets the legislative criteria, at the request of the patient. Federal law (Bill C-14) governs who is eligible, and the processes under which MAiD can be delivered to a patient.
Who is eligible to receive MAiD?
The federal law governs who is eligible to receive Medical Assistance in Dying. To be eligible, a patient must:
- Be at least 18 years of age.
- Be eligible for publicly funded health care services in Canada.
- Be capable of making healthcare decisions for themselves.
- Have a medical condition that:
• Is a serious and incurable illness, disease or disability,
• Is in an advanced state of decline that cannot be reversed,
• The patient is experiencing unbearable physical or mental suffering from illness, disease, disability or state of decline that cannot be relieved under conditions that they consider acceptable,
• The patients natural death has become reasonably foreseeable (this takes into account all of their medical circumstances and does not require a specific prognosis as to how long they have left to live).
- Have all the information required to make informed decisions, specifically about:
• Their medical diagnoses,
• Available forms of treatment,
• Available options to relieve suffering, including palliative care.
- Have made a voluntary request for Medical Assistance in Dying that is free from any influence.
What does it mean to be capable?
To be capable to make decisions about your health care you must:
• Understand and remember information that is relevant to making a decision about your medical treatment.
• Appreciate the reasonably foreseeable consequences of a decision, or failing to make a decision.
The medical condition of people approaching end of life can change rapidly, and can result in a loss of capacity. If this occurs, MAiD is no longer possible.
Can I write down my wishes for Medical Assistance in Dying in case I lose the capacity to make decisions? Or, can family members make the decision for me?
You must be able to ask for Medical Assistance in Dying at the time of the request. It cannot be written down ahead of time and no one else, including family, can make the decision.
I think I am eligible for MAiD. What does the process involve?
In order for MAiD to occur, a series of steps must be followed. In general, it usually takes a minimum of about two weeks to complete the necessary steps, but this timing can increase based on each patient’s circumstance. If it is expected that you will die very soon, then there may be other end-of-life care options that are more appropriate for you.
Step 1: Written Request
You must make a written request for Medical Assistance in Dying.
You can access the Ontario Ministry of Health MAiD Written Request Form here: Clinician Aid A
Your signature must be witnessed by two independent witnesses, who must sign the document at the same time.
An independent witness must be 18 years of age and understand what it means to request Medical Assistance in Dying.
To be considered independent, the witnesses cannot:
• Benefit from your death,
• Be an owner or operator of a healthcare facility where you live or are receiving care,
• Be directly involved in providing you with health or personal care.
There is a provision for patients who cannot sign for themselves
Step 2: Assessments of Eligibility
You will be assessed by at least two independent assessors. The physician or nurse practitioner who usually looks after you and knows your history and situation best may act as the first assessor.
For MAiD to occur, both assessors must agree that you meet the eligibility criteria above. The assessment can take up to 1-2 hours per assessor. The assessment may include the following:
• A review of relevant medical history and your current medical situation.
• An assessment of your capacity to make decisions.
• A review of your current medications.
• A psycho social assessment.
• A limited physical examination.
• A detailed explanation of the MAiD medications and procedure.
• Answering any questions or concerns you or your family may have.
• Signing a consent form.
Step 3: A Period of Reflection
The law requires that a minimum of 10 clear days must pass between the date that you sign the written request form and the date that MAiD occurs. For example, if a patient signs the request form on November 1, then the first possible day when MAID could occur would be November 12. MAID could also occur after this date.
Depending on timing, it is possible that the reflection period may have passed before the medical assessment process has been completed.
The legal requirement for a period of reflection may be shortened in special circumstances if both assessors are in agreement that this is necessary.
Step 4: Provision of MAiD
If you are deemed eligible and decide to proceed with MAiD, your physician or nurse practitioner will work with you to create a detailed plan. This will include a discussion of the date, location, who will be present, and any special arrangements that are required.
It is necessary for the provider to confirm capacity (see above) and consent immediately prior to provision of MAiD. This is an important safeguard for your protection.
Can I change my mind?
Yes. You can change your mind at any time, for any reason. Simply tell your physician, nurse practitioner or a member of your healthcare team that you have changed your mind. Your physician or nurse practitioner will discuss what other options are available for your care, and you can be assured that they will all be high-quality and compassionate. Your provider will also give you an opportunity to change your mind just prior to the provision of MAiD.
Do I have to undergo treatment first?
No, you do not have to undergo treatment before requesting Medical Assistance in Dying.
What if my healthcare provider objects to Medical Assistance in Dying?
Healthcare providers have the right to conscientiously refuse to participate in Medical Assistance in Dying based on moral or religious beliefs. If you request Medical Assistance in Dying from a healthcare provider who objects, they have an obligation to provide you with an effective and timely referral.
What else is involved?
The Office of the Chief Coroner must investigate cases of Medical Assistance in Dying and will be contacted just after MAiD has been provided. Usually, a representative from the coroner’s office will wish to speak briefly to a patient’s family member at this time.
Is there a fee associated with this service?
If you have provincial healthcare coverage, then the costs of the assessments, medication and procedure are fully covered.
If I choose MAiD, will it affect my life insurance?
In Ontario, law has been passed that ensures that the choice of MAiD may not be used as a reason to deny insurance benefits under a valid policy.
What if I am not eligible?
If you are not eligible for MAiD, you will continue to be supported with the compassionate care that you require.
What if I have other questions?
If you have questions, please discuss them with your physician or with a member of your healthcare team. For more information about MAiD, contact Ross Memorial Hospital MAiD Program at 705-324-6111-ext. 6159