Medical Assistance in Dying: Frequently Asked Questions for Care Professionals

NSHA’s comprehensive policy is under development. In the interim, if the information in this document does not answer your questions, please contact the office of Medical Affairs Advisor at 902-491-5892. The voicemail box will be checked regularly during the hours of 8:30 a.m. to 4:30 p.m., Monday to Friday, and we are committed to getting back to you as soon as possible. Please leave your name, number and a brief explanation of the information you are seeking so we can best address your questions and concerns.

What is medical assistance in dying? 


The Criminal Code defines medical assistance in dying to mean:
(a) the administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death; or
(b) 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. 

Who can provide medical assistance in dying?

Only a doctor or nurse practitioner is eligible to provide medical assistance in dying.

Who can receive medical assistance in dying?


The Criminal Code provisions state that a person may receive medical assistance in dying if they meet all of the following criteria:
   (a) The person is eligible for health services funded by the federal government, or a province or territory (or during the applicable minimum period of residence        or waiting period for eligibility);
   (b) The person is at least 18 years of age and capable of making decisions with respect to his/her health;
   (c) The person has a grievous and irremediable medical condition;
   (d) The person has made a voluntary request for medical assistance in dying that, in particular, was not made as a result of external pressure; and 
   (e) The person gives informed consent to receive medical assistance in dying.

What is considered a “grievous and irremediable” medical condition?


The Criminal Code states that a person has a grievous and irremediable medical condition if:
(a) they have a serious and incurable illness, disease or disability;

(b) they are in an advanced state of irreversible decline in capability;

(c) that illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and 

(d) their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.

What is excluded from the legislation?
At this time, the following are excluded:

Requests by mature minors – the Criminal Code sets the age at 18 for a person to request medical assistance in dying.
 
Requests set out in an advance directive  – requests for medical assistance in dying that is set out in a personal directive or similar document cannot be acted upon.

Mental Illness or Physical Disability

A person with a mental illness or a physical disability may be eligible to receive MAiD.  Eligibility is assessed on an individual basis, looking at all of the relevant circumstances. The person must meet all the criteria to be eligible for medical assistance in dying. 
 
It should be noted that the preamble to the legislation provides 
“The Government of Canada has committed to develop non-legislative measures that would support the improvement of a full range of options for end-of-life care, respect the personal convictions of health care providers and explore other situations — each having unique implications — in which a person may seek access to medical assistance in dying, namely situations giving rise to requests by mature minors, advance requests and requests where mental illness is the sole underlying medical condition.”

Can a person decided not to proceed with medical assistance in dying?

A person may choose to withdraw their request at any time in the process and in any manner.


What is NSHA’s role in medical assistance in dying?


NSHA is committed to providing decision-making support to patients, families and health care providers. In keeping with the medical assistance in dying legislation and professional standards of practice for health care professionals, NSHA will:
  • Provide information about the procedure
  • Facilitate access to the procedure
  • Provide support to physicians, nurse practitioners and other involved staff as required
  • Provide education to physicians, nurse practitioners, staff, patients and public

What do I do if I receive a request for medical assistance in dying? 


Should you receive a request for medical assistance in dying in a hospital setting, inform the attending physician. It is also appropriate that you advise your direct manager that a request is under consideration so that appropriate arrangements to support the health care team, the patient and their loved ones can be initiated. The physician will then contact the office of the MAiD coordinator, who will work with the physician and the team to co-ordinate and operationalize the procedure.
 


If you receive a request and are in a community setting, please contact the MAiD Coordinator at 902-491-5892.



What documentation and forms are available for medical assistance in dying?


NSHA, with guidance from the College of Physicians and Surgeons’ Professional Standard Regarding Medical Assistance in Dying, provides physicians and NPs with a request and consent form, and documentation and procedure checklist to help in documenting the decision-making process and required consent for medically assisted dying. You can find these forms at:

How do I find out more about my profession’s role in Medical Assistance in Dying? 


Regulatory bodies such as CRNNS, CLPNNS, NSCP, CPSNS and Doctors NS will provide guidelines and information specific to individual professions.

Which health care providers are involved in medical assistance in dying, and what is their role? 


Physicians and nurse practitioners are the only health care providers able to perform medical assistance in dying. However, it is legal for other health care providers such as pharmacists, nurses, psychiatrists, and social workers to aid a physician or nurse practitioner to provide medical assistance in dying.

What if I don’t feel comfortable assisting with medical assistance in dying?

You have the right to choose not to participate in providing medical assistance in dying. However, you have a responsibility to continue to provide patients with other medically required care until such time as your services are no longer needed.
You must ensure that patients have the contact information needed to access timely information and assessment for medical assistance in dying, and/or other end-of-life care medical options if that is their wish.


Where can medical assistance in dying take place? 

Some patients may request to die at home, while others may choose another location. For a variety of reasons, it will not be possible to provide medical assistance in dying at all health care sites in the province. In the period before there is NSHA policy to help with these matters, and should the request relate to a location within an NSHA facility, the MAiD coordinator for NSHA, will provide the necessary assistance. Please call 902-491-5892.

What other options are there to relieve the suffering of my patients and/or provide end-of-life medical care?

It’s important that you talk to your patient about their options. These options could include medical treatments, a referral to a palliative care specialist/team, psychological support, spiritual care and/or medical assistance in dying. 
 
Palliative Care is different than medical assistance in dying.
 
A member of the health care team and a patient’s physician can and will, with their patient’s consent and involvement, take steps to connect the patient with palliative care services. It is important that when a patient has been given a diagnosis of a life-limiting illness with a serious or grave prognosis, that they have the option for palliative care. 
 
Palliative Care is defined by the World Health Organization as an approach that improves the quality of life of patients and their families facing challenges associated with life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other physical, psychological and spiritual problems.
 
Palliative Care and other practitioners will continue to work closely with patients and families to understand and manage their disease and symptoms. Palliative care seeks to:
  • provide relief from pain and other distressing symptoms
  • help individuals manage symptoms, address physical, emotional and spiritual concerns
  • support families
  • enhance quality of life and help patients live as actively as possible
  • prepare individuals for death, and
  • offer bereavement support to loved ones
Palliative care involves a team made up of various health providers. This type of care can support people in their homes, at hospices, in supportive living environments and in hospitals. We understand that the Provinces and Territories will be working with the Federal Government to improve palliative care services for all Canadians.


I’m not sure how I will feel about being involved with assisted dying. What supports will be available to me?


Medical assistance in dying can be a very challenging care scenario for professionals. It is important that we support each other and seek out counsel and support from our managers, professional colleges and co-workers.
 
Employee and Families Assistance Program (EFAP) is also available to you. It is a voluntary, confidential, short-term counselling, advisory and information service for employees of NSHA and eligible family members.
 
Metro Halifax: 902-422-2273
Toll Free: 1-800-461-5558