Medical Assistance in Dying: Frequently Asked Questions for Public

Updated August 20, 2019

Death and dying can be difficult subjects to talk about. If you are thinking about medical assistance in dying, talk to someone who can help inform you about your potential options: a doctor, nurse practitioner or other health care provider. The following questions and answers will give you some basic information about medical assistance in dying.

Please review the information below and call 902-491-5892, if you have any questions.

What is medical assistance in dying? 


Medical assistance in dying is when a doctor or nurse practitioner (NP) gives a drug to a person, at their request, that intentionally causes their death.
 
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.
 
A person seeking medical assistance in dying must meet a number of criteria to access medical assistance in dying. 

Who can have medical assistance in dying?



A person requesting medical assistance in dying (MAiD) may be eligible if all of the following apply:
  1. The person has a valid health card from a Canadian province or territory, or satisfies other specific residency criteria.
  2. The person is at least 18 years of age.
  3. The person is capable of making decisions about their health.
  4. The person has a “grievous and irremediable medical condition” which requires that:
    a. The person has a serious and incurable illness, disease or disability;
    b. The person is in an advanced state of irreversible decline in capability;
    c. The illness, disease or disability or that state of decline causes the person enduring physical or psychological suffering that is intolerable to the person, and cannot be relieved under conditions that the person considers acceptable;
    d. The person’s death has become reasonably foreseeable, taking into account all of the medical circumstances, without a prognosis necessarily having been made as to the specific length of time that the person has remaining.
  5. The person is not being pressured or influenced to choose to die by another person.
  6. The person has given informed consent to receive medical assistance in dying after having been informed of their medical diagnosis, available forms of treatment and available options to relieve suffering, including palliative care.

Can I change my mind?

You can change your mind at any time right up until the time you have medical assistance in dying. Immediately before receiving medical assistance in dying, the physician or nurse practitioner providing the medication will confirm with you if you wish to receive medical assistance in dying.
 

What is the process to have medical assistance in dying?



  1. Talk to a doctor or nurse practitioner to arrange an assessment.

    If a person is interested in learning more about medical assistance in dying (MAiD), they should talk to a doctor or nurse practitioner about their options. These options could include medical or surgical treatments, a referral to a palliative care specialist/team, psychological support, spiritual care, and/or MAiD.

    If it is determined that MAiD could be an option, the doctor or nurse practitioner can start the MAiD assessment process themselves, or they can make a written request for a MAiD assessment. Written requests for a MAiD assessment are sent to
    the NSHA MAiD Coordinator, who will help to move the process forward.

    If a person does not have a doctor or nurse practitioner, or does not feel comfortable talking to them about MAiD, they are welcome to call the NSHA MAiD Coordinator’s answering machine (902-491-5892), and leave their name, phone number, and a brief reason for their call. The answering machine is checked from 8:30 a.m. to 4:30 p.m., Monday to Friday. The MAiD Coordinator returns all calls in a timely manner, and will be able to provide information about MAiD, and put the person in touch with a doctor or nurse practitioner who is familiar with MAiD.
     

  2. Be assessed for eligibility for MAiD.

     •Two health professionals (doctors, nurse practitioners, or one of each) must independently determine whether a person meets the eligibility criteria for MAiD.

     •Typically, the health professional completing the first assessment (if it is not the person’s own doctor or nurse practitioner) will call the person making the request for MAiD, and arrange to meet them at a time and place of their choosing.

     •The first visit will include a discussion about the person’s health history, as well as a discussion about why the person is considering MAiD. The health professional will determine whether the person requesting MAiD meets the established criteria (section C above), and will spend the time required to answer the person’s questions.

     •A second health professional will complete a similar assessment in a timely manner.
     

  3. Submit a written MAiD consent form.

    During either the first or second assessment described above, one of the health care providers will give the person requesting MAiD a consent form, which must be completed by the person requesting the MAiD procedure before MAiD can take place.

    The person requesting MAiD must sign and date the consent form with two independent witnesses present. The independent witnesses must also sign the consent form. An independent witness is any person over the age of 18, who understands the nature of the request for MAiD, and does not stand to benefit from the person’s death. Anyone meeting these criteria may act as an independent witness, except if they:

      •Know of or believe that they are a beneficiary under the will of the person making the request, or a recipient, in any other way, of financial or other material benefit resulting from that person’s death.

      •Are an owner or operator of any health care facility at which the person making the request is being treated or any facility in which that person resides.

      •Are directly involved in providing health care services to the person making the request. NSHA staff cannot act as an independent witness.

      •Directly provide personal care to the person making the request.

      •Questions or concerns about witnessing forms may be directed to the Medical Affairs Advisor.
     

  4. Wait at least 10 days (with some exceptions).

    •There must be at least 10 days between the time that a person signs the consent form and the time that the person can have a medically assisted death.

    •Some people have a date and time in mind for the MAiD procedure, and some do not. Some people may choose to wait for a period of time (longer than 10 days) before acting on their request for MAiD.

    •If both of the health care providers who completed the assessments are of the opinion that a person may die, or may lose their capacity to give informed consent before the 10 days are up, the 10-day waiting period may be waived, and the MAiD procedure may take place sooner.

  5. The day of the MAiD procedure.

    •Once a person has been assessed and found to meet the criteria for MAiD, and has signed the consent form, and after the 10-day waiting period (or sooner in exceptional cases) has passed, MAiD can take place.

    •During this time, the doctor or nurse practitioner involved in the process will work with the person requesting MAiD (and those family and friends that the person wishes to involve) to plan the day, time and location of the MAiD procedure. Some people prefer to have MAiD at home, and some do not. It is possible for MAiD to be provided in an NSHA facility, or in a home for special care, such as a nursing home.

    •Any decisions about who will be present at the time of the MAiD procedure are entirely up to the person having the procedure.

    •On the day of the procedure, the doctor or nurse practitioner will meet with the person again, and have a conversation to make sure that they still have the capacity to choose to have MAiD, and to confirm once again that they consent to the procedure. The person is given an opportunity to change their mind if they wish.

    •After this final confirmation, the MAiD procedure can take place.

    •For the procedure, several drugs are injected through an intravenous (IV) line, which is usually placed in a vein in the arm. The injection of the drugs does not hurt. The first drug typically causes the person to fall into a deep sleep, following which they become unaware and remain unaware until their death.


If I lose capacity during the 10-day waiting period, can I still receive medical assistance in dying?

No. You must be able to give consent up until the moment you receive medical assistance in dying. However, If both of the doctors or NPs involved feel that your death is fast approaching or that there is a high likelihood that you will lose your capacity to provide informed consent within the 10 day period, a shorter waiting period than 10 days may be allowed. 

Where does medical assistance in dying take place?



We will make sure medical assistance in dying is provided in a timely way, as close to your home as possible. It can take place in your home, if there are doctors or NPs able to provide this service in your area. It can also take place in an NSHA facility or a hospice (where available). We will work with you to find a location that ensures privacy, safety and a peaceful setting.



Can I change mind about going ahead with medical assistance in dying? 


Yes, you can change your mind at any time before you receive medical assistance in dying. You can do this in writing or verbally. You must make this decision yourself.


Which health care providers are involved in medical assistance in dying? 

Doctors and NPs are the only health care providers able to provide medical assistance in dying. However, it is legal for other health care providers to help a doctor or NP. Pharmacists, nurses, spiritual care practitioners or social workers may be involved. They can also support you and your family throughout the process.

How should I prepare for death and dying? 


Planning for end of life is important. Each person will need to consider the many details that are unique to them. You may benefit from having family or others help you find the resources you need to make sure your wishes about health care decisions, finances, and estate and funeral arrangements are known. 


You may wish to read the following resources:

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

When a patient receives a diagnosis of a life-limiting illness with a serious or grave prognosis, it is important that they have the option to receive palliative care. Palliative care is an approach that improves the quality of life of patients with life-limiting illness and their families. 

 
Palliative care involves a team of health providers. The team can support people in their homes, hospices, supportive living environments and hospitals. 

 
The palliative care team and other providers work closely with patients and families to understand and manage their disease and symptoms. 
 
Palliative care: 
  • provides relief from pain and other distressing symptoms 
  • helps people manage symptoms and address physical, emotional and spiritual concerns 
  • supports families 
  • enhances quality of life and help patients live as actively as possible 
  • prepares people for death, and 
  • offers bereavement support to loved ones
 
With a patient’s consent and involvement, a member of the health care team will connect the patient with palliative care services.

Can I ask for medical assistance in dying in my advance care plan/personal directive?


No. You must be able to provide informed consent to medical assistance in dying up until the time it is provided.

Can someone else ask for medical assistance in dying for me?


No. To ask for medical assistance in dying, you must be able to make your own health care decisions. By law, substitute decision-makers are not allowed to make the decision for medical assistance in dying for you.

Must my family be consulted about my decision?


No. As with any other care, it is up to the patient to decide whether to consult with or inform family. This is your decision.
 

Will my decision about medical assistance in dying be kept private?

A person’s discussions and/or decision about medical assistance in dying (MAiD) is personal health information and is protected by the Personal Health Information Act. NSHA will not share a person’s health information, including information about discussions or decisions about MAiD, unless the person consents to disclose that information.

•If a person becomes unable to make their own health care decisions, the person(s) with the legal authority to make health care decisions on their behalf (for example, a delegate appointed under the Personal Directives Act) will have access to a person’s health information to make decisions on their behalf. In this role, this person may request a copy of a person’s health record and they could then be aware of a person’s prior discussions and/or decision about MAiD.

•Executors of a person’s estate are also legally allowed to get a copy of a person’s health record, upon request, after their death.

•Under the Personal Health Information Act, family members are also able to get recent information about a person’s care, unless the person has given instructions that they are not to have access to that health care information. As such, unless a person gave instructions not to release this information, family members may become aware of discussions and/or a decision about MAiD.

•Death certificates include information that refers to MAiD, as well as to the disease(s) resulting in the request for MAiD.

Will having MAiD affect a person’s insurance policy?

No. Death by MAiD is considered a ‘natural death’ – insurance contracts will be honoured as long as MAiD is consistent with the law.

Is there a fee to request or have medical assistance in dying?

No. There is no fee to request or receive medical assistance in dying. 

Where can I learn more about medical assistance in dying?

You can learn more about medical assistance in dying on the Government of Canada website at https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html