Medical Assistance in Dying: Frequently Asked Questions for Public

Updated March 6, 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?



Patients may be eligible for medical assistance in dying if all of the following apply:
  • You are eligible to receive provincial health services. You have a valid Nova Scotia health card.

  • You are at least 18 years of age.

  • No one is pressuring or influencing you to choose to die, or has done so at any time.

  • Your doctor or NP has diagnosed you with a serious and incurable illness, disease or disability. 

  • You are in an advanced state of decline that cannot be reversed.

  • You suffer unbearably from your medical condition. You are not able to find relief in a way that is acceptable to you.

  • Your doctor(s) and/or NP(s) have told you that you can expect to die in the near future. They may not have given a specific length of time.

  • You are capable of making decisions about your health.


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 your doctor or NP

Preparing for death and dying can be very hard. First, talk to your doctor or NP about your 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. 

If you decide to explore the option of medical assistance in dying, the following process will be required.

2 - Submit a request in writing

If you want to have medical assistance in dying, your doctor or NP will ask you to complete a patient request form. You must sign and date the request form with two independent witnesses present. 
 
An independent witness is any person who is at least 18 years of age and who understands the nature of the request for medical assistance in dying. Anyone meeting these criteria may act as an independent witness, except if they:
  • Know of or believe that they are a beneficiary of the will of the person making the request, or a recipient, in any way, of financial or other material benefit resulting from that person’s death.

  • Are an owner or operator of any health care facility treating the person making the request is being treated 

  • Are an owner or operator of any facility in which the person making the request lives

  • Are directly involved in health care services for the person making the request

  • Directly provide personal care to the person making the request.
 
3 - You will require two assessments
 
A doctor or NP will complete an assessment. This includes:
  • providing a diagnosis and prognosis of your condition 
  • assessing your capacity to make your health care decision 
 
If you do not have a doctor or NP, you can call NSHA, 902-491-5892. This voicemail will be checked from 8:30 a.m. to 4:30 p.m., Monday to Friday. Please leave your name, number and a brief reason for your call so we can best address your questions and concerns We will get back to you as soon as possible and assist with arranging for the assessment for medical assistance in dying .

 
Once the first  doctor or NP decides that you qualify for medical assistance in dying, a second doctor or NP must also assess you to confirm that you meet the criteria.
 
4 - Waiting period
There must be at least 10 days between the time you sign the request form and the time you have medical assistance in dying. You can change your mind at any time during the waiting period.

If both of the doctors or NPs involved feel that your death, or loss of your capacity to provide informed consent, is about to happen, a shorter waiting period may be allowed. 
Once the waiting period is over, the doctor or NP will:
  • confirm that you are still capable of making this choice
  • get your final consent to go ahead
After you have given your consent, the doctor or NP will give you (administer) the drugs.


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


Your discussions and/or decision about medical assistance in dying is personal health information and is protected by the Personal Health Information Act. Nova Scotia Health Authority will not share your health information, including information about your decision relating to medical assistance in dying, unless you consent to disclose, or where the Personal Health Information Act allows disclosure without your consent. 

 
If you become unable to make your own health care decisions, your substitute decision maker/delegate will have access to your health information to make decisions on your behalf. In this role, this person may request a copy of your health record and they would then be aware of your decisions about medical assistance in dying. 
 
Executors of your estate are also legally allowed to obtain a copy of your health record, upon request, after your death. And, under the Personal Health Information Act, family members are able to obtain recent information about your care, unless you have gave instructions that they are not to have access to your health care information.  As such, family members may become aware of your decisions about medical assistance in dying.

 
As well, death certificates may include information that refers to medical assistance in dying. 


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