Medical Assistance in Dying: Frequently Asked Questions for Public

Updated April 26, 2021

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 or email maid@nshealth.ca if you have any questions.

What is medical assistance in dying? 

MAID is a process where a person who meets a number of specific criteria is given medications at their request by a qualified health care provider to bring about the person’s death.

Canadian Law defines medical assistance in dying (MAID) as:

“the administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death”; or

“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 have medical assistance in dying?

A person requesting MAID will be assessed to find out if they are eligible. The health care provider doing the assessment must make sure that the person meets all of the following criteria:

  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.” This means that:
    1. the person has a serious and incurable illness, disease, or disability;
    2. the person is in an advanced state of irreversible decline (will not get better) in capability;
    3. the illness, disease, disability, or state of decline causes the person to endure physical or psychological suffering that is intolerable to the person, that cannot be relieved under conditions that the person considers acceptable;
    4. if the person’s natural death is reasonably foreseeable*, and if they meet the eligibility requirements, MAID can be provided soon after consent is obtained.
    5. If the person’s death is not reasonably foreseeable*, a 90 day evaluation period must be undertaken, during which further assessments will be completed.
  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 MAID after having been informed of their medical diagnosis, available forms of treatment, and available options to try to relieve suffering, including palliative care.

*“Reasonably foreseeable” means that taking into account all of the person’s medical circumstances, their health care providers can reasonably predict how or when a natural death will happen.

What is the process to have medical assistance in dying?

  1. Talk with a Medical Doctor (MD) or Nurse Practitioner (NP) to arrange an assessment. If you are interested in learning more about MAID, talk with an MD or NP about your options. These options may include a more detailed discussion about your health and illness, a referral to a palliative care specialist/team, psychological support, spiritual care, and/or MAID.

    If the MD or NP finds that MAID may be an option, they can start the MAID assessment process themselves, or they can make a written request for a MAID assessment. Written requests for MAID assessments are sent to Nova Scotia Health’s MAID Care Coordination Office.

    If you do not have an MD or NP, or do not feel comfortable talking with them about MAID, you can call Nova Scotia Health’s MAID Care Coordination Office 

    Phone (Halifax area): 902-491-5892
    Phone (toll-free): 1-833-903-6243

    Leave a message with your name, phone number, and a brief reason for your call. Messages are checked from 8:30 a.m. to 4:30 p.m., Monday to Friday.
    Your call will be returned within 1 to 2 business days. They are able to provide information about MAID, and can arrange for you to talk with an MD or NP who is familiar with MAID.

  2. Be assessed for eligibility for MAID.

    Two health care providers (two MDs, two NPs, or one of each) must independently determine whether you meet the eligibility criteria for MAID.

    The health care provider completing the first assessment (if it is not your own MD or NP) will contact you and arrange to meet you at a time and place of your choosing to talk about MAID, and to start the process.

    At this visit, the health care provider will talk about your health history, and why you are considering MAID. They will determine whether you meet the established criteria (section B above), and will take the time needed to answer all of your questions.

    A second MD or NP will complete a similar assessment as soon as possible.  These assessments are required by law. If assessors are not in agreement as to whether a patient meets the criteria for MAID, a third assessment can be arranged to assist in making this determination.

  3. Complete a written MAID consent form.

    During either the first or second assessment described above, you will be given a consent form, which you must complete before MAID can take place.

    You must sign and date the consent form with 1 independent witness present. The independent witness must also sign the consent form. An independent witness is any person over the age of 18, who:

    1. understands the nature of the request for MAID,
    2. does not stand to benefit from your death (i.e. will not inherit from your estate, or be named in your will)
    3. is not the owner or operator of any health care facility at which you are being treated or any facility in which you reside, and
    4. is not either of the clinicians involved in your MAID assessment
       
  4. Waiting Period.
    Patients whose death is reasonably foreseeable are not subject to a defined waiting period following the signing of the consent form.  In most cases, however, there will be a period during which the clinicians’ availability is confirmed, medications are ordered, and MAID is planned. Some patients have a date and time in mind for MAID, and some do not. Some patients may choose to wait for a period of time before acting on their request for MAID; this decision is entirely up to you and you may change your mind at any time.
    For those patients whose death is not reasonably foreseeable, there is a mandatory 90 day period of further evaluation that begins after the first assessment.  This will be discussed with you during the assessment process.
     
  5. Schedule the MAID procedure.
    Once you have been assessed and found to meet the criteria for MAID, and have signed the consent form, MAID can take place.
    During this time, the MAID Nurse Navigator and the MD or NP who will be involved in the MAID procedure will work with you (and any family and friends that you wish 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 a place of your choosing:
    1. a home setting
    2. any Nova Scotia Health facility
    3. a home for special care, such as a nursing home
    4. a hospice

      ​In certain circumstances, where there may be concern that you could lose capacity to make decisions before your scheduled procedure, advance consent may be arranged.  This will be discussed when you choose a date for MAID. For the procedure, several medications are injected (given) through an intravenous (IV) line, which is usually placed in a vein in the arm. The injection of the medications does not hurt. The first medication will likely cause you to fall into a deep sleep, after which you will become unaware and remain unaware until your death. IV lines may be placed the day before the procedure, in some cases. This will be decided by you and the MD or NP. 

      After the procedure, after death has occurred, your remains will be removed (usually by a funeral home) according to the plans you have made. Decisions about who you would like to be present at the time of the MAID procedure will be discussed with you. 

      On the day of the procedure, the MD or NP will talk with you again, to make sure that you are still able to make a decision about going ahead with the MAID procedure, and to confirm once again that you consent (fully agree) to the procedure. You will be given a chance to change your mind, if you wish.  After this final confirmation, the MAID procedure can take place.

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

(Capacity is the ability to fully understand one’s situation, and the result of any act or decision one chooses.)

In most cases, you must be able to give consent up to the moment you receive MAID.

However, as noted above, if your death is reasonably foreseeable, and there is concern that you are at risk of losing capacity to consent and you have chosen a date for MAID, you may fill out an Advance Consent Agreement with your MAID provider.

An Advance Consent Agreement is a document that tells the MAID physician or NP that you would like to have your MAID procedure on the discussed date, even if you lose the ability to consent at that time.  This will be discussed further with your MAID provider.

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.

Which health care providers can be involved in MAID?

Medical Doctors (MDs) and Nurse Practitioners (NPs) are the only health care providers who may assess patients and provide MAID.  Other health care providers (such as pharmacists, nurses, spiritual care practitioners, and/or social workers) may also be involved, and can support persons requesting MAID, and their families and friends, throughout the process.

Can I change my mind about going ahead with MAID?

Yes. You can change your mind at any time right up until the moment that you receive MAID. Right before receiving MAID, the MD or NP providing the medications will give you a chance to withdraw your request for MAID.

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

No. A request for MAID must be made in person to the health care provider who is completing the assessment; written requests made in advance are not allowed.

Can a person ask for MAID for another person?

No. A request for MAID must be made by the person requesting the MAID procedure. By law, no one can make a request for MAID for another person.

Does my family need to be consulted about a decision to have MAID?

No. As with any other health care decisions, it is up to you to decide whether to talk with or tell your family members.

Will discussions about MAID be kept private?

All discussions about MAID involving health care providers are confidential. With your permission, the health care provider completing your assessment will include information about the discussion in your health care record. All of this information, including your discussions and/or decision about MAID, is personal health information and is protected by the Personal Health Information Act.

Nova Scotia Health will not share your health information, including information about discussions or decisions about MAID, unless you consent to share that information.

If you become unable to make your own health care decisions, the person(s) with the legal authority to make health care decisions on your behalf (for example, a delegate appointed under the Personal Directives Act) 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 could then be aware of your discussions and/or decision about MAID.

Executors of your estate are also legally allowed to request a copy of your health record, upon request, after your death.

Under the Personal Health Information Act, family members are also able to request recent information about your care, unless you have given instructions that they are not to have access to that information. This means that unless you gave instructions to Nova Scotia Health NOT to release this information, family members may become aware of discussions and/or a decision about MAID.

In Nova Scotia, 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 my 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 receive MAID?

No. There is no fee to request or receive MAID. Medication costs are covered by the province, whether MAID is administered in a health care facility or at home.

Where can I learn more about medical assistance in dying?

You can learn more about MAID on the Government of Canada’s website:

www.canada.ca/en/health-canada/services/medical-assistance-dying.html

You can also find information on Nova Scotia Health’s website:

www.nshealth.ca/about-us/medical-assistance-dying

How should I prepare for the end of life?

Planning for the end of life is important. Each person must consider many details that are unique to them. It may help to have family members 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.

Helpful resources:

What other options are there to lower suffering and/or receive end-of-life medical care?

If you are considering MAID, it is important to be aware of the option to receive palliative care.

Palliative care aims to improve the quality of life of patients with life-limiting illnesses and their families. Palliative care involves a team of health care providers. The palliative care team can support people in their homes, in hospices, supportive living environments, and hospitals.

Your primary care provider may work with the palliative care team and other health care providers to help you and your family understand and manage your illness and symptoms.  Seeking MAID does not prevent you from accessing palliative care support, and both of these teams may work together to care for you.

Palliative care:

  • may provide relief from pain and other upsetting symptoms.
  • helps you to manage symptoms and address physical, emotional, and spiritual concerns.
  • supports your family members.
  • improves your quality of life and helps you to live as actively as possible.
  • prepares you and your family for death.
  • offers bereavement support to your loved ones.

Please ask a member of your health care team if you are interested in being referred to palliative care services.