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Medical assistance in dying

Introduction

Medical Assistance in Dying

The Criminal Code of Canada has been amended to allow a person to request and receive, under limited circumstances, a substance intended to end their life.
Only two forms of medical assistance in dying (MAiD) are permitted under the Criminal Code:

  • the administering by a medical practitioner or a nurse practitioner of a substance to a person at their request
  • the prescribing or providing by a medical practitioner or a nurse practitioner of a substance to a person at their request, for their self-administration

A person is eligible for medical assistance in dying only if they meet all of the following criteria:

  • they are eligible for publicly funded health-care services in Canada
  • they are at least 18 years of age and capable of making decisions with respect to their health
  • they have a grievous and irremediable medical condition
  • they have made a voluntary request in writing for MAiD that, in particular, was not made as a result of external pressure
  • they have given informed consent to receive MAiD after having been informed of the means that are available to relieve their suffering including palliative care

A person has a grievous and irremediable medical condition only if all of the following criteria apply:

  • they have a serious and incurable illness, disease, or disability
  • they are in an advanced state of irreversible decline in capability
  • the illness, disease, or disability causes them enduring physical or psychological suffering that is intolerable to them and cannot be relieved under conditions that they consider acceptable
  • 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 they have remaining

There are three roles related to medical assistance in dying —determining eligibility, providing MAiD and aiding in the provision of MAiD.

The role of the registered nurse, who is not also a nurse practitioner, is limited to aiding a physician or nurse practitioner in the provision of medical assistance in dying. Registered nurses, who are not also a nurse practitioner, are not allowed to prescribe, compound, dispense or administer any substance intended for the purpose of medical assistance in dying.  

As of July 27, 2016, under certain limited circumstances, nurse practitioners may determine the eligibility of a person requesting medical assistance in dying and provide a person with medical assistance in dying. Nurse practitioners determining eligibility for providing medical assistance in dying follow the Medical Assistance in Dying Nurse Practitioner Scope of Practice Standard, found in the Scope of Practice for Nurse Practitioners: Standards, Limits and Conditions.

Nurse practitioners may also aid in the provision of medical assistance in dying by a medical practitioner or another nurse practitioner. Nurse practitioners aiding in the provision of medical assistance in dying by a medical practitioner or nurse practitioner adhere to the Medical Assistance in Dying Registered Nurse Scope of Practice Standards.

Nurses approached about aiding in the provision of medical assistance in dying need to confer with their employer and are also encouraged to seek the guidance of the Canadian Nurses Protective Society.

Organizations establish processes, supports and resources (e.g., policies, procedures, decision support tools) to ensure that nurses meet the standards of practice set out by BCCNP.

End of life care