Medical Assistance in Dying A patient’s choice and assessing eligibility

The Patient’s Decision Pre contemplative The patient is seeking information and exploring available options for treatment, including medical assistance in dying Contemplative The patient is seeking specific information on assisted dying Determination The patient completes the Record of Patient Request; the Care Coordination Centre may become involved to support the patient’s access to service, if needed Action Plan details of location (home or facility), timing, presence of family/friends, environmental comforts

The practitioner accepts the patient’s invitation to engage in a therapeutic conversation to discuss the patient’s fears, needs, and wants. 9 out of 10 individuals who request this conversation do not to proceed with MAiD after a more fulsome discussion of their alternatives. maid

If your inner beliefs and values do not support MAiD then an appropriate response may be: “I am not comfortable discussing this topic, but I can arrange for someone else to answer your questions.” You may connect with the Care Coordination Centre if unsure of a practitioner who can speak with your patient

Acting on the patient request When a patient makes a written request for medical assistance in dying, the first step is to perform the formal assessment of eligibility The assessor may be the family physician or nurse practitioner The Care Coordination Centre may help connect the patient with an assessor

The assessor: Confirms there is no conflict of interest with the patient: To the best of your knowledge, you are not a beneficiary under the patient’s will You do not stand to gain financially or materially from patient’s death, other than through standard compensation You are not connected to the patient requesting medical assistance in dying in a way that would affect your objectivity

The assessor: Confirms there is no conflict of interest with the prescriber: You do not act as a mentor or supervisor to the provider You are not connected to the provider in any other way that would affect your objectivity What kind of business relationship

Patient Eligibility Criteria Eligible for health services funded by a government in Canada At least 18 years of age Capable of making decisions with respect to their health Have a grievous and irremediable medical condition Have made a voluntary request for medical assistance in dying, not made as a result of external pressure Have given informed consent to receive medical assistance in dying, after having been informed of the means that are available to relieve their suffering, including palliative care. Update age 18 and add forseeable future

Grievous and Irremediable Medical Condition A person has a grievous and irremediable medical condition if the meet all of the following criteria: Serious and incurable illness, disease, or disability Advanced state of irreversible decline or capability State of decline causes enduring psychological or physical suffering, intolerable to them, and not relieved by means acceptable to them Natural death is reasonably foreseeable, taking into account all of the medical circumstances, but not requiring a specific prognosis

Assessing capacity The decision to receive medical assistance in dying is a healthcare decision The patient must: Understand their diagnosis/prognosis Know about feasible alternatives to assisted death, including comfort care, palliative care, and pain control Maintain capacity for the service to proceed If there is any doubt regarding the patient’s cognitive ability to make a medical decision, then a referral to an appropriate specialist or general practitioner with additional qualifications MAID

Voluntary Request Ensure that the request for medical assistance in dying was not made as a result of external pressure; whether that be from an individual, organization, or societal Consider elder abuse, family or caregiver pressure on the patient, and the effects of marginalization Ensure the request for medical assistance in dying was made before two independent witnesses Ensure the patient is aware they may rescind their request at any time

Assessing the patient Determine the patient’s communication needs If an interpreter is required, using an independent interpreter will reduce the risk of undue family influence Augmentative communication devices such as a communication board or electronic device are acceptable, as are alternate means of communication, like blinking

Assessing the patient Obtain copies of all relevant medical records from other physicians/practitioners involved in the patient’s care supporting the diagnosis and prognosis of the patient’s grievous and irremediable condition. Talk with the patient privately Obtain consent to talk to others in their circle of care – family doctor/family/friends

Documentation Document your discussion in the patient record Complete the provincial Record of Assessment (Assessor) form, and retain a copy in the patient record Provide a copy of the assessor’s documented discussion and Record of Assessment (Assessor) to the Prescriber, or to the Care Coordination Centre, if support is needed in finding a Prescriber Maid

Care Coordination Centre The role of the Care Coordinator is to: Connect patients requesting assisted dying with participating physicians Facilitate the care required for assisted dying in an NH facility Offer to support assisted dying provided by physicians and nurse practitioners in the community Contact: kirsten.thomson@northernhealth.ca Phone: 250-645-6417 Fax 250-565-2640 update