Exercise professional judgment as it relates to the registered nurse’s role in medical assistance in dying (MAiD).
Objectives – the nurse practitioner will:
- Define the process of Medical Assistance in Dying (MAiD)
- Explain the NP role in the provision of MAiD
- Identify statutory safeguards that must be met before an eligible client can receive MAiD
SYNOPSIS OF INFORMATION
On June 17, 2016, the federal government enacted legislation regulating the provision of medical assistance in dying (MAiD). This was in response to the Supreme Court of Canada’s Carter decision delivered on February 6, 2015 which struck down the law prohibiting MAiD for Canadians who met certain conditions outlined by the court.
Definition of MAiD
MAiD refers to the process where, at the client’s request, an NP or physician:
- Prescribes and administers a medication to the client that causes their death; or
- Prescribes or provides a medication to the client so that the client may self-administer the medication and in so doing cause their own death.
If a client asks about MAiD, you can explore reasons for the client’s request but do so in the context all other end of life care options, including palliative care. You may provide information and answer client questions about MAiD that is client centered and reflects the client’s values.
NPs who provide MAiD as a member of the health care team are required to determine the client’s eligibility. However, before assuming any role in the process, you must:
- discuss the client’s request for assisted dying with other members of the healthcare team,
- review the client record and
- review the client’s written request for assisted dying.
In addition, you must:
- follow employer/agency policy regarding your participation in MAiD
- raise your concerns with the health care team or your manager if you have reason to believe that the client does not meet eligibility criteria.
The Criminal Code sets out a number of safeguards that must be met before an eligible client can receive assistance in dying. As an NP providing MAiD, you should be aware of these safeguards as well as any additional safeguards outlined in employer or agency policy.
As with client eligibility concerns, if you know or reasonably believe that not all mandatory safeguards have been complied with, you must immediately discuss these issues with other health care team members or your manager.
The safeguards in section 241.2(3) of the Criminal Code include, but are not limited to, the following:
- The client’s request must be made in writing and signed and dated by the client
- The client’s request must be signed and dated before two independent witnesses
- Another NP or physician has provided a written opinion confirming that the client meets all of the eligibility criteria set out in section 241.2(1) of the Criminal Code
- There are at least 10 clear days between the day on which the request was signed by the client and the day on which MAiD is provided or – if both NPs and/or physicians assessing the eligibility criteria are of the opinion that the client’s death, or the loss of capacity to provide informed consent, is imminent – any shorter period that the first NP/physician considers appropriate in the circumstances
- Immediately before the provision of MAiD, the NP or physician must give the client an opportunity to withdraw their request and ensure that the client gives express consent to receive MAiD.
Administration of Medication
NPs are authorized to prepare and administer the medication being used for MAiD. The healthcare provider (NP or physician) who administers the medication must also prepare the medication (e.g. drawing the medication into the syringe).
Witnessing a Written Request for MAiD
A client who wishes to receive assistance in dying must submit a request to the providing NP or physician. The request must be written, signed and dated by the client after they have been informed of or diagnosed with the grievous and irremediable medical condition.
The client may ask you to act as a witness to their signature on their written request for MAiD. You may act as a witness as long as you:
- are aware that the document is a formal request for assisted dying;
- are not directly involved with providing health care services or personal care services to the client making the request;
- do not directly provide personal care to the client;
- are not or reasonably believe that you are not a beneficiary under the client’s will or will receive a financial or other material benefit from the client’s death; are not an owner or operator of a health care facility where the client is being treated or any facility in which the client resides.
NOTE: As per agency policy, NPs employed by the Nova Scotia Health Authority are not permitted to witness the signature of a client requesting MAiD.