Medical Assistance in Dying is a deeply personal matter for many people. It is a complex issue that has implications for patients and families, health care providers, and health policy and programs.
Medical Assistance in Dying occurs when a physician or registered nurse (nurse practitioner) [RN(NP)]* administers or provides a prescription for self-administration of a lethal dose of drugs to intentionally cause the death of a competent adult, at the adult's request. In 2015, the Supreme Court of Canada struck down the current law that makes it a criminal offence for a physician or RN(NP) to assist a patient in dying in certain circumstances.
Status of Legislation
On June 17, 2016, federal legislation on Medical Assistance in Dying (Bill C-14) was passed and received Royal Assent. The legislation permits Medical Assistance in Dying for patients who meet all the criteria as outlined below.
Eligibility
Under the federal legislation, an individual needs to meet the following criteria to be considered eligible for Medical Assistance in Dying.
A patient must:
- be eligible for health services funded by the federal government, or a province or territory;
- generally, visitors to Canada are not eligible for Medical Assistance in Dying.
- be at least 18 years old and mentally competent (this means capable of making health care decisions for themselves);
- have a grievous and irremediable medical condition;
- make a request for Medical Assistance in Dying which is not the result of outside pressure or influence; and
- give informed consent to receive Medical Assistance in Dying. This means the person has consented to Medical Assistance in Dying after being given all the information needed to make a decision. This includes information about:
- their medical diagnosis;
- available forms of treatment; and
- available options to relieve suffering, including palliative care.
To be considered as having a grievous and irremediable medical condition, a patient must meet all the following conditions. They must:
- have a serious illness, disease or disability;
- be in an advanced state of decline that cannot be reversed;
- be suffering unbearably from an illness, disease, disability or state of decline; and
- be at a point where their natural death has become reasonably foreseeable, which takes into account all their medical circumstances.
People with mental health conditions as the sole underlying medical condition, and mature minors are not eligible under the legislation. In addition, advance care directives cannot be used as authority to provide the service.
Requesting Medical Assistance in Dying
An individual seeking Medical Assistance in Dying must clearly provide informed, expressed, written, and voluntary consent to the termination of life. Informed consent means that a patient understands the nature, benefit, risks, alternatives and consequences of a health care decision. It also means the patient has had all their questions sufficiently answered.
Status of legislation
Federal legislation (Bill C-14) received Royal Assent on June 17, 2016.
Patients interested in Medical Assistance in Dying can approach their physician or RN(NP) to inquire about whether they qualify for Medical Assistance in Dying. Physicians and RN(NP)s are guided by their respective regulatory bodies: the College of Physicians and Surgeons of Saskatchewan and the Saskatchewan Registered Nurses Association.
Saskatchewan's progress
The Ministries of Justice and Health are working closely with provincial health system stakeholders and partners on the development of standard provincial processes and support resources.
Getting more information or requesting Medical Assistance in Dying
Patients are advised to have a discussion with their physician or RN(NP).
If a patient's physician or RN(NP) doesn't provide the service
Not all physicians or RN(NP)s will be able to offer this service or will choose to do so. However, they will continue to provide other medically required care, and ensure the patient has access to information on end-of-life care options and access to information on Medical Assistance in Dying if that is their wish.
Additional support and information
The College of Physicians and Surgeons of Saskatchewan and the Saskatchewan Registered Nurses' Association can provide details about processes and guidelines for physicians and RN(NP)s. Health providers can contact their respective professional regulatory bodies for information specific to their areas of practice.
*RN(NP)s will have the ability to provide Medical Assistance in Dying after the Saskatchewan Registered Nurses' Association (SRNA) has developed the applicable practice guideline. In the meantime, RN(NP)s should consult with the SRNA practice team for advice.