Status of legislation
On June 17, 2016, federal legislation on Medical Assistance in Dying was passed and received Royal Assent. The federal legislation permits Medical Assistance in Dying for patients who meet all the criteria as outlined below.
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 a 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 that 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.
The Ministries of Justice and Health have been working closely with provincial health system stakeholders and partners. Work is underway on standard provincial processes and support resources.
Receiving a request for Medical Assistance in Dying
Physicians or registered nurse (nurse practitioners) [RN(NP)s]* who are asked for information or access to Medical Assistance in Dying should first compassionately explore the patient's reasons for requesting this service. Assisted death should not be promoted or encouraged, since criminality provisions around counselling for suicide remain in force in Canada. Physicians or RN(NP)s who have questions about the legalities of their role should consult with the Canadian Medical Protective Association (CPMA) or the Canadian Nurses Protective Society (CNPS).
Are Saskatchewan physicians and RN(NP)s obligated to provide Medical Assistance in Dying? Can they decline?
No physician or RN(NP) is required to assess a patient for Medical Assistance in Dying or to perform Medical Assistance in Dying, in accordance with criteria. Physicians and RN(NP)s should review the policy guidance developed by their respective regulatory body for clarity on expectations related to the practitioner's responsibility if their patient seeks information about Medical Assistance in Dying.
Physicians and RN(NP)s are not obligated to provide information to a patient about Medical Assistance in Dying or assess a patient for Medical Assistance in Dying if:
- it would violate their moral conscience; or
- they do not consider themselves properly trained to safely provide it.
Physicians' and RN(NP)s' obligations to patient if they can't provide the service
If a physician or RN(NP) elects not to provide the service, they must provide all other medical care required until a transfer of care has taken place. Out of respect for the patient's request, the physician or RN(NP) must arrange timely access to information or resources, or offer the patient information and advice about all medical options available. An option may be to refer the patient to a contact person who can put the patient in touch with a physician or RN(NP) who has indicated they may be willing to provide Medical Assistance in Dying. This is consistent with the CPSS policy.
Process if physician or RN(NP) agrees to provide the service
Physicians and RN(NP)s who are willing and able to provide Medical Assistance in Dying must follow the requirements of the federal legislation as well as the policy guidance developed by their respective regulatory body.
Additional support and information
Physicians and RN(NP)s who have questions concerning Medical Assistance in Dying are advised to contact the CPSS and SRNA to ensure consistency with emerging policies and practice guidelines. Other 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.