As of June 2016, physicians and nurse practitioners in Canada can provide medical assistance in dying (MAiD) for patients who meet eligibility criteria.
What is MAiD?
MAiD is a legal medical service where a medical practitioner (physician) or nurse practitioner, at an individual’s request: (a) administers a substance that causes an individual’s death; or (b) prescribes a substance for an individual to self-administer to cause their own death.
Where can MAiD happen?
MAiD can happen anywhere, including in the hospital or in your own home.
Can MAiD take place at Osler?
Yes. Osler supports MAiD for both in-patients and out-patients.
Who can provide MAiD?
Physicians and nurse practitioners are legally authorized to provide MAiD. However, staff may assist in some aspects of care during, if appropriate, and provide the usual care before and after.
Who can request MAiD?
Anyone can request MAiD for themselves and those who meet all of the eligibility criteria can receive MAiD.
What are the eligibility criteria?
To be eligible for MAiD, patients must:
- Be eligible for health services funded by a government of Canada;
- Be at least 18 years of age;
- Be capable of making health care decisions;
- Be suffering from a serious and incurable illness, disease or disability;
- Be in an advanced state of irreversible decline that is causing enduring physical or psychological suffering that is intolerable;
- Have a natural death that is reasonably foreseeable; and >
- Give informed consent in writing.
What is the first step for accessing MAiD?
In order obtain MAiD, patients must make a request in writing. The Government of Ontario has made publically available a form called the Clinician Aid A for this purpose. Someone from the patient’s health care team can provide this form. The patient must sign Clinician Aid A. If they are unable to sign, a proxy may sign on their behalf. Two independent witnesses must also sign Clinician Aid A.
Who can sign as an independent witness for a MAiD request?
An independent witness, any person who is at least 18 years of age and who understands the nature of the request for medical assistance in dying, may act as an independent witness, except if they:
- know or believe that they are a beneficiary under the will of the person making the request, or a recipient, in any other way, of a financial or other material benefit resulting from that person’s death;
- are an owner or operator of any health care facility at which the person making the request is being treated or any facility in which that person resides;
- are directly involved in providing health care services to the person making the request; or
- directly provide personal care to the person making the request.
Osler’s Ethics Department can provide support in obtaining witnesses for the written request. Call 905-494-2120 x 56630. Dying With Dignity Canada can also provide MAiD witnesses and can be reach at 1-877-389-1251.
What happens after a written request for MAiD?
The health care team will continue to support and care for the patient. They can assist in connecting the patient with a MAiD provider. The patient will be assessed for MAiD by two separate physicians or nurse practitioners, who will use Clinician Aid B and Clinician Aid C for their assessments. A patient can withdraw their request for MAiD at any time. See this infographic for a summary of the patient’s steps in the MAiD process.
What if a health care provider says that they disagree with MAiD or that they cannot support a patient’s request for MAiD?
All patients have a right to request and be assessed for access to MAiD. Osler recognizes the legal right of physicians and staff to conscientiously object to participating in MAiD or any other aspects of patient care. However, physicians and staff who are unwilling or unable to participate in MAiD will find a colleague who can support the patient in the MAiD process. Patient may ask different physicians or health care providers for information or access to MAiD. Patients may also contact Osler’s Ethics team for information or support in accessing MAiD. Osler’s Ethics Department be reach at 905-494-2120 x 56630.
How long does it take to receive MAiD?
Typically, it takes a minimum of 10 days to receive MAiD from the time of the written request. The procedure itself, takes about 5-10 minutes.
Can family or substitute decision makers request MAiD or consent to MAiD on a patient’s behalf?
No, only a capable patient can request and consent to MAiD.
Can patients make advanced requests for MAiD?
No, at present, the law does not allow for advanced requests.
Who can provide more information or support?
Patients can speak directly with their physician or health care team about MAiD. They can also contact the Osler’s ethics team at 905-494-2120 ext. 56630.
In addition, support is available from the Provincial MAiD Coordination Service at 1-866-286-4023 or TTY 844-953-3350.
More information can be found in the Ministry of Ontario’s Medical Assistance in Dying Information for Patients and on the Ministry of Health and Long-Term Care’s webpage. General inquiries about medical assistance in dying can be directed to firstname.lastname@example.org.