5. Medical Assistance in Dying

When you work with patients who have a terminal diagnosis, or a diagnosis with no prospect of a cure, at some point you may be confronted with a request for medical assistance in dying, or a request for information on this matter.

In June 2016, the Canadian government passed legislation to allow eligible adults to request medical assistance in dying. This means that upon the request of an eligible adult, if certain conditions are met, either a doctor or a nurse practitioner can administer the lethal dose of medication (commonly referred to as “voluntary euthanasia”), or provide the lethal dose of medication to the patient to self-administer (commonly referred to as “medically-assisted suicide”). A request can be made by the patient at any time, including when the patient is already receiving palliative care, and a number of conditions must be met.

Who can Provide Medical Assistance in Dying?

Doctors and nurse practitioners (not registered nurses) are the healthcare professionals who can provide medical assistance in dying, depending on the province or territory. When a request for medical assistance in dying has been granted, the appropriate healthcare providers cannot be charged under existing laws that cover causing someone’s death or providing the agent to cause someone’s death.

The legislation also makes it clear that healthcare providers who object to providing medical assistance in dying are not required to provide such assistance. They are responsible to refer the patient to another practitioner who is willing to provide assistance, and to continue to care for the patient in the meantime.

Safeguards

The legislation specifies that anyone making the request has to be informed of other options available to them, including palliative care alternatives. The healthcare provider also has a duty to make sure that the patient is making their own decision, and is not experiencing any kind of external pressure to make this decision. Once a request has been approved, unless there are exceptional circumstances, there is a 10-day waiting period before the request is carried out, to allow time for serious consideration of this final step.

Ongoing Issues

It is important to note that this legislation represents a relatively new dimension of palliative care in Canada. This is a complex area and there are many issues that may emerge and will need to be addressed in future.

For instance, if a healthcare provider objects to providing assistance in dying, an eligible patient’s request for medical assistance in dying may not be granted if there is not another healthcare provider in the community who is willing to provide assistance.

In addition, Advance Care Directives (discussed earlier in this course) are not currently accepted in this matter. In other words, the patient must be able to make the request themselves. At this time, mental health conditions do not currently qualify as a sole underlying condition for requesting medical assistance in dying.

For more information and updates on this legislation, please visit the Government of Canada’s website: Medical Assistance in Dying.