In accordance with the
Criminal Code and other legislation, the BCCNM standards of practice, and provincial and organizational policies and procedures, nurse practitioners may provide a client with medical assistance in dying (MAiD).
The purposeful and intended outcome of medical assistance in dying is to assist an eligible client explicitly requesting assistance in dying to end their life in a respectful, culturally appropriate, safe, ethical, legal and competent manner.
Nurse practitioners contemplating participation in medical assistance in dying need to confer with their employer about their employer’s requirements.
Nurse practitioners may contact
practice support at BCCNM to discuss professional and ethical obligations. Legal advice is also available for nurse practitioners from the
Canadian Nurses Protective Society.
Only two forms of medical assistance in dying are permitted under the
Criminal Code requires that a client requesting medical assistance in dying is informed of the means that are available to relieve their suffering, including palliative care. This supports the client requesting medical assistance in dying to gather information needed to make an informed decision about their health care options.
Health professionals are permitted to provide information about medical assistance in dying. However, directing, counselling or recommending a client to end their life remains an offence under the
As of March 17, 2021 the MAiD eligibility criteria and safeguards in the
Criminal Code were updated. Updates include that clients with a grievous and irremediable medical condit ion no longer require their death to be reasonably foreseeable to be eligible receive MAiD; however, additional safeguards have been added to the
Criminal Code which must be satisfied before a MAiD can be provided to such a client. In certain circumstances, clients whose death is reasonably foreseeable can also now waive the requirement for final consent to receive MAiD if they lose the capacity to consent before MAiD is provided to them.
The following terms are used in this standard:
The nurse practitioner role in medical assistance in dying under the
Criminal Code can encompass:
Any nurse practitioner receiving a written request for MAiD who transfers the care of the client for any reason must complete the provincial form to report details about this transfer of care. See the
BC Ministry of Health Medical Assistance in Dying website for more details.
A nurse practitioner may have beliefs and values that differ from those of a client. Nothing in the
Criminal Code compels nurse practitioners to aid in the provision of medical assistance in dying, determine eligibility for, or provide medical assistance in dying. The
Duty to Provide Care practice standard provides guidance on how a nurse practitioner can address conscientious objection.
The standard requires nurse practitioners with a conscientious objection to take all reasonable steps to ensure that the quality and continuity of care for clients seeking or receiving medical assistance in dying are not compromised. This includes ensuring a safe transfer of care to an alternate provider that is timely, continuous, respectful and addresses the unique needs of a client.
Duty to Provide Care practice standard also requires nurse practitioners with a conscientious objection to notify their organization well before the client is to receive medical assistance in dying. If medical assistance in dying is unexpectedly proposed or requested and no arrangement is in place for alternative providers, that practice standard further requires nurse practitioners to inform those most directly involved in the care of the client of their conscientious objection.
As of March 17, 2021, clients who wish to receive MAiD must satisfy all of the following eligibility criteria:
The following procedural safeguards must be satisfied before MAiD is provided to any client:
In addition to all of the above safeguards, the following further procedural safeguards must also be satisfied before MAiD is provided to any client whose natural death is not reasonably foreseeable:
To act as the client’s assessor-prescriber or as the second independent assessor who assesses the client, a nurse practitioner or medical practitioner must meet all of the following requirements:
The role of the independent witness is to provide confirmation of the client’s signing and dating of their request for MAiD, and that the client understands what they are signing.
An independent witness must be at least 18 years of age and must understand what it means to request MAiD.
An independent witness can be a paid professional personal or health care worker who does not act as the client’s assessor-prescriber or the second independent assessor.
To be considered independent means that the witness
If the client requesting MAiD has the mental capacity to make a free and informed decision with respect to their health, but is physically unable to sign and date the request for MAiD, another person may sign in the client’s presence, on the client’s behalf, and under the client’s express direction. The person acting as a proxy must:
As of March 17, 2021, the requirement for the client to confirm their final consent immediately before receiving MAiD may be waived for a client whose natural death is reasonably foreseeable, in the event that the client loses the capacity to consent before MAiD is provided, provided that:
The agreement to waive final consent will be invalid if the client, after having lost decision-making capacity, demonstrates refusal or resistance to the administration of MAiD by words, sounds or gestures. Reflexes and other types of involuntary movements, such as a response to a touch or to the insertion of a needle, do not constitute refusal or resistance.
As of March 17, 2021, clients approved to receive MAiD who choose to self-administer the substance for MAiD may also make an arrangement in writing with the assessor-prescriber if complications arise after the ingestion of the substance, causing loss of decision-making capacity but not death.
Such arrangements allow the client to provide their consent in advance to practitioner-administered MAiD, in the event of complications with self-administration, and if the practitioner is present at the time of self-administration. All clients who choose to self-administer a substance for the purpose of MAiD can make such an arrangement with the assessor-prescriber, regardless of their prognosis.
For the purpose of oversight or monitoring of MAiD, there are specific requirements and timeframes for reporting MAiD information. Reporting requirements that may apply to nurse practitioners include the following situations:
For more information on reporting requirements and timeframes, visit the
BC Ministry of Health Medical Assistance in Dying website.
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