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  1. Nurse​​ practitioners participating in any aspect of medical assistance in dying understand and comply with the Criminal Code and other legislation, the BCCNM standards of practice, and provincial and organizational policies and procedures related to medical assistance in dying.

  2. Nurse practitioners have a complete and full discussion with the client about medical assistance in dying that provides the client with the information required to make informed decisions about medical assistance in dying. This must include inf​​ormation about the means that are available to relieve the client’s suffering, including palliative care (Criminal Code, section 241.2(1)(e)). More specifically, when the client’s natural death is not reasonably foreseeable, the nurse practitioner acting as an assessor-prescriber must ensure that the client has been informed of the means available to relieve their suffering, including, where appropriate, counselling services, mental health and disability support services, community services and palliative care, and that the client has been offered the opportunity for consultations with professionals who provide those services or that care (Criminal Code, section 241.2(3.1)(g)).

  3. Nurse practi​​tioners ensure that all necessary measures are taken to provide a reliable means by which the client will understand the information that is provided to them and communicate their decision, including when the client has difficulty communicating.

  4. Nurse practitioners mus​​​t inform the client requesting medical assistance in dying of the following:

    a.

    the client’s diagnosis and prognosis

    b.

    feasible alternatives (including palliative care and pain control)

    c.

    option to withdraw the request for medical assistance in dying at any time

    d.

    risks of taking the prescribed substances intended to cause death

  5. Nurse practitioners ensure the information provided in standard 4 is included in the client’s medical record and that a copy is provided to the client.
  6. Nurse practitioners assess the cultural and spiritual needs and wishes of the client seeking medical assistance in dying and explore ways the client’s needs could be met within the context of the c​​are delivery.

  7. Nurse practitioner​​s work with their organizations and other members of the health care team to ensure that the client requesting medical assistance receives high quality, coordinated and uninterrupted continuity of care and, if needed, safe transfer of the client’s care to another health care provider.

  8. Nurse practitioners acting as a​n assessor or assessor-prescriber must ensure clients requesting medical assistance in dying meet the eligibility criteria set out in the Criminal Code (section 241.2(1) and (2))1

  9. Nurs​e practitioners acting as an assessor or assessor-prescriber must ensure that:

    a.​

    they meet the independence requirements set out in the Criminal Code (section 241.2(6)).2.

    b.

    the client requesting MAiD is competent and able to give free and informed consent to MAiD. Consent cannot be given for MAiD through an alternate or substitute decision-maker, or a personal a​dvance directive.

    c.

    both assessors are satisfied that the client is mentally capable of making a free and informed decision with respect to medical assistance in dying at the time of the request.

    d.

    if either assessor is unsure that the client has capacity to consent to medical assistance in dying, the client must be referred to another practitioner with expertise in capacity assessment (e.g., a psychologist, psychiatrist, neurologist, geriatrician, or family physician/general practitioner with additional training and expertise) for a further capacity assessment.

  10. Nurse practitioners ac​​ting as an assessor or assessor-prescriber may provide their assessment virtually if they comply with the following conditions:

    ​​a.

    ​Nurse practitioners ensure that during the virtual assessment, another regulated health professional is in physical attendance with the client to act as a witness to the assessment, unless no other re​gulated health professional is reasonably available to attend in person​.

    ​b.

    ​​Virtua​​l assessments must meet the requirements set out in federal legislation and all other standards and expectations that apply to in-person assessments.

    ​c.

    ​​Virtual ass​​essment must include video of sufficient quality to ensure expected safeguards are in place.

  11. Nurse prac​titioners acting as an assessor-prescriber, before prescribing, providing or administering medical assistance in dying to a client, must comply with all applicable procedural safeguards set out in the Criminal Code (section 241.2(3) or (3.1)).3

  12. Immediate​​ly before providing medical assistance in dying, the nurse practitioner acting as an assessor-prescriber must give the client an opportunity to withdraw their request and ensure that the client ​​gives express consent to receive medical assistance in dying, unless they meet the criteria in the Criminal Code for waiver of final consent (section 241.2(3.2) or (3.5)).4

  13. Nurse practitioners acting as an assessor-prescriber, who prescribe5 or administer the substances to be used in medical assistance in dying, must do so in the client’s name, using the provincial medical​​ assistance in dying prescription form.

  14. The nurse practitioner acting as an assessor-prescriber must receive the substances for medical assistance in dying directly from the dispensing pharmacist, and must inform the dispensing pharmacist th​​at the substances are intended for the purpose of medical assistance in dying.

  15. Nurse pract​​itioners acting as an assessor-prescriber must personally attend the client during the self-administration or personally administer the substances for medical assistance in dying, and must remain in attendance until death is confirmed. This responsibility must not be delegated or assigned to any other person.

  16. Nurse pra​​ctitioners acting as an assessor-prescriber complete the medical certificate of death. The medical certificate of death must indicate that the manner of death involved medical assistance in dying and that the cause of death is the underlying illness/disease causing the grievous and irremediable medical condition.

  17. Nurse practitioners comply with information or medical record requests made by a provincial agency tasked with a review of medical assistance in dying.
  18. Nurse​​ practitioners comply with reporting requirements established for the oversight or monitoring of MAiD. The required information must be submitted to the BC Ministry of Health using the applicable provincial forms and within the established timeframes for reporting6

  19. Nurse practitioners acting as an assessor-prescriber are responsible for ensuring that any unused substances are returned to the pharmacy as soon as reasonably practicable, within 72 hours of confirmation of the client’​s death.

    ​a.

    ​​If a nurse practitioner acting as an assess​or-prescriber is not reasonably available to return unused substances to the pharmacy themselves, they may ask another nurse practitioner, or a licensed practical nurse, registered nurse, registered psychiatric nurse, physician or pharmacist to return the substances to the pharmacy. The nurse practitioner must document the name of the person assigned to return the substances in the client re​​cord​.

  20. Nurse practitioners use and follow the applicable provincial forms, prescriptions and guidelines, specific to medical assistance in dying.
  21. Nurse p​​ractitioners must ensure the following information is present in the client’s medical record:

    a.

    all applicable provincial forms for medical assistance in dying, including the BC Medical Assistance in Dying Prescription form and Medication Administration Record

    b.

    copies of all relevant medical records from other medical practitioners/health care professionals involved in the client’s care supporting the diagnosis and prognosis of the client’s grievous and irremediable condition, disease or disability

    c.

    documentation of all requests for medical assistance in dying with a summary of the discussion

    d.

    confirmation that the assessor-prescriber and the second assessor discussed and determined which practitioner would prescribe and/or administer the substance used for medical assistance in dying

    e.

    confirmation by the assessor-prescriber that all the requirements have been met including the steps taken and the substance prescribed

    f.

    confirmation that after the completion of all documentation, and just prior to administration, the client was offered the opportunity to withdraw their request, or that the client waived final consent and did not demonstrate refusal or resistance to the administration of MAiD by words, sounds or gestures.

Footnotes

1 Section 241.2(1) sets out the general eligibility criteria to receive MAiD. Section 241.2(2) set out the criteria for a “grievous or irremediable condition”.

2 Section 241.2(6) establishes independence requirements for both the assessor-prescriber and the second assessor who assesses the client to confirm their eligibility for MAiD.
3 Section 241.2(3) establishes the procedural safeguards when death is reasonably foreseeable. Section 241.2(3.1) establishes the procedural safeguards when death is not reasonably foreseeable.
4 Section 241.2(3.2) sets out criteria for a waiver of final consent for clients whose death is reasonably foreseeable. Section 241.2(3.5) sets out criteria for advance consent for clients who choose to self-administer a MAiD substance.
5 When prescribing substances for MAiD, nurse practitioners also follow the Prescribing Drugs standards, limits, and conditions found in Part F, including the limits and conditions on controlled drugs and substances.
6 Timeframes for reporting are dependent on the information being submitted. Refer to the BC Ministry of Health Medical Assistance in Dying website for more information.

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