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Part 5: Medical assistance in dying


Introduction

The Criminal Code allows a person, under limited circumstances, to request and receive a substance intended to end their life (sections 241.1 – 241.4).

Only two forms of medical assistance in dying (MAiD) are permitted under the Criminal Code:

  • the administering by a medical practitioner or nurse practitioner of a substance to a person at their request that causes their death
  • the prescribing or providing by a medical practitioner or a nurse practitioner of a substance to a person at their request, for their self-administration that in doing so causes their own death

The role of registered nurses1  may include:

  • providing information
  • acting as an independent witness, as described in the Criminal Code
  • acting as a proxy, for a mentally capable client who is physically unable to sign a request for medical assistance in dying
  • acting as a witness in a virtual assessment
  • aiding a medical practitioner or nurse practitioner in the provision of medical assistance in dying

Registered nurses cannot prescribe, compound, prepare, dispense or administer any substance intended for the purpose of medical assistance in dying. Registered nurses can record information for reference use by the assessor-prescriber2 as needed, but the assessor-prescriber is responsible for documenting the substance they administer or provide in the client’s record and medication administration record.

Registered nurses approached about aiding in the provision of medical assistance in dying should speak with their employer for further information about their role in MAiD. Employers may also further limit the role of nurses in 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.

Registered nurses have important roles in providing high quality client-centered end of life care. These activities include: advocating for clients, providing information, participating in decision-making, caring for and supporting clients and their families and collaborating with members of the health care team to ensure that clients have their care and information needs met.

The Criminal Code requires that any person requesting medical assistance in dying is informed of the means that are available to relieve their suffering, including palliative care. More specifically, when the client’s natural death is not reasonably foreseeable, the Criminal Code requires that this must include information, where appropriate, about counselling services, mental health and disability support services, and community services, as well as palliative care, and that the client must be offered the opportunity to consult with professionals who provide those services or that care. This ensures that the person requesting medical assistance in dying is able to make a fully informed decision about their health care options for end of life care and palliation.

Directing, counselling or recommending a client to end their life remains an offence under the Criminal Code. However, health professionals are permitted to provide information about medical assistance in dying.

Independent witness for MAiD requests 3

The Criminal Code requires that a client’s request for MAiD must be made in writing, in the presence of an independent witness who must sign the request.

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, other than a nurse practitioner or medical practitioner who completes a required eligibility assessment for the client.
To be considered independent means that the witness cannot:

  • know or believe that they are a beneficiary under the client’s will, or that they will benefit in any other way from the client’s death
  • be an owner or operator of a health care facility where the client lives or is receiving care
  • be a caregiver for the client, unless that is their primary occupation for which they are paid

Acting as a Proxy

The Criminal Code also allows another person to sign a client’s request for MAiD as their proxy, if the client 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. The proxy must sign the request in the client’s presence, on the client’s behalf, and under the client’s express direction.

To be eligible to act as a proxy, a person must:

  • be at least 18 years of age
  • understand what it means to request MAiD
  • not know or believe that they are a beneficiary under the client’s will, or that they will benefit in any other way from the client’s death

Acting as a Witness to a Virtual Assessment

The medical assistance in dying standards for nurse practitioners and medical practitioners also require the physical attendance of a regulated health professional at a virtual assessment of eligibility, to act as a witness to the assessment. Registered nurses can act in this role, even if they are providing care to the patient.

Registered nurses should seek clarification from their employer before acting in the formal role of an ‎independent witness, acting as a proxy for signing any forms related to medical assistance in dying, or acting as a witness to a virtual assessment.‎

Conscientious Objection

A registered nurse may have beliefs and values that differ from those of a client. Nothing in the Criminal Code compels nurses to aid in the provision of medical assistance in dying. The Duty to Provide Care practice standard addresses conscientious objection. That practice standard requires registered nurses 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.

The Duty to Provide Care practice standard also requires registered nurses 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 registered nurses to inform those most directly involved of their conscientious objection, and to ensure a safe transfer of care to an alternate provider that is continuous, respectful and addresses the unique needs of a client.

Footnotes

1 Within this document, "registered nurse" includes a nurse practitioner who is aiding a medical practitioner or another nurse practitioner in the provision of medical assistance in dying. This is in accordance with Footnote 1 of the Prescribing standard of the Scope of Practice for Nurse Practitioners: Standards, Limits, and Conditions.
2 A nurse practitioner or medical practitioner who is responsible for completing both an eligibility assessment and providing medical assistance in dying.
3 Health Canada. (2021, March 18). Medical assistance in dying. https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html.

Standards, limits and conditions >>

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