Bill C-14 (an Act to amend the Criminal Code relative to medical assistance in dying) received royal assent on Friday, June 17, 2016 and is now part law in Canada. This federal legislation defines MAID as circumstances where a physician or a nurse practitioner (NP), at the request of a patient/client, will either:
- administer a substance that causes the patient/client’s death; or
- prescribe a substance for the patient/client to self-administer to cause their own death.
The legislation goes on to state that healthcare providers and others who aid a physician or NP in providing medical assistance in dying will not be charged under criminal law provided they follow the rules set out in the Criminal Code, as well as any applicable federal and provincial requirements. As in all aspects of practice, RTs are also expected to adhere to the standards, guidelines, regulations and polices that govern the profession in Ontario.
For more information on MAID, please visit the Government of Canada’s Medical Assistance in Dying website.
Criteria for MAID
The physician or NP directing the patient/client’s care is responsible for assessing whether the patient/client meets the eligibility criteria for MAID. RTs are not responsible for assessing whether a patient/client meets the requisite criteria. In accordance with the federal legislation, a person may receive MAID only if they:
- are eligible for publically funded health services in Canada;
- are at least 18 years of age1 and capable of making decisions2 with respect to their health;
- have a grievous and irremediable medical condition; which means the patient/client:
- has a serious and incurable illness, disease or disability, and
- is in an advanced state of irreversible decline in capability, and
- is enduring physical or psychological suffering, caused by the illness, disease or disability or that state of decline, that is intolerable to the person and that cannot be relieved under conditions that they consider acceptable, and
- natural death has become reasonably foreseeable;
- have made a voluntary request for MAID that was not made as a result of external pressure; and
- have given informed consent3 to receive MAID after having been informed of the means that are available to relieve their suffering, including palliative care.
1 It is important to note that the requirement the patient/client be 18 years of age to consent to MAID is a departure from Ontario’s Health Care Consent Act, which does not specify an age of consent.
2 Current federal legislation requires that the patient/client requesting the MAID must maintain decision-making capacity right up until the time of their death. This means that MAID cannot be arranged through an advance directive. In addition, consent to MAID must be provided by a capable patient/client and not by a substitute decision maker.
3 The informed consent for MAID must be obtained by the physician or NP who is authorizing the procedure. RTs cannot obtain consent for MAID.
Respiratory Therapist’s (RTs) Role in MAID
Even though RTs will not be directing the plan of care in situations in which a patient/client has requested assistance to end their life, an RT may be asked to assist in carrying out a request for MAID. For example, an RT may be asked remove a patient/client from a ventilator or insert an IV*. Fortunately, most of the parameters that will govern the RT’s role in MAID already exist in normal, day-to-day practice. All the current expectations regarding obtaining valid orders, documentation, patient/client confidentially, competence and ethical conduct, etc., still apply for RTs who are part of the care team implementing a request for MAID – just as it does for any other practice scenario.
* RTs are not permitted to administer any medications for the purpose of MAID.
The legislation requires a patient/client’s request for MAID to be signed and dated by two (2) “independent witnesses”. An independent witness in this context is someone who:
- is at least 18 years of age;
- understands the nature of the request for MAID;
- has no financial or material interest in the patient/client requesting MAID (e.g., beneficiary in the patient/client’s will);
- does not own or operate the healthcare facility where the patient/client is being treated; and
- is not directly involved in providing care to the patient/client requesting MAID.
An RT who meets all of the above criteria may act as an independent witness to a request for MAID.
Handling Inquiries from Patient/clients Regarding MAID
Bill C14 states that:
(s. 5.1) For greater certainty, no social worker, psychologist, psychiatrist, therapist, medical practitioner, nurse practitioner or other health care professional commits an offense if they provide information to a person on the lawful provision of medical assistance in dying.
RRTs are permitted to provide information and engage in discussions with their patients/clients regarding the lawful provision of medical assistance in dying (MAID). Resources, such as this brochure produced by the Ontario Ministry of Health and Long Term Care entitled Medical Assistance In Dying: Information for Patients, as well as other material provided by employers, may be used to aid these discussions. If the patient/client wishes to be assessed in order to determine if they meet the criteria for MAID, the RRT should then refer the individual to the appropriate physician or nurse practitioner.
Please note that RRTs must not discuss any aspect of MAID with the patient’s/client’s family or substitute decision maker without the patient’s/client’s consent. Also, it is important to remember that subsection 241(a) of the Criminal Code continues to make it a criminal offence to “counsel” a person to commit suicide. Therefore, RRTs must not encourage, recommend or in any way influence a person to seek to end their own life.
In addition to the information provided here, the CRTO requires that its Members adhere to their organization’s policies (if applicable) with respect to the handling of inquiries from patients/clients regarding MAID.
Conscientiously Objecting Health Care Providers
The matter of conscientious objection is not addressed in the current federal legislation; the CRTO has guidelines in place for circumstances where an RT disagrees with the plan of care. If an RT finds that their beliefs and values are incompatible with MAID, the expectation of the CRTO is that the RT continue to provide the necessary care until it can be appropriately transferred to another health care provider. RTs are not obligated to assist in the implementation of a plan of care that they feel is not in the best interest of the patient/client. They are, however, responsible for ensuring that the patient/client is still able to receive the care they require and have consented to.
- Government of Canada – Legislative Background: Medical Assistance in Dying (Bill C-14)
- Supreme Court of Canada Judgements – Carter vs. Canada
- Ontario Government – Medical Assistance in Dying and End-of-Life Decisions
- Ministry of Health and Long-Term Care MAID page
- College of Physicians and Surgeons of Ontario (CPSO) – MAID
- College of Nurses of Ontario (CNO) – Guidance on Nurses’ Roles in MAID
- Ontario College of Pharmacists (OCP) – MAID