UPDATE - Medical Assistance in Dying (MAID) - May 2016

Bill C-14, called An Act to amend the Criminal Code and to make related amendments to other Acts (or Medical Assistance in Dying) was tabled on Thursday April 14, 2016 in response to the Supreme Court of Canada (SCC) Carter v Canada decision of February 6, 2015.

To view the CHPCA’s original MAID Policy Alert from April 15, CLICK HERE.

Status of the Legislation: 

The House of Commons Standing Committee on Justice and Human Rights studied the legislation and tabled their report on May 11, 2016. The House committee report can be viewed HERE. Simultaneously, the Standing Senate Committee on Legal and Constitutional Affairs studied the legislation and tabled their report on May 17, 2016. The Senate committee report can be viewed HERE. Bill C-14 is currently at third  Reading in the House of Commons. The House resumes sitting the week of May 30, and shortly thereafter, a vote will likely be called, after which the Bill will be sent to the Senate. The most up-to-date legislative status of the bill can be viewed HERE at any time.

Provincial Regulations:

All 10 Provincial Medical regulating bodies and one territorial body now have MAID guidelines in place and are detailed below, with source link included:

British Columbia

  • Two independent physicians must agree a patient meets the criteria set out by the Supreme Court.
  • The patient must be eligible for publicly funded health care, able to give free and informed consent throughout the process.
  • No advance requests.
  • The patient must consistently express a desire for MAID over a "reasonable period of time" — 15 days in most cases but dependent on each patient's condition and circumstances.
  • Formal written request required, signed by the patient and one witness who is not related, entitled to a portion of the patient's estate, or involved in treatment.
  • Physicians may refuse to provide MAID but they must provide "an effective transfer of care."

Source

Alberta

  • Two doctors must independently agree the patient meets all criteria set out by the Supreme Court.
  • Patient must be "competent throughout the process." No advance requests.
  • The college notes that legal precedent recognizes mature minors as adults in their ability to consent but recommends "a careful and conservative approach" to mature minors.
  • Doctors may refuse to provide MAID but have "an obligation" to provide patients with timely referrals to doctors who will perform the service.
  • Requests must be in writing, signed by the patient and two witnesses, at least one of whom cannot be related to the patient, entitled to any portion of the patient's estate or involved in treatment of the patient.
  • Where capacity is unclear or where a person is suffering from depression or other mental illness, a psychiatric or psychological consult is required.
  • A period of reflection of 14 days from initial request to final consent is recommended.

Source

Saskatchewan

  • Two doctors must agree the patient meets the criteria set out by the Supreme Court. Adult is defined as at least 18 years of age.
  • Patient must repeatedly give free, informed consent throughout the process, up to the time of dying.
  • No advance requests.
  • Attending doctor must ensure the patient has consistently expressed a desire for MAID "over a reasonable period of time," the length of which is dependent on the patient's condition.
  • Physicians may refuse to provide MAID but must arrange "timely access" to another doctor or resource.
  • Patient must fill out a prescribed form confirming informed consent to receive MAID.

Source

Manitoba

  • At least two physicians must independently agree the patient meets the Supreme Court's criteria. Adult is defined as 18 years of age.
  • Independent psychiatric assessment required where a patient does not have a terminal illness (prognosis of less than six months) or is not suffering from a "catastrophic and irreversible physical injury" or intractable physical pain or an advanced state of irreversible, significantly impaired function or imminent decline to that state. The assessment must rule out a treatable psychiatric disorder that is impairing patient's ability to tolerate suffering or assess treatment options.
  • Each doctor must meet at least once with the patient to ensure that the patient is competent, fully informed and that the decision to terminate life "a clear and settled" choice, without undue coercion or influence.
  • No advance requests.
  • A waiting period of at least seven days, except for those whose death is imminent.
  • Written consent, signed by the patient.
  • Physicians may refuse to provide MAID or to refer a patient to another doctor but must provide "timely access to a resource" that will provide the necessary information.

Source

Ontario

  • Two doctors must agree the patient meets criteria set out by the Supreme Court. College recommends that only patients in Canada, covered by publicly funded health care, be eligible. It notes that the court did not define the term "adult."
  • No advance requests.
  • Physicians may refuse to provide MAID but must make an "effective referral" of the patient to an available, accessible physician or agency that will.
  • An unspecified waiting period is required, length depending on the patient's condition.
  • A formal written request is required, signed by the patient, the attending physician and an independent witness.

Source

Quebec*

  • A patient must be covered by provincial health care, be of "full age" and capable of giving consent, be at the end of life, suffering from a serious and incurable illness, in an advanced state of irreversible decline and experiencing constant and unbearable physical or psychological suffering which can't be relieved in a manner acceptable to the patient.
  • Two doctors must agree patient meets the criteria for MAID.
  • Request must be made in writing.
  • No advance requests.
  • Physicians may refuse to provide MAID but must immediately notify authorities who will take steps to find another doctor.

*Note:  The Quebec provincial law on assisted dying was drafted before the Supreme Court ruling

New Brunswick

  • Patient must meet criteria set out by the Supreme Court, which is further defined as suffering from a grievous illness for which there is no cure and which will eventually cause death.
  • The college notes that MAID could theoretically be available to any patient who can legally consent. In N.B., the age of legal consent is 16.
  • Patients with progressive illnesses who are also suffering from "intractable depression" are not automatically ineligible but doctors should proceed with "extraordinary caution" in such cases.
  • Physicians may refuse to provide MAID or to make a direct referral but must provide patients with information on accessing MAID.
  • Doctor must be satisfied that patient's wish is "persistent, consistent and unshakable," documenting patient's request for MAID at least twice, two weeks apart, and again just before administering MAID.
  • No advance requests.
  • Administering physician should obtain additional medical opinions as deemed appropriate to confirm prognosis, alternative options, and patient's capacity to make a free, fully informed choice.

Source

Nova Scotia

  • Two doctors must agree a patient meets criteria set out by the Supreme Court. Adult is defined as at least 19 years of age.
  • No advance requests.
  • Physicians may refuse to provide MAID for reasons of conscience but college recommends they provide "an effective referral" to another doctor.

Source

Newfoundland and Labrador

  • Two doctors must agree a patient meets the criteria set out by the Supreme Court. Adult is defined as at least 19 years of age.
  • No advance requests.
  • Written request required, signed by patient and one independent witness.
  • Physicians may refuse to provide MAID but should provide "timely access" to another doctor or information resource that is available and accessible to the patient.

Source

Prince Edward Island

  • Two doctors must agree the patient meets the criteria set out by the Supreme Court. Must have a current provincial health care card and the capacity to freely and repeatedly consent throughout the process, up to the time of dying. Adult is defined as at least 18 years of age.
  • Request must be in writing, witnessed by two independent persons with no connection to the patient.
  • Doctor must ensure patient has repeatedly expressed a desire for MAID "over a reasonable period of time," which may vary depending on patient's condition.
  • No advance requests.
  • Physicians may refuse to provide MAID but must provide, or arrange to be provided, the patient's chart to other physicians.

Source

Yukon

  • Two doctors must agree the patient meets criteria set out by the Supreme Court. The Yukon Medical Council notes that it is uncertain if MAID could be legally available to minors.
  • Patient must maintain decision-making capacity throughout the process, up to time of dying.
  • No advance requests.
  • Written request for MAID required, signed by patient and two witnesses, one of whom is not related, entitled to any benefit from the patient's estate or involved in the provision of treatment.
  • If a physician believes the patient suffers from psychiatric or psychological disorder or depression that could impair capacity to make an informed choice, the patient must be referred for assessment.
  • A waiting period of 14 days is recommended.
  • Physicians may refuse to provide MAID but must arrange "timely access" to another doctor or resource.

Source

With text from Canadian Press article dated May 26 2016

What’s Next:

At this point, it seems unlikely that a federal law will be in place before the June 6, 2016 SCC deadline, however with the above-mentioned provincial guidelines in place, medical practitioners will not be operating in policy limbo across most of Canada.

In addition to CHPCA’s contributions to this policy debate leading up to the April 16 tabling of MAID legislation, we have since met with Health Minister Jane Philpott in late April, and submitted written policy briefs to both parliamentary committees studying the legislation. A number of member organizations also had representatives appear at both committees.

The Health Minister issued a statement for National Hospice Palliative Care Week at the beginning of May which can be viewed HERE.

While the government has indicated that it will commit to providing $3 billion over four years to improve home care, which will include palliative care, the funding hinges on the successful renegotiation of the Health Accord with the provinces, which is realistically not likely to conclude before late 2016.

CHPCA will continue to be engaged on this file and will issue policy alert update emails as more information becomes available.

Sharon Baxter
Executive Director
Canadian Hospice Palliative Care Association
Friday May 27, 2016