Dialogue Volume 12 Issue 3 2016 - Page 31

Assisted death practitioner and practitioner confirming the patient’s eligibility agree that: 1. The patient’s loss of capacity is imminent; and/or 2. The patient’s death is imminent. It is contrary to federal law to shorten the 10-day reflection period for any reason other than the two circumstances outlined above. 3 Witnesses to the patient’s written request A health-care provider in the facility where the patient is being treated may serve as an independent witness as long as that provider is not directly involved in the patient’s care. The federal law includes safeguards regarding who can and cannot witness a patient’s written request for medical assistance in dying. This safeguard is outlined in Step 3 of the Process Map in the College’s Medical Assistance in Dying policy. The witness must be independent of the patient requesting medical assistance in dying. An independent witness IS: at least 18 years of age and understands the nature of the request for medical assistance in dying. An independent witness IS NOT: a beneficiary or recipient of any financial or material benefit resulting from the patient’s death; the owner of the health-care facility where the patient is being treated, or directly involved in the patient’s health care or personal care. Physicians should be aware that a health-care provider in the facility where the patient has requested medical assistance in dying can be a witness as long as this individual: does not own the facility; and is not directly involved in the patient’s health care or personal care. 4 Coordination and Communication Coordination and communication among all health professionals involved in the provision of medical assistance in dying is essential. The provision of medical assistance in dying requires the involvement of multiple health practitioners. Communication and coordination among practitioners involved in an assisted death case, either in assessing the patient, confirming the patient’s eligibility, or providing medical assistance in dying is of paramount importance. Early engagement with the pharmacy/pharmacists involved in dispensing medication(s) for medical assistance in dying will help ensure that required medication and supplies are available in a timely manner. Where the patient will be self-administering medication to end their own life, the physician who prescribed the medication is strongly encouraged to communicate proactively with the patient and their family to establish a process to be undertaken following death. This may include identifying: any individual(s) who will be present at the time of death; the practitioner who will certify death; and the individual who will notify the Coroner once death has occurred. 5 Drug Protocols Physicians must exercise their professional judgment in determining the appropriate drug protocol to follow to achieve medical assistance in dying. The College has provided examples of drug protocols for both self-administration and physician administration of medical assistance in dying. These are available on the College Members page on the College’s website. Physicians must use their professional judgment to determine which drug protocol is appropriate for the patient. The College encourages physicians to communicate and collaborate with the pharmacist who will ultimately dispense the medication. The goals of any drug protocol for medical assistance in dying include ensuring the patient is comfortable, and that pain and anxiety are controlled. MD Issue 3, 2016 Dialogue 31