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