What does client-centred practice mean in the context of medical assistance in dying ?
Kevin Reel , OT Reg . ( Ont .)
Ethicist , Toronto Central Community Care Access Centre Assistant Professor , Department of Occupational Science and Occupational Therapy Member , Joint Centre for Bioethics Faculty , Global Institute for Psychosocial , Palliative and End-of-Life Care University of Toronto
As you likely know , the Supreme Court of Canada ruling of February 2015 striking down the Criminal Code ’ s total prohibition on “ assisting suicide ” has resulted in changes to the Criminal Code as of June 17 , 2016 .
The revised Criminal Code now outlines the criteria for medical assistance in dying ( MAiD ). This exempts MAiD from being a criminal act - distinguishing it from other situations of causing someone ’ s death . The current legislation limits eligibility for MAiD to capable adults whose ‘ natural ’ death is reasonably foreseeable - this effectively means adults with incurable terminal illness who are suffering intolerably . You can find the full criteria outlined in the College Interim Guidelines on Medical Assistance in Dying 1 . However , the law also identifies three eligibility issues for review in the next two years : minors , mental health conditions and the use of advance directives for those who become incapable .
The law speaks to the central roles of physicians , nurse practitioners and pharmacists , but it also recognizes that other health professionals might be involved as part of a larger team – occupational therapists thus being included here . This acknowledges the need for an interprofessional team to provide quality services in this context 2 , 3 , especially as these requests for assisted dying could arise in many domains of practice – oncology , nephrology / dialysis , neurology , geriatrics , and community practice .
For some occupational therapists , assisted dying can create ethical unease . In a profession where
client-centred practice is a fundamental principle , how does one pursue an intervention that may feel contrary to our focus on meaning , purpose and enablement ? The law recognizes these conflicts , and allows for practitioners to opt out of involvement on conscience grounds . Individual OTs will have to consider the extent to which they may be able to be involved or not .
“ In a profession where client-centred practice is a fundamental principle , how does one pursue an intervention that may feel contrary to our focus on meaning , purpose and enablement ?”
9 College of Occupational Therapists of Ontario ON THE RECORD 2016