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Medical Assistance in Dying (MAiD)

monika phunal

Updated Feb. 20, 2019

Transcript

Medical Assistance in Dying (MAiD)

By: Gagan Kullar & Monika Phunal

Introduction

What is MAiD?

Medical Assistance in Dying provides an opportunity for patients who have been experiencing intolerable suffering and incurable medical conditions the option to end their lives with the assistance of a doctor or nurse practitioner. An authorized nurse or doctor provides or administers medication that will bring a person to their death as requested (Government of British Columbia, 2018, para.1 ). MAiD policies vary amongst each country, where few countries legalize it whereas others do not. This analysis will provide information regarding different policies that coutries have on MAiD.

Comparing and Contrasting Policies

Policy Analysis

Policies and ACTs have been established to help provide the best care. In terms of MAiD, it provides the exact rules and regulations that need to be followed when provided the access to end a patient's life as their request.

Vancouver Coastal Health

Vancouver Coastal Health, provides a policy which states the expectation of staff member and addressing their patients' request for MAiD (Vancouver Coastal Health, 2017).

Vancouver Coastal Health

Policy

2.1. VCH supports capable patients' request for MAiD

VCH has legal authority to provide MAiD for any patient

2.2 MAiD is an option for those with intolerbale suffering

Strictly for patients for experience grevious and irremediable medical condition

2.3 Capability and voluntariness are critical elements

Patient must voluntarly request with no uncertainty for MAiD

2.4 Consent must be confirmed throughout

Patient can withdraw at anytime

2.5 VCH provides confirmed, no remediable challenges

Patient suffering must be considered before MAiD

2.6 Individual conscientious objection must be respected for care directly related to MAiD

Health care provides are able to object serving an assessor with MAiD

2.7 Staff act in good faith

2.8 Potential acknowledge for conscientious objection by Faith Based organization

Faith-Based Organizations are can be except from providing MAiD, however need to respect and provide full services to their patients.

2.9 Responsibilities

2.10 Compliance

(Vancouver Coastal Health, 2017).

Policy Link

Vancouver Coastal Health Policy Link : http://blush.vch.ca/wp-content/uploads/sites/13/2016/04/Policy-draft-25-4-16.pdf

Netherlands

Netherlands being one of the countries to legalize assisted suicide however, unlike other countries this is only performed for very special occasions and they are only considered through a committee. This committee makes all the decisions for every request for assisted suicide and goes through a rigorous 6 week procedure before informing both the patient and attending physician.

(Review procedures for the termination of life on request and assisted suicide and amendment of the Criminal Code and the Burial and Cremation Act (Termination of Life on Request and Assisted Suicide (Review Procedures), n.d.)

Policy

Section 1: Definition

The ministry that is involved; Ministry of Justice, Ministry of Health, Welfare, and Sport
The attending physician: the physician has terminated a life on request or assisted suicide
The committee: Regional review committee who help justify if the patient is eligible for assisted suicide.

Section 2: Due Care Criteria

In order to comply with the care, a physician must
Be satisfied that the patient made a voluntary and careful request
Be satisfied with the patients suffering is unbearable and there was no other alternative choice to relieve the pain.
Inform that patient about their decision
Have come to the conclusion with the patient that there is no other solution
Have consulted with other attending doctors.

Section 3: Regional Review Committees for the Termination of Life on Request and Assisted (The establishment, composition, and appointment)

The committee will review the reported requests of termination of life

Section 4:

Consists of the individuals of the committee and they secretary who is solely responsible in the committees work

Section 5, 6, 7

Any member of the committee are able to relieve their duties at anytime

Section 8:

Committee will assess on based report whether the attending physician is legally allowed to perform the assisted suicide through the criminal code.
The committee may request any extra information to supplement the attending physicians report through orally or written reports.

Section 9, 10:

The committee can take up to 6 weeks to inform the attending physician if the request is allowed to go through.
The committee is empowered to explain the findings and results orally rather than written.

Section 11:

The committee is responsible to keep records of all of the actions that have been taken in regards to every request.

Section 12:

The committee shall adopt its findings by simply majority votes

Policy Link

Termination of Life on Request and Assisted Suicide Act 2002 Link: https://www.ieb-eib.org/fr/pdf/loi-euthanasie-pays-bas-en-eng.pdf

United Kingdom

There are many arguments in favour of legalizing assisted dying, including personal autonomy, compassion, alleviation of suffering, dignity and choice. "The UK government’s repeated reluctance to review the law is unacceptable, especially in light of frequent reports of people taking their own life at home or travelling abroad early in their disease to end their life."

(Papadopoulou, N., 2017)

Prosecution Policy

Policy

“If someone has helped a person to die, it is up to prosecutors if they will prosecute them or not. In England and Wales, the Director of Public Prosecutions and the Crown Prosecution Service decide if it is in the public interest to prosecute. Similar rules govern the Crown Office in Scotland and the Public Prosecution Service Northern Ireland. In England, Wales and Northern Ireland, a published policy describes when a case is likely to be prosecuted. The policy distinguishes between compassionate and malicious acts. The guidelines give individuals an indication of how the law is likely to treat them, but do not provide guarantees and have not decriminalised assisted dying.”

The law: Both euthanasia and assisted suicide are illegal under English law.

Assisted suicide: Assisted suicide is illegal under the terms of the Suicide Act (1961) and is punishable by up to 14 years' imprisonment. Trying to kill yourself is not a criminal act.

Euthanasia: Depending on the circumstances, euthanasia is regarded as either manslaughter or murder. The maximum penalty is life imprisonment.

(Papadopoulou, N., 2017)

Policy Link:https://www.dignityindying.org.uk/assisted-dying/the-law/

Policy Link

Vancouver Coastal Health (VCH) and Netherlands both support MAiD whereas it is illegal in the United Kingdom.
VCH policy allows the physicians to make the final decision in regards to whether the patient is eligible for MAiD whereas Netherlands has a committee who is responsible in every request for assisted suicide.
The patient must voluntarily request MAiD and it must be repeated consistently in both VCH and Netherlands.
VCH requires written and verbal consent for MAiD to occur whereas Netherlands only requires verbal consent.

Compare and Contrast

Legalization In Canada

National & Global Context

MAiD became legal in Canada following the royal assent of Bill C-14 on June 16, 2016. The bill created exemptions in the Criminal Code for certain caregivers to work with those seeking or receiving MAiD. Key issues around MAiD still exist, including:

· Regulations from the federal health minister, in cooperation with the provinces and territories, on data collection for monitoring and analyzing MAiD

· In order for an individual to request medical assistance in dying, it needs to be legally requested under the jurisdiction. A valid request must precede the provision of assistance in death. Furthermore, failure to adhere to this can cause civil/ or criminal liability.

(Canadian Nurses Association. Medical Assistance in Dying. 2019)

Netherlands

In the Netherlands, there is an act called the Termination of Life on Request and Assisted Suicide Act 2002, which is the policy that is taken into consideration when a patient is requesting Medical Assistance in Death.
When a patient requests this, the physician must meet the specific requirements that are under this Act.
The physician must consult a psychiatrist to ensure that the patient is mentally stable to make this specific request.
Furthermore, the attending physician needs to provide information to the patient to ensure that they are well-informed about what they are requesting.
This Act unlike other countries does not need to be formally written and can be strictly established verbally.
This Act is strictly enforced through a committee that makes the final approval.

(Government of the Netherlands, 2016)

Belgium

On the other hand, for Belgium, it is necessary that this request be in writing, signed and dated.
A patient who requests MAiD, must request this voluntarily and must repeat the request over a period of time to ensure that the patient is able to recognize what they are requesting.
The attending physician must inform that patient about:
their state of health
life expectancy
the time remainder
finally the other therapeutic options there are.

(Lewis, P., & Black, I.,2013)

Oregon

Oregon has an act called the Death With Dignity Act 1997 which governs another act called Physician Assisted Death (PAD).
Here a patient must have the ability to make and communicate their health choices to a health care provider.
The patient must have both written and oral request of PAD and must repeat their oral request no later than 15 days of their original request.

(Lewis, P., & Black, I., 2013)

Relating to RPN

Registered Psychiatric Nurse

This policy relates to psychiatric nursing because many patients suffer intolerably from certain medical conditions and not everyone is capable of alleviating their pain levels. We personally believe that our field of psychiatry has not reached a state of knowledge that is precise enough to tell us whether the patient who suffers from psychiatric condition is also suffering from an illness that is cureless and if the patient is in a state of irreversible decline with death in the foreseeable future. We as individuals cannot experience the pain that our patients feel physically so therefore cannot determine if they are able to live through it and tolerate it. This is where MAiD comes in. As nurses, we cannot ignore, avoid, or just ‘rubber stamp’ our patients’ requests for MAiD. It is legally our responsibility to advocate for the best evidence-informed care for our patients.

Role of RPN

• Addressing a patients request for information, and/or  

• Caring for a patient who has made a request, and/or  

• Caring for a patient who will be receiving a medically assisted death  

• Responding to a patients’ request for information about medical assistance in dying (providing information and/or informing appropriate team members).  

• Providing standard nursing care before the death occurs including establishing, adjusting and implementing care plans. 

• Initiating (if required) intravenous access for the purpose of medical assistance in dying.  

• Documenting the times of medication administration on a transitory document to be given to the  Prescriber for official documentation by the Prescriber.  

• Providing standard nursing care once the death has occurred.

(Vancouver Coastal Health, 2017)

Roles of RPN Cont'd..

DO NOT aid in provision of medical assistance in dying for a family member.  

• DO respond to a patient’s expression of interest in medical assistance in dying by providing information and/or referring the patients request to a colleague, physician, unit leadership team and/or Care Coordination Service - Assisted Dying Program and document all interactions.  

• DO provide end-of-life care to patients as part of their regular routine care.  

• DO NOT initiate, offer, encourage medical assistance in dying or in any way seek to  influence a patient’s decision about medical assistance in dying.  

• DO NOT assess for or determine a person’s eligibility for medical assistance in dying.  

• DO NOT prescribe, compound, dispense, prepare or administer a substance included in  the medical assistance in dying protocol or pre-printed order (including saline flushes  between medication administrations).  

• DO NOT document the medical assistance in dying substances administered by the  physician or nurse practitioner on official medical assistance in dying documentation that will be submitted to the BC Coroner.  

(Vancouver Coastal Health, 2017)

Suggestions for future

There are many ethical, legal, regulatory, clinical, and individual implications that all come together in this unique option of assisted dying.
Nurses are directly impacted by changes to the Criminal Code that now allows MAiD.
Even nurses with expertise in providing end‐of‐life care are being called to rethink their practice by re-orienting toward directly assisting and hastening dying for patients who make this choice.
Workshops, support tools, educational modules, and information sessions should be more readily available to support nurses.
Nurses must respect patient autonomy as they have right to request or deny any form of medical treatment such as MAiD.
According to the Center for Addiction and Mental Health recognizing that the current law would limit most of those with only mental illness from accessing MAiD (2017) - the government should implement the reinforcement for a specific policy which allows individuals that suffer from mental illness the ability to request MAiD.

Conclusion

Every country has their own view on Medical Assistance in Dying and this has raised significant controversy amongst many countries. Some countries support the autonomy of patients which resulted in the legalization of MAiD. However, some countries do not value patients’ autonomy as a key factor in patient care, therefore responded negatively towards MAiD, which led to MAiD becoming illegal in these countries. This presentation focused on presenting policies and analyzing the differences and similarities amongst different countries.

References

Canadian Nurses Association. Medical Assistance in Dying. (2019). Retrieved from https://www.cna-aiic.ca/en/policy-advocacy/palliative-and-end-of-life-care/medical-assistance-in-dying

CARTER, R. M., & RODGERSON, B. (2018). Medical Assistance in Dying: Journey to Medical Self-Determination. Alberta Law Review, 55(3), 777–803. https://doi-org.ezproxy.kpu.ca:2443/10.29173/alr2459\

Euthanasia and assisted suicide. 2017. Retrieved from https://www.nhs.uk/conditions/euthanasia-and-assisted-suicide/

Government: scope for assisted suicide for people who regard their life as completed. Government of the Netherlands. (2016). Retrieved from https://www.government.nl/topics/euthanasia/news/2016/10/21/government-scope-for-assisted-suicide-for-people-who-regard-their-life-as-completed

Lewis, P., & Black, I. (2013). Adherence to the Request Criterion in Jurisdictions Where Assisted Dying Is Lawful? A Review of the Criteria and Evidence in the Netherlands, Belgium, Oregon, and Switzerland. Journal of Law, Medicine & Ethics, 41(4), 885–898. https://doi-org.ezproxy.kpu.ca:2443/10.1111/jlme.12098

Medical Assistance in Dying. Vancouver Coastal Health. Retrieved from http://blush.vch.ca/wp-content/uploads/sites/13/2016/04/Policy-draft-25-4-16.pdf

Medical assistance in dying. (2018). Retrieved from https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html

References

Medical assistance in dying. (2017). Vancouver Coastal Health. Retrieved from http://www.vch.ca/public-health/health-topics-a-z/topics/medical-assistance-in-dying

Medical Assistance in Dying. Government of British Columbia. (2018). Retrieved from

https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care/medical-assistance-in-dying

Papadopoulou, N. (2017). Assisted-dying laws are progressing in some places - the UK isn’t one of them. Retrieved from https://www.independent.co.uk/news/health/assisted-dying-laws-are-progressing-in-some-places-the-uk-isn-t-one-of-them-a7679846.html

Policy Advice on Medical Assistance in Dying and Mental Illness. Centre for Addiction and Mental Health. (2017). Retrieved from https://www.camh.ca/-/media/files/pdfs---public-policy-submissions/camh-position-on-mi-maid-oct2017-pdf.pdf

The Law. Campaign For Dignity In Dying. Retrieved from https://www.dignityindying.org.uk/assisted-dying/the-law/

Review procedures for the termination of life on request and assisted suicide and amendment of the Criminal Code and the Burial and Cremation Act (Termination of Life on Request and Assisted Suicide (Review Procedures) Act). (n.d). Retrieved from https://www.ieb-eib.org/fr/pdf/loi-euthanasie-pays-bas-en-eng.pdf

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