Submission to Canadian Regulatory Authorities and Ministers of Health
Re: Health Canada's Model Practice Standard for Medical Assistance in Dying (MAID) (March, 2023)
Appendix “C”
Practitioner Obligations to Patients* in relation to MAID
(Regulatory adaptation of Model Standard Part 5.0 and 6.0)
*Including persons who wish to become patients.
Full Text
General
C1. No person can be compelled under any circumstances to prescribe, administer or assist or facilitate the prescription or administration of substances for the purpose of causing the death of a patient. [Adapting Standard 5.1]
C2. Practitioners who believe that a patient does not meet the criteria for practitioner exemption from prosecution in s 241.1(2) of the Criminal Code must not do anything that would facilitate the administration or self-administration of a substance intended to cause the death of the patient, and must not recommend or suggest the administration or self-administration of such substances as treatment options.
C3. To minimize inconvenience to patients and avoid conflict, practitioners who, for other reasons, are unwilling to provide or facilitate the administration or self-administration of a substance for the purpose of causing the death of the patient should develop a plan to meet the requirements of this policy. [Supplementing Standard 5.2]
Providing information to patients
C4. Practitioners must provide patients with sufficient and timely information to make them aware of relevant treatment options consistent with their values and goals, including MAID, so that they can make informed decisions about accepting or refusing treatment and care. [Adapting Standard 6.1 & Advice, Question 14]
- The Canadian Healthcare Association, the Canadian Medical Association, the Canadian Nurses’ Association, the Catholic Health Association of Canada, Joint Statement on Preventing and Resolving Ethical Conflicts Involving Health Care Providers and Persons Receiving Care, (Ottawa: CHA, 1999) [CHA, CMA, CNA, CHAC Joint Statement] at I.4, I.7.
- The Canadian Medical Association, Code of Ethics and Professionalism, Ottawa: CMA, 8 December, 2018
[CMA Code of Ethics and Professionalism] at para 4–6, 11– 12.
- The Canadian Medical Association, Principles-based Recommendations for a Canadian Approach to Assisted Dying, Ottawa: CMA, 2015
[Canadian Medical Association Principles] at s 1.2, s 5.2.
- The Canadian Medical Association, Policy: Medical Assistance in Dying, Ottawa: CMA; May, 2017
[Canadian Medical Association MAID Policy] at Addressing Adherence to Moral Commitments, b(i).
- Canadian Medical Protective Association, Consent: A guide for Canadian physicians, 4th ed (Ottawa: CMPA, May, 2006–updated April, 2021)
[CMPA Consent] at “Standard of disclosure.”
C5. The information provided must be responsive to the needs of the patient, and communicated respectfully and in a way likely to be understood by the patient. Practitioners must answer a patient’s questions to the best of their ability. [Adapting Standard 6.4]
- CHA, CMA, CNA, CHAC Joint Statement at I.4
- CMA Code of Ethics and Professionalism at para 5, 11, 14.
- Canadian Medical Association Principles at Foundational Principle 6, 10.
- CMPA Consent at “Patient comprehension.”
C6. Practitioners must not assume that all patients are aware that MAID is legal and available in Canada, nor that all patients are not aware of it. [Adapting Standard 6.2 & Advice Question 14]
C7. Practitioners should be aware that patients who appear to meet the criteria for practitioner exemption from prosecution for providing MAID may or may not be disposed to beneficially assimilate that information. A decision to provide this information and the point at which it ought to be provided must be guided by and responsive to the circumstances and expressed interests of each patient. If a patient does not express an interest, careful reflection, prudent judgement and a focus on the good of individual patients are required to determine if, when and how the option of MAID should be presented. Practitioners must document their rationale if they exercise so-called “therapeutic privilege.” [Adapting Standard 6.3, Advice, Question 14]
- CMPA Consent at “Some practical considerations about informed consent.”
C8. Practitioners who are unable or unwilling to comply with these requirements must promptly arrange for a patient to be seen by another practitioner or health care worker who can do so. [Adapting Standard 6.4]
Declining to participate
C9. Subject to C2, practitioners who decline to provide or facilitate MAID must advise patients seeking it of their position and reasons for it. They must also advise patients that may seek the services elsewhere, and advise them how to contact other health care practitioners or providers. Practitioners must, upon request, transfer the care of the patient and/or all necessary and relevant patient records to the practitioner or health care provider chosen by the patient. [Adapting Standard 5.2.2, 5.2.3]
- CHA, CMA, CNA, CHAC Joint Statement at II.10–11.
- CMA Code of Ethics and Professionalism at para 2, 4, 19.
- Canadian Medical Association Principles at s 5.2.
- Canadian Medical Association MAID Policy at Addressing Adherence to Moral Commitments – a (i); b (ii),(iii); c; d.
C10. In response to a patient request or inability, practitioners must take positive action to connect a patient either to a practitioner who provides MAID, or to an individual, agency, programme, or office that can facilitate patient contact with health care services, including but not limited to MAID. [Adapting Standard 5.2.1]
- CHA, CMA, CNA, CHAC Joint Statement at II.10–11.
- Canadian Medical Association Principles at s 5.2.
- Canadian Medical Association MAID Policy at Addressing Adherence to Moral Commitments – b (ii), (iii).
C11. In acting pursuant to C9 or C10, practitioners must continue to provide other treatment or care until a transfer of care is effected, unless the practitioner and patient agree to other arrangements. [Adapting Standard 5.2.4, 5.3]
- CHA, CMA, CNA, CHAC Joint Statement at I.16, II.11.
- CMA Code of Ethics and Professionalism at para 2.
- Canadian Medical Association MAID Policy at Addressing Adherence to Moral Commitments – b(iii); d.
C12. Physicians unwilling or unable to comply with these requirements must promptly arrange for a patient to be seen by another physician or health care worker who can do so. [Adapting Standard 5.2.1]