Sep 05, 2016
Medical assistance in dying: Legal implications for nurses
On June 17, the federal government’s Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), became law in Canada. As a result, two forms of medical assistance in dying (MAID) are exempt from criminal prosecution:
- the administration of a substance to a person, at their request, to cause their death
- the prescription or provision of a substance to a person, at their request, so that they may self-administer the substance to cause their own death
The Criminal Code now explicitly recognizes that the nurse practitioner scope of practice could be sufficiently broad to allow NPs to provide all aspects of MAID. Accordingly, it explicitly exempts from criminal prosecution NPs who provide MAID and individuals, such as registered nurses, who assist medical practitioners and NPs in the provision of MAID in accordance with the requirements in the Criminal Code.
Importantly, the Criminal Code stipulates that MAID must be provided with “reasonable knowledge, care and skill and in accordance with any applicable provincial laws, rules or standards.” This statement suggests that failure to comply with any provincial/territorial law, rule or standard of practice could nullify the exemption. Nurses must therefore educate themselves on the MAID-specific regulatory and legislative frameworks in their jurisdictions.
The Criminal Code outlines several eligibility criteria and other conditions, which must be adhered to in the provision of MAID to be exempt from criminal prosecution. To be eligible, an individual must be at least 18 years of age and capable of making decisions about their health. They must have a “grievous and irremediable medical condition,” as defined by the legislation, and must have made their request for MAID voluntarily. Further, they must give informed consent to receive MAID after having been advised of the available means to relieve their suffering, including palliative care. Finally, they must be eligible for health services funded by a government in Canada. This latter criteria is also met if the individual would be eligible for government-funded health services but for a minimum period of residence or waiting period. MAID is not available to children or mature minors, and it cannot be requested in an advance directive.
Bill C-14 requires that requests for MAID be made in writing, that a second eligibility assessment be conducted by another authorized professional, that authorized professionals and witnesses comply with the legislative independence requirements, and that the client be informed of all palliative care options and be provided with the opportunity to withdraw their request at any time, including immediately before its provision.
Finally, the amendments to the Criminal Code do not impose a mandatory obligation on any nurse to participate in MAID. Nurses choosing to decline to participate on the basis of conscientious objection should review the relevant resources in place with their regulatory body and their employer.
Nurses asked to participate in MAID should familiarize themselves with provincial/territorial and federal regulations, guidelines, standards and legislation as well as any employer restrictions. Specific considerations for both NPs and RNs are set out in detail in Medical Assistance in Dying: What Every Nurse Should Know, available at cnps.ca. CNPS beneficiaries may also call for advice or ask specific questions about their obligations surrounding MAID at 1-844-4MY-CNPS (1-844-469-2677).