DWDC Vancouver presents...
MAID 101
Your presenter today is Connie Jorsvik , BSN, Independent Healthcare Navigator & Patient Advocate. The DWDC Vancouver MAID 101 Team: ➔ Dr. Sue Hughson ➔ Alex Muir ➔ Darrell Mahoney ➔ Susan Jobes 4
Dying With Dignity Canada We are the national organization committed to improving quality of dying, expanding end of life choices, and helping Canadians avoid unwanted suffering. 5
We do all we do with a small staff and hundreds of dedicated volunteers around the country. Please consider a one time or monthly donation to help us keep Canadians informed and expand end of life choice. 6
DWDC has a four part mandate: 1. We advocate for compassionate end of life choices, and work to accurately inform the public about the constitutional right of medical assistance in dying. 2. We inform Canadians about legal end of life options and the importance of Advance Care Planning. 3. We provide personal support to adults suffering greatly from a grievous and irremediable illness or medical condition, who wish to die on their own terms. 4. We advocate for strong patient rights legislation and support those whose rights are being violated. 7
BC has some of the most robust legislation in Canada under the Health Care Consent Act and the Representation Act. 8
Know your rights… ➢ As a Patient... ➢ As a Representative... ➢ As a Substitute Decision Maker. ➢ To be fully informed of all treatment options. ➢ To the recognition of your Representative or Substitute Decision Maker. ➢ The recognition of your Advance Directive. ➢ To a second opinion. ➢ To pain and symptom management. ➢ To refuse treatment. ➢ To end your own life. ➢ To assisted death. 9
You ALWAYS have the right to change your mind!
About any treatment option, at any time, including MAID.
Medical Assistance in Dying (MAID) 101 It’s all about patient choice… 12
Background: Bill C-14 received royal assent on June 17, 2016. This gives all Canadians the right to access medical assistance in dying under certain conditions. Administration of the MAID process is under provincial legislation. 13
The MAID process in BC, including the criteria to qualify for MAID, is described on the BC government website: 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 (See Resources) 14
MAID eligibility
In order to be eligible to receive medical assistance in dying, a person must meet all of the following criteria: 16
1 . Being registered or eligible for B.C.’s Medical Services Plan; 2. Be at least 18 years of age and capable of making decisions about their health; 3. Have made a voluntary request for medical assistance in dying that, in particular, was not made as a result of external pressure; 4. Have given informed consent to receive medical assistance in dying after being informed of the means that are available to relieve their suffering, including palliative care; and... 17
Have a grievous and irremediable medical condition, which means: a) They have a serious and incurable illness, disease or disability; b) They are in an advanced state of decline that cannot be reversed; 18
c) That illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and cannot be relieved under conditions that they consider acceptable; and... 19
d) Their natural death has become reasonably foreseeable , taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time they have remaining. 20
In other words, multiple separate medical conditions can be part of “Grievous, Irremediable, & Advanced State of Decline” 21
1+1+1=3
MAID access limitations
The criteria to qualify for MAID are more restrictive than what was articulated in recent case law and rights established in the Charter of Rights and Freedoms. This has led to current court challenges from Dying with Dignity Canada and the BC Civil Liberties Association. 24
Specific limitations being challenged are: Death must be “reasonably foreseeable”, which is ambiguous, subjective and more restrictive than previous case law on this topic. Mental illness alone does not qualify. This typically excludes anyone suffering from any form of dementia in the absence of other illnesses. 25
➢ Mature minors (under 18 years old) do not qualify. ➢ The patient must be capable at both the time of the MAID request and the administration of the procedure. ➢ Advanced consent is not allowed (such as in an Advance Directive). 26
When to apply for MAID
Timing is totally dependent on the patient. Many people choose to apply when they receive a grim diagnosis or prognosis but before the symptoms are debilitating. A patient can apply, get approved, and yet never exercise their right to MAID. Having qualified for MAID can be reassurance that an Adult can access MAID whenever their suffering becomes intolerable. 28
MAID application process
Obtain a copy of the MAID Patient Request Record from the BC government website (above) or through your local health authority. 30
Independent witness and proxy requests
There is specific criteria for who can be an independent witness: ➢ A witness must be at least 18 years old and... ➢ It cannot be anyone who financially benefits from the patient’s death (typically a beneficiary in the will) or anyone who provides care to the patient. 35
Similarly, a proxy who signs on behalf of the patient must be someone of legal age who does not financially benefit from the death of the patient. 36
As some patients have difficulty finding independent witnesses and proxies, volunteers with Dying with Dignity Canada (DWDC) are willing and able to provide this service. To make a request for two witnesses and a proxy, if necessary, contact the MAID coordinator with the local health authority, as identified on the BC government website. 37
Next steps...
After the MAID patient request is completed, the MAID coordinator from the local health authority will help find two assessors who are required to verify eligibility to proceed with MAID. Once the assessment is completed and approval to proceed has been granted, the patient decides if and when to proceed with MAID. Important: There is no expiry date once this approval has been granted. 39
The patient has the option to self-administer oral drugs or have a clinician-assisted death (physician or nurse practitioner) using intravenous drugs. In both cases, a clinician must be present. All associated costs are borne by the BC medical system. There is no cost to the patient. 40
Will my wish for MAID be honoured?
As of February 6, 2016 it became your right to access MAID if you qualify. As of June 17, 2016 in the Supreme Court Decision in their Carter ruling, this right was severely restricted. 42
What about Dementia?
The Supreme Court of Canada gave a broad and open ruling regarding those who are suffering, HOWEVER, you must be a competent adult to request MAID, including at the time it is provided. 44
What is our position?
DWDC encourages all Canadians to make Advance Care Plans in sufficient detail, while mentally competent, for their end of life care. We further encourage that future legislation honour each individual’s ACP, regardless of the diagnosis which finds the individual in grievous and irremediable suffering. 46
The Federal Government has tasked the Council of Canadian Academies (CCA) to investigate the issues of Advance Consent, Mature Minors, Mental Illness regarding MAID. They are expected to make their findings known in late 2018, however they have not been asked to make new or existing laws and at this point it remains unclear how and which stakeholders they will be solicited to gather information. 48
Time for questions... 49
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