Medical Assistance in Dying
Last Updated: Nov. 9, 2016
The College of Registered Nurses of Manitoba, the College of Licensed Practical Nurses of Manitoba and the College of Registered Psychiatric Nurses of Manitoba are working together to develop materials on medical assistance in dying and the impact it could have on LPNs, RNs, RN(NP)s and RPNs. The following is a joint statement from the three nursing regulators.
In February 2015 the Supreme Court of Canada made the decision to legalize medical assistance in dying of “a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition. On June 17, 2016, Bill C-14 became law which means eligible adults can request medical assistance in dying in Canada.
What is Bill C-14?
Bill C-14 amends the Criminal Code by creating an exemption from criminal prosecution for health-care providers participating in medical assistance in dying. There are two types of medical assistance in dying that would be permitted under the Criminal Code:
- Direct administration of a substance to a person, at their request, to cause their death. This is referred to as voluntary euthanasia.
- Provide or prescribe to a person, at their request, so that they may self-administer the substance to cause death. This is referred to as medically assisted suicide.
How does this impact nurses?
The amendments to the Criminal Code do not mean nurses must participate in medical assistance in dying. If a nurse chooses not to participate in medical assistance in dying for moral or religious reasons, it remains important for the nurse to be aware of the resources his or her regulatory body and employer have available for consultation. Please refer to our Conscientious Objection document for further information.
There are a number of important considerations that a nurse contemplating participating in medical assistance in dying will have to take into account:
- First, there is an important limitation to the nursing role in Bill C-14. The limitation requires that the physician or nurse practitioner administer the substance. In this situation, a nurse may assist by arranging intravenous access and providing support to patients/clients and family. However, a nurse may NOT administer the substance even with an order from a prescriber. If a nurse administers a substance and fails to comply with the limitation, the participating nurse, physician or nurse practitioner and other members of the team may be placed at risk as the legal exemption may be annulled.
- Secondly, Bill C-14 currently stipulates that medical assistance in dying must be provided in accordance with “reasonable knowledge, care and skill and in accordance with any applicable provincial laws, rules or standards.” This means that failure to comply with any provincial law, rule or the standard of care could nullify the exemption. Nurses should ensure that all of the necessary conditions set out in section 241.2 of the Criminal Code have been met before participating in the process.
For nurses in practice, this can occur in one of three ways:
- Participate in discussions with a patient/client as a member of the collaborative interprofessional team,
- review the chart to determine whether documentation clearly indicates that all requirements have been met, or
- inquire directly with the physician or nurse practitioner providing medical assistance in dying.
In any scenario, the nurse should carefully document in the patient/client’s chart that they have verified that all legal conditions for medical assistance in dying have been satisfied.
The regulated nursing colleges of Manitoba have developed some initial guidelines for nurses if they choose to participate in medical assistance in dying. Nurses are encouraged to contact representatives of their respective nursing colleges if they are facing ethical or moral dilemmas in practice.
All nurses must:
- familiarize themselves with the wording of the new Criminal Code provisions,
- review any guiding documents from their regulatory college,
- understand the applicable policies, guidelines, procedures and or processes in place to guide medical assistance in dying in their practice setting,
- ensure that their practice is in accordance with the applicable provisions of Bill C-14 and all other applicable laws, rules, and standards; and
- seek legal advice (when applicable) to understand the relevant provisions of the Criminal Code.
Nurse Practitioners or RN(NP)s
RN(NP)s are able to provide medical assistance in dying as long as they ensure they are providing this service in accordance with all the requirements contained in the Criminal Code to avoid criminal prosecution.
A practice direction is being developed in consultation with RN(NP)s and other subject matter experts in order to develop guidance for RN(NP)s. Resources will be posted as soon as they are available. Please check back often for updates.
What does "counsel" mean?
The provision of objective information is not prohibited by the Criminal Code. Bill C-14 currently incorporates a clarification that permits health-care professionals to provide information about the lawful provision of medical assistance in dying to a patient/client. However, subsection 241(a) of the Criminal Code has stipulated that it is a criminal offense to “counsel” a person to die by suicide.
It is important for nurses to understand that there is a difference in the context in which the term “counsel” is being used in medical assistance in dying. For the purposes of the Criminal Code, “counsel” includes the concept of procure, solicit and incite. This is important to note because health-care professionals often use the word “counsel” within a therapeutic relationship as a means of communication, information sharing, active listening, client education and the provision of psychological support. This does not prevent nurses from having conversations with patients/clients to address underlying needs related to medical assistance in dying. It is important for nurses to understand where the line is drawn between the two definitions of counselling. If you are in doubt, you may want to call your respective college for guidance about how to address questions about medical assistance in dying. Documentation of any interaction with patients/clients is always an expectation of practice along with communication with the health-care team members regarding client needs.
- June 17, 2016 update from the Canadian Nurses Protective Society: What Every Nurse Should Know
- Government of Canada: Medical Assistance in Dying
- MBPHEN: Responding to Patient Questions about Assisted Death
- The Provincial MAID Services Team out of the WRHA, in collaboration with Manitoba Health, has been supporting staff and patients with medical assistance in dying in Manitoba. For further questions they can be contacted at 204-926-1380 or email@example.com.
College of Licensed Practical Nurses of Manitoba
Tracy Olson LPN
College of Registered Nurses of Manitoba
Darlene O’Reilly RN BN MHS
College of Registered Psychiatric Nurses of Manitoba
Ryan Shymko RPN