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Medical Assistance in Dying

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Where are We At and What Does It Mean for Me?

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Medical Assistance in Dying

  1. 1. MEDICAL ASSISTANCE IN DYING Where are We At and What Does it Mean for Me? Erin Wolff – MLT Aikins LLP May 6, 2017 1
  2. 2. AGENDA • Background • MAID Legislation • Impact on Practice • Liability • New Developments & Unresolved Issues 2
  3. 3. BACKGROUND 3
  4. 4. • Until 2015, assisted dying was illegal • Carter v. Canada (Attorney General) • SCC struck down provisions of Criminal Code that created absolute prohibition • Charter rights of patients and physicians need to be recognized • Physicians not compelled to assist • Declaration of invalidity suspended until June 6, 2016 4
  5. 5. • Interim period prior to enactment of legislation where MAID could be sought in Québec (under its provincial legislation) or by court application in other jurisdictions. • A number of applications were granted in reported court decisions. 5
  6. 6. MAID LEGISLATION 6
  7. 7. BILL C-14 (AN ACT TO AMEND THE CRIMINAL CODE AND TO MAKE RELATED AMENDMENTS TO OTHER ACTS (MEDICAL ASSISTANCE IN DYING)) • Became law on June 17, 2016 • Permits medically-assisted dying in certain circumstances • Prescribes criteria for eligibility and safeguards 7
  8. 8. BILL C-14 (CONT’D.) Two types of MAID: • Voluntary euthanasia • Medically-assisted suicide 8
  9. 9. BILL C-14 (CONT’D.) Who can participate in MAID: • Provision of MAID: • Physicians • Nurse Practitioners • Assist in provision of MAID: • Pharmacists • Health care providers • Other persons 9
  10. 10. BILL C-14 (CONT’D.) Eligibility Criteria: • Eligible for health services • At least 18 and mentally competent • Grievous and irremediable medical condition • Voluntary request • Informed consent 10
  11. 11. BILL C-14 (CONT’D.) Grievous and irremediable medical condition: • Serious illness, disease or disability • Advanced state of irreversible decline • Caused enduring physical or psychological suffering • Reasonably foreseeable death 11
  12. 12. BILL C-14 (CONT’D.) Consent: • Must be: • Informed • Expressed • Written • Voluntary • Patient must fully understand the decision 12
  13. 13. BILL C-14 (CONT’D.) Safeguards: • Before providing MAID, physician or NP must ensure: • All eligibility criteria are satisfied • Second, independent medical opinion is obtained • Individual given opportunities to withdraw consent 13
  14. 14. HOW IS PHARMACY PRACTICE AFFECTED? 14
  15. 15. APPLICATION • Bill C-14 only contemplates involvement of “pharmacists” • Ongoing debate about interpretation and involvement of pharmacy technicians • Section 21 of SCPP: MAID Practice Guideline 15
  16. 16. SCPP MAID PRACTICE GUIDELINE • Result of extensive consultation • Pharmacists expected to undertake MAID activities in accordance with this guideline 16
  17. 17. ETHICAL CONSIDERATIONS • MAID raises important ethical issues • Be prepared to respond quickly if asked to participate in MAID 17
  18. 18. CONSCIENTIOUS OBJECTION • May decline to participate in MAID for reasons of conscience or religion, provided that pharmacist complies with “Refusal to Provide Products or Services for Moral or Religious Reasons Statement”: http://scp.in1touch.org/uploaded/web/refmanual/REF _Refusal_of_Services_for_Moral- Religious_Reasons_Stmt_Current.pdf 18
  19. 19. CONSCIENTIOUS OBJECTION (CONT’D.) • If objecting: • Inform physician or NP at earliest opportunity • Provide physician or NP with effective referral • Inform pharmacy management of objections • Do not impede or block access to information, care or services for MAID; • Take steps to ensure continuity of care for patient 19
  20. 20. PARTICIPATION REQUIREMENTS Pharmacists who choose to participate MUST: • Receive from physician or NP: • Request for MAID • Prescription for MAID • Written confirmation that: • Prescribed drug is intended for MAID for specified patient • patient meets all eligibility criteria; and • Informed consent has been obtained 20
  21. 21. PARTICIPATION REQUIREMENTS (CONT’D.) • Have requisite competency • Ensure that prescription for MAID meets requirements • Document MAID process using approved forms • Personally prepare, label and distribute prescriptions for MAID • No aspect of dispensing MAID drugs shall be delegated 21
  22. 22. PARTICIPATION REQUIREMENTS (CONT’D.) • Store prepared MAID prescriptions in pharmacy’s locked safe • Only release MAID prescriptions to physician or NP on specified date • Ensure that: • patient counselling related to the drugs is provided • Physician or NP has information re: preparation, stability, storage and administration of drugs 22
  23. 23. PARTICIPATION REQUIREMENTS (CONT’D.) • Support secure and timely return and disposal of any unused drugs • Report information to any designated government organizations in accordance with any required format, manner and schedule • Refer any individuals seeking MAID to physician, NP or appropriate RHA delegate 23
  24. 24. PRACTICE LIMITATIONS Pharmacists shall NOT: • participate in MAID without first receiving request from physician or NP • lead the MAID process • assess a patient to determine if he or she meets eligibility criteria • collect patient consent for MAID • prescribe drugs for MAID 24
  25. 25. PRACTICE LIMITATIONS (CONT’D.) Pharmacists shall NOT: • Dispense drugs intended for MAID as “office use” • Engage in any pharmacy practice that presents a conflict of interest or compromised professional independence, judgment or integrity 25
  26. 26. LIABILITY 26
  27. 27. CRIMINAL CODE • s. 241(1): criminal offence for everyone who aids a person to die by suicide • imprisonment for up to 14 years • S. 241(3) creates exemption for pharmacists and others who aid a physician or NP in providing MAID in accordance with all requirements prescribed in section 241.2 27
  28. 28. CRIMINAL CODE (CONT’D.) • Criminal offences also exist for: • Forgery in relation to a request for MAID • Destruction of documents relating to MAID • Interfering with rights and obligations relating to MAID • Penalty of imprisonment for up to 5 years 28
  29. 29. OTHER CONSIDERATIONS Non-compliance may also result in: • Disciplinary action (termination of employment and/or privileges) • Professional discipline/liability • Prosecution for other offences prescribed in applicable legislation 29
  30. 30. NEW DEVELOPMENTS & UNRESOLVED ISSUES 30
  31. 31. Information Reporting • Regulations prescribing information reporting requirements not yet in force • Limited information available to date • Difficult to accurately assess: • number of MAID requests • number of medically-assisted deaths • medical conditions that motivate requests • if MAID is being consistently implemented across Canada 31
  32. 32. Quebec 469 Dec.10/15 – Dec. 9/16 Ontario 365 June 17/16 – March 31/17 B.C. 285 June 17/16 – Feb. 28/17 Alberta 100 June 17/16 – March 31/17 Manitoba 37 June 17/16 – March 31/17 Nova Scotia 31 June 17/16 – March 31/17 Saskatchewan 21 June 17/16 – March 31/17 New Brunswick 9 June 17/16 – Dec. 31/16 N.L. 7 June 17/16 – March 31/17 P.E.I. 0 June 17/16 – March 31/17 N.W.T. 0 - Nunavut 0 - Yukon * Would not divulge, saying small population raises confidentiality concerns 32 MEDICALLY-ASSISTED DEATHS IN CANADA **CBC News (April 20, 2017)
  33. 33. REGULATORY GUIDANCE • Professional regulatory bodies across Canada have implemented MAID guidelines and standards • Provincial legislative changes in some jurisdictions 33
  34. 34. SASKATCHEWAN’S PROGRESS • Standard provincial processes and resources being developed • Patients interested in MAID advised to approach their physician or NP • CPSS and SRNA provide guidance to members • SCPP has developed MAID practice guideline 34
  35. 35. FURTHER REVIEW • Federal government required to initiate review of issues not addressed by Bill C-14 (i.e. mature minors, advance requests, and mental illness) • Review expected to be complete by Dec. 2018 • Parliamentary review of Bill C-14 by June, 2021 35
  36. 36. CONSTITUTIONAL CHALLENGES Lamb v Canada, Court file No S-165851 (BCSC): • individual with spinal muscular atrophy & BC Civil Liberties Association • claim that certain requirements for MAID are unconstitutional 36
  37. 37. CONSTITUTIONAL CHALLENGES (Cont’d.) Quebec government: • Looking at ways to broaden eligibility for medically-assisted dying • seeking court's opinion to clarify requirement that natural death be "reasonably foreseeable” • result of concerns expressed by a variety of professional organizations 37
  38. 38. CLOSING REMARKS 38
  39. 39. RESOURCES MLT Aikins Insights - https://www.mltaikins.com/insights/ SCPP – MAID Practice Guideline: http://scp.in1touch.org/uploaded/web/refmanual/RE F_MAID_Practice_Guidelines_Current.pdf Saskatchewan Government - https://www.saskatchewan.ca/residents/health/acce ssing-health-care-services/medical-assistance-in- dying/accessing-medical-assistance-in-dying- services 39
  40. 40. Q&A 40
  41. 41. THANK YOU 41 Erin Wolff • ewolff@mltaikins.com • (306) 347-8449
  42. 42. DISCLAIMER 42 “MLT Aikins”, the MLT Aikins Designs and “Western Canada’s Law Firm” are trademarks of MLT Aikins LLP. Copyright © 2017 MLT Aikins LLP. All rights reserved. The information contained in this presentation is general in nature and does not constitute legal advice, nor is it an exhaustive discussion of the subjects noted.
  • RonaldGeorge4

    Sep. 11, 2018

Where are We At and What Does It Mean for Me?

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