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

1. MEDICAL ASSISTANCE IN DYING
Where are We At and What Does it Mean for Me?
Erin Wolff – MLT Aikins LLP
May 6, 2017
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2. AGENDA
• Background
• MAID Legislation
• Impact on Practice
• Liability
• New Developments & Unresolved Issues
2

3. BACKGROUND
3

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
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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.
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6. MAID LEGISLATION
6

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
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8. BILL C-14 (CONT’D.)
Two types of MAID:
• Voluntary euthanasia
• Medically-assisted suicide
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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
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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. 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
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12. BILL C-14 (CONT’D.)
Consent:
• Must be:
• Informed
• Expressed
• Written
• Voluntary
• Patient must fully understand the decision
12

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
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14. HOW IS PHARMACY
PRACTICE AFFECTED?
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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. SCPP MAID PRACTICE GUIDELINE
• Result of extensive consultation
• Pharmacists expected to undertake MAID
activities in accordance with this guideline
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17. ETHICAL CONSIDERATIONS
• MAID raises important ethical issues
• Be prepared to respond quickly if asked to
participate in MAID
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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
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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
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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
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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
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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
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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
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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
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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
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26. LIABILITY
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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
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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
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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
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30. NEW DEVELOPMENTS &
UNRESOLVED ISSUES
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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
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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
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MEDICALLY-ASSISTED DEATHS IN CANADA
**CBC News (April 20, 2017)

33. REGULATORY GUIDANCE
• Professional regulatory bodies across Canada
have implemented MAID guidelines and
standards
• Provincial legislative changes in some
jurisdictions
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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
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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
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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
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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
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38. CLOSING REMARKS
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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
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40. Q&A
40

41. THANK YOU
41
Erin Wolff
• ewolff@mltaikins.com
• (306) 347-8449

42. DISCLAIMER
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“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.