Part 5: Medical assistance in dying

Introduction​​

The Criminal Code allows a person, under limited circumstances, to request and receive a substance intended to end their life (sections 241.1 – 241.4).

Only two forms of medical assistance in dying (MAiD) are permitted under the Criminal Code:

• the administering by a medical practitioner or nurse practitioner of a substance to a person at their request that causes their death

• the prescribing or providing by a medical practitioner or a nurse practitioner of a substance to a person at their request, for t​heir self-administration that in doing so causes their own death
  

The role of licensed practical nurses (LPNs) may include​:

• providing information
• acting as an independent witness, as described in the Criminal Code
• acting as a proxy, for a mentally capable client who is physically unable to sign a request for medical assistance in dying
• acting as a witness in a virtual assessment

• aiding a medical practitio​​ner or nurse practitioner in the provision of medical assistance in dying

Licensed practical nurses cannot prescribe, compound, prepare, dispense or administer any substance intended for the purpose of medical assistance in dying. Licensed practical nurses can record information for reference use by the assessor-prescriber  as needed, but the assessor-prescriber¹ is responsible for documenting the substance they administer or provide in the client’s record and medication administration record.

Licensed practical nurses approached about aiding in the provision of medical assistance in dying should speak with their employer for further info​rmation about their role in MAiD. Employers may also further limit the role of nurses in MAiD.

The purposeful and intended ou​tcome of medical assistance in dying is to assist a person explicitly requesting assistance in dying to end their life in a respectful, culturally appropriate, safe, ethical, legal and competent manner.  Palliative care is care that improves the day-to-day quality of life for a person experiencing a life-limiting illness.

Independent witness for MAiD requests²

The Criminal Code requires that a client’s request for MAiD must be made in writing, in the presence of an independent witness who must sign the request.

The role of the independent witness is to provide confirmation of the client’s signing and dating of their request for MAiD, and that the client understands what they are signing.

An independent witness must be at least 18 years of age and must understand what it means to request MAiD.

An independent witness can be a paid professional personal or health care worker, other than a nurse practitioner or medical practitioner who completes a required eligibilit​y assessment for the client.

To be considered independent means that the witness cannot:

• know or believe that they are a beneficiary under the client’s will, or that they will benefit in any other way from the client’s death

• be an owner or operator of a health care facility where the client lives or is receiving care
  

• be a caregiver fo​​r the client, unless that is their primary occupation for which they are paid
  

Acting as a Proxy

The Criminal Code also allows another person to sign a client’s request for MAiD as their proxy, if the client has the mental capacity to make a free and informed decision with respect to their health but is physically unable to sign and date the request. The proxy must sign the request in the client’s presence, on the client’s behalf, and under the client’s express direction.

To be eligible to act as a proxy, a person must:

• be at least 18 years of age
  

• understand what it means to request MAiD
  

• not know or believe that ​​they are a beneficiary under the client’s will, or that they will benefit in any other way from the client’s death
  

Acting as a Witness to a Virtual Assessment

The medical assistance in dying standards for nurse practitioners and medical practitioners also require the physical attendance of a regulated health professional at a virtual assessment of eligibility, to act as a witness to the assessment. Licensed practical nurses can act in this role, even if they are providing care to the patient.

Licensed practical nurses should seek clarification from their employer before acting in the formal role of an ‎independent witness, acting as a proxy for signing any forms related to medical assistance in dying, or acting as a witness to a virtual assessment.‎

Conscientious Objec​​​tion

An LPN may have beliefs and values that differ from those of a client. Nothing in the Criminal Code compels LPNs to aid in the provision of medical assistance in dying. The Duty to Provide Care practice standard addresses conscientious objection. That practice standard requires LPNs with a conscientious objection to take all reasonable steps to ensure that the quality and continuity of care for clients seeking or receiving medical assistance in dying are not compromised.

The Duty to Provide Care practice standard also requires LPNs with a conscientious objection to notify their organization well before the client is to receive medical assistance in dying. If medical assistance in dying is unexpectedly proposed or requested and no arrangement is in place for alternative providers, that practice standard further requires LPNs to inform those most directly involved of their conscientious objection, and to ensure a safe transfer of care to an alternate provider that is continuous, respectful and addresses the unique needs of a client.

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Foot​​notes