Medical Assistance in Dying — Consultation

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First major review of expectations since 2016

Council released a draft Medical Assistance in Dying (MAID) policy for external consultation. The draft sets clear expectations for physicians who assess patients for and/or provide MAID in accordance with the federal legal framework.

The MAID policy was first approved in June 2016 and although it has been updated three times since then, the amendments were housekeeping in nature. This is the first comprehensive review of the policy.

The draft MAID policy retains the majority of the core professional expectations set out by CPSO in the current MAID policy, but changes have been proposed to both the content and structure of the policy. The proposed changes were informed by research and feedback from a preliminary consultation, public opinion polling, a Stakeholder Roundtable Discussion, and the Citizen Advisory Group.

Feedback, for example, indicated it may take some time for pharmacists to obtain medications for MAID as they aren’t commonly stocked in every pharmacy. As such, the draft policy now requires that physicians notify the dispensing pharmacist as early as possible that medications for MAID will be required to help prevent any delays.

The draft policy also now clarifies patients must have capacity to consent at specific points in the MAID process. “Our concern was that the wording in the current policy regarding fluidity of capacity was unclear. In the draft policy, we have articulated the specific points in the MAID process where patients must have capacity and we believe this will be much more helpful for physicians,” said Dr. Camille Lemieux, a member of the Policy Working Group.

A new expectation has been added to the draft policy that requires physicians have a contingency plan in place before administering medications for MAID. “Research regarding the potential complications that can and do occur when administering MAID highlighted the importance of having a contingency plan in place,” said Dr. Lemieux, who is Department Head, Family and Community Medicine at the University Health Network. The addition of this expectation is consistent with a recommendation made by the Office of the Chief Coroner for Ontario.

The draft policy has also been redesigned and streamlined. The policy itself focuses on professional expectations set out by CPSO and the key legal requirements have been moved to a new companion resource.

Dr. Lemieux explained the rationale. “The legal framework has been, and continues to be, in a state of evolution and setting out the legal requirements in a companion resource rather than in the policy allows us to be nimble and make updates in real-time, consistent with right-touch regulation,” she said.

Other changes include removing the ‘Process Map’ section and instead — within the companion Advice document — providing links to process maps for MAID developed by a health system partner.

The professional expectations regarding health services that conflict with physicians’ conscience or religious beliefs have also been removed, and physicians are directed to the draft Human Rights in the Provision of Health Services policy for these expectations. The Working Group reaffirmed that CPSO’s expectations are the same for all services, including MAID, and therefore it was not necessary to repeat these professional expectations in the draft MAID policy.