Medical Assistance in Dying (MAiD) is a complex topic. Here are some questions we've received from nurses. If you don't see the information you're looking for, or have feedback for the college, feel free to contact us at firstname.lastname@example.org.
Counseling a person to commit suicide is still a criminal offence. For the purposes of the Criminal Code, “counsel” means encourage, solicit or incite. Due to the criminal significance of the word “counsel,” you need to be mindful in your work with clients not to encourage, counsel, advise, recommend or in any way seek to influence a client to end their life.
The Criminal Code permits health care professionals, including nurses, to provide information about the lawful provision of medical assistance in dying to a client. So nurses can provide information, engage in discussions and educate their clients about medical assistance in dying .
You may also choose to refer a client’s inquiries about medical assistance in dying to:
If you are providing care that is directly related to a client’s assisted death, you are required to have additional education about medical assistance in dying. There are new and complex legal, regulatory, procedural requirements and employer policies for medical assistance in dying that you need to understand and follow.
When a client begins the journey to write a request for medical assistance in dying, the client has substantial needs specific to medical assistance in dying. You require a level of knowledge about medical assistance in dying to be able to appropriately answer the client’s questions and to ensure that the client receives appropriate nursing care.
If you are providing general nursing care to a client not specific to medical assistance in dying, you may benefit from, but are not required to have, additional education. This general nursing care could include for example:
Use your professional judgement to document your assessments and care you provide, following your employer policies and the CRNBC Documentation practice standard. The nurse practitioner or physician providing the assisted death will document their own assessments and care.
Yes, you can. Nurses can aid a nurse practitioner or physician to provide medical assistance in dying, in accordance with the law. This could include inserting an intravenous or PICC line (with an order) that will be used to administer medications that will cause the death of a client.
RN Scope of practice standards related to medical assistance in dying and
Standards for acting within autonomous scope of practice and client-specific orders would apply.
Clients who are eligible for medical assistance in dying may need an IV or PICC line for care not specific to medical assistance. Starting an IV or PICC line is considered general nursing care if not directly related to the provision of medical assistance in dying.
Yes. If a nurse practitioner or physican requests this assistance, in accordance with the law you may pass them the syringes of medication. However, nurses are not allowed to prepare these medications.
Informing the IV team about the purpose for the IV start would be appropriate, as they are involved in the care of the client . It's possible the IV nurse may have a conflict with this based on his/her basic values and beliefs. Providing information to the IV team in advance may prevent a potential conflict for that nurse. It may also prevent a delay in starting the IV because, due to a conflict, the client's care would need to be transferred to another nurse.
Let the client know that other health team members such as the IV team will need to be informed about the purpose of the IV. Assure the client that this information will be disclosed only as necessary to those who are involved in their care. Be aware of and follow any organizational policies related to client privacy.
You need to ensure that the person requesting medical assistance in dying receives high quality, coordinated and uninterrupted continuity of care. Discuss with your manager about how continuity of care can be assured for this client and their family before, during, and after the procedure. It is important that this be done in advance so that alternate care can be provided to the client if needed.
Depending on the circumstances, your manager may decide to either arrange for you to provide the client's care with a handover to another nurse during the actual time of assistance or may decide to arrange to have another nurse take over the client's care for the entire time.
While it's ethically appropriate that, based on your basic values and beliefs, you not be the one to provide the information, it's ethically not appropriate to prevent your client from receiving information about medical assistance in dying or to influence their decision to pursue medical assistance in dying. If the client is asking about medical assistance in dying, it is essential that you acknowledge the information request and resist the inclination to 'ignore' or abandon conversation about the request. Some clients from time to time express that they wish to die or 'are ready' to die. A request for medical assistance in dying should prompt a discussion to find out the reasons for the request.
Respond with empathy, in a professional and non-judgmental way, when approached by a client with a request for information about medical assistance in dying. This may help to uncover unmet needs or fears. Listen very carefully to what is being said (and what is not said), and check that you have understood the client's concern accurately. Clarify your understanding, as clients sometimes talk about issues concerning death in ways that can be confusing. Acknowledge the client's feelings and concerns regarding their illness, and gently probe for more details about their perceptions of their illness, prognosis, and death and dying.
You will need to involve other team members as appropriate to ensure that the client is aware of the range of end of life options and care. An example of a response that you could provide when you are asked for information about medical assistance in dying: "I’m not able to answer some of your questions. Let me find someone who can help to make sure you are aware of all the end of life options and care."
There is a difference between caring for a client as a person, and having a conflict with a client's request for a particular treatment or procedure, in this case, medical assistance in dying, based on your basic values and beliefs. This is an important consideration. You are not required to assist in the provision of medical assistance in dying. However, you have a professional and legal obligation to provide your clients with safe, competent and ethical care. Don't allow your personal judgments about a client who has requested a medically assisted death to compromise the client's care by withdrawing or refusing to provide general nursing care.
If the client rings their bell, it is important to answer it promptly to find out what they need. Assistance with personal hygiene, toileting, or a request for fluids or nourishment are general nursing care activities nurses provide to clients. You will need to ensure that these needs are met.
Post-mortem care is also a general nursing care activity that you may need to provide if requested to do so.
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