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Update on Medical Assistance in Dying

posted June 6, 2016

Background

As of June 6, 2016, Bill C-14 tabled by the federal government in response to the Supreme Court Carter v. Canada (2015) decision is still under deliberation by Parliament.

With the Carter decision taking effect, physicians are no longer prohibited from providing physician-assisted dying to a person who is a competent adult with a grievous and irremediable condition that causes enduring and intolerable suffering to the person. There is no longer a requirement for individual patients to seek approval from a court for physician-assisted dying.

The Carter decision exempts physicians from criminal prosecution for providing physician-assisted dying. The Carter decision did not address the role of a nurse practitioner in providing physician-assisted in dying or a registered nurse in aiding in the provision of physician-assisted dying.

Without legislation or a court order in effect that exempts registered nurses and nurse practitioners from potential criminal liability for aiding or providing physician-assisted dying, it remains unclear what involvement nurses may have related to physician-assisted dying. Guidelines or standards established by physician regulatory authorities do not apply to registered nurses or nurse practitioners.

Preparing for legislation

CRNBC is a member of the provincial MAiD working group convened by the Ministry of Health. The group includes representatives from the Ministry of Health, Ministry of Justice and Attorney General, Vital Statistics Agency, BC Health Authorities, College of Physicians and Surgeons of BC and College of Pharmacists of BC. An important goal of the provincial working group is to ensure that provincial level protocols, forms and quality assurance systems are in place. We have been working closely with these partners, and are also keeping the College of Registered Psychiatric Nurses of BC updated on our progress.

In preparation for legislation that would exempt health care professionals from criminal liability for the provision of medical assistance in dying (MAiD), CRNBC recently consulted with our professional practice colleagues from the health authorities on standards, limits and conditions related to MAiD that will go into effect when legislation is in place.

Nurses' accountabilities do not change

While we await the final legislation, it is important to note that the Carter decision does not change nurses' accountabilities as they relate to their current roles with clients seeking information or requiring palliative or end of life care. Nurses continue to have an integral role in providing quality care for clients who require end of life care. This includes:

  • advocating for clients
  • providing comfort care to those who are dying and their families.
  • creating and implementing nursing plans of care
  • collaborating and consulting with other members of the health care team
  • referring to other members of the health care team to ensure clients get their care and information needs met
  • conducting assessments
  • administering medications and treatments

Until the new legislation is in place, CRNBC advises nurses to avoid initiating a discussion about physician-assisted dying with a patient. If a patient asks you about physician-assisted dying please ensure that you encourage the person to speak with their physician. If a nurse is approached to participate in physician-assisted dying, CRNBC strongly recommends that you seek an independent legal opinion regarding your specific situation and contact the Canadian Nurses Protective Society. You may also want to discuss the matter with your workplace supervisor and your organization’s risk management and professional practice program staff.

Questions? 

Please visit the MAiD section of the website for additional information or contact CRNBC Practice Support

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