Medical Assistance in Dying

The CRPNBC regulatory framework on medical assistance in dying (MAiD) includes standards, limits and conditions. This framework can be found in the CRPNBC Scope of Practice for RPNs: Standards, Limits and Conditions. It interacts with other requirements such as the CRPNBC Code of Ethics, the CRPNBC Standards of Practice, the CRPNBC Bylaws and relevant legislation.

Registered Psychiatric Nurses (RPNs) approached about aiding in the provision of MAiD need to confer with their employer. Organizations establish processes, supports and resources such as policies, procedures and decision support tools to ensure that RPNs meet the standards of practice set out by CRPNBC.

CAUTION: The following information is not intended to be exhaustive of all legislation that may have a bearing on medical assistance in dying and should not be used as a substitute for consulting the actual legislation or obtaining appropriate legal advice.

Introduction

The Criminal Code of Canada allows a person to request and receive, under limited circumstances, a substance intended to end their life. Only two forms of medical assistance in dying (MAiD) are permitted under the Criminal Code:

  • the administering by a medical practitioner or a nurse practitioner of a substance to a person at their request
  • the prescribing or providing by a medical practitioner or a nurse practitioner of a substance to a person at their request, for their self-administration

Roles

There are three roles related to medical assistance in dying (MAiD):

  • determining eligibility for MAiD
  • providing MAiD
  • aiding in the provision of MAiD

The role of the RPN is limited to aiding a physician or nurse practitioner in the provision of medical assistance in dying.

Standards, Limits and Conditions

Standards

  1. RPNs respond with empathy, in a professional and non-judgmental way, when approached by a client with a request about medical assistance in dying
  2. RPNs listen carefully and explore the client’s reason for requesting medical assistance in dying
  3. RPNs ensure that a client has access to the information that the client requires to understand all of their options and to make informed decisions about medical assistance in dying or other end-of-life options such as palliative care
  4. RPNs assess the cultural and spiritual needs and wishes of the person seeking medical assistance in dying and explore ways the person’s needs could be met within the context of the care delivery
  5. RPNs work with their organizations and other members of the health care team to ensure that the person requesting medical assistance in dying receives high quality, coordinated and uninterrupted continuity of care and, if needed, safe transfer of the client’s care to another health care provider

Limits and Conditions

  1. RPNs may only aid in the provision of medical assistance in dying and must not prescribe, compound, dispense or administer substances specifically intended for the purpose of providing medical assistance in dying
  2. RPNs must not direct or counsel clients to end their lives
  3. RPNs may aid a person requesting medical assistance in dying only as permitted under the Criminal Code and other legislation, regulations and regulatory college standards, court decisions and provincial and organizational policy and procedures
  4. RPNs may aid a health professional authorized to provide a person with medical assistance in dying only as permitted under the Criminal Code and other legislation, regulations and regulatory college standards, court decisions and provincial and organizational policy and procedures
  5. RPNs who aid in the provision of medical assistance in dying must successfully complete additional education
  6. RPNs who aid in the provision of medical assistance in dying must follow an employer approved decision support tool
  7. RPNs must not aid in the provision of medical assistance in dying for a family member
  8. RPNs must not pronounce death related to medical assistance in dying

Education

Many of the competencies required for aiding in the provision of medical assistance in dying (MAiD) are entry to practice competencies for RPNs including providing end of life care, supporting access to information, providing holistic client-care, providing education and collaborating with the health care team. RPNs who are aiding in the provision of MAiD:

  • provide end of life care specific to MAiD
  • discuss a client’s request for MAiD including understanding the client’s motivation (e.g. pain, emotional or physical distress), providing information, and helping to ensure that the client understands the options available related to end-of-life care
  • understand requirements for a client requesting MAiD including understanding the legislative requirements such as eligibility, witnessing consent, use of forms and documentation
  • understand their role in aiding in the provision of MAiD including:
  • responding to the client’s request for MAiD
  • participating in decision-making with the health care team including sharing information and consulting on the client’s request for MAiD

Related Standards of Practice

Standards of Practice of note for medical assistance in dying include:

Registrants who have questions about MAiD should contact a CRPNBC Practice Consultant by email at [email protected] or call 604.931.5200 or 1.800.565.2505. Registrants may also seek independent legal advice.

If you have any questions, please contact a CRPNBC Practice Consultant by email at [email protected] or call 604.931.5200 or 1.800.565.2505.

 

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