Appendix "A"

Recommended MAiD Paragraph 22

When completing the death certificate, physicians:

When completing the death certificate, the government has requested that physicians:

a) must list the illness, disease or disability leading to the request for MAID as the cause of death; and

a) list the illness, disease or disability leading to the request for MAID as the cause of death; and

b) must not make any reference to MAID or the drugs administered on the death certificate.

b) not make any reference to MAID or the drugs administered on the death certificate.

Practitioners who object to this for reasons of conscience or professional judgement should note their refusal/objection in the reports they are required to submit to the OCC about each MAID death. The OCC can then arrange for a willing coroner to complete the death certificate as requested by the government.

Recommended MAiD Paragraph 11

Physicians who decline to provide MAID on the basis of their conscientious convictions or professional judgement

a) must do so in a manner that respects patient dignity and must not interfere with access to MAID;

b) must communicate their reasons to the patient directly and with sensitivity;

c) must not criticize or denigrate the beliefs, lifestyle, identity or characteristics of the patient.  This should not be understood to preclude respectful discussion of beliefs or habits that may adversely affect a patient's health.

d) must provide the patient with information about all options for care that may be available or appropriate to meet their clinical needs, concerns, and/or wishes and must not withhold information about the existence of any procedure or treatment because it conflicts with their conscience or religious beliefs, subject to the following considerations:

i) Assisted suicide is one method of medical assistance in dying, but counselling suicide remains a criminal offence. Absent an inquiry or expression of interest from a patient, practitioners should not suggest assisted suicide or medical assistance in dying as treatment options. This does not preclude suggesting euthanasia alone.

ii) What information is clinically relevant to informed decision making and the point at which it ought to be provided must be guided by and responsive to the facts in each case and expressed interests of each patient.

iii) Suggesting euthanasia or assisted suicide in certain situations may be insensitive, offensive, harmful or even abusive. Careful reflection, prudent judgement and a focus on the best interests of individual patients are required.

Recommended MAiD Paragraph 11

[Physicians who decline to provide MAID . . .]

e) must respond to patient requests or enquiries expeditiously so as to enable interventions that are most likely to cure or mitigate the patient's medical condition, prevent it from deteriorating further, avoid interventions involving greater burdens or risks to the patient, and avoid delay in processing the patient’s request for MAiD;

f) if the patient appears to be unable to contact other service providers without assistance, must ensure that the patient is connected with a family member or other reliable and responsible person who can assist;

g) must continue to provide care and treatment for the patient unrelated to MAiD, unless the physician and patient agree to other arrangements;

h) unless they believe the patient is not eligible for MAiD, advise affected patients that they may seek MAiD from other practitioners;

i) when appropriate, communicate to a person in authority a patient's request for a complete transfer of care so that the person in authority can facilitate the transfer. Physicians who believe the patient is not eligible for MAiD must communicate their opinion in writing to the person in authority.

j) upon the request of a person in authority or the patient, transfer the patient's records to someone identified by the person in authority or patient. Physicians who believe the patient is not eligible for MAiD must communicate their opinion in writing to the person receiving the records.

k) if consistent with their conscientious convictions and professional judgement,

i) arrange for the patient to be seen by a practitioner willing to provide medical assistance in dying; or

ii) arrange for a transfer of care to another practitioner willing to provide medical assistance in dying; or

iii) enable patient contact with the MAiD Care Coordination Service or Ontario Telehealth; or

iv) enable patient contact with health care personnel or services in the community or in institutional settings who will ensure that the patient has access to all available treatment options, including medical assistance in dying and palliative care.

l) if unable to comply with 11(e to k), promptly arrange for the patient to be seen by an available health care practitioner accessible to the patient who is able to do so.

Recommended Advice: MAiD

What Physicians Need to Know

Physicians must not make referrals or do anything else that would support or facilitate medical assistance in dying in the case of a patient whom they consider to be ineligible.

In all other cases, the College recognizes that physicians have the right to limit health services they provide for reasons of conscience or religion and so may choose not to be involved in assessing or providing MAID

In recognizing this right, the College does not require physicians to assess a patient’s eligibility for MAID or provide MAID in any circumstances.

When physicians decline to provide MAID for reasons of conscience or religion, the College requires that they comply with College policy, “Medical Assistance in Dying.”

[Replace with]

The objective is to ensure access to care and respect for patient autonomy without violating the professional or moral integrity of physicians.

Patients who are so debilitated or circumstantially handicapped that they are unable to contact health care personnel or obtain medical treatment are clearly at risk and in need of assistance in all circumstances, not just in relation to accessing MAiD.  Physicians encountering such patients should recognize this problem and respond to it in all situations out of concern for their welfare and safety. This can be done by finding a responsible and reliable person who can help patients to overcome circumstantial handicaps, enabling them to obtain necessary assistance and navigate the health care system.  The helper could be a family member, friend, social worker, outreach worker, etc.

Physicians who choose to facilitate medical assistance in dying may do so by any reasonable means consistent with professional obligations, including formal clinical referral or informal methods of communication. They may delegate this responsibility to someone whom they know to be capable and reliable.

Physicians who decline to facilitate medical assistance in dying for eligible patients for reasons of conscience or professional judgement

— must not interfere with patient access to MAiD. They must respect patient dignity, be respectful and sensitive in communicating with patients and provide them with information necessary to enable informed medical decision-making. [MAiD, para. 11(a) to (d)]

— must act expeditiously and avoid delays [MAiD, para. 11(e)]

— must continue to provide care and treatment for the patient unrelated to MAiD, unless the physician and patient agree to other arrangements. [MAiD, para, 11(f)]

— unless they believe the patient is not eligible for MAiD, advise affected patients that they may seek MAiD from other practitioners; [MAiD, para. 11(g)]

— cooperate with transfers of care requested by or on behalf of a patient. Physicians who believe the patient is not eligible for MAiD must communicate their opinion in writing. [MAiD, para. 11(h-i)]

In addition, they must act on one of the following options: [MAiD, para. 11(j)

i) arrange for the patient to be seen by a practitioner willing to provide medical assistance in dying; or

ii) arrange for a transfer of care to another practitioner willing to provide medical assistance in dying; or

iii) enable patient contact with the MAiD Care Coordination Service or Ontario Telehealth; or

iv) enable patient contact with health care personnel or services in the community or in institutional settings who will ensure that the patient has access to all available treatment options, including medical assistance in dying and palliative care.

Physicians unable to comply options (i) to (iv) must promptly arrange for the patient to be seen by an available health care practitioner accessible to the patient who able to do so.