Physiotherapists may find themselves in situations where medical assistance in dying is discussed. This document is intended to provide facts about medical assistance in dying, guidance to the profession and links to excellent supportive resources.
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To clarify what is meant by medical assistance in dying the following definition is found in the legislation:
Medical assistance in dying means:
- the administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death; or
- the prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person, at their request, so that they may self-administer the substance and in doing so cause their own death.
The following criteria is required for the eligibility of medical assistance in dying.
Eligibility for medical assistance in dying
A person may receive medical assistance in dying only if they meet all of the following criteria:
- they are eligible — or, but for any applicable minimum period of residence or waiting period, would be eligible — for health services funded by a government in Canada;
- they are at least 18 years of age and capable of making decisions with respect to their health;
- they have a grievous and irremediable medical condition;
- they have made a voluntary request for medical assistance in dying that, in particular, was not made as a result of external pressure; and
- they give informed consent to receive medical assistance in dying after having been informed of the means that are available to relieve their suffering, including palliative care.
Grievous and irremediable medical condition
A person has a grievous and irremediable medical condition only if they meet all of the following criteria:
- they have a serious and incurable illness, disease or disability;
- they are in an advanced state of irreversible decline in capability;
- that illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and
- their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.
Only physicians or nurse practitioners can assess a client’s eligibility for and provide medical assistance in dying.
Specific guidance to physiotherapists
- Continue providing competent and ethical physiotherapy services to the patient in accordance with your clinical judgment, Standards of Practice, Code of Ethics and professional obligations.
- Acknowledge any requests for information related to Medical Assistance in Dying in a compassionate way. Engaging in conversation can be part of the therapeutic intervention. A patient’s request for information is their constitutional right and physiotherapists along with other health-care providers can support access to accurate and objective information. Note that physiotherapists should not initiate the conversation about medical assistance in dying, just respond to the request to avoid any perception of advising or counselling.
- Understand the legislation and that a physiotherapist is not committing an offence under the criminal code if they provide information to a person on the lawful provision of medical assistance in dying. Providing information is quite different from advising or counselling a patient, which should only be done by a physician or nurse practitioner. Specifically, The Act indicates:
- “For greater certainty, no social worker, psychologist, psychiatrist, therapist, medical practitioner, nurse practitioner or other health care professional commits an offence if they provide information to a person on the lawful provision of medical assistance in dying.”
- If making a referral, refer the patient to their most responsible health-care provider, preferably a physician or nurse practitioner or, if you are unsure of the information or not comfortable providing information, refer the patient to the Alberta Medical Assistance in Dying Care Coordination Teams. Information is available at http://www.albertahealthservices.ca/assets/info/hp/maid/if-hp-maid-coordination-service.pdf
- Advise the patient if a referral has been made.
- Document discussions or referrals in the patient record.
- Consider your own ethical perspective related to this issue. AHS has developed a Values Based Self-Assessment that may assist you to identify your position. It can be found at: http://www.albertahealthservices.ca/assets/info/hp/maid/if-hp-maid-self-assessment-tool.pdf
- Physiotherapists are not required to be part of discussions related to medical assistance in dying if it is in conflict with your moral beliefs and values (conscientious objection). You have the right to respect your own moral beliefs and values as does the patient. In this circumstance, refer the patient to the Medical Assistance in Dying Care Coordination Team
- Practice and be prepared with your responses.
- There are many excellent resources available to support all Albertans including health care providers who have questions about medical assistance in dying. The links below are comprehensive and are updated as new information is available.
- Alberta Health Services information on medical assistance in dying: http://www.health.alberta.ca/health-info/medical-assistance-dying.html
Helpful legislative links
If you have questions, please contact Physiotherapy Alberta at (780) 438-0338.
Updated November 27, 2016