Medical Assistance in Dying
Patients and their families have many decisions to make when faced with end-of-life care or intolerable suffering. It’s important for British Columbians to know and understand all the health care options available to them.
Medical assistance in dying provides patients, who may be experiencing intolerable suffering due to a grievous and irremediable (incurable) medical condition, the option to end their life with the assistance of a doctor or nurse practitioner.
Medical assistance in dying is provided only to legally eligible patients. To ensure this service is provided in a safe manner, a system of safeguards has been designed to protect vulnerable people and support all people to make an informed decision.
British Columbians seeking medical assistance in dying should speak with their doctor, nurse practitioner or local health authority.
See below for more information.
What is medical assistance in dying?
Medical assistance in dying occurs when an authorized doctor or nurse practitioner provides or administers medication that intentionally brings about a person’s death, at that person’s request. This procedure is only available to eligible patients.
Who is eligible for medical assistance in dying?
In order to be eligible to receive medical assistance in dying, a person must meet all of the following criteria:
- Be eligible for health services publicly funded by a government in Canada, such as being registered or eligible for B.C.’s Medical Services Plan;
- Be at least 18 years of age and capable of making decisions about their health;
- Have made a voluntary request for medical assistance in dying that, in particular, was not made as a result of external pressure;
- Have given informed consent to receive medical assistance in dying after being informed of the means that are available to relieve their suffering, including palliative care; and
- Have a grievous and irremediable medical condition, which means:
- they have a serious and incurable illness, disease or disability;
- they are in an advanced state of decline that cannot be reversed;
- that illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and 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 they have remaining.
What safeguards are in place for medical assistance in dying?
Federal law includes the following safeguards to ensure vulnerable people are protected:
- A person’s request for medical assistance in dying must be made in writing and signed and dated in front of two "independent witnesses" (see below), who must also sign and date the request.
- A person’s request must be signed and dated after they have been informed by a doctor or nurse practitioner that they have a medical condition that fits the “grievous and irremediable” criteria.
- Two independent doctors or nurse practitioners must assess the person to confirm their eligibility.
- A person must be given the opportunity to withdraw their request throughout the process, including immediately before being provided with medical assistance in dying.
- A person must be given a period of reflection of at least 10 days from the date they signed their request, unless both practitioners agree that a shorter period is appropriate in the circumstances.
- Medical assistance in dying can only be provided to persons who can give consent. Consent through an alternate or substitute decision maker or through a personal advance directive is not applicable. (If a person is capable of providing informed consent but is physically unable to sign a request, another person may sign the request under the patient’s express direction).
The province of B.C. has implemented the following additional safeguards:
- A regulated health professional must witness an eligibility assessment conducted via the Telehealth videoconferencing system. (A Telehealth assessment would be arranged by the doctor or nurse practitioner.)
- If one or both doctors or nurse practitioners are concerned about a patient’s capability to provide informed consent, they will request a capability assessment from a third doctor or specialist.
- The pharmacist must dispense the drugs directly to the prescribing doctor or nurse practitioner and the prescribing doctor or nurse practitioner must return any unused drugs to the pharmacy.
- The doctor or nurse practitioner must be present with the patient during the self-administration or administration of medical assistance in dying and remain with the patient until death is confirmed. This may not be delegated to another person or professional.
Who can be an “independent witness” to a patient’s request for medical assistance in dying?
An “independent witness” can be any person who is at least 18 years of age and who understands the nature of the request, except if they:
- know or believe that they are a beneficiary under the will of the person making the request, or would receive a financial or other material benefit resulting from that person’s death;
- are an owner or operator of any health care facility where the person making the request is being treated or lives; or
- are directly involved in providing health care services or personal care to the person making the request.
How can eligible patients receive medical assistance in dying in B.C.?
Patients looking to access medical assistance in dying should bring their wishes or questions to the attention of their doctor or nurse practitioner, who can discuss the options available to the patient or assist them to find someone who can help.
Every B.C. health authority has a designated person to help connect patients requesting information on medical assistance in dying with a doctor or nurse practitioner who can provide guidance.
Visit the health authority links below for information and contacts:
Patients can expect requests for medical assistance in dying to be received in a compassionate and respectful manner. Before anyone is able to receive medical assistance in dying, they must be assessed by two independent doctors or nurse practitioners to see if they are eligible for this service. This process also ensures the patient is aware of all of the care options available to them and has the information required to make an informed decision.
Is there a Patient Request form to fill out, and where should I send it?
There is a provincial form called the Patient Request Record that must be filled out by the patient to request medical assistance in dying. The patient must sign and date page 1 of this form in front of two independent witnesses, who must also sign and date the form on page 2. (Note: page 3 should not be signed by the patient for their initial request – it should be signed in front of the doctor or nurse practitioner immediately before medical assistance in dying is provided.) The Patient Request Record fulfills the requirement in the federal legislation that a person must submit a written request for medical assistance in dying.
The patient can submit their Patient Request Record directly to their doctor or nurse practitioner, or they can contact a health authority’s care coordination service for medical assistance in dying (see health authority links above).
Will patients have to pay for the drugs used to perform assistance in dying?
Patients will have full coverage for medications used in medical assistance in dying.
Where is medical assistance in dying available in B.C.?
Not all doctors or nurse practitioners will be willing or able to provide medical assistance in dying. This is a new service and it will take time before health-care providers acquire the skills, training and experience to provide this service.
Patients should speak to their doctor or nurse practitioner or contact their health authority regarding the options available within their region. Medical assistance in dying will not be immediately available in every community. However, the B.C. government is working to support patient-centred access within each region of the province.
Who is allowed to perform medical assistance in dying?
Doctors and nurse practitioners are able to provide medical assistance in dying as long as they comply with the rules set out in the Criminal Code, and all applicable provincial and territorial laws, rules and policies. For example, B.C. physicians must follow the standards of the College of Physicians and Surgeons of British Columbia, and nurse practitioners must follow the standards of the College of Registered Nurses of British Columbia.
Other health-care providers, such as registered nurses and pharmacists, as well as family members or loved ones requested by the patient, may help in providing medical assistance in dying, so long as they also comply as stated above and are not in a position to benefit from the person’s death.
What if my doctor or nurse practitioner won’t perform medical assistance in dying?
For a variety of reasons, not all doctors or nurse practitioners will provide medical assistance in dying and no one will be forced to do so. For some, providing medical assistance in dying may conflict with their personal beliefs.
Even if a doctor or nurse practitioner does not provide medical assistance in dying as a matter of conscience, a patient can still expect to be treated with respect and be provided with information on how to access this service. This means health-care providers must not discriminate against patients and must provide an effective transfer of care if they choose not to offer that care themselves.
What if I change my mind after requesting medical assistance in dying?
Patients requesting medical assistance in dying can change their mind and rescind their request at any time and in any manner.
It’s very important that patients have time to reflect on their decision so, following a patient’s request for medical assistance in dying, a mandatory reflection period of at least 10 days must occur between the day the written request is signed and the day medical assistance in dying is provided, unless death or the patient's loss of capacity are imminent.
Immediately before the doctor or nurse practitioner provides medical assistance in dying – whether in the form of administering or providing the patient with prescribed drugs for self-administration – they must confirm with the patient that they are still sure that this is what they want and the patient must provide consent to proceed.
Can I request medical assistance in dying in advance of experiencing suffering or receiving a diagnosis?
According to federal law, medical assistance in dying cannot be provided based on an advance request and can only be provided after two independent assessors have determined that all of the eligibility criteria set out in the Criminal Code have been met. To be eligible for medical assistance in dying, the patient must be diagnosed with a grievous and irremediable medical condition and experience intolerable suffering.
Furthermore, in order to receive medical assistance in dying, a patient must be able to clearly communicate their consent at the time of the procedure. Only the patient can request and consent to medical assistance in dying. Medical assistance in dying cannot be provided at the request of a substitute decision maker.
Is medical assistance in dying legal?
Medical assistance in dying is now legal in Canada, as long as criteria established in the federal legislation are followed.
In February 2015, the Supreme Court of Canada decided that it would no longer be a criminal offence in Canada for a physician to help someone end their life in certain circumstances. On June 17, 2016, the federal government passed legislation to amend the Criminal Code and bring medical assistance in dying into practice throughout Canada.
For more information and background on medical assistance in dying in Canada, see:
- Government of Canada information on medical assistance in dying
- Guidance from the College of Physician and Surgeons of B.C. (PDF, 140KB)
- College of Physicians and Surgeons of B.C. - Medical Assistance in Dying FAQs (PDF, 152KB)
- Guidance from the College of Registered Nurses of B.C.
- Guidance from the College of Pharmacists of B.C.
- Federal Bill C-14: Medical Assistance in Dying
- The Supreme Court ruling Carter v. Canada