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Medical Assistance in Dying

Last updated on December 19, 2023

Individuals 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 people, who are 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 persons. 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’s care co-ordination service for medical assistance in dying.

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 individuals.

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; and
    • 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.

* Note: For the purposes of eligibility for medical assistance in dying, a mental illness is not considered to be an “illness, disease, or disability” under the current legislation. This restriction is expected to be repealed in the future.

What safeguards are in place for medical assistance in dying? 

Federal law includes the following safeguards to ensure vulnerable people are protected. As of March 17, 2021, there are two different sets of safeguards depending on whether the person’s natural death is reasonably foreseeable (without a prognosis necessarily having been made as to the specific length of time they have remaining) or whether it is not.

Safeguards – Natural Death Is Reasonably Foreseeable

  • 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.
  • A person’s request for medical assistance in dying must be made in writing and signed and dated in front of one "independent witness" (see below), who must also sign and date the request.
    • If a person can provide informed consent, but is physically unable to sign a request, another person may sign the request under the person’s express direction (a “Proxy”).
  • 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.

Exception to Requirement to Provide Final Consent

  • Medical assistance in dying may be provided to a person who has lost the ability to provide final consent if all of the following conditions are met:
    • The person met all other required eligibility criteria and safeguards;
    • The person was informed of the risk of losing the capacity to consent by the doctor or nurse practitioner and the person, before losing the capacity to consent, entered into a written agreement with the doctor or nurse practitioner that specifies a date on which medical assistance in dying will be provided;
    • In the written arrangement, the person consented to the administration by the doctor or nurse practitioner of a substance to cause their death on or before the date specified, if they lost their capacity to consent to receiving medical assistance in dying prior to that day;
    • The person has lost the capacity to consent to medical assistance in dying;
    • Prior to administration, the person does not demonstrate refusal or resistance, by words, sounds or gestures, to having medical assistance in dying provided; and
    • The substance is provided to the person in accordance with the terms of the agreement.

 

Safeguards – Natural Death Is Not Reasonably Foreseeable

  • 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.
  • A person’s request for medical assistance in dying must be made in writing and signed and dated in front of one "independent witness" (see below), who must also sign and date the request.
    • If a person can provide informed consent, but is physically unable to sign a request, another person may sign the request under the person’s express direction (a “Proxy”).
  • 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, one of whom must have expertise in the person’s illness, disease or disability.
    • If neither of the two assessing doctors or nurse practitioners has expertise in the illness, disease, or condition causing the person’s suffering, one of the assessors must consult with a doctor or nurse practitioner who does have this expertise, and must share the results of that consultation with the other assessor.
  • The two assessing doctors or nurse practitioners must ensure that all reasonable means available to relieve the person’s suffering have been discussed and, furthermore, that the person has given serious consideration to these means.
  • A person must be given a period of reflection of at least 90 days from the date of their first eligibility assessment to the date that medical assistance is provided, unless both assessors agree that the person is at risk of losing their ability to consent and agree that a shorter period is appropriate under the circumstances.
  • A person must be given the opportunity to withdraw their request throughout the process, including immediately before being provided with medical assistance in dying.

Provincial Safeguards

The province of B.C. has implemented the following additional safeguards:

  • If one or both doctors or nurse practitioners are concerned about an individual’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. When there is no other reasonable option, the prescribing doctor or nurse practitioner may ask another doctor, nurse practitioner, licensed practical nurse, registered nurse, registered psychiatric nurse, or pharmacist to return the substances to the pharmacy. The name of the person assigned to return the substances must be documented in the patient record.
  • The doctor or nurse practitioner must be present with the person during the self-administration or administration of medical assistance in dying and remain with the person until death is confirmed. This may not be delegated to another person or professional.

Oversight of Medical Assistance in Dying

Oversight of medical assistance in dying in B.C. is provided by the Medical Assistance in Dying Oversight Unit within the Ministry of Health. Doctors and nurse practitioners who provide medical assistance in dying in B.C. must submit all required documentation, using standardized provincial forms, to the Oversight Unit within 72 hours. This includes documentation of the person’s request for medical assistance in dying, the doctor or nurse practitioner’s own assessment of the person’s eligibility, a second doctor or nurse practitioner’s assessment of the person’s eligibility, the prescription and medication administration record, the assessment of a third doctor or nurse practitioner of the person’s capacity to give informed consent (if applicable), and the waiver of final consent (if applicable). All cases are reviewed by the Oversight Unit for compliance with the eligibility criteria, federal safeguards, federal regulations, provincial safeguards and professional regulatory college practice standards for medical assistance in dying.

Who can be an “independent witness” to a person’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;
  • provide health care services or personal care to the person making the request (unless this is as their primary occupation for which they are paid); or
  • are a doctor or nurse practitioner who is involved in assessing the person’s eligibility for medical assistance in dying or providing the person with medical assistance in dying.

How can eligible people receive medical assistance in dying in B.C.?

People 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 them or assist them to find someone who can help.

Every B.C. health authority has a designated person to help connect people 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:

Fraser Health
Interior Health
Island Health
Northern Health
Provincial Health Services Authority
Vancouver Coastal Health

For people living in a First Nations community or care providers working in First Nations communities, please email the First Nations Health Authority (maid@fnha.ca) if you have any questions or require further assistance in coordination.

People 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; a consultation with a third doctor or nurse practitioner that has expertise in the condition causing the person’s suffering may also be required. This process also ensures the individual is aware of all of the care options available to them and has the information required to make an informed decision.

Is there a request form to fill out, and where should I send it?

There is a provincial form called the Request for Medical Assistance in Dying that must be filled out by the person requesting medical assistance in dying. The requestor must sign and date page 1 of this form in front of an independent witnesses, who must also sign and date the form on page 2. The Request for Medical Assistance in Dying fulfills the requirement in the federal legislation that a person must submit a written request for medical assistance in dying.

The requestor can submit their Request for Medical Assistance in Dying 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 and contact information located under the Request for Medical Assistance in Dying on the Forms page).

Will individuals have to pay for the drugs used to perform medical assistance in dying?

Individuals enrolled in BC’s Medical Services Plan 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.

People requesting medical assistance in dying should speak to their doctor or nurse practitioner or contact their health authority regarding the options available within their region. Medical assistance in dying may not be readily available in every community. However, the B.C. government is working to support person-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 British Columbia College of Nurses and Midwives.

Other health-care providers, such as registered nurses and pharmacists, as well as family members or loved ones requested by the person, 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 person 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 people who make this request 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?

People requesting medical assistance in dying can change their mind and withdraw their request at any time and in any manner.

For people requesting medical assistance in dying, whose death is not reasonably foreseeable, a mandatory reflection period of at least 90 clear days must pass between the date of first assessment by a doctor or nurse practitioner (day 0) and the day medical assistance in dying is provided (day 91 or later), unless the person’s assessing doctors and/or nurse practitioners are both of the opinion that the person's loss of capacity is imminent and agree to shorten the reflection period.

Immediately before the doctor or nurse practitioner provides medical assistance in dying – whether in the form of administering or providing the person with prescribed drugs for self-administration – they must confirm with the person that they are still sure that this is what they want and the person must provide consent to proceed (unless the person has entered into a written agreement in advance – see “Safeguards – Natural Death Is Reasonably Foreseeable” above).

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 doctors or nurse practitioners 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, a person must be diagnosed with a grievous and irremediable medical condition and experience intolerable suffering. 

Furthermore, in order to receive medical assistance in dying, a person must be capable of making decisions about their health care and able to clearly communicate their consent at the time of the procedure (if a person’s natural death is reasonably foreseeable, an exception can be made under certain conditions – see “Safeguards – Natural Death Is Reasonably Foreseeable” above) . Only the person 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 legal in Canada, as long as the 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. On March 17, 2021 the federal government further amended the Criminal Code regarding medical assistance in dying, expanding eligibility to include people whose natural death is not reasonably foreseeable.

More Information

For more information and background on medical assistance in dying in Canada, see:

 

Other Options for End-of-Life Care

Information on other services for people nearing the end of life is available here:

Information for health-care providers on medical assistance in dying is available here:

Medical Assistance in Dying
request, practitioner and pharmacist forms

BC Quarterly and Annual MAiD Reports