Medical Assistance in Dying - Information for Health-Care Providers

Medical assistance in dying is a relatively new health-care service in B.C. and health-care providers may have questions about the administrative steps in providing this service, as well as their reporting obligations. See below for information on some of the common administrative processes involved in providing medical assistance in dying, as well as information on the reporting requirements and provincial forms to be used for this purpose.

For clarification on practice standards, health-care providers should contact their provincial regulatory college. Each college’s standards are also accessible through links at the bottom of this page.

Changes to Reporting Requirements for Practitioners and Pharmacists

As of Nov. 1, 2018, the requirements for reporting on medical assistance in dying in B.C. are changing. All required provincial forms for medical assistance in dying must now be submitted to the B.C. Ministry of Health, the designated recipient of reportable information from physicians, nurse practitioners and pharmacists. The BC Coroners Service will no longer receive the provincial forms on this date.

Physicians, nurse practitioners and pharmacists have new reporting obligations that they must be aware of. These requirements are specified in new federal Regulations for the Monitoring of Medical Assistance in dying (Regulations – effective Nov. 1, 2018), and in B.C.’s college standards for physicians, nurse practitioners and pharmacists.

All provincial and federal reportable information is included on B.C.’s provincial forms for medical assistance in dying. This means that the practitioner (Assessor and Prescriber) or pharmacist’s completion and submission of their provincial form(s) to the B.C. Ministry of Health will fulfill their provincial and federal reporting obligations regarding medical assistance in dying. A single designated recipient streamlines the reporting process for B.C. practitioners and pharmacists.

NOTE:  The latest provincial forms MUST be used by practitioners and pharmacists if the patient’s written request is dated on or after Nov. 1, 2018. The Ministry of Health will accept old forms if the patient’s written request was dated prior to Nov. 1, 2018.

What is reportable – by who and when?

There are a number of new reporting requirements for practitioners (Assessors and Prescribers) and pharmacists (see 1 to 3 below), as well as the existing requirement that practitioners must report on deaths due to medical assistance in dying (see 4). See the Medical Assistance in Dying in British Columbia: Reporting at a Glance (PDF, 214KB) one-page reference guide.

The reporting requirement for practitioners is triggered once a patient’s written request is received, even if the request does not result in medical assistance in dying.

What constitutes a patient’s written request?

For reporting purposes, a patient’s written request may take any form. It does not have to be in the format required as a safeguard under the Criminal Code (i.e. duly signed, dated and witnessed). However, it must be an explicit request for medical assistance in dying and not just an inquiry or request for information. Examples of a written request include the Patient Request Record (HLTH 1632) form, a written paper request, and a request received by email or text message.

Note: The above definition only applies to what triggers a reporting requirement and not to the actual provision of medical assistance in dying, which in B.C. requires a patient’s completion of the Patient Request Record (HLTH 1632) form.

  1. Transfer of request (Practitioner) - NEW

    A practitioner who receives a patient’s written request for medical assistance in dying and transfers the request or care of the patient to another practitioner or MAiD Care Coordination Service for any reason, must report to the Ministry of Health within 30 days after the day of transfer.

    Reporting is accomplished by the practitioner completing and faxing the Transfer of Request (HLTH 1642) form to the Ministry of Health at 778 698-4678.

    Reporting caveats (under the federal Regulations):

    1. The practitioner submitting a HLTH 1642 form is not required to report further information identified under categories 2, 3 and 4 below.
    2. The reporting is not required if the transfer happens “after the 90th day after the day on which the practitioner received the request.”
    3. The practitioner who is planning to be the provider of medical assistance in dying would be required to submit a HLTH 1642 form if they are unable to provide the service and instead refer the patient’s request to another provider.
       
  2. Ineligibility, withdrawal of request, or death from another cause (Practitioner) - NEW

    A practitioner who receives a patient’s written request for the purpose of eligibility assessment or provision of medical assistance in dying, must report to the Ministry of Health within 30 days of becoming aware of any of the following information related to patient ineligibility or planning being discontinued:

         a)  The patient is assessed as ineligible for medical assistance in dying;
         b)  The patient is now ineligible after previously being assessed as eligible;
         c)  The patient has withdrawn their request; or
         d)  The patient has died from another cause

    The Assessor will report using the Assessment Record (Assessor) form (HLTH 1633).

    The Prescriber will report using the Assessment Record (Prescriber) form (HLTH 1634).

    Note:  The Assessor or Prescriber will include the Patient Request Record (HLTH 1632) and Consultant’s Assessment if applicable (HLTH 1635) with their reporting, and will fax the required forms to the Ministry of Health at 778 698-4678.

    Reporting caveat (under the federal Regulations):

    1. This reporting is not required if the practitioner becomes aware of the information “after the 90th day after the day on which the practitioner received the request”.

  3. Dispensing of substance for medical assistance in dying (Pharmacist) - NEW

    The full pharmacist who dispenses a substance in connection with the provision of medical assistance in dying must report to the Ministry of Health within 6 business days of the day on which the substance is scheduled to be administered to the patient.

    Reporting is accomplished by the full pharmacist completing (in collaboration with the prescribing practitioner) and faxing the Dispensing Record (Pharmacist) (HLTH 1641) form to the Ministry of Health at 778 698-4678.

  4. Provision of medical assistance in dying (Practitioner)

    The practitioner who provides medical assistance in dying (by administering a substance or providing a substance for the patient’s self-administration) must report to the Ministry of Health within 72 hours of confirmation of the patient’s death.

    The Prescriber will report using the Assessment Record (Prescriber) (HLTH 1634) form, which includes sections on the planning and administration of medical assistance in dying. The Prescriber will include the following forms with their reporting and will fax the forms to the Ministry of Health at 778-698-4678: Patient Request Record (HLTH 1632); Assessment Record (Assessor) (HLTH 1633); Consultant’s Assessment (HLTH 1635) if applicable; Prescription and Medication Administration Record. These forms are also identified on the Medical Assistance in Dying in British Columbia: Reporting at a Glance one-page reference document.

    Note 1:  The Medical Certification of Death form must be completed and submitted to the funeral director so that a Disposition Permit may be issued, not to the Ministry of Health fax number for reporting on medical assistance in dying.

    Note 2:  As is the case with other deaths in B.C., if the patient’s underlying condition relates to an accident, violence or self-inflicted injury, the practitioner must also report the death to the coroner on call in the region where the incident giving rise to the injury occurred by calling 1 855 207-0637.

Why are some B.C. reporting timelines shorter than the federal ones?

In B.C., some of the timelines for practitioner and pharmacist reporting have been shortened compared to what are outlined in the federal Regulations. The following two shortened timelines ensure that B.C. practitioners and pharmacists only have to report once to meet provincial oversight and federal monitoring requirements:

  • Provision of medical assistance in dying - the providing practitioner (Prescriber) is required to report within 72 hours of confirmation of the patient’s death (instead of “within 30 days” under the federal Regulations).
     
  • Dispensing for medical assistance in dying - the dispensing pharmacist is required to report within 6 business days after the day on which the substance is scheduled to be administered to the patient (instead of “within 30 days” under the federal Regulations).​

What forms must be completed and where can I find them?

The provincial standardized forms for medical assistance in dying are available on the Ministry of Health’s website (see quick link to Forms in right column of this page). These provincial forms are to be used by patients, practitioners and pharmacists, and must be downloaded from this website each time they are required to ensure the most recent version is used.

The set of provincial forms related to medical assistance in dying includes the following:

  • Patient Request Record (HLTH 1632) - for a patient to record details related to their request for medical assistance in dying.
  • Transfer of Request (HLTH 1642) – for a practitioner to record details of their transfer of a patient’s written request or care to another practitioner or MAiD Care Coordination Service, for any reason.
  • Assessment Record (Assessor) (HLTH 1633) - for an assessing practitioner to record details of a patient’s eligibility assessment, and, if applicable, reasons for planning being discontinued (e.g., due to a patient withdrawing their request).
  • Assessment Record (Prescriber) (HLTH 1634) – for a prescribing practitioner to record details of a patient’s eligibility assessment and, if applicable, reasons for planning being discontinued or details related to the planning and administering of medical assistance in dying.
  • Consultant’s Assessment of Patient’s Informed Consent Decision Capability (HLTH 1635) – for a consulting practitioner to record details of their capability assessment.
  • Dispensing Record (Pharmacist) (HLTH 1641) – for a full pharmacist to record details of their dispensing and the prescribing practitioner’s receipt of medications, as well as the reconciliation of returned medications after medical assistance in dying.
  • Medical Certification of Death (VSA 406A) – the prescribing practitioner must complete this form within 48 hours of death in compliance with Section 18 of the Vital Statistic Act, and provide the completed form to the funeral director so that a Disposition Permit may be issued. (This form is not to be submitted to the Ministry of Health fax number for reporting on medical assistance in dying.)

The completion of these provincial forms meets the requirements of the federal Regulations for the Monitoring of Medical Assistance in Dying, B.C.’s professional regulatory colleges (Physicians and Surgeons, Nursing Professionals, and Pharmacists), the B.C. Ministry of Health and the B.C. Vital Statistics Agency, regarding the completion of documentation and reporting on medical assistance in dying.

Where are the forms to be submitted?

The patient can submit their Patient Request Record (HLTH 1632) directly to their physician or nurse practitioner, or can contact a health authority’s care coordination service for medical assistance in dying (see health authority links below).

The physician, nurse practitioner or pharmacist will fax their requisite provincial form(s) to the Ministry of Health at 778 698-4678, within the timeframe required for each reporting requirement.

Note:  Details on reporting requirements are addressed in the section above titled “What is reportable – by who and when?” As well, instructions are indicated at the top of each provincial form and in its accompanying instruction guide (see quick link to Forms page in right column on this page).

What is the process for prescribing drugs used in medical assistance in dying?

Physicians, nurse practitioners and pharmacists must follow the standards set out by their respective professional college when writing a prescription or dispensing drugs for medical assistance in dying. There is an expectation that the British Columbia  standardized drug protocols and prescription  form will be used.  

The British Columbia Pharmacy Protocols guidance document and the British Columbia Medical Assistance in Dying Prescription form (includes the pre-printed order and medication administration record)  are not available for general distribution.  The prescribing physician or nurse practitioner can access these documents by contacting the health authority care coordination service for medical assistance in dying, or the College of Physicians and Surgeons. Pharmacists may also familiarize themselves with the standardized drug protocols by accessing the British Columbia Pharmacy Protocols guidance document through the secure portion of the College of Pharmacists website.

When drugs need to be purchased from a community pharmacy, in order for patients to get 100% coverage, the prescriber must:

  • Complete the Application for PharmaCare Medication Coverage for Medical Assistance in Dying form.
  • Fax the form to the Ministry of Health PharmaCare Special Authority branch at 1 800 609-4884, along with the following completed sections of the B.C. Medical Assistance in Dying Prescription form:
    • Identification and Declaration section;
    • Intravenous Drug Protocol section; and
    • Oral Drug Protocol section.

Please note that:

  1. The form should not be sent to a health authority or the B.C. Ministry of Health fax number for reporting on medical assistance in dying (which receives the provincial forms that contain reportable information for medical assistance in dying).
  2. The special authority form should be submitted as soon as possible to ensure approval before the drugs are required.
  3. The special authority is approved for a period of 60 days, which can be extended upon request.

When drugs and supplies are dispensed from a health authority pharmacy, they are fully covered by the health authority.

More information on the expectations related to the prescription process is available in the standards of the College of Physicians and Surgeonsthe standards, limits and conditions of the College of Pharmacists of British Columbia, and the standards, limits and conditions of the British Columbia College of Nursing Professionals.

How do I fill out the death certificate after providing medical assistance in dying?

In order to meet the requirement that medical assistance in dying is indicated on the Medical Certification of Death and that the cause of death is the underlying illness or disease causing the grievous and irremediable medical condition, the Vital Statistics Agency recommends that the Medical Certification of Death be completed as follows:

  • Report medical assistance in dying in PART 1 (a);
  • Report the underlying illness/disease causing the grievous and irremediable medical condition in PART I (b); and
  • Report manner of death as "natural."

For example:

example of death certificate indicating medical assistance in dying
 

Who should I contact with questions about medical assistance in dying policy and processes?

Health-care providers working within health authorities should contact their health authority’s designated coordinator for medical assistance in dying, or their supervisor for more information on policy and processes. Health authorities play a central role in the co-ordination of medical assistance in dying services, and are prepared to support patients and care providers who need assistance in navigating the service.

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

Health-care providers not affiliated with a health authority should contact their provincial regulatory college for information on medical assistance in dying processes.

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.

Standards and Guidelines

The provincial regulatory colleges have laid out medical assistance in dying standards and guidelines so registrants know what is expected of them when they are approached about or are participating in providing the service:

How do I bill MSP for medical assistance in dying services?

The following fees for medical assistance in dying have been approved:

P13501    MAiD Assessment Fee – Assessor Prescriber
P13502    MAiD Assessment Fee – Assessor
P13503    Physician witness to video conference MAiD Assessment – Patient Encounter
P13504    MAiD Event Preparation and Procedure
P13505    MAiD Medication Pick-up and Return

The complete description and submission notes can be found in the MSC Payment Schedule located in the following document:

How do I bill for approved travel and training for these services?

The Medical Assistance in Dying Travel and Training Assistance Program provides funding to assist health authorities in the provision of medical assistance in dying services to residents in Rural Subsidiary Agreement communities. The program policy and forms are accessible at the following Rural Practice Programs link: