MAID (Medical Assistance in Dying) Policy
Effective Date: February 2018
St.Amant’s River Road Place facility recognizes its obligation under the Winnipeg Regional Health Authority’s (WRHA) Level 1 Policy: Medical Assistance in Dying – 110.000.400 (referred to in this policy as MAID) and declares itself as an Abstaining Facility.
St.Amant will not provide medical assistance in dying (MAID) at its complex care facility – River Road Place. We will work with individuals receiving services at River Road Place, their families, and the WRHA to facilitate consultation with the Provincial MAID team and, when deemed appropriate, a safe and timely transfer to an alternate setting that provides medical assistance in dying.
When/if a person residing at River Road Place expresses an interest in exploring medical assistance in dying to a Staff of St.Amant, the Staff will immediately notify the Director of Care (or designate). The Director of Care will inform the Chief Executive Officer (or designate) of the request and will respond directly to the resident. The requirement to facilitate this communication in a timely manner applies to all Staff, even those identifying as Conscientious Objectors.
1. An Individual supported at River Road Place who is legally entitled to make her / his own decisions makes a direct inquiry about MAID to a Staff, or, the topic of MAID arises with members of the Interdisciplinary Care Team in discussion of the Individual’s Care Plan.
Members of the Interdisciplinary Care Team seek to identify and understand the circumstances and/or concerns that have prompted the inquiry about, or request for, MAID.
2. The matter is referred to the Director of Care for River Road Place who, after informing the Medical Director and the CEO, will respond directly to the Individual and facilitate contact with the MAID Team (within 24-hours of the individual’s initial inquiry or request).
3. The Individual is informed regarding:
- the River Road Place Policy and the WRHA MAID Policy, highlighting the MAID team assessment process to determine eligibility, and the requirement for transfer of care to an alternate site if the Individual is deemed eligible and opts to proceed with MAID as River Road Place is an Abstaining Facility.
- the contact info for the MAID team, and assistance in making contact as required.
4. St.Amant will share all Personal Health Information in accordance with Personal Health Information Act (PHIA) and will allow access to the full health records of the individual to the MAID team.
5. Potential outcomes following the MAID team assessment:
- The MAID team determines that the individual is not eligible for MAID.
- The MAID team establishes that the Individual’s request is prompted by undisclosed needs and/or unaddressed care needs (e.g. pain management) and/or that the Individual no longer has an interest in / reason for exploring the possible provisions of MAID and the matter is referred back to the interdisciplinary care team. The interdisciplinary care team identifies and discusses available treatment options to address the individual’s expressed needs. The individual consents to a new care plan that does not include medical assistance in dying (MAID).
- The MAID team establishes that the Individual is eligible for MAID, and, consents to receiving MAID. Planning for the timely transfer of the Individual to an alternate health care facility where MAID will be provided proceeds in accordance with established WRHA transfer protocols. Unless the person is too ill or too frail to be transferred or the person declines transfer.
DEFINITION OF TERMS
The following definition(s) apply to this policy and are not necessarily intended for organization-wide use.
Abstaining Facility: The operator of a faith-based facility that is funded, but not owned or operated, by the WRHA, that provides publically funded health services to Individuals in a manner which is consistent with the fundamental religious principles of the religion or faith to which it adheres, and which adopts and publishes an official policy or position that it will not allow MAID, or certain aspects of processes associated with MAID, as defined in section 2.8, to be provided within its facility.
Conscientious Objector: Any staff who refuses to provide or participate in providing MAID because such action would violate a personal, deeply held moral or ethical value.
Individual: A person including a patient, resident or client of a WRHA Facility or a WRHA clinical service.
MAID or Medical Assistance in Dying: The administering by a Medical Practitioner or Nurse Practitioner of a substance to an Individual, at that Individual’s request, that causes death; or the prescribing or providing by a Medical Practitioner or Nurse Practitioner of a substance to an Individual, at that Individual’s request, so that they may self- administer the substance and in doing so cause their own death. For greater certainty, MAID does not include processes that may or may not culminate in MAID.
Grievous and Irremediable Medical Condition: A condition by which the Individual meets all of the following criteria:
(a) the Individual has a serious and incurable illness, disease or disability;
(b) the Individual is in an advanced state of irreversible decline in capability;
(c) that illness, disease or disability, or that state of decline, causes the Individual enduring physical or psychological suffering that is intolerable to the Individual and that cannot be relieved under conditions that the Individual considers acceptable; and
(d) the Individual’s natural death has become reasonably foreseeable, taking into account all of the Individual’s medical circumstances, without a prognosis necessarily having been made as to the specific length of time that the Individual has remaining.
MAID Criteria: The requirements that must be met by an Individual in order that they may be eligible for MAID, which include that the Individual:
(a) is eligible or, but for any applicable minimum period of residence or waiting period, would be eligible for government (federal, provincial or territorial) funded health services; (b) is at least 18 years of age and capable of making decisions with respect to his or her health;
(c) has a Grievous and Irremediable Medical Condition;
(d) has made a voluntary request for MAID that, in particular, was not made as a result of external pressure; and
(e) has given informed consent to receive MAID after having been informed of the means that are available to relieve their suffering, including palliative care.
MAID Team: The group of health care professionals known as the Manitoba Provincial MAID Clinical Team who have been approved by the WRHA chief medical officer to provide MAID.
Staff: All persons employed or engaged by St.Amant including members of the medical staff, physicians, nurses, nurse practitioners, volunteers, board members, students, and other individuals associated through legal contracts, while acting in that capacity, or on behalf of the organization.