medical assistance in dying

is known in Canada as MAiD — the process whereby a physician or nurse practitioner helps and supports a patient who wants to voluntarily and intentionally end their life. MAiD is administered with drugs that can be taken by mouth or given intravenously. When thinking about the end of your life and saying goodbye to those you love, you may feel a deep sense of grief and sadness. You may also feel relieved to have some control over when and how you will die, and knowing a plan is in place.

The patient must initiate the MAiD process by a written request on a prescribed from and be witnessed by two people. However, the 2021 revised Act allows an exception for patients no longer able to speak for themselves (see *NEW* below).

For an overview, watch the 5min video below. Up-to-date information is also available via the following websites: Health Canada, the Canadian Association of MAiD Assessors & Providers, and your local Health Authority (in British Columbia for instance). See also the  handout with Information for Island Health Patients and Families.

To readers in the USA: The following information applies only to jurisdictions across Canada. As of today medical assistance in dying (aka assisted suicide or medical aid in dying) is legal in ten States and the District of Columbia.

A brief summary drawn from public sources

Revised criteria for eligibility [1] Recent changes to the legislation (17 March 2021) allow a broader group of people to be eligible to request and receive MAiD. To be eligible for medical assistance in dying, you must meet all of the following criteria:

• be eligible for health services funded by the federal government, or a province or territory (or during the applicable minimum period of residence or waiting period for eligibility);
• be at least 18 years old and mentally competent (capable of making health care decisions for yourself);
• have a grievous and irremediable medical condition (see definition below);
• make a voluntary request for MAiD that is not the result of outside pressure or influence.

What’s a grievous and irremediable medical condition? To be considered as having a grievous and irremediable medical condition, you must meet all of the following criteria. You must:

• have a serious illness, disease or disability (excluding a mental illness until March 17, 2023)
• be in an advanced state of decline that cannot be reversed
• experience unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable

You do not need to have a fatal or terminal condition to be eligible for medical assistance in dying.

*New* 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:

1. The person met all other required eligibility criteria and safeguards;
2. 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;
3. 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;
4. The person has lost the capacity to consent to medical assistance in dying;
5. Prior to administration, the person does not demonstrate refusal or resistance, by words, sounds or gestures, to having medical assistance in dying provided; and
6. The substance is provided to the person in accordance with the terms of the agreement.

How does the process work? [2] If you wish to proceed with MAiD, your physician or nurse practitioner will either assist you further or connect you to others who can provide MAiD.

1. You will be required to document your request and see two separate physicians or nurse practitioners (assessors).
2. The two assessors will confirm your eligibility.
3. There is a minimum 10-day ‘period of reflection’ from the time of your request until MAiD may be provided.
4. At the end of the reflection period, you will be asked again if you would still like to receive MAiD.
5. MAiD will be provided to you by the method of your choice and, to the greatest extent possible, at a location of your choosing and by one of the two assessors.
6. The health care team will continue to care for you at every stage of this process and will provide assistance in arranging support to make you as comfortable as possible.