Medical Assistance in Dying
Information and Resources
As of June 6, 2016, medical assistance in dying (MAID) is legally available in Canada. Our standard of practice and advice for physicians will be updated shortly to align with federal legislation passed June 17, 2016. (Bill C14)
In the meantime, the College has worked closely with Alberta Health and Alberta Health Services to ensure there is a formal process in place to help guide patients and physicians through MAID.
- If you are a patient or a family member of a patient seeking MAID, talk to your family physician. Excellent information about the process of seeking MAID is also available on the Alberta Health Services website at ahs.ca/maid, or you can call Health Link (811).
- If you are a physician or want to know more about the College's expectations of physicians regarding MAID, please see below.
What guidance does the College have for physicians about medical assistance in dying (MAID)?
It is important to understand that MAID is a process. The College has a new Medical Assistance in Dying standard of practice and advice document – both have been amended based on an Order in Council issued by the provincial government, pending federal legislation.
Physicians should also review new amendments to our Informed Consent and Conscientious Objection standards (formerly Moral or Religious Beliefs Affecting Medical Care). These standards apply to medical assistance in dying, and also to medical practice in general.
Who is eligible for MAID?
Only competent adult patients with a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual, and that cannot be relieved under conditions the patient considers acceptable* are eligible for MAID. At this time, MAID is not available to patients who have lost capacity to consent, even when an advance directive is in place.
*Supreme Court of Canada, Carter decision 2015.
If a patient asks about medical assistance in dying (MAID), what should the physician do?
The physician should contact the Alberta Health Services care coordination service, and also provide this contact information to the patient (or another person identified by the patient). It is not necessary to be connected to an AHS facility to access this service.
Key requirements for MAID include:
- The physician must have a complete and full discussion with the patient, including the natural history and prognosis of the condition and all treatment options.
- The patient’s eligibility for MAID must be confirmed by two medical opinions.
- The patient must provide a written request signed by two independent witnesses.
- The physician must obtain voluntary, informed consent. Physicians must consider whether a patient may be suffering from a psychiatric or psychological condition that could have an effect on the patient’s decision-making capacity.
- A period of reflection/waiting period between the request and the provision of an assisted death is recommended.
- The physician and patient together will develop a plan for how and when MAID will be provided, and who will be present.
- In providing MAID, the physician must use only medication recommended by the Alberta Health Services care coordination service.
Can a physician decline to provide MAID?
Yes, but the physician must ensure that a patient who seeks such advice or medical care is offered timely access to:
- a regulated member who is willing to provide the medical treatment, service or information; or
- a resource that will provide accurate information about all available medical options.
In most circumstances, this will mean providing timely access to Alberta Health Services resources (ahs.ca/maid). Protocols are in place to assist patients and/or their families.
Principles-based Recommendations for a Canadian Approach to Assisted Dying, Canadian Medical Association
A Guide for Reflection on Ethical Issues Concerning Assisted Suicide and Voluntary Euthanasia, College of Family Physicians of Canada, October 2015
Guide to Capacity Assessment under the Personal Directives Act, Alberta Office of the Public Guardian
Guide for Capacity Assessors, Alberta Adult Guardianship and Trusteeship Act
Physician and Family Support Program: 1-877-767-4637 (confidential personal support for physicians)