Nursing Contribution to End-of-Life Care Decisions and Medical Assistance in Dying in Canada Josette Roussel, RN, MSc, M.Ed. Senior Nurse Advisor Canadian Nurses Association
Outline Why did CNA developed a framework? What does it mean for nursing? How is the framework used?
Medical assistance in dying (MAID) legislation passed on June 17, 2016
What does it mean for nursing?
Act to Amend the Criminal Code (MAID): Safeguards (s. 241.2) Written requests, signed and dated Independent witnesses Free will, free of undue pressure Informed consent Informed of other measures Withdrawal of request at any time Necessary measures to ensure understanding and communication
Act to Amend the Criminal Code (MAID): Safeguards (s. 241.2) 2 practitioners 2 written opinions about eligibility 10 clear days Advising the pharmacist Check immediately before administration Reasonable knowledge, skill and care Accordance with provincial/territorial laws, rules, standards
Mandate Develop a national nursing framework on MAID Advise the Canadian Nurses Association on framework content and revisions based on external consultation Participate in teleconferences and a face-to-face meeting
MAID framework: three main sections 1. Ethical decision-making 2. Generic pathway for nurses involved in MAID 3. Case studies to apply nursing values and responsibilities
Purposes Raise awareness of the change in the federal law Outline the role of nurses and nurse practitioners Guide nurses in reflecting on ethical issues that may occur as they care for persons considering MAID in various practice settings Provide additional tools and resources
Eligibility for MAID Eligible for publicly funded health services in Canada 18 years of age Capacity to make health decisions Grievous and irremediable medical condition Voluntary request for MAID
Eligibility for MAID Grievous and irremediable: Serious and incurable illness, disease or disability Advanced state of irreversible decline Enduring physical or psychological suffering intolerable to them and cannot be relieved under conditions they consider acceptable Natural death has become reasonably foreseeable without a prognosis necessarily having been made as to the specific length of time they have remaining
Nursing values and responsibilities Providing safe, compassionate, competent and ethical care Promoting health and well-being Promoting and respecting informed decision-making Preserving dignity Maintaining privacy and confidentiality Promoting justice Being accountable
Process and nursing responsibilities Determining eligibility for MAID Ensuring safeguards are met Providing and aiding in MAID Filing information and reporting requirements
Practice Patient informed about grievous and irremediable condition Obtains information from NP, MD, RN Patient submits written request NP/MD #1: determines eligibility NP/MD #2: provides second opinion about eligibility Minimum 10 clear days, NP/MD administers MAID with or without RN assistance
Statistics on medical assistance in dying (April, 2017) 0 * 188 61 11 21 189 970 * 37 Total:1477 Data not available due to small numbers in Yukon, Nunavut Quebec June 10 December 9, 2016 Other provinces June 17 December 31, 2016
Many questions How often is MAID happening now? What should I do if I conscientiously object? How do I discuss MAID with my patient? Oral vs. intravenous? What should I document? What about LPNs? Who should I call for advice and information? Are the rules the same in every province? How many nurses are already involved in MAID?
Medical Assistance in Dying: What Nurses Need to Know e-modules Coming Soon Describe how recent changes in the law have allowed patients the right to seek medical assistance in dying Detail the respective roles of registered nurses and nurse practitioners in caring for patients requesting or receiving MAID under the new law Conduct their role in accordance with federal and provincial laws
Testimonials We recognize that patients may have questions about MAID and want more information and to have discussions. Explaining the role of palliative care, providing information, being open to discussions engagement for this national nursing framework was very robust. I was impressed as I looked around the table and saw such diverse representation from all over our country, and from all aspects of nursing.
Thank you Please stay connected with us cna-aiic.ca cna-aiic.ca/maid