Medical Assistance in Dying: Update Stakehlder Presentatin Ministry f Health and Lng-Term Care and Ministry f the Attrney General Week f August 1, 2016
Implementatin Questins: What We Heard Frm Yu 1. Reprting: Have parameters fr reprting been established? I was pleased t see in Quebec that there is reprting n MAID and n ther end-f-life ptins like terminal palliative sedatin. Federal legislatin n MAID requires the federal Minister f Health t intrduce regulatins respecting infrmatin relating t requests fr, and the prvisin f, MAID (s.241.31 (3)). The purpse is t publically reprt n MAID in Canada and t supprt the mandatry review f the Act in five years. Ontari is wrking t develp a rbust mnitring and versight system fr MAID, in partnership with its federal and prvincial/territrial cunterparts. Stay tuned fr mre details. 2. Francphne Patients: Hw are francphne patients accmmdated fr when making a match using the Clinician Referral Service? We ask if the patient has any accmmdatin needs (beynd just language; this is the nly questin we ask abut the patient). We als ask which languages clinicians can prvide services in fr thse wh have registered t be part f the Clinician Referral Service. The specifics f the patient is taken int cnsideratin t make the best pssible match. If we are aware f a language need n the part f the patient it becmes a critical factr in hw matches are made fr the Clinician Referral Service. Currently, 15% f registered clinicians have identified that they are able t prvide services in French. 2
Implementatin Questins: What We Heard Frm Yu Cnt d 3. Organizatinal Plicy: Frm the perspective f individual primary care prviders and frm the perspective f team-based primary care rganizatins like CHCs/AHACs/FHTs/NPLCs, what enabling rganizatinal and/r prfessinal plicies and/r prtcls need t be in place? What key cntent needs t be included in these plicies and prtcls s that they are aligned with legislatin, regulatins etc? Lcal planning is encuraged in rder t apprpriately address inquiries abut and requests fr medical assistance in dying. The Ministry has nt articulated any mandatry elements but in many cases there are sectr-led resurces available. The University f Trnt Jint Centre fr Biethics Taskfrce n Implementing Medical Assistance in Dying has als develped a Draft Plicy Template. The template is available at the fllwing link: http://reprtal.jintcentrefrbiethics.ca/news/dcuments/jcb-maid- Plicy-Template-DRAFT_June52016.pdf Please nte, the Draft Plicy Template is currently being revised, and a new versin will be made available in the next week r tw. In general, institutins and rganizatins are encuraged t infrm patients/residents f any institutinal psitin n MAID, including any and all limits n allwing its prvisin, s that patients can make infrmed chices abut their care ptins. 3
Implementatin Questins: What We Heard Frm Yu Cnt d 4. Cmpensatin: I am assuming there is a fee schedule fr MAID? Existing OHIP billing cdes can be used by physicians fr all services required in the prvisin f MAID. Cnsultatins with MOHLTC s Health Services Branch have indicated that existing billing cdes are adequate fr MAID services. Nurse Practitiners (NP) and pharmacists invlved in the prvisin f MAID will als be cmpensated thrugh existing cmpensatin mechanisms (e.g., salaried cntracts fr NPs; and a payment mechanism set by the MOHLTC fr cmmunity retail setting pharmacists). 5. Legislatin: Any updates n whether ON will pass legislatin? Ontari has indicated that it is explring ptential legislative and regulatin changes t supprt MAID implementatin. We cntinue t track twards a ptential January 1, 2017 date fr implementatin, subject t gvernment decisin-making and apprval by the Legislature. 6. CPSO Challenge: Is the ON gvernment ging t intervene in the challenge against the CPSO s human rights and MAID plicy fr effective referrals? Ontari has filed a letter indicating that it will be intervening in the challenges t the CPSO s MAID and Public Obligatins and Human Rights (POHR) plicies. 4
Implementatin Questins: What We Heard Frm Yu Cnt d 7. Capacity: The CPSO guidelines n MAID prvide that Where the patient s capacity r vluntariness is in questin, the attending physician must refer the patient fr a specialized capacity assessment. Wh will be cnducting these assessments? Will it be a referral t anther physician? Is the CPSO / Gvernment defining what is a specialized capacity assessment and wh cmpletes such an assessment? The Ontari Gvernment des nt define what a specialized capacity assessment is. It is up t each physician t make a determinatin abut capacity in the cntext f MAID n a case by case basis, in line with CPSO plicy. Hwever, as this questin relates t CPSO s MAID Plicy, we recmmend this questin be directed t the CPSO. We are happy t frward the questin n t ur cntacts there if yu prefer. 8. Health Care Cnsent Act: Des the Ministry have further infrmatin n whether the Health Care Cnsent Act will be amended t address the differences between the age f cnsent t treatment and presumptin f capacity in the federal legislatin and the Health Care Cnsent Act? This is a live issue given that the CPSO guidelines specifically pint physicians t the Health Care Cnsent Act fr the definitin f capacity t cnsent t treatment and the framewrk fr ensuring that cnsent is infrmed. Ontari is cnsidering a number f legislative and/r regulatry measures as part f a full system, hwever the legal requirements set ut in federal legislatin (which are nw part f the Criminal Cde) apply t MAID in Canada regardless f any additinal rules set by prvinces r territries. 5
Implementatin Questins: What We Heard Frm Yu Cnt d 9. Cnsent Capacity Bard: Our understanding is that the Ministry has determined that MAID is nt a treatment, and therefre the CCB des nt have jurisdictin t hear capacity appeals. In additin, as we understand it, the Ministry s psitin is that any appeal regarding a finding f incapacity fr a patient requesting MAID wuld g thrugh a secnd physician. Is this the Ministry s perspective, r the CCB s perspective? Have yu advised the CCB f yur psitin that the Ministry des nt cnsider assisted death treatment? Desn t the authrity (absent any regulatin t the cntrary) t determine the scpe f their authrity rest with the CCB? There are n changes currently cntemplated t the Health Care Cnsent Act (HCCA) with respect t the rle f the CCB. If a patient applied under sectin 32 f the HCCA t the CCB fr a review f a physician s finding that he r she is incapable with respect t MAID, it is unlikely that the CCB wuld be able t deal effectively with such applicatins. This is because typically the CCB deals with cases wherein a physician has recmmended a curse f treatment fr the patient, finds the patient t be incapable, and the patient has challenged the finding f incapacity. Because MAID requests will be patient-initiated, and the physician is nt prpsing the treatment in this circumstance, it is unclear whether the CCB wuld find that it has jurisdictin t hear applicatins and, if they d hear the applicatin, whether the CBB is able t prvide an effective remedy fr patients as the Bard is unable t require the physician t prvide MAID t that patient. 6
Future Webinar Updates Lng-Term Care Hmes Update frm the Chief Crner Planned Legislative Amendments (late summer/early fall) Mck MAID Case 7
Key Cntacts / Infrmatin Sharing Mechanisms 1. MOHLTC will cntinue t have these webinar sessins n a bi-weekly r as-needed basis. Future meetings will be crdinated by MOHLTC. 2. Fr clinicians wh have any questins abut the Clinician Referral Service: E-mail: maidregistratin@ntari.ca T access the service, phne: 1-844-243-5880 3. Fr any public inquiries r general questins abut MAID in Ontari: E-mail: endflifedecisins@ntari.ca This is the email address that shuld be shared with yur stakehlders/members fr general inquiries 8