Area Section Subsection Document Type Administration General N/A Policy Scope Approved By Penny Gilson, CEO EMT Meeting 2017-Nov-14 All Staff/Physicians Original Effective Date Revised Effective Date Reviewed Date 2017-Nov-22 N/A N/A DEFINITIONS Abstaining Facility: A faith-based Prairie Mountain Health (PMH) Facility which is funded but not owned or operated by PMH and which adopts and publishes an official policy or position that it will not allow (a) an Assessment Process and/or (b) MAiD (or certain aspects of MAiD), to be provided within its Facility. Abstaining Facilities in PMH include: Ste. Rose General Hospital Dr. Gendreau Personal Care Home (PCH) Winnipegosis & District Health Centre and PCH Dinsdale Personal Care Come Affiliate Facility: A facility which has a funding relationship with, but is not owned and operated by PMH. PMH Facility: Any facility which is PMH owned, operated or funded, including affiliate facilities. Approved Facility: A PMH Facility designated by the PMH Chief Medical Officer (CMO) as where MAiD may be provided. Abstaining Facilities are deemed not to be Approved Facilities. Assessment Process: The process for examination of the medical condition of a Patient so that all appropriate and available therapeutic options of the Patient can be identified, and the resulting consultation with a Patient on those therapeutic options available to the Patient to address the Patient s health and medical needs, including the assessment of the Patient by an Authorized Practitioner in accordance with the MAiD Clinical Guide to determine whether the Patient meets the MAiD Criteria. Authorized Practitioner: A Medical Practitioner or Nurse Practitioner who has been granted privileges by the WRHA CMO to provide MAiD. Conscientious Objector: Any staff who expresses any reservation with respect to providing information about MAiD or participating in any aspect of an Assessment Process or of MAiD on the basis of a conscientious objection. Grievous and Irremediable Medical Condition: A condition of a Patient that meets all of the following criteria: a) the Patient has a serious and incurable illness, disease or disability; b) the Patient is in an advanced state of irreversible decline in capability; Page 1 of 6
c) that illness, disease or disability or that state of decline causes the Patient enduring physical or psychological suffering that is intolerable to the Patient and that cannot be relieved under conditions that the Patient considers acceptable; and d) the Patient s natural death has become reasonably foreseeable, taking into account all of the Patient s medical circumstances, without a prognosis necessarily having been made as to the specific length of time that the Patient has remaining. MAiD or Medical Assistance in Dying: The administering by a Medical Practitioner or Nurse Practitioner of a substance to a person, at that person s request, that causes death; or the prescribing or providing by a Medical Practitioner or Nurse Practitioner of a substance to a person, at that person s request, so that they may self-administer the substance and in doing so cause their own death. For certainty, MAiD does not include the Assessment Process. MAiD Clinical Guide: Clinical guide for the manner of performance of the Assessment Process and the provision of MAiD, including guidance on the MAiD Criteria, and the clinical and administrative procedures to be followed, as may be approved from time to time by the Winnipeg Regional Health Authority CMO and by the Provincial Medical Leadership Council. MAiD Criteria: The Patient is eligible if: a) after any applicable minimum period of residence or waiting period, would be eligible for health services funded by a government in Canada; b) they are at least 18 years of age and capable of making decisions with respect to his or her health; c) they have a Grievous and Irremediable Medical Condition; d) they have made a voluntary request for MAiD that, in particular, was not made as a result of external pressure; and e) they have given informed consent to receive MAiD after having been informed of the means that are available to relieve their suffering, including palliative care. Medical Practitioner: A person who is entitled to practice medicine under the laws of Manitoba. Nurse Practitioner: A registered nurse who, under the laws of Manitoba, is entitled to practice as a Nurse Practitioner or under an equivalent designation and to autonomously make diagnoses, order and interpret diagnostic tests, prescribe substances and treat patients. Patient: Any individual who expresses an interest in having MAiD provided to that individual, including without limitation an individual who may be a patient, resident or client of a PMH Facility or PMH program. Staff: All persons employed or engaged by PMH or by a PMH Facility, including members of the medical staff, physicians, volunteers, board members, students, and other individuals associated through legal contracts, while acting in that capacity, or on behalf of PMH or in a PMH Facility. Provincial MAiD Clinical Team: A multi-disciplinary team made up of Medical Practitioners, Nurses, Social Workers, Pharmacists and a Speech Language Pathologist. Only the provincial medical assistance in dying clinical team is authorized to provide medical assistance in dying within regional health care facilities in Manitoba. Page 2 of 6
PURPOSE The Supreme Court of Canada determined that an absolute prohibition of MAiD violates the rights of some individuals under the Canadian Charter of Rights and Freedoms and is unconstitutional. In response to the Supreme Court ruling, the Canadian Parliament passed legislation, an Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) (The Act). The Act grants individuals the right to autonomy over the decision to end their own lives, when they meet the legislated criteria. The Act recognizes that nothing in the legislation affects individual rights to freedom on conscience and religion. The Act furthermore recognizes that the principles of The Canada Health Act regarding accessibility to medical services apply to MAiD. The purpose of this policy is to provide direction for access to MAiD, to be provided in PMH owned and operated facilities and Affiliate Facilities, as well as clarity for Abstaining Facilities and Conscientious Objectors, respecting compliance with provincial and federal law and consistent with statements on MAiD from the College of Physicians and Surgeons of Manitoba (CPSM), the College of Registered Nurses of Manitoba (CRNM), the College of Licensed Practical Nurses (CLPNM), the College of Registered Psychiatric Nurses of Manitoba (CRPNM), the College of Pharmacists of Manitoba, the Manitoba College of Social Workers, College of Audiologists and Speech Language Pathologists of Manitoba, and other healthcare profession regulators. This policy does not apply to the provision of MAiD in a location which is not a PMH Facility by persons who are not Staff. APPLICATION This policy applies to all employees, students, volunteers and other persons acting on behalf of PMH (including Affiliate Facilities and contracted service providers, and their employees, students, volunteers and other persons that act on their behalf). POLICY STATEMENT Recognized Procedure MAiD is recognized as a medical procedure to the extent that it is permitted by the law, and as one of a number of medical procedures and therapeutic services which are available to individuals who are suffering from a Grievous and Irremediable Medical Condition. Availability Unless otherwise set out in this policy, MAiD shall be made available in all PMH owned and operated facilities and Affiliate Facilities which are Approved Facilities (Affiliate Facilities need to provide written policies and procedures to PMH complaint with this policy) to patients who have been assessed as eligible. At the discretion of an Authorized Medical Practitioner, MAiD may be provided in a location outside of an Approved Facility, including the Patient s residence. Abstaining facilities will develop written policies and procedures that clearly articulate their position with respect to MAiD, as well as procedures for responding to requests for MAiD and information about MAiD. These policies and procedures must be easily accessible and available to the public. PMH will respect the determination of Abstaining Facilities to adopt and comply with such a policy or position. MAiD Criteria MAiD shall not be approved for or provided to a Patient who does not fully satisfy the MAiD Criteria. A Patient who does not fully satisfy the MAiD Criteria shall be informed of and referred to alternative and appropriate therapeutic medical services that may be available. Page 3 of 6
Compliance All PMH Facilities and all Staff (with the exception of those who have registered Conscientious Objection as per this policy) who may be providing healthcare or medical services to Patients shall comply at all times with this Policy in respect of any enquiry or request for MAiD, and assist the Provincial MAiD Clinical Team as required. PMH and the MAiD Team will ensure compliance with any federal/provincial laws and regulations concerning the provision and collection of MAiD data. PMH will cooperate with any provincial committees or councils established to review MAiD in Manitoba. Assessment and Procedures The performance of the Assessment Process to determine eligibility and the provision of MAiD shall be performed in compliance with the provincial MAiD Clinical Guide and shall be completed by the Provincial MAiD Clinical Team located in the Winnipeg Regional Health Authority in Manitoba. No Retaliation Where a Patient, or a member of the family of the Patient, expresses an interest in the provision of MAiD, requests information on MAiD, or otherwise pursues the Assessment Process and/or the provision of MAiD, Staff and PMH Facilities shall not: a) take or threaten any discriminatory or retaliatory action against the Patient; b) take or fail to take any action which may or does result in the reduced availability or diminution of the level of healthcare services provided to the Patient; or c) cause the Patient to be discharged or transferred to another healthcare facility, except in accordance with a documented treatment plan approved for the Patient or for the purposes of the provision of MAiD. Patients and/or families may communicate any concerns about discrimination or retaliation to the PMH Patient Relations Representative where investigations associated with MAiD will be prioritized and expedited. Conscientious Objector A Conscientious Objector shall not be required to directly provide any information about MAiD or to participate in an Assessment Process or in any aspect of MAID. Staff who choose not to participate in MAiD will not be forced, coerced or face retaliation as a result of choosing not to participate. However, this does not relieve the Staff from obligations to comply with the requirements of their applicable professional college or regulatory authority and to provide to the Patient or family member timely access to a resource that will provide accurate information about MAiD as described in the procedures and responsibilities of this Policy. PROCEDURE/RESPONSIBILITIES The Provincial MAiD Clinical Team is responsible for the assessment process, determining eligibility, and the provision of MAiD in all PMH facilities. PMH staff will act primarily as a liaison between the Patient and the Provincial MAiD team. Regardless of where the patient resides or receives health or medical services (including at Abstaining Facilities), the patient may contact or be referred to the website, email address or telephone number maintained by the WRHA to answer enquiries regarding, and to provide more detailed information about MAiD (a link is also located on the PMH public website and internal intranet): o www.wrha.mb.ca/maid o maid@wrha.mb.ca o (204) 926-1380 or 1-844-891-1825 Page 4 of 6
Where a Patient or family member requests that a PMH staff member initiate a referral to the Provincial MAiD Team, or when a Patient or family member notifies a PMH staff member of their intent to make direct contact with the Provincial MAiD team, the PMH Staff Member will: Acknowledge it Explore it and; Respond to it. Responding will include notifying their direct Supervisor. The Supervisor shall notify the Chief Executive Officer (CEO) by e-mail at pgilson@pmh-mb.ca and include in the subject line MAiD. It is important for all PMH staff to be aware of the legal requirements and processes associated with MAiD and their professional responsibilities. Advice for Health Professionals can be found at the WRHA contact information listed above. Where a Patient of an affiliate site requests assistance with the MAiD referral, the above noted process will be followed. Where a Patient is located in an Abstaining Facility, arrangements shall be made to move the Patient to another facility for the assessment process to be completed and, if eligible, to have the MAiD procedure completed. The Abstaining Facility will have a clear protocol to ensure transfer of care proceeds in a safe, timely and coordinated manner. Patients in an Abstaining Facility may not be able to access MAiD if they are too ill or frail to be transferred or if they decline to be transferred. A person who is subject to this policy shall: Not impose their own views and values onto the Patient requesting MAiD, or their family, no use their position to influence, judge or discriminate against persons whose values are different from their own; Respect the autonomy and dignity of the Patient being cared for; Not suggest, counsel, encourage or coerce a person to seek or not seek MAiD; and Continue to provide the health and medical services required by the Patient, until the Provincial MAiD Team arrives at the facility to provide MAiD. A staff member who invokes conscientious objector status shall file their objection in writing to their direct Supervisor. The direct Supervisor shall provide a copy to the Vice President, Human Resources. A conscientious objector will not be expected to actively participate in providing information about MAiD or support the MAiD process. If approached by a patient seeking information on MAiD, timely access shall be ensured by reaching out to a direct Supervisor or referring the patient to the website or toll free number to find out more information on their own. Patients receiving MAiD and their family members will be provided a private and/or quiet room within the facility. PMH will also endeavor to provide appropriate space in a PMH Facility where the person is not currently a patient of PMH, resides in PMH, has met the MAiD eligibility criteria and does not wish to have the procedure performed in their home. Following the death of the Patient the facility staff or family notifies the funeral home and discharge summary is completed as per normal process. Following the death of the Patient in their home, the family notifies the funeral home and documentation is completed as per the Home Care process. Page 5 of 6
The MAID Team completes the death certificate in accordance with any applicable governmental guidelines. The first page, the Registration of Death includes only demographic information. This is the page that will go to the funeral home. MAiD will not be indicated. REFERENCES Criminal Code of Canada College of Physicians and Surgeons of Manitoba By-Law 11 Schedule M College of Registered Nurses of Manitoba - Medical Assistance in Dying: Guidelines for Manitoba Nurses (2017) College of Pharmacists of Manitoba Update on Medical Assistance in Dying Manitoba College of Social Workers Medical Assistance in Dying Information Summary College of Audiologists and Speech Language Pathologists of Manitoba Notice re: Medical Assistance in Dying MHSAL Policy 200.33 WRHA Policy 110.000.400 Medical Assistance in Dying - Interim DOCUMENT HISTORY Version 2017-Nov-22 Changes New. Page 6 of 6