The third meeting of Aging Gracefully was held on Tuesday, June 6th at the Senior Activity Centre in West Vancouver, BC.
Our speaker, Paul Magennis, was introduced by Paula Cline. He is the Regional Clinical Educator for the Vancouver Coastal Health Assisted Dying Program often referred to as MAiD. Paul, who has received a Bachelor of Science Degree from the University of Waterloo and a Nursing Degree from UBC, worked in Acute Palliative Care at Burnaby Hospital before his present position at Vancouver General Hospital. He is now teaching VGH staff the skills and knowledge about medical assistance in dying that they need to support patients as they contemplate their end-of-life care.
Paul first gave us an overview of how and where MAiD fits into the bigger picture of palliative care (see diagram below) and a brief history including how court challenges resulted in the current legislation concerning medical assistance in dying. He emphasized that we have a constitutional right to choose this option, as long as the eligibility criteria and safeguards have been met.
Paul was not aware of any current major challenges to medical assistance in dying laws in Canada. The most recent court decisions have resulted in expanded access, such as for those suffering with a mental disorder as their sole underlying medical condition. The implementation of this ruling has yet to take effect as the federal government determined more time was needed to ensure this ruling was met in a safe, equitable, and ethical manner. There are also parliamentary committees that have been discussing the need to consider Advance Directives and the inclusion of mature minors within MAiD legislation. These are not challenges to the existing laws, but rather discussion about how existing laws should be applied to specific groups and situations in the future.
Conversations and planning regarding palliative care can begin as soon as a person receives a life-limiting diagnosis. Active palliative treatments might not be appropriate at that time, but as a person’s condition and symptoms worsen, palliative care options become more important. We often think of palliative care as end of life care, and while that is a component of it, it is also focusing on symptom management and quality of life at any point in a person’s illness journey. As this diagram illustrates, curative and life prolonging care can and does happen at the same time as palliative care.
How does medical assistance in dying fit into the timeline on the diagram above? While there is no specific time when considering MAiD becomes appropriate—this is a personal choice for the individual when they are considering their illness, disease, or disability, and the level of suffering they are willing to endure as they approach their end of life—medical assistance in dying may fit in with the Life Closure section of this graph, where a person can continue with curative and life prolonging care, and palliative/symptom management, while they also consider and plan for their end of life.
MAiD is available to people who have a grievous and irremediable medical condition, are in an advanced state of irreversible decline in capability, and that condition is causing enduring physical or psychological suffering that is intolerable to them and cannot be relieved under conditions that they consider acceptable. The legislation does not define what conditions do or do not fit into this eligibility criteria—this is to be determined by the MAiD assessors in consultation with the patient, and in consideration of their full medical history and all dimensions of the person’s suffering. Here is a link for the full eligibility criteria as well as a line for the Model Practice Standards published by The Government of Canada.
Full eligibility criteria:
Medical Assistance in Dying - Province of British Columbia (gov.bc.ca)
Model Practice Standards for Medical Assistance in Dying (MAID):
While there is currently no ability to write an Advance Directive for MAID, there are things you can do now if this is something you would want to consider in the event you have a grievous and irremediable medical condition in the future. You can, and should, have conversations with your family and family doctor about your values and goals in regards to your end-of-life. This may include many things (palliative care, hospice, CPR, intubation, etc.) including your beliefs and values about medical assistance in dying. By knowing your beliefs and values about your end of life, your family doctor will know ahead of time whether and when to have these discussions with you if it becomes appropriate.
If you have been assessed and found eligible for medical assistance in dying, have a Reasonably Foreseeable Natural Death, and are at risk of losing capacity, you may enter into an agreement with your MAiD provider (one of the doctors or nurse practitioners that did your assessment) that will allow them to proceed with your assisted death in the event you lose capacity and are not able to provide consent on the day you scheduled your assisted death. This is called the Waiver of Final Consent. This is different from an Advance Directive. More information on this can be found in the two links provided above.
Paul emphasized that patients have complete autonomy when it comes to this procedure. You can start, pause, postpone, or stop the process at any time for any reason. (See comment above about the Waiver of Final Consent.) No one can do it on your behalf. No one can coerce you into applying or decide when you are ready. Only you know your capacity for pain and your desire for a basic quality of life.
Part of the assessment process is to make sure your request is being made freely, without undue influence from family members, health care providers, or others. The assessors must also be of the opinion that the person requesting MAiD has the capacity to make decisions with respect to MAiD at the time of the MAiD assessment.
A person may have their assisted death at the location of their choosing, within practical limits. For instance, faith based hospitals, long-term-care sites (LTC), and hospices typically do not allow assisted dying to occur at their locations. This is something to be aware of when selecting an LTC or a hospice site, as a person will be forced to move to another location to have their assisted death. While Paul is not aware of any laws that prevent having a medically assisted death in places like a park or beach, gaining permission for this might be difficult, and these locations do not provide the privacy you would have in your home or hospital room.
There are a few steps to follow in applying for MAiD. You can call your health authority yourself or you can do this through your doctor or care giver. The phone number for the Assisted Dying Program at Vancouver Coastal Health is 1(844) 550-5556, or (604) 875-4295 with office hours Monday to Friday, 8am to 4pm. As well, you can go to vch.ca and search “MAiD”. The Assisted Dying Program Care Coordinators can answer any questions you have and help you access the Request for Medical Assistance in Dying form (which can also be found by Googling “BC MAiD forms").
If you are found eligible for medical assistance in dying and have met the appropriate safeguards, you may, if you choose, schedule your assisted death. Arrangements will be made with the Assisted Dying Program Care Coordinators and your MAiD provider (one of the doctors or nurse practitioners that did your MAiD assessments). You will discuss with your provider the date and time you would like your assisted death, and whether you would prefer to receive the medication through an IV or an oral liquid. Your provider can discuss the benefits and risks of each of these options. Your provider and at least one nurse will be there to support you and your loved ones at your assisted death.
There is a booklet available on the website below with current information on this process. If you have questions, or would like more information, please visit the Vancouver Coastal Health MAiD website at vch.ca, and search for “MAiD”. Here you will find resources such as:
- Frequently Asked Questions
- The Booklet and Brochure
- Grief and Bereavement Resources
- Links to Palliative Support
https://www.vch.ca/en/service/medical-assistance-dying#resources--73266
Our next meeting will be held in the Fall with our first speaker from VanCity who will explain financial situations during different stages of retirement.
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