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1-800-267-3390On June 17, 2016, the federal government’s Bill C-14 An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) received royal assent and became law in Canada. As a result of receiving royal assent, the provisions of Bill C-14 which amend the Criminal Code now form part of the Code, and set out the circumstances when medical assistance is dying will not be considered a criminal offence. In this document, we will also refer to these provisions of Bill C-14 as “the Criminal Code”.
In order to collect data on the provision of MAID in Canada, the Regulations for the Monitoring of Medical Assistance in Dying were enacted in 2018. Doctors, nurse practitioners, and pharmacists involved with the provision of MAID are required to formally report certain data. Health Canada publishes annual reports on MAID in Canada on the basis of this information.
On March 17, 2021, amendments to the MAID provisions in the Criminal Code were enacted and are now in force. The amendments include several changes to the eligibility criteria and procedural safeguards. The Department of Justice has published a summary of the changes here.
Bill C-7 also included some changes to the monitoring data to be reported by practitioners, including information on gender identity, race, Indigenous identity and disability if the person consents to providing it. These are contained within the Regulations Amending the Regulations for the Monitoring of Medical Assistance in Dying, which will come into force on January 1, 2023. Health Canada’s guidance on this reporting requirement can be found here.
1) Can I provide MAID to my patients?
2) What if I do not want to participate in MAID?
3) What are the eligibility criteria for MAID?
4) What other considerations exist when providing MAID?
5) Can I provide MAID to mature minors or children?
6) Can I provide MAID on the basis of an advance directive? A written agreement?
8) Can I provide information to my patients about MAID now that Bill C-14 has become law?
For registered nurses (and other nursing professions):
1) Now that Bill C-14 is law, what does this mean for RNs?
2) What other considerations exist with respect to MAID?
3) What if I am not prepared to participate in MAID?
4) As an RN, can I provide information to my patients about MAID?
5) Can I still provide nursing care to patients at the end-of-life?
General Q & A: More answers to some pressing questions for NPs and RNs*
1) What is the difference between “physician-assisted death” and “medical assistance in dying”?
3) Can I still provide nursing care to patients at the end-of-life?
4) Can I provide information about assisted death?
7) What if I am not prepared to participate in MAID?
* If you have more questions that are not addressed in this briefing, please send them to us at info@cnps.ca, and we will include the answers in an updated version.
Nurse Practitioners
1) Can I provide MAID to my patients?
2) What if I do not want to participate in MAID?
3) What are the eligibility criteria for MAID?
4) What other considerations exist when providing MAID?
5) Can I provide MAID to mature minors or children?
6) Can I provide MAID on the basis of an advance directive? A written agreement?
8) Can I provide information to my patients about MAID?
1) Can I provide MAID to my patients?
The MAID provisions in the Criminal Code created an exemption from criminal prosecution for healthcare providers participating in MAID. Two forms of MAID are exempt from criminal prosecution under the Criminal Code:
- The administration of a substance to a person, at their request, to cause their death; and
- The prescription or provision of a substance to a person, at their request, so that they may self-administer the substance.
The Criminal Code explicitly recognizes that the NP scope of practice could be sufficiently broad to allow NPs to provide all aspects of MAID (from the determination that the patient suffers from a grievous and irremediable condition, to obtaining the patient’s informed consent, to the prescription or administration of the substance). Accordingly, it exempts NPs from criminal prosecution (to the same extent as physicians) if they provide MAID in accordance with the requirements stipulated in the Criminal Code.
It is important to remember that the Criminal Code stipulates that MAID will have to be provided in accordance with “reasonable knowledge, care and skill and in accordance with any applicable provincial laws, rules or standards.” This suggests that failure to comply with any provincial law, rule, or the standards of practice could nullify the exemption. There are several other conditions outlined in section 241.2 of the Criminal Code, which nurses should carefully review.
Accordingly, before contemplating providing MAID, NPs should ensure that such activities fall within their provincially or territorially-regulated scope of practice. The NP will then have to ensure that they are providing MAID in accordance with all the requirements contained in the Criminal Code to avoid criminal prosecution. As mentioned, these requirements are comprehensive and are set out in a new section of the Criminal Code (section 241.2).
If an NP elects to participate in the provision of MAID, it would be prudent to:
- Familiarize themselves with the wording of the MAID Criminal Code provisions, including the requirements for eligibility, independence of the physicians or NP, informed consent, and conditions to be satisfied at the time of substance administration;
- Ensure that the activities that comprise MAID, such as administering the substance that causes death or prescribing the substance that causes death, fall within the NP’s scope of practice and is in accordance with the applicable provisions of any provincial legislation or regulation;
- Review any guiding documents from their regulatory body and ensure that the provision of MAID is in compliance with any applicable standards of practice;
- Ensure that they possess the necessary knowledge, skill and judgment to fulfill their responsibilities in the provision of MAID;
- Ascertain that MAID can be provided in the employment setting and review any applicable policies, guidelines, procedures and/or processes in place to guide the NP’s practice in the provision of MAID;
- Thoroughly document their patient care provided before, during, and after the provision of MAID;
- Ensure that they maintain, within the patient record, all of the documents specified in the relevant provisions of the Criminal Code for the provision of MAID, such as the written request for MAID, written opinion from another medial practitioner or NP confirming that the person has met all the criteria, and any other relevant document that could be required under the regulations;
- Proceed with the necessary assessment and be prepared to confirm that the patient meets the eligibility criteria in writing
- Seek legal advice to understand the relevant provisions of the Criminal Code.
2) What if I do not want to participate in MAID?
The amendments to the Criminal Code do not impose a mandatory obligation on any NP to participate in MAID (see section 241.2 (9)).
An NP can review the resources their nursing regulatory body and employer/health institution have in place for NPs who do not want to participate in MAID, usually called conscientious objection. If the NP declines to participate in MAID, the changes to the Criminal Code do not impose an obligation on the NP to refer a patient to a medical practitioner or NP who is willing to assist. However, NPs have a pre-existing legal duty of care to patients which prevents NPs from abandoning patients and necessitates effective referral to other healthcare providers in certain circumstances. If an NP declines to participate in MAID because it does not fall within their scope of practice, for moral or religious reasons, or because they are concerned about legal risk, it would be prudent for an NP to seek direction from their regulatory body and legal representative.
3) What are the eligibility criteria for MAID?
Before determining a patient’s eligibility for MAID, an NP must first ensure they have the regulatory and legislative ability to participate in MAID in their jurisdiction. Should the determination of eligibility and/or the ability to provide MAID to a patient be within their legislated scope of practice, an NP must turn to the new provisions of the Criminal Code to determine a patient’s eligibility.
According to these provisions, patients must meet the following criteria:
- They are eligible for health services funded by a government in Canada. Individuals who would be eligible but for an applicable minimum period of residence or waiting period would also be eligible
- They are at least 18 years of age and have the capacity to make decisions with respect to their health
- They have a grievous and irremediable medical condition*, which is a defined term in the Criminal Code
- Their request for MAID is voluntary and was not made as a result of external pressure
- They give informed consent to receive MAID after having been informed of the means that are available to relieve their suffering, including palliative care
* Grievous and irremediable medical condition is a defined term in the Criminal Code. An NP must refer to the legislative definition of this term when assessing a patient’s eligibility for MAID. CNPS is available to provide additional information about the definition of “grievous and irremediable medical condition”.
Bill C-7 responded to the Court decision that MAID could not be restricted to those whose natural death is reasonably foreseeable by removing that stipulation from the Criminal Code definition of a grievous and irremediable medical condition. A grievous and irremediable medical condition now meets the Criminal Code definition if all the following criteria exist:
- (a) they have a serious and incurable illness, disease or disability;
- (b) they are in an advanced state of irreversible decline in capability; and
- (c) that illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.
The Criminal Code now contains two sets of safeguards, depending on whether or not the person’s natural death is reasonably foreseeable.
When natural death is reasonably foreseeable, the original safeguards remain as they were prior to Bill C-7 with the exception of:
- (a) the removal of the 10 day reflection period before MAID could be given; and
- (b) one witness now required to the written request for MAID rather than two.
When natural death is not reasonably foreseeable, the original safeguards apply, with some additional safeguards as well:
- If the physician or NP does not have expertise in the condition causing the person’s suffering, one of the practitioners is to consult with an physician or NP with expertise and share the results with the other physician or NP.
- The physician or NP must ensure the person has been informed of the means available to relieve their suffering, e.g. where appropriate, counselling; disability support services; community services; palliative care; and have been offered consultation with those professionals.
- Both MAID physician or NP assessors have discussed with the person the reasonable and available means to alleviate the suffering and they agree with the person that the person has given serious consideration to those means.
- Ensure at least 90 clear days (or shorter period if capacity may be lost) between the first assessment of eligibility criteria and of MAID
4) What other considerations exist when providing MAID?
In addition to setting out the eligibility criteria for MAID and the criteria for a grievous and irremediable medical condition, the Criminal Code mandates several safeguards which must be put in place and followed before MAID can be provided to a patient without constituting a criminal offence.
For instance:
- An NP (or physician) must ensure that the person’s request for MAID was made in writing and was signed and dated. The request and signatures must be witnessed by one independent witness who also signs and dates the request. Independence as it relates to the witnesses is defined in detail in the Criminal Code and includes, notably, that a witness cannot be the physician or NP who provided a MAID eligibility opinion or who will provide MAID. The request must then also be signed and dated after the person has been informed by an NP or physician that they have a grievous and irremediable medical condition that would render them eligible for MAID.
- Prior to proceeding with MAID, another physician or NP must have provided a written opinion confirming that the patient meets all of the criteria set out above.
- The physicians or NPs providing their opinion regarding eligibility for MAID must be independent from one another. Independence is defined within the Criminal Code and NPs should carefully review this definition prior to agreeing to evaluate a person for MAID eligibility.
- The person requesting MAID must be informed that they may withdraw their request for MAID at any time. Further, immediately before the provision of MAID, that person must be given an opportunity to withdraw their request and to confirm their express consent to proceed with MAID (there is an exception; see Question 6 below regarding “a written agreement”).
- An NP providing MAID must advise the dispensing pharmacist that the prescribed substance is intended for the purpose of MAID before the substance is dispensed.
It is important for NPs to remember that failure to comply with those safeguards could provide the basis for a criminal prosecution.
5) Can I provide MAID to mature minors or children?
No. As a result of the eligibility criteria set out above, MAID is not available to mature minors or children.
6) Can I provide MAID on the basis of an advance directive? A written agreement?
Not on the basis of an advance directive when the person is no longer capable and a substitute decision maker is responsible for making health care decisions. As a result of the criteria set out above, and the safeguards contained in the Criminal Code, MAID cannot be provided as a result of an advanced directive where the individual receiving MAID would not have capacity to provide express consent at the time of the provision of MAID.
Bill C-7 created two situations where a written agreement can be entered into regarding MAID.
If a person whose natural death is reasonably foreseeable has been found eligible for MAID, they may enter into a written agreement with the physician or NP to have MAID on a specific day if the person has lost capacity by that day. In this situation, there is no need for express consent immediately before MAID is provided. However, MAID cannot be provided if the person demonstrates by words, sounds, or gestures their refusal to have the MAID substance administered or resistance to its administration, with the exception for involuntary responses to contact that do not demonstrate refusal or resistance. Careful assessment and documentation of the person’s behaviour on the day of MAID is strongly recommended.
A written agreement may also be entered into to permit MAID to be completed by an physician or NP if the person loses the capacity to consent to it as a result of the self-administration of a MAID substance. The physician or NP would have to be present at the time the person self-administered the first substance.
The Criminal Code contains more detailed requirements about written agreements than are summarized here, and so a full review of those provisions must take place prior to an NP determining that the circumstances that permit a written agreement exist.
7) Can I be part of a MAID team consisting of multiple health professionals with the sole purpose of providing MAID services to patients?
As an NP, you may be asked to be part of a designated group of health care professionals who provide MAID services in a particular institution or health authority. There is no prohibition against participating in such a dedicated team. NPs should be mindful of their role within the team as well as the regulatory and legislative limitations placed on them with respect to MAID such as their ability to prescribe controlled substances, and the requirement of independence between practitioners assessing patients for MAID eligibility.
The conditions of eligibility and safeguards for MAID now set out in the Criminal Code must be met regardless of how MAID is to be implemented by a particular institution or health authority. The designation of a MAID-specific team does not change the underlying legal and regulatory requirements for the participating NPs and other health professionals (e.g. the requirement of independence between those assessing eligibility for MAID and those providing MAID as well as the requirement of independence between the patient and witnesses to the patient’s request for MAID). It would be prudent for NPs who contemplate providing MAID as part of a dedicated team to ascertain that the independence criteria is satisfied. CNPS beneficiaries can contact us if they require further information in this regard.
As is the case when an NP is not part of a health team, the NP must continue to be mindful that subsection 241(a) of the Criminal Code makes it a criminal offence to “counsel” a person to commit suicide. Due to the criminal significance of the word “counsel” (to encourage, solicit or incite), an NP must be mindful not to encourage or incite a patient to seek MAID in their role as a member of a MAID team.
8) Can I provide information to my patients about MAID?
Yes. The provision of objective information is not prohibited by the Criminal Code nor is it impacted by the changes brought about by Bill C-7. In addition, the Criminal Code now incorporates a clarification that permits NPs and other health care professionals to provide information about the lawful provision of MAID to a patient (section 241 (5.1)). NPs can share information and engage in discussions about MAID with their patients.
However, NPs must be mindful that subsection 241(a) of the Criminal Code continues to make it a criminal offence to “counsel” a person to commit suicide. For the purposes of the Criminal Code, “counsel” means encourage, solicit or incite. Due to the criminal significance of the word “counsel,” an NP must be mindful not to encourage or incite a patient to seek MAID.
To reduce the risk of allegations of counselling within the meaning of the Criminal Code, it would be prudent for nurses (amongst other things) not to participate in the preparation of any written request for MAID made by the patient including the completion of a standardized MAID request form used within their employer institution. Further, as addressed above, the requirements of independence from witnesses would prohibit NPs from witnessing request for MAID for patients with whom they are directly involved in their care.
Registered Nurses (all non-NP classes of nursing registration)
- What does MAID mean for RNs?
- What other considerations exist with respect to MAID?
- What if I do not want to participate in MAID?
- As an RN, can I provide information to my patients about MAID?
- Can I still provide nursing care to patients at the end-of-life?
- As an RN, can I be part of a MAID team consisting of multiple health professionals with the sole purpose of providing MAID services to patients?
- Will I be considered to be “assisting” in the provision of MAID simply by being present in the room while the patient is being prepared and the substance is administered?
- Can I help to draft policies and procedures for MAID in the institution where I work?
1) What does MAID mean for RNs?
Bill C-14 amended the Criminal Code and created an exemption from criminal prosecution for health care professionals who assist physicians or NPs in the provision of MAID (section 241 (3)). Two forms of MAID would be permitted under the Criminal Code:
- The administration of a substance to a person, at their request, to cause their death; and
- The prescription or provision of a substance to a person, at their request, so that they may self-administer the substance.
There are a number of important considerations that an RN contemplating participating in the provision of MAID will have to take into account.
First, an important limitation to the role of the RN exists in the Criminal Code, in that it expressly requires that the physician or the NP administer the substance which will bring about death. Although there are other provisions which contemplate that physicians and NPs may be assisted by other health care professionals, a court could find that this requirement must be applied literally. This means that while RNs could assist by arranging IV access, or preparing the medication, for instance, they cannot administer the substance pursuant to a prescription. Failure to comply with this requirement could nullify the exemption for both the physician or the NP who issued the prescription and the RN who administered the substance. Accordingly, it would be prudent to ensure that the NP or physician administer the substance personally. Similarly, because the Criminal Code expressly provides that a person may be given a prescription to “self-administer”, in that case, the patient would have to be the one to physically take the medication and the nurse would be prudent to not assist with the actual administration of the medication.
If an RN should elect to participate in MAID, it would be prudent to:
- Familiarize themselves with the wording of the new Criminal Code provisions
- Review any guiding documents from their regulatory body
- Determine the employer’s position in permitting MAID in the employment setting and be aware of any applicable policies, guidelines, procedures and/or processes in place to guide the RN’s role in MAID
- Ensure that their practice is in accordance with the applicable provisions of the new law, all other applicable laws, rules, and standards
- Seek legal advice to understand the relevant provisions of the Criminal Code
2) What other considerations exist with respect to MAID?
In addition to setting out the eligibility criteria for MAID and the criteria for a grievous and irremediable medical condition, the Criminal Code mandates several safeguards which must be put in place and followed before MAID can be provided to a patient.
Many of the safeguards apply to NPs or physicians conducting the assessment for MAID or its subsequent administration. However, there remain several factors of important to RNs throughout the MAID process.
For instance, the Criminal Code requires that a person’s request for MAID must be made in writing, signed and dated, and witnessed by an independent witnesses who also sign and date the request. The Criminal Code states that in order to be independent, a witness cannot know or believe to be a beneficiary under the will of the person making the request, and cannot be an owner or operator of a health care facility where the person making the request is being treated.
Bill C-7 changed one of these restrictions and now, a witness can be a someone who provides health care services or personal care services as their primary occupation and who is paid to provide that care to the person requesting MAID (except for the physicians or NPs who provided a MAID eligibility opinion about that person or who will provide MAID to that person). This change reduces a barrier to access to MAID but since the spirit and intention of the law is patient autonomy without external influence, nurses and health institutions may decide their best practice is that such an independent witness who is a health care or personal services provider is used as a last resort.
Second, the Criminal Code stipulates that MAID will have to be provided in accordance with “reasonable knowledge, care and skill and in accordance with any applicable provincial laws, rules or standards.” This suggests that failure to comply with any provincial law, rule, or the standard of practice could nullify the exemption.
Third, before participating in the process, RNs should verify that a medical or nurse practitioner has documented their determination that the conditions set out in s. 241.2 of the Criminal Code have been met. For the most part, this can occur by:
- Reviewing the chart to determine whether documentation clearly indicates that all requirements have been met (e.g. this may be in the form of a standardized document, completed by the physician or nurse practitioner indicating that all required criteria have been met)
- Inquiring directly with the physician or NP providing MAID
Then it would be prudent for the nurse to carefully document in the client’s chart what steps the nurse took to verify the determination that the eligiblity criteria and safeguards have been met.
RNs must familiarize themselves with the applicable safeguards to ensure that they are acting appropriately with respect to a patient who is requesting MAID.
3) What if I do not want to participate in MAID?
The amendments to the Criminal Code do not require any nurse to participate in MAID (see section 241.2 (9)).
A nurse can review the resources their regulatory body and employer have in place for nurses who do not want to participate in MAID, usually called conscientious objection. If the nurse declines to participate in MAID, the changes to the Criminal Code do not impose an obligation on the nurse to participate but nurses have a pre-existing legal duty of care to patients which prevents them from abandoning patients. Quickly engaging with the employer’s resources will help with assignment of patient care. If a nurse declines to participate in MAID because it does not fall within their scope of practice, for moral or religious reasons, or because they are concerned about legal risk, it would be prudent for the nurse to seek direction from their nursing regulatory body and legal representative.
4) As an RN, can I provide information to my patients about MAID?
Yes. The provision of objective information is not prohibited by the Criminal Code, which contains a provision that permits NPs and other healthcare professionals to provide information about the lawful provision of MAID to a patient (section 241 (5.1)). RNs can share information and engage in discussions about MAID with their patients.
However, RNs must be mindful that subsection 241(a) of the Criminal Code makes it a criminal offence to “counsel” a person to commit suicide. For the purposes of the Criminal Code, “counsel” means encourage, solicit or incite. Due to the criminal significance of the word “counsel,” an RN must be mindful not to encourage or incite a patient to seek MAID.
To reduce the risk of allegations of counselling, within the meaning of the Criminal Code, it would be prudent for nurses not to participate in the preparation of any written request for MAID made by the patient, such as the completion of a standardized MAID request form used within their employer institution.
RNs may also chose to refer a patient’s inquiries about MAID to their treating physician or NP, to a designated MAID health care team, if available, or to health institution personnel who may be in a better position to respond to questions about services available at the institution.
5) Can I still provide nursing care to patients at the end-of-life?
RNs working with patients who are making decisions about end-of-life care can continue to care for these patients as they have done up to this point. However, it is prudent to recognize that there is a difference between initiating an intravenous [“IV”] line for the sole purpose of administering a substance that would terminate a patient’s life versus doing so to administer a substance that is part of the patient’s normal course of treatment.
If an RN is asked to initiate an IV line for the purpose of facilitating a physician’s administration of a substance that causes a patient’s death, they may be considered to be participating in MAID and must make the necessary inquiries to satisfy themselves that the patient has met the legal requirements for MAID. As always, RNs are encouraged to contact a CNPS legal counsel member (1-800-267-3390) to discuss the legal risks associated with participating.
6) As an RN, can I be part of a MAID team consisting of multiple health professionals with the sole purpose of providing MAID services to patients?
As an RN, you may be asked to be part of a designated group of health care professionals who provide MAID services to a particular institution or health authority. As a member of a MAID team, an RN will continue to be able to share information about MAID with inquiring patients. However, an RN should be mindful of their role within the team as well as the regulatory and legislative limitations placed on them with respect to MAID. While RNs are exempt from criminal prosecution for assisting a physician or an NP with the provision of MAID, they should ensure that their conduct does not fall outside of the legislated exemption; for instance, the RN should not be in the position of determining the eligibility of the patient for MAID or administering the substance that brings about death. The RN must be mindful that subsection 241(a) of the Criminal Code makes it a criminal offence to “counsel” a person to commit suicide. Due to the criminal significance of the word “counsel” (to encourage, solicit or incite), an RN must be mindful not to encourage or incite a patient to seek MAID in their role as a member of a MAID team.
The existence of MAID teams does not prohibit an RN from being involved in the provision of MAID outside of the team setting.
The conditions of eligibility and safeguards for MAID set out in the Criminal Code must be met regardless of how MAID is to be implemented by a particular institution or health authority. The designation of a MAID-specific team does not change the underlying legal and regulatory requirements for the participating RNs and other health professionals (e.g. the requirement of independence between those assessing eligibility for MAID and those providing MAID).
7) Will I be considered to be “assisting” in the provision of MAID simply by being present in the room while the patient is being prepared and the substance is administered?
Likely no. However, anything done directly in support of the provision of MAID (for example, the preparation of a substance, or the insertion of an IV) could be considered to be participation in the provision of MAID.
8) Can I help to draft policies and procedures for MAID in the institution where I work?
Yes. Assisting with the drafting of policies and procedures for MAID is likely not considered “assisting” in the provision of MAID for the purposes of the Criminal Code and will likely not attract criminal liability for assisted suicide or culpable homicide.
General Q&A
1) What is the difference between “physician-assisted death” and “medical assistance in dying”?
3) Can I still provide nursing care to patients at the end-of-life?
4) Can I provide information about assisted death?
7) What if I am not prepared to participate in MAID?
1) What is the difference between “physician-assisted death” and “medical assistance in dying”?
The term used in the Carter v. Canada decision is “physician-assisted death”. However, recognizing that this process involves the entire health care team, legislators revised the term to “medical assistance in dying” in Bill C-14 to be more inclusive and reflective of actual practice. Now that Bill C-14 has become law, the revised language of MAID is in effect and reflects the participation of the entire health care team in this process.
2) If my province or territory issued a statement regarding exemption from criminal prosecution for participating in MAID, is that statement still valid given the coming into force of Bill C-14?
In the time after the Supreme Court of Canada’s deadline of June 6, 2016 and before the coming into force of Bill C-14 on June 17, 2016, many jurisdictions issued statements regarding exemption from criminal prosecution for nurses participating in MAID. Now that Bill C-14 has received royal assent, it has officially become law and has amended the Criminal Code. These amendments to the Criminal Code are now the governing law on the subject of MAID. Nurses participating in MAID should ensure that they are meeting the legislative requirements for MAID, regardless of whether their jurisdiction has issued a statement or letter regarding exemptions from criminal prosecution.
3) Can I still provide nursing care to patients at the end-of-life?
Nurses working with patients who are making decisions about end-of-life care can continue to care for these patients as they have done up to this point. However, it is prudent to recognize that there is a difference between initiating an intravenous [“IV”] line for the sole purpose of administering a substance that would terminate a patient’s life versus doing so to administer a substance that is part of the patient’s normal course of treatment.
If a nurse are asked to initiate an IV line for the purpose of facilitating a physician’s administration of a substance that causes a patient’s death, they may be considered to be participating in MAID and must make the necessary inquiries to satisfy themselves that the patient has met the legal requirements for MAID. As always, RNs are encouraged to contact a CNPS legal counsel member (1-800-267-3390) to discuss the legal risks associated with participating.
4) Will I be considered to be “assisting” in the provision of MAID simply by being present in the room while the patient is being prepared and the substance is administered?
Likely no. However, anything done directly in support of the provision of MAID (for example, the preparation of a substance, or the insertion of an IV) could be considered to be participation in the provision of MAID.
5) Can I provide information about MAID?
Yes. The provision of objective information is not prohibited by the Criminal Code. In fact, the Criminal Code incorporates a clarification that permits NPs and other health care professionals to provide information about the lawful provision of MAID to a patient (section 241 (5.1)). RNs can share information and engage in discussions about MAID with their patients.
However, nurses must be mindful that subsection 241(a) of the Criminal Code will continue to make it a criminal offence to “counsel” a person to commit suicide. For the purposes of the Criminal Code, “counsel” means encourage, solicit or incite. Due to the criminal significance of the word “counsel,” an RN must be mindful not to encourage or incite a patient to seek MAID.
6) Can I undertake work in helping to draft policies and procedures for MAID in the institution in which I work?
Yes. Assisting with the drafting of policies and procedures for MAID is likely not considered “assisting” in the provision of MAID for the purposes of the Criminal Code and will likely not attract criminal liability for assisted suicide or culpable homicide.
7) What if I am not prepared to participate in MAID?
There may be situations where a nurse may not be prepared to participate in MAID. A nurse may have moral objections, religious objections, or may not want to participate because they believe that participating in MAID would pose too great a legal or professional risk. The amendments to the Criminal Code do not in any way create a positive obligation on a nurse to participate in MAID (see section (241.2 (9)).
However, nurses have a pre-existing legal duty of care to patients which prevents nurses from abandoning patients and necessitates referral to other healthcare providers in certain circumstances. As a result, in the event a nurse refuses to participate in MAID because it does not fall within their scope of practice, for moral or religious reasons, or because they are concerned about legal risk, it would be prudent for the nurse to consult with their regulatory body and/or employer for guidance on what to do in these circumstances. The Canadian Nurses Association Code of Ethics also contains information on ethical considerations in addressing expectations that are in conflict with one’s conscience.
For your information:
The CNPS will continue to make written submissions to parliamentarians and committees regarding the legal implications of MAID for nurses.
For background information on the Carter decision, please refer to the CNPS “Physician-Assisted Death: What Does this Mean for Nurses?”
CNPS beneficiaries can contact CNPS at 1-800-267-3390 to speak with a member of CNPS legal counsel. All calls are confidential.
Last revision in July 2021
THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY. NOTHING IN THIS PUBLICATION SHOULD BE CONSTRUED AS LEGAL ADVICE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE.