Medical Assistance in Dying (MAiD)

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MEDICAL ASSISTANCE IN DYING (MAID)

Changes to the MAiD Process In Response to the COVID-19 Pandemic

[May 7, 2020]

Temporary Exemption for Dispensing Drugs for the Purposes of MAiD

A temporary exemption allowing injectable drugs, previously dispensed for the purpose of providing Medical Assistance in Dying (MAiD), to be returned to inventory, is now in effect. 

This means that during the COVID-19 public health emergency in British Columbia, if there is a shortage for any injectable drug dispensed for the purpose of MAiD, all unused injectable MAiD drugs dispensed and returned within the same, original sealed tamper-proof kit may be returned to inventory. 

Shortages may include manufacturer reported shortages (i.e. those listed on Drug Shortages Canada), or those proactively assigned by Health Canada, such as a Tier 3 Drug Shortage.

Prior to returning unused medications to inventory, the pharmacist must be satisfied that the following conditions have been met: 

  • The medication has not left the possession of the prescribing medical practitioner or nurse practitioner, or a licensed health care professional assigned by the physician or nurse practitioner; and the integrity of the medication can be verified. 
  • Each dose is unused and in the original sealed tamper proof kit; and 
  • The medication has been maintained in accordance with the manufacturers requirements and any other applicable requirements. 

Learn More: NEWS - Temporary Exemption for Dispensing Drugs for the Purposes of Medical Assistance in Dying (MAiD) Now in Effect

Effectively immediately and for the duration of the COVID-19 public health emergency in British Columbia, the requirement of the physician not to delegate or assign the return of MAiD substances is temporarily rescinded. This means that when there is no other reasonable option, the physician may ask another physician, nurse practitioner, licensed practical nurse, registered nurse, registered psychiatric nurse, or pharmacist to return the substances to the pharmacy. The physician must document the name of the person assigned to return the substances in the patient record.

The limit allowing only one practitioner to conduct a telemedicine assessment is temporarily rescinded. Both practitioners can conduct the assessment by telemedicine. Telemedicine assessments must meet the requirements set out in federal legislation as well as the standards and expectations that apply to in-person assessments.​

The requirement for a regulated health professional to act as a witness is temporarily rescinded. No witness is required for a telemedicine assessment if they are not reasonably available.

These changes were enabled through amendments to the College of Physicians and Surgeons of BC’s Medical Assistance in Dying practice standard.

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PROVINCIAL REQUIREMENTS FOR DISPENSING DRUGS FOR THE PURPOSES OF MEDICAL ASSISTANCE IN DYING

The College's Code of Ethics and Health Professions Act Bylaws reflect the federal regulations and provincial requirements for MAiD. 

Provincial requirements are included within the Health Professions Act Bylaws – Schedule F – Part 5 – Dispensing Drugs for the Purposes of Medical Assistance in Dying – Standards, Limits and Conditions.

It is important to note that under the amended Pharmacists Regulation, non-compliance to the Health Professions Act Bylaws Schedule F, Part 5 – Dispensing Drugs for the Purposes of Medical Assistance in Dying is considered a provincial offence.

Pharmacists are also authorized to delegate preparation duties to a pharmacy technician for the purposes of MAiD; however dispensing remains limited to pharmacists.

Canada’s New Medical Assistance in Dying (MAiD) Law

As of March 17, 2021, new federal legislation on medical assistance in dying came into effect, including changes to eligibility criteria, safeguards, and processes for MAiD.

See New Federal Legislation Brings Changes to MAiD Eligibility, Safeguards and Monitoring for an overview of the changes.

Transitional Provision for MAiD Requests in Progress

The new legislation includes a transitional provision for MAiD requests in progress. This transitional provision requires that MAiD requests submitted prior to the new legislation coming into effect must be provided in accordance with the requirements of the previous legislation, with two exceptions:

  1. The requirement for 10 clear days between the request for MAiD and the provision of MAiD does not apply.
  2. The individual requesting MAiD will be able to waive the requirement to provide final consent, subject to the requirements for a waiver of final consent under the new legislation.

To help assessors and providers understand the requirements for MAiD requests in progress, a Guide to the Transitional Provision is available from the Ministry of Health.

Patients who were not eligible for MAiD under the previous legislation (e.g. those whose natural death was not reasonably foreseeable) must submit a new request for MAiD. The transitional provision applies only to submitted MAiD requests that were valid under the previous legislation.

All registrants should be aware that it is still a criminal offense to counsel a person to commit suicide. All registrants should ensure that they do not, and cannot be seen to be, advising any person to commit suicide. 

BC Medical Assistance in Dying Pharmacy Protocols Guidance Document and Prescription Form

The British Columbia Pharmacy Protocols guidance document and the British Columbia Medical Assistance in Dying Prescription form (includes the pre-printed order and medication administration record) are not available for general distribution. 

The prescribing physician or nurse practitioner can access these documents by contacting the health authority care coordination service for medical assistance in dying, or the College of Physicians and Surgeons.

Pharmacists may also familiarize themselves with the standardized drug protocols by accessing the British Columbia Pharmacy Protocols guidance document through the College of Pharmacists secure eServices site.

PharmaCare Guidance and Medical Assistance in Dying (MAiD) PINs
Reporting Process for Medical Assistance in Dying in British Columbia

All required provincial forms for MAiD must be submitted to the BC Ministry of Health’s MAiD Oversight Unit 

Pharmacists who dispense drugs for the purposes of MAiD are required to complete and submit the Ministry of Health’s designated Dispensing Record (Pharmacist) form. The form will collect all the information necessary for prescription accountability and meeting the Federal and Provincial MAiD reporting requirements.

The provincial forms have been updated to account for the new federal legislation on medical assistance in dying, and the use of these forms is required for all MAiD requests submitted on or after March 18, 2021 and will help assessors and providers ensure they fulfill all of their requirements under the new legislation.

Dispensing Record (Pharmacist) form HLTH 1641

Pharmacists will need to download a Dispensing Record (Pharmacist) form HLTH 1641 directly from the BC Ministry of Health’s website.
Return of Medications 

See Changes to the MAiD Process in Response to the COVID-19 Pandemic

As part of the prescription planning and accountability process for MAiD, procedures need to be established for the prescriber’s return of any unused and partially used medication(s) within 72 hours of the patient’s death to the pharmacy for secure and timely disposal. Collaboration between the prescriber and pharmacist involved will be needed to ensure this process is followed. 

When the prescriber returns the medication(s) to the pharmacy together with the completed Medication Administration Record, the receiving pharmacist will reconcile and document the return of the medication(s) using the Ministry of Health’s Dispensing Record (Pharmacist) form.

Both the prescriber and the receiving pharmacist will need to sign the Dispensing Record (Pharmacist) form following the medication return.

Records Submission to the Ministry of Health

Competed Dispensing Record (Pharmacist) HLTH 1641 forms need to be faxed to the Ministry of Health’s Medical Assistance in Dying Oversight Unit within 6 business days after the scheduled date of drug administration.  

Fax: 778-698-4678

Resources 

BC Ministry of Health

College of Pharmacists of BC

Federal Government

Other Health Professional Regulators

Questions

For questions or concerns regarding the MAiD regulations and reporting requirements, please contact your health authority’s MAiD Care Coordination Service and the Ministry of Health’s Medical Assistance in Dying Oversight Unit or Health Canada.

BC Ministry of Health - Medical Assistance in Dying Oversight Unit
h[email protected]

236-478-1915

Health Canada (Federal Regulations)
[email protected]

1-833-219-5528

Pharmacists and pharmacy technicians are always welcome to contact the College’s Practice Support with questions or concerns about pharmacy practice.

Practice Support
[email protected]