New Federal Legislation Brings Changes to MAiD Eligibility, Safeguards and Monitoring

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New Federal Legislation Brings Changes to MAiD Eligibility, Safeguards and Monitoring 

On March 17, 2021, the Federal Bill C-7, An Act to Amend the Criminal Code (medical assistance in dying) received Royal Assent. This new legislation expands eligibility of medical assistance in dying (MAiD); modifies existing safeguards and adds new safeguards; introduces a waiver of final consent to receive MAiD in certain circumstances; and expands the monitoring regime for MAiD. 

The BC Ministry of Health has also updated the provincial forms and form guides for patients, MAiD assessors and providers in order to ensure that all requirements are being fulfill under the new legislation. 

The College welcomes this new legislation and will continue to work with the Ministry of Health, the College of Physicians and Surgeons, the College of Nurses and Midwives, and other partners to support a smooth transition to the new MAiD regime. 

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

Bill C-7 and Pharmacy Practice in British Columbia 

The College’s Code of Ethics and Health Professions Act Bylaws reflect the federal and provincial requirements for MAiD and align with the changes introduced through Bill C-7.

In British Columbia, dispensing remains limited to pharmacists as required under the Health Professions Act Bylaws – Schedule F – Part 5 – Dispensing Drugs for the Purposes of Medical Assistance in Dying – Standards, Limits and Conditions.

However, pharmacists are still authorized to delegate preparation duties to a pharmacy technicians for the purposes of MAiD. 

Eligibility, Safeguards and Monitoring 

Bill C-7 introduces a number of changes to eligibility criteria, safeguards and monitoring requirements. 

The College’s Code of Ethics and Health Professions Act Bylaws reflect the federal and provincial requirements for MAiD and align with the changes introduced through Bill C-7

Summary of Changes
 

Eligibility Criteria 

  • While the patient must still have a “grievous and irremediable medical condition,” a reasonably foreseeable natural death is no longer a requirement for MAiD eligibility. 
  • However, patients whose sole underlying condition is mental illness will not be eligible at this time. 

Note: In two years, this restriction will be removed. However, the Act requires that an independent review determine recommended protocols, guidance and safeguards to apply to requests made for medical assistance in dying by persons who have a mental illness. For more information see Canada’s new medical assistance in dying (MAID) law. 

Safeguards 

Safeguards in the new legislation have been divided into two streams; one set of safeguards applies to patients whose natural death is reasonable foreseeable, while the second set of safeguards applies to patients whose death is not reasonably foreseeable. 

Safeguards for Reasonably Foreseeable Natural Death 

  • There is no longer a requirement for 10 clear days between the patient’s request for MAiD and when MAiD is administered. 
  • The patient’s written request for MAiD must be witnesses and signed by one independent witness (down from two). 
  • If the patient is in danger of losing capacity they may, under certain conditions, waive the requirement to provide final consent before receiving MAiD. 

Safeguards for When Death is Not Reasonably Foreseeable 

  • The patient’s written request for MAiD must be witnessed and signed by one independent witness. 
  • There is a minimum period of 90 days for assessment of the request, which can be shortened if the patient is in imminent danger of losing capacity and all assessments are complete. 
  • The patient must be informed of counselling, mental health supports, disability supports, community services and palliative care, and offered consultation with relevant professionals, as available and applicable, and both assessors must agree that the patient has given these serious consideration.

Monitoring 

  • All practitioners who assess MAiD eligibility (prior to receiving a written request), and any person who undertakes a preliminary assessment of whether a person meets the eligibility criteria, will be required to provide the information required by federal regulations (currently only practitioners who receive written requests for MAiD must do so). This requirement will only come into effect when the federal reporting regulations are updated.
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. 
Updated Provincial MAiD Forms and Related Resources 

The BC Ministry of Health has updated the provincial forms and form guides for MAiD, which are now available. 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. Additional resources are also available for patients and their families and providers. 

Questions

Please contact your health authority’s MAiD Care Coordination Service or reach out to the MAiD Oversight Unit at the Ministry of Health ([email protected]).

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

Resources

College of Pharmacists of BC
BC Ministry of Health
Federal Government
Mar 22, 2021