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Last edited on October 10, 2023

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--- teaching:suicide-medical-assistance-dying [on April 12, 2020]
+++ teaching:suicide-medical-assistance-dying [on October 10, 2023]
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 ====== Medical Assistance in Dying (MAiD)======
-[[https://www.cmaj.ca/content/191/30/E838|Nayyar, D., Kawaguchi, S., & Mah, B. (2019). Request for medical assistance in dying after a suicide attempt in a 75-year-old man with pancreatic adenocarcinoma. Canadian Medical Association. Journal, 191(30), E838-E840.]]
+{{INLINETOC}}
+===== Primer =====
+**Medical Assistance in Dying (MAiD)** was approved in Canada in June 2016, allowing for a legal pathway for Canadians to pursue and receive physician-assisted suicide.
+==== Suicide in Canada ====
+  * Suicide was part of the Canadian Criminal Code starting in 1892, meaning anyone found guilty of committing suicide or aiding in suicide could be incarcerated
+  * Suicide was decriminalized in 1972 as part of greater psychiatric reforms
+  * Aiding in suicide remained criminal until physician-assisted suicide was decriminalized in 2015
-{tag>sh-suicide-death}}
+==== MAiD Criteria in Canada ====
+In Canada, an individual must meet ''all'' of the following criteria:
+  - Be 18 years of age or older and have decision-making capacity
+  - Be eligible for publicly funded health care services
+  - Make a voluntary request that is not the result of external pressure
+  - Give informed consent to receive MAID, meaning that the person has consented to receiving MAID after they have received all information needed to make this decision
+  - Have a serious and incurable illness, disease or disability (excluding a mental illness until March 17, 2024)
+  - Be in an advanced state of irreversible decline in capability
+  - Have enduring and intolerable physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable
+==== Controversy ====
+<alert type="info" icon="fa fa-book fa-lg fa-fw">
+See also: **[[https://www.cambridge.org/core/journals/palliative-and-supportive-care/article/realities-of-medical-assistance-in-dying-in-canada/3105E6A45E04DFA8602D54DF91A2F568|Coelho, R., Maher, J., Gaind, K., & Lemmens, T. (2023). The realities of Medical Assistance in Dying in Canada. Palliative & Supportive Care, 1-8.]]**
+</alert>
+===== Approach =====
+An approach to conversation about MAiD may look something like this:[([[https://phc.eduhealth.ca/media/PHC/GV/GV.170.M468.PHC.pdf|Having Conversations about MAiD at PHC]])]
+  - **Patient directly or indirectly initiates discussion of MAiD**
+    * "Can’t you just give me something so I won’t suffer?"
+    * "I want to know about MAiD."
+    * "Can you help me end my life?"
+    * "What are all my options and alternatives?"
+  - **Care professional responds and clarifies the patient’s interest in MAiD**
+    * "Are you asking for help to die?"
+    * "Are you looking for more information about MAiD?"
+    * "Tell me what a “good death” looks like to you."
+    * "Are you asking about medical assistance in dying or something else?"
+  - **Care professional ensures patient has opportunity to explore their care options**
+    * "Do you need more information about your condition or your options?"
+    * "What are your most important goals if your health situation worsens?"
+    * "What more can I do for you?"
+    * "Has anyone talked to you about treatment options to address your goals and worries?"
+    * "Tell me about your suffering."
+    * "What are your biggest fears and worries about the future with your health?"
+    * "Can I help you with anything else?"
+  - **Care professional informs about the MAiD process**
+    * "I’ll get you a brochure that explains the MAiD request process"
+    * "Let me get the Social Worker here to talk about what’s involved."
+    * "What questions do you have about the process?"
+    * "MAID [is/is not] provided at this facility and we will always provide the best possible care to you no matter what decision you make."
+  - **Care professional provides regular care**
+    * "I know you are considering MAiD. Let’s talk about what we can do to alleviate your suffering right now while you explore your options."
+    * "I understand you are pursuing MAiD. Let’s talk about what treatments and services will help you stay as comfortable and well as possible during this process."
+===== Consult Template =====
+  * Components of a MAID capacity consult
+    * Medical diagnosis
+    * Eligibility
+    * Determination of a grievous and irremediable medical condition
+    * Voluntariness: Ensure there is no coercion. MAID is the patient's decision. Speak with the patient's primary physicians and family members.
+    * [[teaching:on:consent-capacity|Capacity]] (is the patient capable of consenting to MAID?):
+      * What is the patient's understanding of MAID?
+      * Do they understand the MAID process?
+      * Is the patient aware of other options (e.g. - analgesia, physiotherapy, home care, residential facilities)
+    * Clinician's declaration:
+      * The clinician should state they are not a beneficiary under the will of this patient or a recipient of financial or material benefits resulting from the patient's death
+      * The clinician should state they are not mentor or supervisor to the intervention (MAID provider) physician or connected in any way that would affect objectivity
+===== MAiD Across The World =====
+==== Terminal Illness Criterion ====
+  * USA: Terminal illness required
+  * Europe: Only intolerable suffering required
+==== Medication ====
+  * USA, Switzerland: self-administered only
+  * Canada, Netherlands: self-administered or euthanasia (doctor performed)
+==== Psychiatric Consultation ====
+  * USA: Required if patient has depression
+  * Belgium: Required if prognosis > 1 year
+  * Canada: Not required, up to clinician judgment
+===== Resources =====
+==== CMPA ====
+  * [[https://www.cmpa-acpm.ca/en/advice-publications/key-issues/medical-assistance-in-dying?utm_source=23SEP29EN-E-PIP&utm_medium=Email&utm_campaign=Ebulletin|CMPA: Medical assistance in dying (MAID)]]
+  * [[https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2021/the-continuing-evolution-of-medical-assistance-in-dying|CMPA: The continuing evolution of medical assistance in dying]]
+== Research ==
+  * [[https://www.cmaj.ca/content/191/30/E838|Nayyar, D., Kawaguchi, S., & Mah, B. (2019). Request for medical assistance in dying after a suicide attempt in a 75-year-old man with pancreatic adenocarcinoma. Canadian Medical Association. Journal, 191(30), E838-E840.]]
+{{tag>sh-suicide-death}}