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====== Medical Assistance in Dying (MAiD)====== | ====== 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." | ||
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+ | ===== 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 | ||
+ | ===== 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}} |