MEDICAL ASSISTANCE IN DYING – Draft Policy for Saskatchewan

Background

The Canadian Government has adopted legislation to regulate medical assistance in dying (MAID). That legislation authorized Canadian physicians, and nurse practitioners in some provinces, to assess whether patients meet the requirements for medical assistance in dying and, if they do, to either administer the pharmaceutical agents that will cause the patient’s death, or prescribe pharmaceutical agents that will cause the patient’s death.

While the legislation established a number of requirements for medical assistance in dying to occur, some details are not addressed in the legislation. That is left for the provinces or regulatory bodies to address.

The Government of Saskatchewan established a provincial working group with broad representation from a number of groups to assist in developing appropriate standards for physicians and nurse practitioners who deal with medical assistance in dying.

At its September, 2016 meeting, the Council of the College of Physicians and Surgeons of Saskatchewan adopted a policy that addressed medical assistance in dying which was provided in hospitals or similar settings. That policy described the requirements that physicians must meet to comply with Canadian legislation and established standards for the administration of pharmaceutical agents that are intended to cause the patient’s death.

The provincial working group subsequently provided recommendations related to patient self-administration. The Council of the College met on January 20, 2017 and approved those recommendations in principle for the purpose of consulting physicians and the public. The Council will consider responses to this consultation request at its meeting on March 25 and expects to adopt a final policy on that date.

Subject of Consultation

The Council of the College seeks your input specifically on the recommendations related to patient self-administration as outlined below.

Summary of the recommendations from the provincial working group

The working group addressed two primary issues:

1. Should a physician who prescribes the pharmaceutical agents that are intended to cause the patient’s death be required to be immediately available to complete administration by intravenous agents if something goes wrong with the patient’s self-administration?

2. Should there be a process which approves physicians who wish to participate in medical assistance in dying? If so, who should do that and what should be the process?

The Council agreed with the working committee’s recommendations when it approved in principle the redraft of the College policy. The draft of the College’s Medical Assistance in Dying Policy states that:

1. A physician who prescribes pharmaceutical agents for self-administration should receive those pharmaceutical agents from a pharmacy and personally deliver the pharmaceutical agents to the patient at a time that the patient and the physician agree the patient will self-administer. The physician should be required to be immediately available, with the pharmaceutical agents and equipment necessary to administer medical assistance in dying by intravenous means if patient self-administration fails.

2. A physician who will assess a patient to determine whether the patient meets the criteria to receive medical assistance in dying or who prescribes or administers the pharmaceutical agents to cause the patient’s death must be approved by the College to do so if the medical assistance in dying will occur in a place that is not a Regional Health Authority Facility.

The Council was aware that both issues are controversial and that individuals have expressed inconsistent positions on these two issues. The Council’s perspective in approving in principle the policy is that:

1. We currently do not have sufficient information to know what risks exist that a patient may not be able to complete self-administration of pharmaceutical agents to cause death. There are reports of patients who have been unable to complete swallowing pharmaceutical agents or who have vomited after partially consuming the pharmaceutical agents. If no physician is present to complete medical assistance in dying in such circumstances, the consequences may be catastrophic for the patient and the patient’s family.

2. This is an issue to be revisited when better information is available, which should be not more than one year after a policy is adopted, to determine if there should be changes to the policy. Such a review should be based upon the best available evidence of the experience with patient self-administration. That review should also consider whether the requirement that a physician be available is a barrier to patient access to medical assistance in dying.

3. The College currently has a requirement that physicians cannot change their scope of practice without approval from the College. Assessing patients for eligibility for medical assistance in dying is a change of a physician’s scope of practice. The College expects that in situations where Regional Health Authorities have approved physicians to assess patients for eligibility for medical assistance in dying, or have approved physicians to administer medical assistance in dying, that approval will be sufficient for the College to approve the change in scope of practice.

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