The following information is from the Ontario Ministry of Health Medical Assistance in Dying: Information for Patients handout.
Getting the right help
We know that death and dying can be difficult subjects to think and talk about. We also know that making a decision about medical assistance in dying can be challenging and that you may need help at many points along the way. If you are thinking about medical assistance in dying, talk to someone who can help inform you about your options: a doctor, nurse practitioner or other health care provider. You can also speak with your family, friends or a spiritual advisor. If you want to consider a formal request for medical assistance in dying you will need to speak with your doctor or nurse practitioner.
Your doctor or nurse practitioner can guide you through the process
Your doctor or nurse practitioner can discuss your medical condition with you – your diagnosis and prognosis, and all of the appropriate treatment and care options that are available. These may include, counselling services, mental health and disability support services, community services and/or medical assistance in dying.
If you need help – such as an interpreter or another form of assistance – to understand the options, your doctor or nurse practitioner must take all necessary measures to ensure that you understand the information and can communicate your decision.
Some doctors or nurse practitioners may not want to provide medical assistance in dying. They may choose not to provide the service. However, in Ontario, it is their professional duty to refer you in a timely manner to a doctor or nurse practitioner who is available to assess you for medical assistance in dying. A care coordination service is available to clinicians, patients and caregivers looking for information and help to facilitate access to medical assistance in dying.
Please find information about contacting the care coordination service under the section “ HOW TO GET HELP IN FINDING A DOCTOR OR NURSE PRACTITIONER TO PROVIDE MEDICAL ASSISTANCE IN DYING”.
A request for medical assistance in dying must be in writing
Your doctor or nurse practitioner can provide you with a Patient Request form, or you can fill out a Clinician Aid A – Patient Request for Medical Assistance in Dying form.
If you are physically unable to complete and sign the request, you can ask someone else to do it for you.
You must sign and date your written request. This request should be observed by at least one independent witness who must also sign and date the request. This may occur only after you are told by your doctor or nurse practitioner that you have a grievous and irremediable medical condition. You can withdraw your request at any time.
Learn more about other eligibility criteria for medical assistance in dying in the federal legislation.
Important to know:
You must personally consent to medical assistance in dying. Another person, often called a substitute decision-maker, cannot consent to medical assistance in dying on your behalf, or make the request for you.
You can withdraw your request at any time by using words, sounds or gestures that demonstrate your refusal to receive medical assistance in dying.
Even if you make the request, you can still receive all the other types of health care you need from your doctor or nurse practitioner.
Whether you’re eligible depends on specific requirements
Once you make your request, your doctor or nurse practitioner will assess whether you are eligible to receive medical assistance in dying.
Who is eligible for medical assistance in dying?
The eligibility requirements for medical assistance in dying are set out in federal legislation. In order to be eligible to receive medical assistance in dying, you must meet all these requirements.
In general, to receive medical assistance in dying, you must:
• Be eligible for publicly funded health care services in Canada (or be in the applicable waiting period),
• Be 18 years of age or older,
• Be capable of making health care decisions, including providing informed consent
• Be making a request for medical assistance in dying voluntarily, and
• Have a grievous and irremediable medical condition, which means you:
Have a serious and incurable illness, disease or disability, and
Are in an advanced state of irreversible decline in capability, and
Are enduring physical or psychological suffering, caused by the medical condition or the state of decline, that is intolerable to you and cannot be relieved under conditions that you consider acceptable.
Please note: If you are seeking medical assistance in dying solely due to a mental illness, you will not be eligible until March 17, 2023. This temporary exclusion will provide the Government of Canada more time to study how medical assistance in dying can be provided safely to those who are suffering from a mental illness.
Your doctor or nurse practitioner will make sure that you are making your request voluntarily, and that you are giving permission to receive medical assistance in dying after having received all of the information that you need to make your decision (informed consent). Your doctor or nurse practitioner must inform you of the options that are available to relieve your suffering, including, counselling services, mental health and disability support services, community services and palliative care, and offer consultations with relevant professionals who provide those services before you consent to medical assistance in dying.
Please speak with your doctor or nurse practitioner to review all the eligibility requirements for medical assistance in dying as required by federal law.
A second assessment is required
If your doctor or nurse practitioner decides that you are eligible for medical assistance in dying, a second doctor or nurse practitioner must complete another assessment to confirm that you meet all the eligibility criteria. The second doctor or nurse practitioner must provide the assessment in writing to the first doctor or nurse practitioner.
You have time to think about your decision
Once your request for medical assistance in dying is approved, you still have time to consider your decision. You may also withdraw your request at any time.
If your death is not reasonably foreseeable, you must wait at least 90 clear days from the day on which the first eligibility assessment to receive medical assistance in dying is made to the day on which it is provided.
In cases where the loss of your capacity to provide consent to medical assistance in dying is imminent, the doctors or nurse practitioners may approve a shorter waiting period. These conditions are defined in the federal law.
What is the service itself?
The doctor or nurse practitioner will either administer the drugs to cause your death, or will write a prescription for you to fill on your own. This means that you will be able to take them in a setting of your choice. How you receive the drugs is your choice.
Right before providing the drugs or giving you the prescription, your doctor or nurse practitioner will give you an opportunity to withdraw your request, subject to the waiver of final consent rules set out below, will confirm they find that you are still medically capable of making this choice, and will get your final consent to proceed.
Waiving final consent
Although the law requires you to provide your consent to medical assistance in dying immediately before it is provided, this requirement can be waived if the following conditions are met:
• Your natural death has become reasonably foreseeable;
• You are assessed as eligible for and approved to receive medical assistance in dying;
• Your procedure for medical assistance in dying has been scheduled with a specific doctor or nurse practitioner and that arrangement has been made in writing;
• You have been informed by your doctor or nurse practitioner that you are at risk of losing decision-making capacity before the scheduled date;
• You consent to your doctor or nurse practitioner administering a substance to cause your death on the scheduled date; and
• You do not demonstrate by words, sounds or gestures, refusal or resistance to having the substance administered.
The request to waive final consent must be received in writing and your doctor or nurse practitioner must agree to administer a substance to cause your death on a specified day.
Final consent for self-administered medical assistance in dying
If you choose to self-administer the substance for medical assistance in dying, you can make an arrangement with your doctor or nurse practitioner that if complications occur after you take the substance, causing a loss of decision-making capacity, but not death, the doctor or nurse practitioner may administer a substance to cause your death.
This arrangement must be made in writing and the doctor or nurse practitioner must be present at the time of self-administration. Anyone who chooses to self-administer the substance for medical assistance in dying can make this arrangement with their practitioner.
How to get help in finding a doctor or nurse practitioner to provide medical assistance in dying
If you do not have access to a doctor or nurse practitioner willing to provide medical assistance in dying, you (or a family member or caregiver) can request a referral for medical assistance in dying through a care coordination service which can be reached toll-free at: 1-866-286-4023.
The information line operates 24 hours a day, 7 days a week, and referral services are available Monday to Friday, 9 a.m. to 5 p.m.
The care coordination service is available in English and French (translations for other languages can also be requested). TTY services are also available at: 1- 844-953-3350.
You can also contact the care coordination service for additional information and questions regarding end-of-life care in Ontario, including palliative care resources.
What will be done after I die?
All medically assisted deaths in Ontario must be reported by the doctor or nurse practitioner to the Office of the Chief Coroner. While the Coroner must be notified of all medically assisted deaths, an investigation is not required unless the Coroner deems one to be necessary.
Patients who choose to take the prescribed drugs on their own are strongly encouraged to share their plans and the contact information of their doctor or nurse practitioner with family or friends, or in writing somewhere easily located. This will help ensure authorities are aware the death was planned.
Patients should make sure that they or their family can provide all the information and documentation that the doctor, nurse practitioner or coroner may require.
For more information on MAID and Organ and Tissue Donation please see the linked form.