Bill C-14, legislation on medical assistance in dying, received royal assent on June 17, 2016. For more information, visit canada.ca/health
- Advanced state of irreversible decline in capability
- When combined with the requirements that death be reasonably foreseeable and that the person be suffering intolerably, the requirement to be in an advanced state of irreversible decline ensures that medical assistance in dying would be available to those who are in an irreversible decline towards death, even if that death is not anticipated in the short term. This approach to eligibility gives individuals who are in decline toward death the autonomy to choose their preferred dying process.
- Reasonably foreseeable death
- “Natural death has become reasonably foreseeable” means that there is a real possibility of the patient’s death within a period of time that is not too remote. In other words, the patient would need to experience a change in the state of their medical condition so that it has become fairly clear that they are on an irreversible path toward death, even if there is no clear or specific prognosis. Each person’s circumstances are unique, and life expectancy depends on a number of factors, such as the nature of the illness, and the impacts of other medical conditions or health-related factors such as age or frailty. Physicians and nurse practitioners have the necessary expertise to evaluate each person’s unique circumstances and can effectively judge when a person is on a trajectory toward death. While medical professionals do not need to be able to clearly predict exactly how or when a person will die, the person’s death would need to be foreseeable in the not too distant future.
- In terms of the Carter decision, the concept of reasonable foreseeable death is consistent with the factual circumstances of Carter and persons in the situation of Ms. Taylor and Ms. Carter i.e., taking into account all of the patient’s medical circumstances, they were on an irreversible trajectory toward death. In all of the medical circumstances of the person, it is fairly clear to the medical practitioner/nurse practitioner (and the second confirming practitioner) that the person is on an irreversible trajectory toward death, even if the practitioner cannot give a specific period of time for the prognosis.
- Grievous and irremediable medical condition
- A grievous and irremediable medical condition is defined in the Bill as having all of the following characteristics:
- A serious and incurable illness, disease or disability;
- The person is in an advanced state of irreversible decline in capability;
- The illness, disease, or disability or state of decline causes the person enduring physical or psychological suffering that is intolerable to them and that cannot be relieved in a manner that the person considers acceptable to them; and
- The person’s natural death has become reasonably foreseeable due to all of their medical circumstances, without requiring that a prognosis has been made as to the length of time that they have remaining.
- Independent physicians and nurse practitioners
- With respect to the independence of the first medical or nurse practitioner from the second one, the Bill provides that they could not be connected to each other in any way that could impair their objectivity, such as by being in a business or mentoring relationship with each other. They would also need to be independent of the patient, in the sense that they could not be a beneficiary under his or her will, or be otherwise connected to the patient in a manner that could affect their objectivity.
- Independent witness
- An independent witness would be a person who would not be a beneficiary under the patient’s will or otherwise benefit from their death. Persons responsible for the patient’s personal care, the health care treatment team and those responsible for any facility where the patient resides or is being treated, would also not be considered independent witnesses. A family member could witness a patient’s request if none of these circumstances apply to them.
- Informed consent
- Informed consent is a medical term that means that a person has consented to a particular medical treatment after having been given all of the information they need to make that health care decision. Information that is necessary to be provided includes their diagnosis, their prognosis, available forms of treatment and the benefits and side-effects of those treatments. It also requires that the person be mentally competent or capable, i.e., that they be able to understand the relevant information and the consequences of their choices.
- Mature minors
- Minors (below 18 or 19 depending on applicable provincial laws) who have the intellectual capacity and maturity to understand the information relevant to their medical decision and appreciate the consequences of such decision.
- Mentally competent or capable
- A person is mentally competent or capable when they have the capacity to understand the nature and consequences of their actions and choices, including decisions related to medical care and treatments.
- Nurse practitioner
- Nurse practitioners have the authority to deliver many of the same medical services as family physicians; they can assess, diagnose, prescribe and treat patients. They can act independently in every jurisdiction except Quebec, where they practice under the authority of a physician.
- Physician-assisted suicide
- Where a physician or nurse practitioner gives or prescribes to a person a substance that they can self-administer to cause their own death.
- Voluntary euthanasia
- Where a physician or nurse practitioner directly administers a substance that causes the death of the person who has requested it.
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