Update on Medical Assistance in Dying (MAID)
Note: New information is available with respect to MAID - please visit the College website: http://www.bcpharmacists.org/medical-assistance-dying
Between January 6 and June 6, 2016, the Supreme Court of Canada permitted individuals seeking medical assistance in dying (MAID) to apply to a court for an order that legally authorized physicians and other health care professionals, including pharmacists, to provide MAID to that person. This was a temporary measure to assist individuals who satisfied the criteria for a physician-assisted death established by the Court in Carter. The deadline for the federal government to bring a new law regulating MAID was June 6, 2016. However, the new legislation is not yet in force.
Until a new law is in effect, a pharmacist or pharmacy technician who chooses to participate in a MAID process is at some risk of criminal prosecution.
For pharmacists, the risk is small. The information below provides guidance to pharmacists who choose to participate in MAID that minimizes risk.
For pharmacy technicians, the risk is greater. It is not sufficiently clear that pharmacy technicians are protected from legal liability if they participate in a MAID process. Accordingly, the College recommends that pharmacy technicians do not participate in MAID at this time.
The Carter decision established that physician-assisted death is not a criminal offense if it is provided to competent adult who:
…clearly consents to the termination of life and has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.
Subsequent Court cases have held that pharmacists who participate in a physician-assisted death of an individual who meets the Carter criteria are acting lawfully. The small legal risk arises from the fact that, if a pharmacist participates in a MAID process for an individual who does not meet the Carter requirements, the pharmacist may be criminally prosecuted.
Individuals in this province will seek medical assistance in dying despite the absence of federal legislation. Their personal circumstances may be urgent. Pharmacists must make their own measured and informed decisions about whether to provide their professional services to such persons. The guidelines below minimize the legal risk to pharmacists who choose to participate in MAID processes prior to the enactment of legislation.
A pharmacist may, for reasons of conscience or religion, decline to participate in a physician-assisted death without contravening the College’s Code of Ethics.
If a pharmacist chooses to provide pharmacy services in the context of a physician-assisted death, the following principles, derived from Carter, should be adhered to:
The pharmacist is satisfied that the assisted death is being led by a physician;
The pharmacist ensures that he or she does not lead the assisted death process or is seen as leading it, and that he or she does not administer the prescribed drugs to the patient; and
The drugs used for the assisted death are prescribed by the physician and are only dispensed by the pharmacist directly to the physician;
Prior to dispensing the drugs, the pharmacist confirms with the physician leading the process that he or she has made a medical determination that the patient is a competent, consenting adult with an irremediable medical condition that causes intolerable suffering. The pharmacist should document the confirmation.
The College has amended the Code of Ethics, the existing practice standards and has created new Standards, Limits and Conditions specific to MAID.
- Updated Code of Ethics
- Updated Standards of Practice
- New Standards, Limits and Conditions
The College will keep registrants informed of developments as they arise. See the College website for more information: http://www.bcpharmacists.org/medical-assistance-dying
Note: “Physician-assisted dying” is the term used by the Supreme Court of Canada in Carter and refers to a physician-led process; “Medical assistance in dying” or “MAID” refers to a process led by health professionals, for example, the process described in Bill C-14, that includes various physicians and nurse practitioners.
Links to other MAID Resources