MEDICAL ASSISTANCE IN DYING (MAID)
Changes to the MAiD Process In Response to the COVID-19 Pandemic
[May 7, 2020]
Temporary Exemption for Dispensing Drugs for the Purposes of MAiD
A temporary exemption allowing injectable drugs, previously dispensed for the purpose of providing Medical Assistance in Dying (MAiD), to be returned to inventory, is now in effect.
This means that during the COVID-19 public health emergency in British Columbia, if there is a shortage for any injectable drug dispensed for the purpose of MAiD, all unused injectable MAiD drugs dispensed and returned within the same, original sealed tamper-proof kit may be returned to inventory.
Prior to returning unused medications to inventory, the pharmacist must be satisfied that the following conditions have been met:
Effectively immediately and for the duration of the COVID-19 public health emergency in British Columbia, the requirement of the physician not to delegate or assign the return of MAiD substances is temporarily rescinded. This means that when there is no other reasonable option, the physician may ask another physician, nurse practitioner, licensed practical nurse, registered nurse, registered psychiatric nurse, or pharmacist to return the substances to the pharmacy. The physician must document the name of the person assigned to return the substances in the patient record.
The limit allowing only one practitioner to conduct a telemedicine assessment is temporarily rescinded. Both practitioners can conduct the assessment by telemedicine. Telemedicine assessments must meet the requirements set out in federal legislation as well as the standards and expectations that apply to in-person assessments.
The requirement for a regulated health professional to act as a witness is temporarily rescinded. No witness is required for a telemedicine assessment if they are not reasonably available.
These changes were enabled through amendments to the College of Physicians and Surgeons of BC’s Medical Assistance in Dying practice standard.
On June 17, 2016, the federal government introduced Bill C-14, which decriminalizes medical assistance in dying (MAiD). Bill C-14 addresses physicians, nurse practitioners, pharmacists, and other health care professionals, and exempts them from prosecution under the Criminal Code.
The College's Code of Ethics and Health Professions Act bylaws reflect the federal regulations and provincial requirements for MAiD.
Pharmacists who participate in the MAID process should refer to the following guidelines. Pharmacists are also authorized to delegate preparation duties to a pharmacy technician for the purposes of MAID; however dispensing remains limited to pharmacists.
If a pharmacist provides pharmacy services in the context of a medical assisted death, the following principles, derived from An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), should be adhered to:
The pharmacist is satisfied that the assisted death is being led by a medical practitioner or nurse practitioner;
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 medical practitioner or nurse practitioner and are only dispensed by the pharmacist directly to the medical practitioner or nurse practitioner;
Prior to dispensing the drugs, the pharmacist confirms with the medical practitioner or nurse practitioner leading the process that he or she has made a medical determination that the patient satisfies the criteria for medical assistance in dying set out in section 241.2 of the Criminal Code. The pharmacist should document the confirmation.
BC Medical Assistance in Dying Pharmacy Protocols Guidance Document and Prescription Form
The British Columbia Pharmacy Protocols guidance document and the British Columbia Medical Assistance in Dying Prescription form (includes the pre-printed order and medication administration record) are not available for general distribution.
The prescribing physician or nurse practitioner can access these documents by contacting the health authority care coordination service for medical assistance in dying, or the College of Physicians and Surgeons.
Pharmacists may also familiarize themselves with the standardized drug protocols by accessing the British Columbia Pharmacy Protocols guidance document through the College of Pharmacists secure eServices site.
Reporting Process for Medical Assistance in Dying in British Columbia
All required provincial forms for MAiD must be submitted to the BC Ministry of Health’s MAiD Oversight Unit
On November 1, 2018, the Ministry of Health became the designated recipient of all reportable information from pharmacists, physicians, and nurse practitioners. Learn more about the change to MAiD reporting requirements.
Pharmacists who dispense drugs for the purposes of MAiD are required to complete and submit the Ministry of Health’s designated Dispensing Record (Pharmacist) form. The form will collect all the information necessary for prescription accountability and meeting the Federal and Provincial MAiD reporting requirements.
Dispensing Record (Pharmacist) form HLTH 1641
Pharmacists will need to download a Dispensing Record (Pharmacist) form HLTH 1641 directly from the BC Ministry of Health’s website.
Note: The Dispensing Record (Pharmacist) form HLTH 1641 replaces the Prescription Planning and Prescription Accountability sections on page 5 of the previous Prescription document for MAiD. As a result, the Prescription Planning and Prescription Accountability sections will no longer be included as part of the Prescription document (which will include the Prescription order and Medication Administration Record).
The latest provincial forms MUST be used by practitioners and pharmacists if the patient’s written request is dated on or after November 1, 2018. The Ministry of Health will accept the old forms if the patient’s written request was dated prior to November 1, 2018.
Return of Medications
As part of the prescription planning and accountability process for MAiD, procedures need to be established for the prescriber’s return of any unused and partially used medication(s) within 72 hours of the patient’s death to the pharmacy for secure and timely disposal. Collaboration between the prescriber and pharmacist involved will be needed to ensure this process is followed.
When the prescriber returns the medication(s) to the pharmacy together with the completed Medication Administration Record, the receiving pharmacist will reconcile and document the return of the medication(s) using the Ministry of Health’s Dispensing Record (Pharmacist) form.
Both the prescriber and the receiving pharmacist will need to sign the Dispensing Record (Pharmacist) form following the medication return.
Records Submission to the Ministry of Health
(Starting November 1, 2018)
Competed Dispensing Record (Pharmacist) HLTH 1641 forms need to be faxed to the Ministry of Health’s Medical Assistance in Dying Oversight Unit within 6 business days after the scheduled date of drug administration.
Provincial Requirements for the Dispensing Drugs for the Purposes of Medical Assistance in Dying
Provincial requirements are included within the Health Professions Act Bylaws – Schedule F – Part 5 – Dispensing Drugs for the Purposes of Medical Assistance in Dying – Standards, Limits and Conditions.
It is important to note that under the amended Pharmacists Regulation, non-compliance to the Health Professions Act Bylaws Schedule F, Part 5 – Dispensing Drugs for the Purposes of Medical Assistance in Dying is considered a provincial offence.
All registrants should be aware that it is still a criminal offense to counsel a person to commit suicide. All registrants should ensure that they do not, and cannot be seen to be, advising any person to commit suicide.
- BC Government webpage on Medical Assistance in Dying (for patients and families)
- Ministry of Health - Medical Assistance in Dying - Information for Health-Care Providers
- Pharmacare Guidance and Medical Assistance in Dying (MAiD) PINs
- Ministry of Health Forms for Medical Assistance in Dying
- College of Pharmacists of BC: New Reporting Requirements for Medical Assistance in Dying come into effect November 1, 2018
- Federal Government - Schedule 7 of the Regulations for the Monitoring of Medical Assistance in Dying under the Criminal Code of Canada
- College of Pharmacists of BC Code of Ethics
- Health Professions Act Bylaws – Schedule F – Part 5 – Dispensing Drugs for the Purposes of Medical Assistance in Dying – Standards, Limits and Conditions
- BC College of Nursing Professionals - MAiD
- CPSBC Professional Standards and Guidelines on Medical Assistance in Dying (Updated June 24, 2016)
For questions or concerns regarding the MAiD regulations and reporting requirements, please contact the Ministry of Health’s Medical Assistance in Dying Oversight Unit or Health Canada.
Health Canada (Federal Regulations)
Pharmacists and pharmacy technicians are always welcome to contact the College’s Practice Support with questions or concerns about pharmacy practice.