In February 2015, the Supreme Court of Canada ruled in Carter v. Canada that certain sections of the Criminal Code would need to be amended to comply with the Charter of Rights and Freedoms. In particular, the Court held that parts of the Criminal Code that prohibited medical assistance in dying ("MAID") would no longer be valid under specific conditions. In response, the federal government introduced An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) (the "Act") to allow eligible adults who meet certain criteria set out in the Act to request and receive MAID by medical and nurse practitioners. The Act received Royal Assent on June 17, 2016.
The provincial government has introduced Bill 84 to provide clarity to patients and health care providers who engage in MAID.
An Overview of Bill 84
The following summarizes relevant sections of Bill 84 as they would amend various existing provincial acts:
(a) Notice to Coroner by Physician or Nurse Practitioner
- If an individual dies as a result of MAID, the physician or nurse practitioner who provides MAID must give notice of the death to the coroner. Upon the notice, the coroner may investigate and hold an inquest into the death.
(b) Information to Coroner by Physician or Nurse Practitioner and Any Other Person
- Such medical and nurse practitioner must provide any information to the coroner about the facts and circumstances relating to the death that the coroner considers necessary to form an opinion about the investigation. Further, any other person who has knowledge of the death must also provide information on the request of the coroner.
Two years after Bill 84 receives Royal Assent, the Minister of Health and Long-Term Care must establish a process to review these sections.
2. Civil Liability and Benefits
(a) No Tortious Allegations for Physician and Nurse Practitioners Except Negligence
- Actions or proceedings for damages cannot be brought against physicians, nurse practitioners or any other person assisting such physician or nurse practitioner who acted in good faith when performing MAID. However, the proposed immunity from civil liability does not apply if there is an allegation of negligence.
(b) Benefits or other sums of money under contract or statute may not be refused or denied
- Benefits, such as insurance payouts and workplace safety benefits, that would otherwise be available cannot denied as a result of a medically-assisted death.
(a) Identifying information about persons or facilities in relation to MAID is excluded
- This section means that health care providers and facilities that administer MAID cannot be identified under access to information requests.
- A worker who has received MAID is considered to have died as a result of his or her underlying injury or illness. This means that insurance payouts and workplace safety benefits cannot be denied solely because of MAID.
Since the federal legislation was enacted, Ontario has taken steps with respect to MAID. The Ministry of Health and Long-Term Care has instituted a Clinician Referral Service to support physicians and nurse practitioners and to arrange for assessment referrals and consultations for patients requesting MAID. It has also made MAID an insured service under OHIP and the drugs required for medical assistance in dying are available at no cost to patients. Currently, the province is proposing to establish a care coordination service to assist patients and caregivers to access additional information and services for MAID and other end-of-life options.
Under the Patients First Act, 2016 (which received Royal Assent on December 8, 2016), the Minister can issue operational or policy directives to the board of a hospital, but cannot require the board of a hospital that is associated with a religious organization to provide a service that is contrary to the religion related to the organization. Therefore, it appears that religious hospitals will not be required to provide MAID at present. Bill 84 does not provide further elaboration on this point.
Health care providers who administer MAID may wish to review their policies and procedures to determine what revisions may need to be made should Bill 84 receive Royal Assent and become law.
For further information on MAID, please see: