Canada: New Reporting Requirements For Practitioners Providing Medical Assistance In Dying

Last Updated: November 7 2018
Article by Sheila Morris

Medical assistance in dying ("MAID") has been legal in Canada for nearly three years. In that time, there have been more than 3,700 medically assisted deaths, 1 but there has been no consistency in MAID reporting across provinces and territories. Health Canada has introduced new reporting requirements for clinicians administering MAID and for pharmacists dispensing medication, which will come into effect on November 1, 2018. These regulations also require Health Canada to release a public report at least once per year based on the data collected. The objective of the new monitoring system is to "create a base of evidence that will inform ongoing discussions about MAID in Canada." 2 It is anticipated that these new requirements will capture and disseminate data where there are currently many unknowns.

The Requirements

All physicians and nurse practitioners in Canada who receive a written request for assisted death will be required to file a report with basic information including the patient's and clinician's information, the date of the written request and from whom it was received, the physician's area of specialty, and whether the patient consulted the clinician for another reason prior to requesting MAID. The format of the written request can include an unsigned email or text message, or a request written on paper from a patient who is unable to speak. 3 If a clinician proceeds to assess the patient's eligibility, further reporting is required, including, among other things, the type of illness experienced by the patient, a description of the patient's suffering, whether and for how long the patient received disability support and/or palliative care, and whether disability support and/or palliative care was accessible.

Different scenarios will require different reporting. For example, clinicians who administer MAID must report on a certain set of factors, including but not limited to the dates and place the substance was administered, whereas clinicians who transfer the patient's care must report on the date and reason for referral, and whether an eligibility assessment was conducted prior to referral or transfer. Clinicians in the majority of provinces and territories will submit reporting through the Canadian MAID Data Collection Portal developed by Health Canada and Statistics Canada. Clinicians in Ontario will report to the Chief Coroner for cases resulting in a MAID death, and to the federal Minister of Health for cases not involving a MAID death. Further information on the new reporting requirements can be found at https://www.canada.ca/en/health-canada/services/medical-assistance-dying/reporting-requirements.html#a8 

The Legal Perspective

Myriad legal implications may arise following the implementation of the new reporting requirements. Practitioners and pharmacists are now legally required under section 241.31 of the Criminal Code to file the requisite information within the relevant timeframe (most often, within 30 days of an event). Any practitioner or pharmacist who fails to comply with the reporting requirements could face a maximum two-year prison term. Arguably, practitioners who fail to comply could also face disciplinary action from their governing body, or liability in a civil suit.

Although clinicians providing MAID have been capturing data and reporting it over the past few years, there has been no uniform rule with respect to patients deemed ineligible for MAID, and it is this information that may have the biggest impact on future policy discussions. Physicians and nurse practitioners across the spectrum of practice settings will be under closer scrutiny, and the failure to first prescribe or refer patients to appropriate pain management, or to direct patients to the relevant disability or palliative programs in the community before seeking MAID could conceivably result in disciplinary consequences or legal action.

As part of the assisted dying legislation, the federal government has committed to studying three special cases relating to MAID: requests from mature minors under the age of 18; advance requests or directives that would authorize MAID when the person became incapable; and, MAID requests where mental illness is the sole underlying condition. Undoubtedly, there are complex legal issues at play in each of these cases. Practitioners will gain more insight into these situations when the Council of Canadian Academies presents its findings to Parliament in December 2018. 4

Footnotes

1 Third Interim Report on Medical Assistance in Dying in Canada, Health Canada, June 2018

2 Third Interim Report on Medical Assistance in Dying in Canada, Health Canada, June 2018

3 https://www.canada.ca/en/health-canada/services/medical-assistance-dying/guidance-reporting-summary/document.html

4 http://scienceadvice.ca/reports/medical-assistance-in-dying/

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