B.C. takes the lead in help for medically assisted dying
Canada’s health-care system remains in the middle of a massive shift on the question of death less than a year after medically assisted dying was deemed legal.
So where can patients and their families turn if they want to understand their options? In B.C., that job falls to five medical assistance in dying patient care co-ordinators — each regional health authority has one — who help health-care workers and patients understand who’s eligible and connect critically ill people with doctors and nurses who can help.
While the system — known as MAID — has been in place in B.C. for months, other provinces are still trying to work out who patients can call if, for example, their family doctor has a moral objection.
B.C.’s preparedness appears to be the result of extensive advance planning before the law changed in June 2016. At Vancouver Coastal Health, preparations for the assisted dying program began a full six months early, according to Darren Kopetsky, who oversees MAID as regional director of risk management.
“We knew there was going to be some sort of law and we didn’t seek to replicate or get involved in legal decisions, but rather what would be the considerations from us, from the policy perspective, whatever the law turned out to be,” Kopetsky said.
The position of MAID care co-ordinator is a full-time job at Coastal Health, and is currently filled by an advanced practice nurse who juggles calls and emails while making time to talk to staff about how to support patients who are considering ending their lives.
In cases where people can’t find two independent witnesses to their request for MAID, the care co-ordinator connects patients with volunteers from Dying with Dignity Canada. Her job also involves tracking down the doctors or nurse practitioners needed to perform two independent assessments of whether patients are medically eligible and capable of making the decision to end their lives.
“A patient might go to their family physician, and their family physician might be willing to assist, to help make connections, but not be prepared to be an assessor or a prescriber. The physician might contact the care co-ordination service and say, ‘What do I do with this request?’ ” Kopetsky said.
One of those assessors will also serve as the prescriber — the person who administers the substances that will end a patient’s life. At Coastal Health, there are nine people with prescribing privileges.
“It’s a specially assigned privilege, after having demonstrated proficiency, knowledge of the law, understanding of the medications,” Kopetsky said.
Other doctors in private practice are likely also offering this service, but no one is keeping track of how many there are in the region, or how many professionals there are serving as prescribers in health authorities and private practice across the province.
The ultimate goal for MAID care co-ordinators is to connect people with the information and help they need as quickly as possible.
“Our philosophy has been that, if people consider their position to be one of intolerable suffering, we don’t want to be a delay in that proceeding for them … and if they’re not eligible, then they know that sooner rather than later,” Kopetsky said.