ARNNL Commentary on Medical Assistance in Dying (MAID) Update

July 14, 2016

ARNNL Commentary on Medical Assistance in Dying (MAID)

UPDATE:  July 14, 2016

ARNNL RELEASES REGISTERED NURSES AND NURSE PRACTITIONERS – AIDING IN MEDICAL ASSISTANCE IN DYING REGULATORY DOCUMENT

Registered Nurses (RNs) and Nurse Practitioners (NPs) in Newfoundland and Labrador (NL) have and will continue to be central care providers in end-of-life care and may inevitably be involved in the care to clients and their families who request medical assistance in dying (MAID). On July 13, 2016, ARNNL Council approved the Regulatory Document REGISTERED NURSES AND NURSE PRACTITIONERS – AIDING IN MEDICAL ASSISTANCE IN DYING.  This Regulatory Document provides direction for RNs and NPs in relation to regulatory responsibilities for aiding in MAID.

With the evolving implementation and interpretations of MAID in NL, ARNNL will keep members apprised of any changes/updates to their regulatory responsibilities.

For more information, please contact:
Pam King-Jesso
Nursing Consultant – Policy and Practice, ARNNL
709.753.6193
pkingjesso@arnnl.ca

Michelle Carpenter
Nursing Consultant – Policy and Practice, ARNNL
709.753.6174
mcarpenter@arnnl.ca

Siobhainn Lewis
Nursing Consultant – Policy and Practice, ARNNL
709.753.0124
slewis@arnnl.ca

 

UPDATE:  June 17, 2016

Bill C-14, legislation on medical assistance in dying, received royal assent on June 17, 2016. For more information, visit canada.ca/health.

RNs & NPs can also visit the Canadian Nurses Protective Website for a June 17, 2016 update on Medical Assistance in Dying: What Every Nurse Should Know.

Currently the NP scope of practice in NL does not authorize NPs to provide all aspects of MAID (such as the determination that the patient suffers from a grievous and irremediable condition, to obtaining the patient’s informed consent, to the administration or prescription of the substance(s)). Section 37(3)(c) of the Registered Nurses Act (2008), states the [nurse practitioner standards] committee shall establish standards for nurse practitioners designating the drugs that a nurse practitioner may prescriber and the circumstances under which the drugs may be prescribed. Given this requirement ARNNL will communicate with all NPs in the very near future regarding Scope of Practice and MAID following further consultation with the NP standards committee.

Please connect with Policy and Practice Consultants if you have any questions related to MAID.

 

UPDATE: June 15, 2016

On June 9, 2016, Newfoundland and Labrador’s Director of Public Prosecutions, in the absence of federal legislation regulating physician assisted death, released an Interim Practice Directive to crown prosecutors in the province.

This Interim Practice Directive provides health care professionals who participate in a physician-assisted death will not be prosecuted for their action so long as the act occurs within the parameters set in the Supreme Court of Canada’s decision, in Carter vs Canada 2015.

Courts across the country, including Newfoundland and Labrador, are addressing Applications by individuals requesting a Declaration that their circumstance meets the criteria for physician-assisted death established by the court in Carter.

 

UPDATE: June 8, 2016

The Canadian Nurses Protective Society has released a document on Medical Assistance in Dying: What Every Nurse Should Know. It is available from the CNPS home page, as well as at http://cnps.ca/MAID.

This document addresses scenarios for NPs and RNs given that Bill C-14 has not come into force by the June 6, 2016, deadline. The document further addresses what will happen once/if Bill-C14 becomes law, and provides a general Q&A section.

The Canadian Nurses Association also released a Statement on the absence of medical assistance in dying legislation on June 6, 2016.

Please connect with Policy and Practice Consultant, Pam King-Jesso at pkingjesso@arnnl.ca  or 709-753-6193 if you have any questions related to MAID.

 

UPDATE: May 3, 2016

On February 6, 2015, the Supreme Court of Canada in the Carter decision struck down the law prohibiting physician-assisted death for Canadians who have a grievous and irremediable medical condition causing intolerable suffering. It is important to note that the Carter decision was silent on the role of registered nurses and nurse practitioners in physician-assisted death.

The Supreme Court of Canada extended the effective date of its ruling to June 6, 2016 to provide parliament the opportunity to make amendments to the criminal code. On April 14, 2016, BILL C-14: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) received first reading in the House of Commons. Bill C-14 created exemptions to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process. Regulatory parameters and guidelines need to be in place when Bill C-14 and any amendments are passed into law. It is important to note that there remains numerous questions on proposed Bill C-14 and related provincial and regulatory implications.

Please connect with Policy and Practice Consultant, Pam King-Jesso at pkingjesso@arnnl.ca  or 709-753-6193 if you have any questions related to MAID.

Resources

Below is a list of reports and submissions that reflect some of the questions and commentary that are relevant to future directions that ARNNL will need to pursue in preparation for the June 6th deadline:

At the March 12, 2016 Council meeting of the College of Physicians and Surgeons Newfoundland and Labrador, a resolution was proposed and accepted that the College Council approve a Policy/Standard of Practice for Physician-Assisted Dying.

The Canadian Nurses Association and the Canadian Nurses Protective Society have also posted positions that are helpful to review:

ARNNL has included other commentary in both the January 2016 edition of ACCESS and the May 2016 Edition.

 

Get Involved

ARNNL will keep members apprised of any amendments to the law and the Standards of Practice regarding the role of nurse practitioners and registered nurses in MAID. RNs and NPs should continue to check this website for any updates related to MAID, any educational opportunities, and any opportunity to become involved in discussions/document development related to MAID and nursing practice.

Please connect with Policy and Practice Consultant, Pam King-Jesso at pkingjesso@arnnl.ca  or 709-753-6193 if you have any questions related to MAID.

 

UPDATE: April 27, 2016

As you may be aware, the first reading of Bill C-14 (An Act to amend the Criminal Code and to make amendments to other Acts (medical assistance in dying) was read on April 14, 2016 in the House of Commons.

The Act created exemptions to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process. As a result of this legislation, regulatory parameters and provincial legislative requirements and guidelines etc., need to be in place by June 6, 2016.

ARNNL would like an opportunity to connect with NPs across the province to have an open dialogue on the legislation that has been tabled, to share ARNNL’s work to date related to medical assistance in dying, and to hear your thoughts and questions related to this important change in legislation.

ARNNL will have an open conference call on Monday, May 2, 2016 from 1300-1400. 

Teleconference Information: Phone: 1-888-875-1833

Passcode: 432928374#

In preparation for Monday’s meeting, you may want to review the following documents/information that will be referenced in this teleconference:

Document 1: Government introduces legislation to provide medical assistance in dying (April 14th, 2016)

Document 2: BILL C-14: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)  (April 14th, 2016)

Document 3: At the March 12, 2016 Council meeting of the College of Physicians and Surgeons Newfoundland and Labrador, a resolution was proposed and accepted that the College Council approve a Policy/Standard of Practice for Physician-Assisted Dying

 

March 24, 2016

On February 6, 2015, the Supreme Court of Canada in the Carter decision struck down the law prohibiting physician-assisted death for Canadians who have a grievous and irremediable medical condition causing intolerable suffering.  This decision was to be effective as of February 6th, 2016 but was given a 4 month extension in January 2016 by the Supreme Court of Canada.  It is important to note that the Carter decision was silent on the role of nurses in physician- assisted death; therefore at this time it is unclear what involvement nurses can or should undertake.  ARNNL is committed to understanding the impact of this ruling on nursing practice and has been pursuing a number of activities to this effect. ARNNL will continue to monitor the situation for further developments that may provide additional clarity about the role of nurses in physician-assisted death. As there have been no federal or provincial legislation publically proposed to date it is too soon to know what the implications for RNs and NPs are at this point.

Resources

Below is a list of reports and submissions that reflect some of the questions and commentary that are relevant to future directions that ARNNL will need to pursue once legislative decisions are made:

The Canadian Nurses Association and the Canadian Nurses Protective Society have also posted positions that are helpful to review:

Get Involved

ARNNL will keep members apprised of any amendments to the law and the Standards of Practice for Registered Nurses (2013) regarding the role of registered nurses in physician- assisted death. RNs and NPs should continue to check ARNNL’s website for any updates related to physician-assisted death, any educational opportunities, and any opportunity to become involved in discussions/document development related to physician assisted death and nursing practice.

Please connect with Policy and Practice Consultant, Pam King-Jesso at pkingjesso@arnnl.ca   or 709-753-6193 if you have any questions related to physician-assisted death.

©2014 Association of Registered Nurses of Newfoundland and Labrador