An update regarding palliative care in Ontario…
Medical Assistance in Dying and End-of-Life Decisions
Editor: Following the federal legislation legalizing medical assistance in dying, the Ontario Government has set its regulations within which one may seek this service. The Ontario Government has also established alternative palliative care services.
Queen’s Printer for Ontario, 2012-16
www.ontario.ca/page/medical-assistance-dying-and-end life-decisions?_ga=1.159509172.844200669.1482496960
Doctors and nurse practitioners in Ontario can now provide medical assistance in dying. Federal legislation, passed on June 17, 2016, guides how Ontario’s doctors and nurse practitioners are allowed to provide this option.
Background
In February 2015, the Supreme Court of Canada struck down the federal law prohibiting medical assistance in dying (also known as assisted suicide) in certain circumstances.
In response to the Supreme Court’s decision, Parliament passed legislation on medical assistance in dying on June 17, 2016. This legislation now guides how medical assistance in dying can be provided.
This service is covered by the Ontario Health Insurance Plan (OHIP) and drugs required for medical assistance in dying will be available at no cost. Health care providers, including physicians, nurses and pharmacists, should refer to their regulatory colleges for more information and guidance.
How to access medical assistance in dying
Step 1: Talk to your doctor
If you are suffering from a grievous and irremediable medical condition, you can talk to your doctor or nurse practitioner about your options for treatment and care. These options may now include medical assistance in dying.
While some doctors or nurse practitioners may choose not to be involved in medical assistance in dying, they must follow professional requirements set by the College of Physicians and Surgeons of Ontario and the College of Nurses of Ontario. This includes helping patients find another doctor or nurse practitioner who can provide medical assistance in dying. Your doctor or nurse practitioner can call a referral service for help finding another doctor.
Step 2: Know your options
You can ask to receive medical assistance in dying no matter where you live or receive care. This includes:
- a hospital
- a long-term care home
- a hospice or palliative care facility
- your home
Some facilities may choose not to provide medical assistance in dying or have limitations on how they provide it. Facilities are encouraged to make this information available, so individual will know their options.
If you’re already in a hospital or long-term care home, speak to your doctor or care provider about your options.
What is Palliative Care?
Palliative care refers to care for patients and their families who are facing a serious, life-limiting illness. Palliative care aims to relieve suffering and improve quality of life for patients and their families at all stages of the illness. Palliative care focuses on treating the impact that an illness has on patients, and is often provided in addition to other care that focuses on treating the illness itself.
What types of services are provided?
The types of palliative care services that may be provided include:
- Physician and nursing services to assess and manage the progression of the illness. This includes providing pain and symptom management to improve comfort and quality of life
- Personal support services (e.g., homemaking)
- Psychological, spiritual and bereavement support
- Other services, such as physiotherapy, caregiver support, pharmacy, social work.
How can I access palliative care?
Palliative care can be provided or accessed through the following channels:
- Your primary health care provider (e.g. family doctor). Many types of palliative care are provided directly by primary health care providers who are already treating individuals for disease. For individuals requiring more specialized services, primary health care providers can provide appropriate referrals.
- Your local Community Care Access Centre can refer you to hospice or other support services
- Your local hospital
- Your long-term care home
Where is palliative care provided?
Palliative care is delivered in all care settings, including the following:
- Individual homes
- Hospices
- Long-Term Care Homes
- Hospitals
What does it cost to receive palliative care?
There is no cost to patients for medically necessary palliative care services in their homes, hospices, or hospitals. For example, this includes any treatments that a physician may provide. While residents of long-term care homes may pay a co-payment, these funds represent the individual’s contribution to food and accommodations – not palliative care services.
What supports exist for caregivers?
There are a variety of supports available to caregivers in Ontario. These may include respite care or hospice-based bereavement. The 2015 Patients First: A Roadmap to Strengthen Home and Community Care [PDF] commits to investing more in training and education programs and developing a onestop online source for information and resources available to caregivers to enable them to work with providers to ensure appropriate services are delivered.
Contact a local Community Care Access Centre for more information, or use http://thehealthline.ca, which can help individuals locate caregiver supports in their area.
What is Advance Care Planning?
Advance Care Planning is a process that encourages patients, family members and health care providers to talk about patients’ health care wishes, in case there comes a time when the patient may not be able to make his or her own health care decisions. While Advanced Care Planning conversations can be difficult, they help support patient-centred palliative care and help friends and family by taking away some of the stress and uncertainty that comes at an already emotional time.
How are palliative care and medical assistance in dying related?
As of June 6, 2016, medical assistance in dying will be permitted in Canada. This will not change how Ontario patients with life-limiting illness access other medical treatments, including palliative care.
Based on the experience of other countries, only a small number of Ontarians will choose to access medical assistance in dying. Patients with life-limiting illnesses will generally choose to access palliative care and other treatments.
Federal Review of Medical Assistance in Dying
Editor: The original legislation regarding assistance in dying was considered too restrictive when matched with the Supreme Court ruling. To address some
of the concerns, an independent review has been commissioned.
Independent reviews related to medical assistance in dying requests
Source: http: //news. gc. ca/web/article-en. do?nid=1167959&tp=930
On June 17, 2016, legislation was enacted to allow for safe and consistent access to medical assistance in dying for mentally competent adults who are suffering unbearably, are in an advanced state of irreversible decline, and whose natural deaths have become reasonably foreseeable. It strikes an appropriate balance between personal autonomy for those seeking access to medical assistance in dying and the protection of vulnerable persons. it also addresses other important societal interests such as conscience rights of health care providers, and supporting the equal and inherent dignity and value of every person’s life.
Although provinces and territories are primarily responsible for the implementation of medical assistance in dying in Canada, the legislation provides for a continued role for the Government of Canada. Ongoing federal responsibilities include working with jurisdictions to support access to and referrals for medical assistance in dying and end-of-life care, and developing regulations to establish a system for monitoring and reporting on medical assistance in dying.
The legislation also requires the federal government to initiate independent reviews into three complex and sensitive circumstances outside the scope of the law that Parliament passed in June: requests by mature minors, advance requests and requests where mental illness is the sole underlying medical condition.
The reviews will be conducted by the Council of Canadian Academies (CCA), an independent, not-for-profit organization that undertakes evidence-based, expert assessments to support and inform public policy development in Canada. The CCA has extensive expertise and demonstrated experience in conducting reviews on high profile issues in an objective and rigorous manner.
The CCA will establish one or more expert panels that reflect a range of expertise, including legal, medical, ethical, social and health sciences perspectives. As part of the review process, the CCA will consider additional evidence from national and international experts, other levels of government, health care providers, and stakeholders impacted by the issues under review. The process will also examine information already available from previous expert panels and a Parliamentary Committee, as well as domestic and international experience with medical assistance in dying.
Within two years of initiating the studies, the CCA will produce three final reports, which will be made available to Parliamentarians and the public. These reports will not provide recommendations, but will summarize the findings of the reviews and provide a basis for an informed, evidence-based dialogue among Canadians and between Canadians and decision-makers.
