Week 5: End-of-Life Flashcards
MAiD, Advanced Directives, Witholding/Withdrawing Tx
Define MAiD
-Administration of a substance that causes death → requested by a person believed to meet the necessary legal criteria that has provided fully informed consent
-NOT part of the health care act; part of the Criminal Code of Canada
What are the two types of MAiD?
- Self-administered medical assistance in dying
- Clinician-assisted medical assistance in dying
What is Self-administered MAiD?
o The clinician who approved the request prescribed medication
o Patient (self) administers medication
o Oral medication
What is Clinician-Assisted MAiD?
o Clinician who approved the request prescribes & administers the medication
o IV medication – works faster than oral and effective
▪ College of Physicians have their own by-laws to follow; have to be present during the admin of the IV med *for oral, they don’t have to be present
What is the eligibility criteria for MAiD?
-Eligible govt. funded health services (no tourists allowed to access MAID)
-Adult (18 y/o) & capable of making own medical decisions
-Serious & permanent medical condition *must have all of the following:
1.Need to have a serious & incurable disease or disability (excluding mental illness)
2.Be in an advanced state of irreversible decline in capability *need to be incapable of ADLs
3. Have intolerable suffering d/t 1. or 2. that can’t be relieved by treatment acceptable to pt.
-Voluntary request wasn’t a result of external pressure
-Informed consent after reviewing all options *including palliative care
Define the process of Reasonably Foreseeable Natural Death (RFND; track 1)
*not an emergency service (takes < 2-4 weeks)
o On a path towards death
▪INTAKE: provider/pt./family contacts MAID
▪TRIAGE: by RN over the phone
▪ASSESSMENTS: 2 independent assessments (by MD/NP) *in person OR virtual
▪WRITTEN REQUEST
*By law, pt. needs to submit a written request for MAID (there’s a standard form for this)
*Requires 1 witness *can be a paid care provider
▪PROVISION *death day
Define the process of No Reasonably Foreseeable Natural Death (NRFND; track 2)
oHas a chronic illness (but not life-limiting)
*Same as RFND plus:
*Patient questionnaire: to explore history & current functioning in detail
*HCP input *on MAID criteria
*Psychosocial assessment if appropriate
*Minimum 90-day assessment period
*Expert input re: condition causing suffering
*‘Serious consideration’ of all treatment options
What medications are used with MAiD?
-Series of IV medications over 5-10 mins: midazolam → propofol → rocuronium
-Very peaceful & gentle *no incontinence/movement
▪Lose consciousness (1-2 min) → apnea (5-6 min) → cardiac arrest (8-10 min)
Define the Waiver of Final Consent
-Pt. approved for MAID + RFND (track 1)
-Pt. has chosen a date for MAID provision
-Pt. has been informed they’re at risk of loss of capacity
-Pt. & MAID practitioners have completed a written agreement → must be done before pt. loses capacity & can’t be done by anyone other than the pt.
-CANNOT proceed if pt. showing signs of ‘refusal’
Who is not permitted to get MAiD?
-Minors → undergoing treatment like chemo, emancipated minors
-Advance request/living will o Must give consent at time of requesting provision*
▪ CANNOT be a decision you pass onto SDM (have to be mentally capable at the time of decision)
- When mental illness is the only medical condition
What are the DO’s of managing a request of MAiD?
- Acknowledge it
- Explore it:
– ‘Sit Down & Lean In’
Lean into what they are saying and explore it deeper - Convey it:
To the healthcare provider/unit manager
To MAID team
Provide MAID contact info - Document it
What the DONT’s in managing a request for MAiD?
- Ignore a request or request for information on MAiD
- Counsel on MAiD
Dont encourage a patient ⇒ “Have you thought about MAiD?”
-Minimize the client’s request or feelings ⇒ “Im sorry to hear that” continues conversation
- Provide information on MAiD unless the client explicitly asks
- Guess or speculate – make sure the information is correct!
Define Conscientious Objection
If nursing care is requested that’s in conflict w/ the nurse’s moral beliefs & values but in keeping w/ professional practice, the nurse provides safe, compassionate, competent & ethical care UNTIL alternative care arrangements are made to meet the person’s needs or desires
- For non-emergent situations – if there is not a suitable replacement during life or death situation
- Nurses need to alert their employer in advance → so that they are aware so that placegaurds are in place
Define Death
irreversible cessation of all brain function
Define Homicide
illegal; deliberate act to end a life
