MAID Forms Staging*

Clinician chooses to participate in the discussion of MAID

Patient chooses NOT to proceed with MAID eligibility assessments

Clinician chooses NOT to participate in eligibility assessment

• Chooses not to participate in eligibility assessments and/or provision of MAID
• Refers the patient to another Clinician, institution or agency (e.g. CCS) that is willing and able to provide MAID

Clinician chooses to participate in eligibility assessment

• Is 18 years of age or older and has decision-making capacity.
• Is eligible for publicly funded health care services
• Has made a voluntary request that is not the result of external pressure. See
• Has provided informed consent to receive MAID, meaning that the patient has consented to receive MAID after they have received all information needed to make this decision
• Has a serious and incurable illness, disease or disability*
• Is in an advanced state of irreversible decline in capability
• Has enduring and intolerable physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable

Patient does NOT meet eligibility criteria for MAID

Patient meets ALL eligibility criteria for MAID

Natural death is NOT reasonably foreseeable

Track One: Natural death is reasonably foreseeable

• Request for MAID must be made in writing. A written request must be signed by one independent witness, and it must be made after the patient is informed that they have a “grievous and irremediable medication condition” (Clinician Aid A)
• Two independent Clinicians must provide an assessment and confirm that all of the eligibility requirements are met
• The patient must be informed that they can withdraw their request at any time, in any manner

Provision of MAID

Clinician develops a plan for the administration of MAID, in consultation with the patient, and

Designated facilities under the Trillium Gift of Life Network (TGLN) Act notify TGLN of the patient’s request for MAID when the patient’s death is imminent due to injury or disease

Clinician doe not provide MAID

Patient has decision-making capacity

• Confirms the patient’s express consent for MAID
• Provides the patient with the opportunity to withdraw the request

Clinician does not provide MAID

Clinician provides MAID

Certification of Death and Reporting

Self-administered MAID WITHOUT “advance consent for failed self-administration” written arrangement

Patient self-administers MAID with no complications

Clinician administers MAID

Certification of Death and Reporting

Patient self-administers MAID with complications, and the Clinician cannot administer MAID

Clinician chooses to participate in the discussion of MAID

Patient chooses NOT to proceed with MAID eligibility assessments

Clinician chooses NOT to participate in eligibility assessment

• Chooses not to participate in eligibility assessments and/or provision of MAID
• Refers the patient to another Clinician, institution or agency (e.g. CCS) that is willing and able to provide MAID

Clinician chooses to participate in eligibility assessment

Patient does NOT meet eligibility criteria for MAID

Patient meets ALL eligibility criteria for MAID

Natural death is NOT reasonably foreseeable

Track One: Natural death is reasonably foreseeable

• Request for MAID must be made in writing. A written request must be signed by one independent witness, and it must be made after the patient is informed that they have a “grievous and irremediable medication condition” (Clinician Aid A)
• Two independent Clinicians must provide an assessment and confirm that all of the eligibility requirements are met
• The patient must be informed that they can withdraw their request at any time, in any manner

Clinician doe not provide MAID

Patient has decision-making capacity

• Confirms the patient’s express consent for MAID
• Provides the patient with the opportunity to withdraw the request

Clinician does not provide MAID

Clinician provides MAID

Certification of Death and Reporting

Self-administered MAID WITHOUT “advance consent for failed self-administration” written arrangement

Patient self-administers MAID with no complications

Clinician administers MAID

Certification of Death and Reporting

Clinician chooses to participate in the discussion of MAID

Patient chooses NOT to proceed with MAID eligibility assessments

Clinician chooses NOT to participate in eligibility assessment

• Chooses not to participate in eligibility assessments and/or provision of MAID
• Refers the patient to another Clinician, institution or agency (e.g. CCS) that is willing and able to provide MAID

Clinician chooses to participate in eligibility assessment

• Is 18 years of age or older and has decision-making capacity.
• Is eligible for publicly funded health care services
• Has made a voluntary request that is not the result of external pressure. See
• Has provided informed consent to receive MAID, meaning that the patient has consented to receive MAID after they have received all information needed to make this decision
• Has a serious and incurable illness, disease or disability*
• Is in an advanced state of irreversible decline in capability
• Has enduring and intolerable physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable

Patient does NOT meet eligibility criteria for MAID

Patient meets ALL eligibility criteria for MAID

Natural death is reasonably foreseeable

Track Two: patients whose natural death is NOT reasonably foreseeable

• Request for MAID must be made in writing. A written request must be signed by one independent witness, and it must be made after the patient is informed that they have a “grievous and irremediable medication condition” (Clinician Aid A)
• Two independent Clinicians must provide an assessment and confirm that all eligibility requirements are met
• If neither of the two Clinicians who assesses eligibility has expertise in the medical condition that is causing the patient’s suffering, they must consult with a Clinician who has such expertise
• The patient must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services, and palliative care, and the patient must be offered consultations with available professionals who provide those services
• The patient and the Clinicians must have discussed reasonable and available means to relieve the patient’s suffering and agree that the patient has seriously considered these means
• The patient must be informed that they can withdraw their request at any time, in any manner

• The 90-day period begins on the day of the patient’s first MAID eligibility criteria assessment
• The Clinician must document the start and end-date of the 90-day assessment
• The Clinician must document if the period is shortened, why, and the new start and end-date

Provision of MAID

Designated facilities under the Trillium Gift of Life Network (TGLN) Act notify TGLN of the patient’s request for MAID when the patient’s death is imminent due to injury or disease

Clinician doe not provide MAID

Patient has decision-making capacity

• Confirms the patient’s express consent for MAID
• Provides the patient with the opportunity to withdraw the request

Clinician does not provide MAID

Clinician provides MAID

Certification of Death and Reporting

Self-administered MAID WITHOUT “advance consent for failed self-administration” written arrangement

Clinician administers MAID

Certification of Death and Reporting

Patient self-administers MAID with complications, and the Clinician cannot administer MAID

Clinician chooses to participate in the discussion of MAID

Patient chooses NOT to proceed with MAID eligibility assessments

Clinician chooses NOT to participate in eligibility assessment

• Chooses not to participate in eligibility assessments and/or provision of MAID
• Refers the patient to another Clinician, institution or agency (e.g. CCS) that is willing and able to provide MAID

Clinician chooses to participate in eligibility assessment

Patient does NOT meet eligibility criteria for MAID

Patient meets ALL eligibility criteria for MAID

Natural death is reasonably foreseeable

Track Two: patients whose natural death is NOT reasonably foreseeable

• Request for MAID must be made in writing. A written request must be signed by one independent witness, and it must be made after the patient is informed that they have a “grievous and irremediable medication condition” (Clinician Aid A)
• Two independent Clinicians must provide an assessment and confirm that all eligibility requirements are met
• If neither of the two Clinicians who assesses eligibility has expertise in the medical condition that is causing the patient’s suffering, they must consult with a Clinician who has such expertise
• The patient must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services, and palliative care, and the patient must be offered consultations with available professionals who provide those services
• The patient and the Clinicians must have discussed reasonable and available means to relieve the patient’s suffering and agree that the patient has seriously considered these means
• The patient must be informed that they can withdraw their request at any time, in any manner

• The 90-day period begins on the day of the patient’s first MAID eligibility criteria assessment
• The Clinician must document the start and end-date of the 90-day assessment
• The Clinician must document if the period is shortened, why, and the new start and end-date

Clinician doe not provide MAID

Patient has decision-making capacity

• Confirms the patient’s express consent for MAID
• Provides the patient with the opportunity to withdraw the request

Clinician does not provide MAID

Clinician provides MAID

Certification of Death and Reporting

Self-administered MAID WITHOUT “advance consent for failed self-administration” written arrangement

Patient self-administers MAID with no complications

Clinician administers MAID

Certification of Death and Reporting