MAID Track One: Full pathway Patient inquires about MAID Clinician chooses to participate in the discussion of MAID Clinician chooses not to participate in the discussion of MAID See Patient inquiries Clinician chooses not to participate in the discussion of MAID See Conscientious objections and patient referral Clinician: Informs the patient that they are unwilling to discuss MAID due to conscientious objections Refers the patient to another Clinician, institution or agency (e.g. CCS) that is willing and able to provide MAID Continue to provide ongoing care to the patient Must report all requests for MAID. See federal reporting requirements for more information Clinician chooses to participate in the discussion of MAID See Discussion To Understand Motivation Behind Patient’s Inquiry About MAID Clinician discusses and explores the motivation and suffering behind the patient’s request for MAID. The Clinician provides information on the available treatments and care options including MAID. Note: Clinicians must report all requests for MAID even if it does not result in death. See federal reporting requirements for more informationAfter discussion of MAID with Clinician, Patient chooses: To proceed with MAID eligibility assessments Not to proceed with MAID eligibility assessments Patient chooses NOT to proceed with MAID eligibility assessments Patient chooses not to pursue MAID eligibility assessments at this time and chooses to explore alternate care options Does Clinician choose(s) to participate in eligibility assessment? Yes, Clinician chooses to participate in eligibility assessment No, Clinician chooses not to participate in eligibility assessment Clinician chooses NOT to participate in eligibility assessment Clinician 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 MAIDClinician chooses to participate in eligibility assessment Clinician conducts eligibility assessment for MAID (Clinician Aid B [for the Clinician assessing/providing MAID] and Clinician Aid C [for the Second Clinician]). Eligibility criteria includes: 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 * Patients whose only medical condition is a mental illness will not be eligible for MAID until March 2023 Does patient meet ALL eligibility criteria for MAID? Yes, Patient meets ALL eligibility criteria for MAID No, Patient does not meet eligibility criteria for MAID Patient does NOT meet eligibility criteria for MAID Communicate ineligibility to the patient and inform the patient of their right to consult a different Clinician to obtain another eligibility assessmentPatient meets ALL eligibility criteria for MAIDClinician determines what procedural safeguard track the patient is on Track One: Natural death is reasonably foreseeable Track Two: Natural death is NOT reasonably foreseeable Natural death is NOT reasonably foreseeable For more information on patients whose natural death is NOT reasonably foreseeable, see the CEP’s resource on Track TwoTrack One: Natural death is reasonably foreseeable Track One procedural safeguards for patients whose 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 Provision of MAID is Clinician-Administered MAID Self-Administered MAID Clinician identifies that patient is at risk of losing decision-making capacity? Yes, patient is at risk of losing decision-making capacity No, patient is not at risk of losing decision-making capacity See Competent Adult and Assessing Capacity Patient wants to create a “waiver of final consent” written arrangement with their Clinician Yes, patient wants to create a “waiver of final consent” No, patient does not want to create a “waiver of final consent” See waiver of final consent Clinician administers MAID When the patient loses decision-making capacity and all other conditions of the written arrangement are met, the Clinician will administer MAID on or before the specified date outlined in the written arrangementImmediately before administering medication for MAID, the Clinician assesses the patient’s decision-making capacityPatient has decision-making capacity Yes, patient has decision-making capacity No, patient does not have decision-making capacity Clinician doe not provide MAID Clinician doe not provide made if patient does not have decision-making capacity immediately before administering MAID Patient has decision-making capacity Clinician: Confirms the patient’s express consent for MAID Provides the patient with the opportunity to withdraw the requestPatient expressly confirms consent Yes, patient expressly confirms consent No, patient does not confirm express consent or chooses to withdraw request Clinician does not provide MAIDClinician does not provide MAID if Patient doesn’t confirm express consent or chooses to withdraw requestClinician provides MAIDClinician provides MAID if patient expressly confirms consentCertification of Death and ReportingClinician contacts the Office of the Chief Coroner after the death is confirmed. The Office of the Chief Coroner obtains information from the Clinician and family members/caregivers to ensure complete reporting and an adequate understanding of the circumstances to determine if further investigation steps are required. The Clinician will complete and sign the medical certificate of death in all cases except when the coroner completes a further investigation.Self-administered MAID with “advance consent for failed self-administration” written arrangement Yes, self-administered MAID with “advance consent for failed self-administration” written arrangement No, self-administered MAID without “advance consent for failed self-administration” written arrangement See Advance consent for failed self-administration Self-administered MAID with “advance consent for failed self-administration” written arrangementImmediately before providing the prescription for MAID, the Clinician: Confirms with patient that they must be present during self-administration Self-administered MAID WITHOUT “advance consent for failed self-administration” written arrangement Immediately before providing the prescription for MAID, the Clinician: Confirms the patient’s express consent for MAID Provides the patient with the opportunity to withdraw the requestPatient self-administers MAID with no complications Yes, Patient self-administers MAID with no complications No, Patient self-administers MAID with complications Patient self-administers MAID with no complications Clinician contacts the Office of the Chief Coroner after the patient’s death by self-administration is confirmed. If the patient is still alive or has died from another cause or the outcome is unknown, the Clinicians must report to Health Canada via the Canadian MAID Data Collection Portal no earlier than 90 days and no later than 120 days* after prescribing or providing the drugs for MAID. *If the Clinician becomes aware of the patient’s death from any cause in <90 days, the Clinician may report to Health Canada before the 90th dayClinician administers MAID Patient self-administers MAID with complications, and the Clinician administers MAID Certification of Death and ReportingClinician contacts the Office of the Chief Coroner after the death is confirmed. The Office of the Chief Coroner obtains information from the Clinician and family members/caregivers to ensure complete reporting and an adequate understanding of the circumstances to determine if further investigation steps are required. The Clinician will complete and sign the medical certificate of death in all cases except when the coroner completes a further investigation Patient self-administers MAID with complications, and the Clinician cannot administer MAID
MAID Track One: Patient inquiry Patient inquires about MAID Clinician chooses to participate in the discussion of MAID Clinician chooses not to participate in the discussion of MAID See Patient inquiries Clinician chooses not to participate in the discussion of MAID See Conscientious objections and patient referral Clinician: Informs the patient that they are unwilling to discuss MAID due to conscientious objections Refers the patient to another Clinician, institution or agency (e.g. CCS) that is willing and able to provide MAID Continue to provide ongoing care to the patient Must report all requests for MAID. See federal reporting requirements for more information Clinician chooses to participate in the discussion of MAID See Discussion To Understand Motivation Behind Patient’s Inquiry About MAID Clinician discusses and explores the motivation and suffering behind the patient’s request for MAID. The Clinician provides information on the available treatments and care options including MAID. Note: Clinicians must report all requests for MAID even if it does not result in death. See federal reporting requirements for more informationAfter discussion of MAID with Clinician, Patient chooses: To proceed with MAID eligibility assessments Not to proceed with MAID eligibility assessments Patient chooses NOT to proceed with MAID eligibility assessments Patient chooses not to pursue MAID eligibility assessments at this time and chooses to explore alternate care options Does Clinician choose(s) to participate in eligibility assessment? Yes, Clinician chooses to participate in eligibility assessment No, Clinician chooses not to participate in eligibility assessment Clinician chooses NOT to participate in eligibility assessment Clinician 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 MAIDClinician chooses to participate in eligibility assessment Continue to Assessment of patient eligibility and procedural safeguards
MAID Track One: Assessment of Patient Eligibility and Procedural Safeguards Clinician chooses to participate in eligibility assessment Clinician conducts eligibility assessment for MAID (Clinician Aid B [for the Clinician assessing/providing MAID] and Clinician Aid C [for the Second Clinician]).Eligibility criteria includes: 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. 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* s 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 * Patients whose only medical condition is a mental illness will not be eligible for MAID until March 2023 Does patient meet ALL eligibility criteria for MAID? Yes, Patient meets ALL eligibility criteria for MAID No, Patient does not meet eligibility criteria for MAID Patient does NOT meet eligibility criteria for MAID Communicate ineligibility to the patient and inform the patient of their right to consult a different Clinician to obtain another eligibility assessmentPatient meets ALL eligibility criteria for MAIDClinician determines what procedural safeguard track the patient is on Track One: Natural death is reasonably foreseeable Track Two: Natural death is NOT reasonably foreseeable Natural death is NOT reasonably foreseeable For more information on patients whose natural death is NOT reasonably foreseeable, see the CEP’s resource on Track TwoTrack One: Natural death is reasonably foreseeable Track One procedural safeguards for patients whose 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 Continue to Provision of MAID
MAID Track One: Provision of MAID Clinician develops a plan for the administration of MAID, in consultation with the patient, individuals chosen by the patient and other members of the care team (including the pharmacist) 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 Provision of MAID is Clinician-Administered MAID Self-Administered MAID Clinician identifies that patient is at risk of losing decision-making capacity? Yes, patient is at risk of losing decision-making capacity No, patient is not at risk of losing decision-making capacity See Competent Adult and Assessing Capacity Patient wants to create a “waiver of final consent” written arrangement with their Clinician Yes, patient wants to create a “waiver of final consent” No, patient does not want to create a “waiver of final consent” See waiver of final consent Clinician administers MAID When the patient loses decision-making capacity and all other conditions of the written arrangement are met, the Clinician will administer MAID on or before the specified date outlined in the written arrangementImmediately before administering medication for MAID, the Clinician assesses the patient’s decision-making capacityPatient has decision-making capacity Yes, patient has decision-making capacity No, patient does not have decision-making capacity Clinician doe not provide MAID Clinician doe not provide made if patient does not have decision-making capacity immediately before administering MAID Patient has decision-making capacity Clinician: Confirms the patient’s express consent for MAID Provides the patient with the opportunity to withdraw the requestPatient expressly confirms consent Yes, patient expressly confirms consent No, patient does not confirm express consent or chooses to withdraw request Clinician does not provide MAIDClinician does not provide MAID if Patient doesn’t confirm express consent or chooses to withdraw requestClinician provides MAIDClinician provides MAID if patient expressly confirms consentCertification of Death and ReportingClinician contacts the Office of the Chief Coroner after the death is confirmed. The Office of the Chief Coroner obtains information from the Clinician and family members/caregivers to ensure complete reporting and an adequate understanding of the circumstances to determine if further investigation steps are required. The Clinician will complete and sign the medical certificate of death in all cases except when the coroner completes a further investigation.Self-administered MAID with “advance consent for failed self-administration” written arrangement Yes, self-administered MAID with “advance consent for failed self-administration” written arrangement No, self-administered MAID without “advance consent for failed self-administration” written arrangement See Advance consent for failed self-administration Self-administered MAID with “advance consent for failed self-administration” written arrangementImmediately before providing the prescription for MAID, the Clinician: Confirms with patient that they must be present during selfadministration Self-administered MAID WITHOUT “advance consent for failed self-administration” written arrangement Immediately before providing the prescription for MAID, the Clinician: Confirms the patient’s express consent for MAID Provides the patient with the opportunity to withdraw the requestPatient self-administers MAID with no complications Yes, Patient self-administers MAID with no complications No, Patient self-administers MAID with complications Patient self-administers MAID with no complications Clinician contacts the Office of the Chief Coroner after the patient’s death by self-administration is confirmed. If the patient is still alive or has died from another cause or the outcome is unknown, the Clinicians must report to Health Canada via the Canadian MAID Data Collection Portal no earlier than 90 days and no later than 120 days* after prescribing or providing the drugs for MAID. *If the Clinician becomes aware of the patient’s death from any cause in <90 days, the Clinician may report to Health Canada before the 90th dayClinician administers MAID Patient self-administers MAID with complications, and the Clinician administers MAID Certification of Death and ReportingClinician contacts the Office of the Chief Coroner after the death is confirmed. The Office of the Chief Coroner obtains information from the Clinician and family members/caregivers to ensure complete reporting and an adequate understanding of the circumstances to determine if further investigation steps are required. The Clinician will complete and sign the medical certificate of death in all cases except when the coroner completes a further investigation Patient self-administers MAID with complications, and the Clinician cannot administer MAID
MAID Track Two: Full Pathway Patient inquires about MAID Clinician chooses to participate in the discussion of MAID Clinician chooses not to participate in the discussion of MAID See Patient inquiries Clinician chooses not to participate in the discussion of MAID See Conscientious objections and patient referral Clinician: Informs the patient that they are unwilling to discuss MAID due to conscientious objections Refers the patient to another Clinician, institution or agency (e.g. CCS) that is willing and able to provide MAID Continue to provide ongoing care to the patient Must report all requests for MAID. See federal reporting requirements for more information Clinician chooses to participate in the discussion of MAID See Discussion To Understand Motivation Behind Patient’s Inquiry About MAID Clinician discusses and explores the motivation and suffering behind the patient’s request for MAID. The Clinician provides information on the available treatments and care options including MAID. Note: Clinicians must report all requests for MAID even if it does not result in death. See federal reporting requirements for more informationAfter discussion of MAID with Clinician, Patient chooses: To proceed with MAID eligibility assessments Not to proceed with MAID eligibility assessments Patient chooses NOT to proceed with MAID eligibility assessments Patient chooses not to pursue MAID eligibility assessments at this time and chooses to explore alternate care options Does Clinician choose(s) to participate in eligibility assessment? Yes, Clinician chooses to participate in eligibility assessment No, Clinician chooses not to participate in eligibility assessment Clinician chooses NOT to participate in eligibility assessment Clinician 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 MAIDClinician chooses to participate in eligibility assessment Clinician conducts eligibility assessment for MAID (Clinician Aid B [for the Clinician assessing/providing MAID] and Clinician Aid C [for the Second Clinician]). Eligibility criteria includes: 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 * Patients whose only medical condition is a mental illness will not be eligible for MAID until March 2023 Does patient meet ALL eligibility criteria for MAID? Yes, Patient meets ALL eligibility criteria for MAID No, Patient does not meet eligibility criteria for MAID Patient does NOT meet eligibility criteria for MAID Communicate ineligibility to the patient and inform the patient of their right to consult a different Clinician to obtain another eligibility assessmentPatient meets ALL eligibility criteria for MAIDClinician determines what procedural safeguard track the patient is on Track One: Natural death is reasonably foreseeable Track Two: Natural death is NOT reasonably foreseeable Natural death is reasonably foreseeable For more information on patients whose natural death is reasonably foreseeable, see the CEP’s resource on Track TwoTrack Two: patients whose natural death is NOT reasonably foreseeable Track Two procedural safeguards for 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 90-day assessment period The patient undergoes a 90-day assessment period* 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 * This period can be shortened if both Clinicians are of the opinion that the loss of the patient’s capacity to provide consent to receive MAID is imminent and if both assessments have been completed Provision of MAID Clinician develops a plan for the administration of MAID, in consultation with the patient, and individuals chosen by the patient and other members of the care team (including the pharmacist) 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 Provision of MAID is Clinician-Administered MAID Self-Administered MAID Immediately before administering medication for MAID, the Clinician assesses the patient’s decision-making capacityPatient has decision-making capacity Yes, patient has decision-making capacity No, patient does not have decision-making capacity Clinician doe not provide MAID Clinician doe not provide made if patient does not have decision-making capacity immediately before administering MAID Patient has decision-making capacity Clinician: Confirms the patient’s express consent for MAID Provides the patient with the opportunity to withdraw the requestPatient expressly confirms consent Yes, patient expressly confirms consent No, patient does not confirm express consent or chooses to withdraw request Clinician does not provide MAIDClinician does not provide MAID if Patient doesn’t confirm express consent or chooses to withdraw requestClinician provides MAIDClinician provides MAID if patient expressly confirms consentCertification of Death and ReportingClinician contacts the Office of the Chief Coroner after the death is confirmed. The Office of the Chief Coroner obtains information from the Clinician and family members/caregivers to ensure complete reporting and an adequate understanding of the circumstances to determine if further investigation steps are required. The Clinician will complete and sign the medical certificate of death in all cases except when the coroner completes a further investigation.Self-administered MAID with “advance consent for failed self-administration” written arrangement Yes, self-administered MAID with “advance consent for failed self-administration” written arrangement No, self-administered MAID without “advance consent for failed self-administration” written arrangement See Advance consent for failed self-administration Self-administered MAID with “advance consent for failed self-administration” written arrangementImmediately before providing the prescription for MAID, the Clinician: Confirms with patient that they must be present during self-administration Self-administered MAID WITHOUT “advance consent for failed self-administration” written arrangement Immediately before providing the prescription for MAID, the Clinician: Confirms the patient’s express consent for MAID Provides the patient with the opportunity to withdraw the requestPatient self-administers MAID with no complications Yes, Patient self-administers MAID with no complications No, Patient self-administers MAID with complications Patient self-administers MAID with no complications Clinician contacts the Office of the Chief Coroner after the patient’s death by self-administration is confirmed. If the patient is still alive or has died from another cause or the outcome is unknown, the Clinicians must report to Health Canada via the Canadian MAID Data Collection Portal no earlier than 90 days and no later than 120 days* after prescribing or providing the drugs for MAID. *If the Clinician becomes aware of the patient’s death from any cause in <90 days, the Clinician may report to Health Canada before the 90th dayClinician administers MAID Patient self-administers MAID with complications, and the Clinician administers MAID Certification of Death and ReportingClinician contacts the Office of the Chief Coroner after the death is confirmed. The Office of the Chief Coroner obtains information from the Clinician and family members/caregivers to ensure complete reporting and an adequate understanding of the circumstances to determine if further investigation steps are required. The Clinician will complete and sign the medical certificate of death in all cases except when the coroner completes a further investigationPatient self-administers MAID with complications, and the Clinician cannot administer MAID
MAID Track Two: Patient Inquiry Patient inquires about MAID Clinician chooses to participate in the discussion of MAID Clinician chooses not to participate in the discussion of MAID See Patient inquiries Clinician chooses not to participate in the discussion of MAID See Conscientious objections and patient referral Clinician: Informs the patient that they are unwilling to discuss MAID due to conscientious objections Refers the patient to another Clinician, institution or agency (e.g. CCS) that is willing and able to provide MAID Continue to provide ongoing care to the patient Must report all requests for MAID. See federal reporting requirements for more information Clinician chooses to participate in the discussion of MAID See Discussion To Understand Motivation Behind Patient’s Inquiry About MAID Clinician discusses and explores the motivation and suffering behind the patient’s request for MAID. The Clinician provides information on the available treatments and care options including MAID. Note: Clinicians must report all requests for MAID even if it does not result in death. See federal reporting requirements for more informationAfter discussion of MAID with Clinician, Patient chooses: To proceed with MAID eligibility assessments Not to proceed with MAID eligibility assessments Patient chooses NOT to proceed with MAID eligibility assessments Patient chooses not to pursue MAID eligibility assessments at this time and chooses to explore alternate care options Does Clinician choose(s) to participate in eligibility assessment? Yes, Clinician chooses to participate in eligibility assessment No, Clinician chooses not to participate in eligibility assessment Clinician chooses NOT to participate in eligibility assessment Clinician 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 MAIDClinician chooses to participate in eligibility assessment Continue to Assessment of patient eligibility and procedural safeguards
MAID Track Two: Assessment of patients eligibility Clinician chooses to participate in eligibility assessment Clinician conducts eligibility assessment for MAID (Clinician Aid B [for the Clinician assessing/providing MAID] and Clinician Aid C [for the Second Clinician]). Eligibility criteria includes: 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 * Patients whose only medical condition is a mental illness will not be eligible for MAID until March 2023 Does patient meet ALL eligibility criteria for MAID? Yes, Patient meets ALL eligibility criteria for MAID No, Patient does not meet eligibility criteria for MAID Patient does NOT meet eligibility criteria for MAID Communicate ineligibility to the patient and inform the patient of their right to consult a different Clinician to obtain another eligibility assessmentPatient meets ALL eligibility criteria for MAIDClinician determines what procedural safeguard track the patient is on Track One: Natural death is reasonably foreseeable Track Two: Natural death is NOT reasonably foreseeable Natural death is reasonably foreseeable For more information on patients whose natural death is reasonably foreseeable, see the CEP’s resource on Track TwoTrack Two: patients whose natural death is NOT reasonably foreseeable Track Two procedural safeguards for 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 90-day assessment period The patient undergoes a 90-day assessment period* 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 * This period can be shortened if both Clinicians are of the opinion that the loss of the patient’s capacity to provide consent to receive MAID is imminent and if both assessments have been completed Continue to Provision of MAID
MAID Track Two: Provision of MAID Provision of MAID Clinician develops a plan for the administration of MAID, in consultation with the patient, and individuals chosen by the patient and other members of the care team (including the pharmacist) 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 Provision of MAID is Clinician-Administered MAID Self-Administered MAID Immediately before administering medication for MAID, the Clinician assesses the patient’s decision-making capacityPatient has decision-making capacity Yes, patient has decision-making capacity No, patient does not have decision-making capacity Clinician doe not provide MAID Clinician doe not provide made if patient does not have decision-making capacity immediately before administering MAID Patient has decision-making capacity Clinician: Confirms the patient’s express consent for MAID Provides the patient with the opportunity to withdraw the requestPatient expressly confirms consent Yes, patient expressly confirms consent No, patient does not confirm express consent or chooses to withdraw request Clinician does not provide MAIDClinician does not provide MAID if Patient doesn’t confirm express consent or chooses to withdraw requestClinician provides MAIDClinician provides MAID if patient expressly confirms consentCertification of Death and ReportingClinician contacts the Office of the Chief Coroner after the death is confirmed. The Office of the Chief Coroner obtains information from the Clinician and family members/caregivers to ensure complete reporting and an adequate understanding of the circumstances to determine if further investigation steps are required. The Clinician will complete and sign the medical certificate of death in all cases except when the coroner completes a further investigation.Self-administered MAID with “advance consent for failed self-administration” written arrangement Yes, self-administered MAID with “advance consent for failed self-administration” written arrangement No, self-administered MAID without “advance consent for failed self-administration” written arrangement See Advance consent for failed self-administration Self-administered MAID with “advance consent for failed self-administration” written arrangementImmediately before providing the prescription for MAID, the Clinician: Confirms with patient that they must be present during self-administration Self-administered MAID WITHOUT “advance consent for failed self-administration” written arrangement Immediately before providing the prescription for MAID, the Clinician: Confirms the patient’s express consent for MAID Provides the patient with the opportunity to withdraw the requestPatient self-administers MAID with no complications Yes, Patient self-administers MAID with no complications No, Patient self-administers MAID with complications Patient self-administers MAID with no complications Clinician contacts the Office of the Chief Coroner after the patient’s death by self-administration is confirmed. If the patient is still alive or has died from another cause or the outcome is unknown, the Clinicians must report to Health Canada via the Canadian MAID Data Collection Portal no earlier than 90 days and no later than 120 days* after prescribing or providing the drugs for MAID. *If the Clinician becomes aware of the patient’s death from any cause in <90 days, the Clinician may report to Health Canada before the 90th dayClinician administers MAID Patient self-administers MAID with complications, and the Clinician administers MAID Certification of Death and ReportingClinician contacts the Office of the Chief Coroner after the death is confirmed. The Office of the Chief Coroner obtains information from the Clinician and family members/caregivers to ensure complete reporting and an adequate understanding of the circumstances to determine if further investigation steps are required. The Clinician will complete and sign the medical certificate of death in all cases except when the coroner completes a further investigation
