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All UHN health professionals are expected to:

  • Respond respectfully and compassionately.
  • Clarify whether the patient is seeking information or making an explicit request.
  • Provide resources on the UHN process for MAID, if the patient is seeking information.
  • Ask the patient why he or she may want MAID, if the patient is making an explicit request.
  • Inform the patient about the eligibility criteria and that there are multiple steps in the process.
  • Advise the patient, at the time of the request, that they must still be mentally capable at the time of MAID delivery.
  • Tell the patient that a reflection period is required - intervention is not immediate.
  • Notify the most responsible physician (MRP) on the same day.

The MRPs must:

  • Have a full discussion about MAID, when requested by a patient. This discussion should include diagnosis and prognosis, reasons for MAID request, adequacy of current symptom management, and measures to relieve physical and psychological suffering.
  • Ensure the patient is intending to receive MAID in the near future. Requests for MAID as a potential future option cannot be approved.
  • Inform patients with certain intent to receive MAID, of the eligibility criteria and steps to access MAID at UHN.
  • Advise the patient, at the time of the request, that they must still be mentally capable at the time of MAID delivery.
  • Tell the patient that a reflection period is required intervention is not immediate.
  • Continue to optimize supportive and palliative care and general medical care, to relieve suffering at all stages of the process.
  • Refer patients to the specialized MAID Supportive Care Team, when clinically warranted. The Supportive Care Team will provide optimal support for the relief of physical, psychological, spiritual and social distress of patients requesting MAID. See how to refer patients to Supportive Care »
  • Advise patients that UHN provides MAID only by using intravenous medications delivered in the hospital.
  • Discuss the limitations of what UHN can provide, in terms of a holistic care plan, at the time of intervention. UHN will do its best to respect religious and cultural preferences which can be reasonably accommodated in a hospital setting.
  • Make a referral through the Ministry of Health care coordination service at 1 866 286 4023 (TTY: 1 844 953 3350) for patients seeking MAID at home.
  • Refer eligible patients continuing to request MAID at UHN to the MAID Assessment Team. See how to refer patients to MAID assessment »

Clinical team members should be available to provide information about the patient to the MAID Assessment Team, and should remain involved in a supportive role to the patient, as needed, throughout the MAID process.

Patients who are requesting MAID can be referred to the MAID Assessment Team if they are:

  • Older than 18
  • Have Canadian medical health care insurance
  • Have an incurable medical illness, disease or disability

The MAID Assessment Team will determine the remaining eligibility criteria of:

  • Grievous and irremediable physical or psychological suffering
  • Advanced state of irreversible decline where natural death is reasonably foreseeable
  • A voluntary request, not coerced
  • Capacity and informed consent

The time from patients signing the MAID Patient Request Form to the delivery of MAID intervention takes 2 weeks on average. This includes

  • time to schedule the assessment interviews
  • the required 10-day reflection period
  • the time to coordinate the intervention.

It may be

  • longer if the assessment team decides that the patients require a longer reflection period, or
  • shorter for patients who are imminently declining.

MAID may not be feasible for many patients who are actively dying because the patient may not be assessed soon enough or may no longer be competent to provide consent at the time of the intervention. Palliative sedation has been applied in some such cases for symptom control.

Rights of Conscientious Objection

  • According to the RCPSC Professional Obligations and Human Rights Policy, "Physicians do not have to provide services that conflict with their conscience or religious beliefs".
  • Staff are not required to assess or provide MAID.

Limits of Conscientious Objection

  • Health care professionals whose personal views do not support MAID still have to respond respectfully to requesting patients. While they can communicate their objection to patients, they must​ not abandon patient care.
  • Most Responsible Physicians (MRPs) must either make an effective referral for MAID or ensure transfer of care to a physician who will refer for MAID.
  • Document presence of serious and incurable disease in the EPR
  • Complete MRP MAID Request Form after ensuring the patient has been informed of prognosis and all treatment options
  • Provide the Patient MAID Request Form to the patient and advise that eligible witnesses (not family members or health care team members) must sign on the same day as the patient
  • Send Attending Physician MAID Request Form and Patient MAID Request Form to maid@uhn.ca
  • For in-patients, inform MAID clinical care coordinator of changes in clinical status or changes in location
  • If translation services are required, inform translation services that this is for the purposes of MAID discussion
  • Remain available to provide information to MAID Teams and support to patient

Watch Our Video

Snapshot of MAID video The clinical process: step by step
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