Regulations for the Monitoring of Medical Assistance in Dying
SOR/2018-166
Registration 2018-07-27
Regulations for the Monitoring of Medical Assistance in Dying
Whereas the Minister of Health considers it necessary that the annexed Regulations be made;
Therefore, the Minister of Health, pursuant to subsection 241.31(3)Footnote a of the Criminal CodeFootnote b, makes the annexed Regulations for the Monitoring of Medical Assistance in Dying.
Return to footnote aS.C. 2016, c. 3, s. 4
Return to footnote bR.S., c. C-46
Ottawa, July 25, 2018
La ministre de la Santé  Ginette Petitpas Taylor Minister of Health |
Interpretation
Marginal note:Definitions
1 The following definitions apply in these Regulations.
- care coordination service
care coordination service means a service that facilitates access to medical assistance in dying. (service de coordination de soins)
- Code
Code means the Criminal Code. (Code)
- eligibility criteria
eligibility criteria means the criteria set out in subsections 241.2(1) and (2) of the Code. (critères d’admissibilité)
- medical certificate of death
medical certificate of death includes, in the Province of Quebec, an attestation of death. (certificat médical de décès)
- patient
patient means a person who has made a written request for medical assistance in dying. (patient)
- personal information
personal information has the same meaning as in section 3 of the Privacy Act. (renseignements personnels)
- practitioner
practitioner means a medical practitioner or nurse practitioner. (praticien)
- refer
refer does not include referring a patient to a practitioner in order to obtain that practitioner’s written opinion, for the purposes of paragraph 241.2(3)(e) of the Code, regarding whether the patient meets all of the eligibility criteria. (aiguiller)
- residential care facility
residential care facility means a residential facility that provides health care services, including professional health monitoring and nursing care, on a continuous basis for persons who require assistance with activities of daily living. (établissement de soins pour bénéficiaires internes)
Provision of Information
Designation of Recipients of Information
Marginal note:Designation — Minister of Health
2 (1) The Minister of Health is designated as the recipient of information for the purposes of subsections 241.31(1) and (2) of the Code.
Marginal note:Designation — other recipients
(2) Despite subsection (1), the following persons are designated as the recipients of information for the purposes of subsections 241.31(1) and (2) of the Code in respect of the following information:
(a) in respect of the information to be provided under paragraph 7(2)(b) or subsection 8(2), the Chief Coroner for Ontario;
(a.1) in respect of the information to be provided by a practitioner who receives a written request for medical assistance in dying in Quebec or by a pharmacist who dispenses a substance there in connection with the provision of medical assistance in dying, the Deputy Minister of Health and Social Services of Quebec;
(b) in respect of the information to be provided by a practitioner who receives a written request for medical assistance in dying in British Columbia or by a pharmacist who dispenses a substance there in connection with the provision of medical assistance in dying, the Deputy Minister of Health of British Columbia;
(c) in respect of the information to be provided by a practitioner who receives a written request for medical assistance in dying in Saskatchewan or by a pharmacist who dispenses a substance there in connection with the provision of medical assistance in dying, the Chief Executive Officer of the Saskatchewan Health Authority;
(d) in respect of the information to be provided by a practitioner who receives a written request for medical assistance in dying in Alberta or by a pharmacist who dispenses a substance there in connection with the provision of medical assistance in dying, the Minister of Health of Alberta;
(e) in respect of the information to be provided by a practitioner who receives a written request for medical assistance in dying in the Northwest Territories or by a pharmacist who dispenses a substance there in connection with the provision of medical assistance in dying, the Deputy Minister of Health and Social Services of the Northwest Territories; and
(f) in respect of the information to be provided by a practitioner who receives a written request for medical assistance in dying in Nunavut or by a pharmacist who dispenses a substance there in connection with the provision of medical assistance in dying, the Minister of Health of Nunavut.
Practitioners
Marginal note:Exception — no information required
3 A practitioner who has received a patient’s written request for medical assistance in dying from the patient directly or from another practitioner, a care coordination service or another person on the patient’s behalf in order to obtain the practitioner’s written opinion, for the purposes of paragraph 241.2(3)(e) of the Code, regarding whether the patient meets all of the eligibility criteria, is not required, in respect of the request, to provide information under subsection 5(1) or 6(1) or section 9.
Marginal note:Referral or transfer of care of patient
4 (1) A practitioner who has received a patient’s written request for medical assistance in dying and refers the patient, in respect of the request, to another practitioner or to a care coordination service, or, as a result of the request, transfers the care of the patient to another practitioner, must provide the applicable recipient designated under section 2 with the information referred to in Schedules 1 and 2 within 30 days after the day on which they refer, or transfer the care of, the patient.
Marginal note:Exception — no other information required
(2) A practitioner who provides information in accordance with subsection (1) is not required to provide information under subsection 5(1) or 6(1) or section 9.
Marginal note:Withdrawal of request
5 (1) A practitioner must provide the following information to the applicable recipient designated under section 2 within 30 days after the day on which the practitioner becomes aware of the withdrawal of a patient’s written request for medical assistance in dying that they received:
(a) the information referred to in Schedule 1;
(b) in the case where the practitioner has determined that the patient met all of the eligibility criteria, the information referred to in Schedule 3;
(c) the patient’s reasons for withdrawing the request, if known; and
(d) in the case where the patient withdrew their request after having been given an opportunity to do so under paragraph 241.2(3)(h) of the Code, an indication to that effect.
Marginal note:Exception — no other information required
(2) A practitioner who provides information in accordance with subsection (1) is not required to provide information under subsection 6(1) or section 9.
Marginal note:Ineligibility
6 (1) A practitioner who has received a patient’s written request for medical assistance in dying and determines that the patient does not meet one or more of the eligibility criteria must provide the applicable recipient designated under section 2 with the information referred to in Schedules 1 and 3 within 30 days after the day on which the practitioner makes that determination.
Marginal note:Clarification
(2) For greater certainty, subsection (1) applies if the practitioner determined that the patient met all of the eligibility criteria but subsequently determines that the patient does not meet one or more of those criteria.
Marginal note:Exception — no other information required
(3) A practitioner who provides information in accordance with subsection (1) is not required to provide information under subsection 5(1) or section 9.
Marginal note:Prescribing or providing a substance — general
7 (1) A practitioner who has received a patient’s written request for medical assistance in dying and provides medical assistance in dying by prescribing or providing a substance to the patient for self-administration must provide the applicable recipient designated under section 2 with the information referred to in Schedules 1 and 3 to 5 no earlier than 90 days after the day on which the practitioner prescribes or provides the substance and no later than 120 days after that day.
Marginal note:Prescribing or providing a substance — Ontario
(2) Despite subsection (1), a practitioner who has received a patient’s written request for medical assistance in dying and provides medical assistance in dying in Ontario by prescribing or providing a substance to the patient for self-administration must provide the information referred to in Schedules 1 and 3 to 5, no earlier than 90 days after the day on which the practitioner prescribes or provides the substance and no later than 120 days after that day,
(a) to the recipient designated under subsection 2(1), except in the case referred to in paragraph (b); or
(b) to the recipient designated under paragraph 2(2)(a), in the case where, when the practitioner provides the information, the practitioner knows that the patient has died following self-administration of the substance.
Marginal note:Exception — time to report
(3) The practitioner may provide the information earlier than 90 days after the day on which the practitioner prescribes or provides the substance to the patient if the practitioner knows that the patient has died.
Marginal note:Exception — no other information required
(4) A practitioner who provides information in accordance with subsection (1) or (2) is not required to provide information under section 9.
Marginal note:Administering a substance — general
8 (1) A practitioner who has received a patient’s written request for medical assistance in dying and provides medical assistance in dying by administering a substance to the patient must provide the applicable recipient designated under section 2 with the information referred to in Schedules 1, 3, 4 and 6 within 30 days after the day on which the patient dies.
Marginal note:Administering a substance — Ontario
(2) Despite subsection (1), a practitioner who has received a patient’s written request for medical assistance in dying and provides medical assistance in dying in Ontario by administering a substance to the patient must provide the recipient designated under paragraph 2(2)(a) with the information referred to in Schedules 1, 3, 4 and 6 within 30 days after the day on which the patient dies.
Marginal note:Death — other cause
9 A practitioner who has received a patient’s written request for medical assistance in dying must, within 30 days after the day on which the practitioner becomes aware that the patient died from a cause other than medical assistance in dying, provide the applicable recipient designated under section 2 with the following information:
(a) the information referred to in Schedule 1;
(b) in the case where the practitioner has determined that the patient met all of the eligibility criteria, the information referred to in Schedule 3; and
(c) the date of the patient’s death, if known, and, if the patient’s medical certificate of death was completed by the practitioner, the immediate and underlying causes of death as indicated on the certificate.
Marginal note:Cessation of certain requirements
10 A practitioner who has received a patient’s written request for medical assistance in dying is not required to provide information under a provision of these Regulations — other than subsection 7(1) or (2) or 8(1) or (2), as the case may be — with regard to any circumstances relating to the request that the practitioner becomes aware of, or any actions that the practitioner takes in respect of the request, after the 90th day after the day on which the practitioner received the request.
Pharmacists
Marginal note:Dispensing of substance
11 A pharmacist who dispenses a substance in connection with the provision of medical assistance in dying must provide the applicable recipient designated under section 2 with the information referred to in Schedule 7 within 30 days after the day on which they dispense the substance.
Collection of Information
Marginal note:Information from provinces and territories
12 (1) The Minister of Health may, for the purposes of monitoring medical assistance in dying, collect personal information relating to written requests for, and the provision of, medical assistance in dying from a provincial or territorial government, or any of its institutions, or from a public body established under an Act of the legislature of a province or territory.
Marginal note:Coroners and medical examiners
(2) Without restricting the generality of subsection (1), the Minister of Health may, for the purposes of monitoring medical assistance in dying, request that the Chief Coroner or Chief Medical Examiner of a province or territory provide the Minister, on a voluntary basis, with the following information:
(a) the number of patients who died as a result of having received medical assistance in dying in the province or territory; and
(b) personal information relating to the death of patients who died as a result of having received medical assistance in dying in the province or territory, including:
(i) copies of medical certificates of death of those patients; and
(ii) the findings of any investigations undertaken by the Chief Coroner or Chief Medical Examiner in respect of the deaths of those patients.
Publication of Information
Marginal note:Report
13 (1) The Minister of Health must cause to be published, at least once a year, on the website of the Government of Canada a report that is based on information that the Minister obtained under these Regulations.
Marginal note:Content — period covered by report
(2) The report must contain information relating to written requests for medical assistance in dying received by practitioners and the provision of medical assistance in dying during the period covered by the report, including:
(a) the number of requests that were made and the results of those requests;
(b) the characteristics, including medical characteristics, of patients;
(c) the nature of the intolerable physical or psychological suffering of patients who received medical assistance in dying;
(d) the reasons for which patients did not receive medical assistance in dying, including which of the eligibility criteria were not met by patients;
(e) the places in which medical assistance in dying was provided;
(f) time periods relating to the handling of requests for, and the provision of, medical assistance in dying;
(g) information as to whether practitioners consulted with other health care professionals or social workers regarding requests;
(h) the nature of involvement of practitioners in requests and the provision of medical assistance in dying, including the respective involvement of medical practitioners and nurse practitioners; and
(i) information as to whether patients consulted with practitioners concerning their health — for a reason other than seeking medical assistance in dying — before practitioners received their requests for medical assistance in dying.
Marginal note:Other content
(3) The report must also contain
(a) the methodology employed to arrive at any findings set out in the report;
(b) information on trends in written requests for, and the provision of, medical assistance in dying; and
(c) the period covered by the report.
Marginal note:Restriction
(4) The report must not include any personal information of an individual
(a) who provided information under these Regulations; or
(b) in respect of whom information was obtained by the Minister of Health under these Regulations.
Other Disclosure
Marginal note:Disclosure to provinces and territories
14 The Minister of Health may disclose to a provincial or territorial government, or any of its institutions, or to a public body established under an Act of the legislature of a province or territory personal information that the Minister obtained under these Regulations if the purpose of the disclosure is to support the monitoring of medical assistance in dying in the province or territory.
Marginal note:Research
15 The Minister of Health may disclose, for the purposes of enabling research or statistical analysis with respect to medical assistance in dying, personal information that the Minister obtained under these Regulations — other than an individual’s name — to any individual or organization if the Minister
(a) determines that the disclosure is necessary to achieve the objectives of the research or statistical analysis; and
(b) receives a written undertaking by the individual or organization
(i) to use the information only for the purpose for which it was disclosed, and
(ii) not to disclose the information in any form that could reasonably be expected to identify the individual to whom it relates.
Marginal note:Disclosure to Minister of Health
16 (1) A recipient designated under subsection 2(2) must disclose to the Minister of Health, within 30 days after the day on which a quarter begins, the information — other than the information referred to in paragraphs 2(a) and (g) of Schedule 1 and paragraphs 2(a) and (d) of Schedule 7 — that the recipient obtained under these Regulations in the preceding quarter.
Marginal note:Definition
(2) For the purposes of subsection (1), quarter means any period of three consecutive months beginning on January 1, April 1, July 1 or October 1.
Coming into Force
Marginal note:Fourth month after registration
Footnote *17 (1) These Regulations, except section 13, come into force on the first day of the fourth month following the month in which they are registered.
Marginal note:Section 13
(2) Section 13 comes into force on the first anniversary of the day on which section 2 of these Regulations comes into force.
Return to footnote *[Note: Regulations, except section 13, in force November 1, 2018; section 13 in force November 1, 2019.]
SCHEDULE 1(Subsection 4(1), paragraph 5(1)(a), subsections 6(1) and 7(1) and (2), section 8, paragraph 9(a) and subsection 16(1))Basic Information — Request for Medical Assistance in Dying
1 The following information in respect of the patient:
(a) date of birth;
(b) sex;
(c) health insurance number and the province or territory that issued it or, in the case where they do not have a health insurance number, the province or territory of their usual place of residence on the day on which the practitioner received the request;
(d) the postal code associated with the patient’s health insurance number or, in the case where they do not have a health insurance number, the postal code of their usual place of residence on the day on which the practitioner received the request.
2 The following information in respect of the practitioner:
(a) name;
(b) an indication of whether they are a medical practitioner or nurse practitioner;
(c) if they are a family physician, an indication to that effect;
(d) if they are a medical practitioner other than a family physician, their area of specialty;
(e) the province or territory in which they practise and, if they practise in more than one province or territory, the province or territory in which they received the request;
(f) the licence or registration number assigned to them in the province or territory in which they received the request;
(g) the mailing address and email address that the practitioner uses for work;
(h) to the best of their knowledge or belief, an indication of whether, before they received the request, the patient consulted them concerning the patient’s health for a reason other than seeking medical assistance in dying.
3 The following information in respect of the request:
(a) the date on which the practitioner received the request;
(b) an indication of whether the practitioner received the request from the patient directly, another practitioner, a care coordination service or another third party.
SCHEDULE 2(Subsection 4(1))Referral or Transfer of Care of Patient
1 The date on which the practitioner referred, or transferred the care of, the patient.
2 An indication of whether the practitioner referred, or transferred the care of, the patient for any of the following reasons, and if so, an indication of the reason:
(a) the referral or transfer of care was the result of the application of the policies on medical assistance in dying of a hospital, a residential care facility or a palliative care facility, in the case where the patient was in a hospital or such a facility;
(b) providing medical assistance in dying to the patient or assessing the patient to determine whether they meet the eligibility criteria would have been contrary to the practitioner’s conscience or beliefs;
(c) the patient asked the practitioner to refer them or transfer their care;
(d) the practitioner was of the view that they lacked the relevant expertise to provide medical assistance in dying.
3 An indication of whether the practitioner had determined that the patient met or did not meet all of the eligibility criteria before they referred, or transferred the care of, the patient.
SCHEDULE 3(Paragraph 5(1)(b), subsections 6(1) and 7(1) and (2), section 8, and paragraph 9(b))Eligibility Criteria and Related Information
1 An indication of whether the practitioner consulted with other health care professionals — other than a practitioner who received the patient’s written request for medical assistance in dying as described in section 3 of these Regulations — or social workers in order to determine whether the patient met the eligibility criteria and, if so, the professions of those persons.
2 An indication of which of the following eligibility criteria were assessed by the practitioner and whether the practitioner was of the opinion that the patient met or did not meet each of those criteria:
(a) the patient was eligible — or, but for any applicable minimum period of residence or waiting period, would have been eligible — for health services funded by a government in Canada;
(b) the patient was at least 18 years of age;
(c) the patient was capable of making decisions with respect to their health;
(d) the patient made a voluntary request for medical assistance in dying that, in particular, was not made as a result of external pressure and, if the practitioner assessed this criterion and was of the opinion that the patient met it, the reasons why the practitioner was of that opinion;
(e) the patient gave informed consent to receive medical assistance in dying after having been informed of the means that are available to relieve their suffering, including palliative care;
(f) the patient had a serious and incurable illness, disease or disability and, if the practitioner assessed this criterion and was of the opinion that the patient met it, a description of the illness, disease or disability;
(g) the patient was in an advanced state of irreversible decline in capability;
(h) the illness, disease or disability or state of decline caused the patient enduring physical or psychological suffering that was intolerable to them and that could not be relieved under conditions that they considered acceptable and, if the practitioner assessed this criterion and was of the opinion that the patient met it, the patient’s description of the suffering;
(i) the patient’s natural death had become reasonably foreseeable, taking into account all of their medical circumstances.
3 An indication of whether the patient received palliative care, if known, and
(a) if the patient received palliative care, how long the patient received it, if known; or
(b) if the patient did not receive palliative care, an indication of whether, to the best of the practitioner’s knowledge or belief, palliative care was accessible to the patient.
4 An indication of whether the patient required disability support services, if known, and if so,
(a) if the patient received disability support services, how long the patient received those services, if known; or
(b) if the patient did not receive disability support services, an indication of whether, to the best of the practitioner’s knowledge or belief, disability support services were accessible to the patient.
5 In the case where the practitioner determined that the patient met all of the eligibility criteria but subsequently determines that the patient does not meet one or more of those criteria, an indication of
(a) whether the patient lost the capacity to make decisions with respect to their health; and
(b) whether the practitioner became aware that the patient’s request was not voluntary.
SCHEDULE 4(Subsections 7(1) and (2) and section 8)Procedural Requirements — Providing Medical Assistance in Dying
1 An indication of
(a) whether the practitioner was of the opinion that the patient met all of the eligibility criteria;
(b) whether the practitioner ensured that the patient’s request was made in writing and was signed and dated by the patient or by another person who met the requirements set out in subsection 241.2(4) of the Code;
(c) whether the practitioner ensured that the request was signed and dated after the patient was informed by a practitioner that the patient had a grievous and irremediable medical condition;
(d) whether the practitioner was satisfied that the request was signed and dated by the patient — or by another person who met the requirements set out in subsection 241.2(4) of the Code — before two independent witnesses who met the requirements set out in subsection 241.2(5) of the Code and who then also signed and dated the request;
(e) whether the practitioner ensured that the patient was informed that they may, at any time and in any manner, withdraw their request;
(f) whether the practitioner ensured that another practitioner provided a written opinion confirming that the patient met all of the eligibility criteria and, if so, an indication of whether the other practitioner is a medical practitioner or nurse practitioner and the date on which the other practitioner signed that opinion;
(g) whether the practitioner was satisfied that they and the practitioner referred to in paragraph (f) were independent within the meaning of subsection 241.2(6) of the Code;
(h) whether the practitioner ensured that at least 10 clear days elapsed between the day on which the request was signed by or on behalf of the patient and the day on which the medical assistance in dying was provided or, in the case where the practitioner considered a shorter period appropriate in the circumstances, an indication of which of the following was the basis for that determination:
(i) the patient’s death was imminent,
(ii) the loss of the patient’s capacity to provide informed consent was imminent;
(i) whether the practitioner, immediately before providing the medical assistance in dying, gave the patient an opportunity to withdraw their request and ensured that the patient gave express consent to receive medical assistance in dying;
(j) whether in the case where the patient had difficulty communicating, the practitioner took all necessary measures to provide a reliable means by which the patient could have understood the information that was provided to them and communicated their decision; and
(k) whether the practitioner informed a pharmacist, before the pharmacist dispensed the substance that the practitioner prescribed or obtained for the patient, that the substance was intended for the purpose of providing medical assistance in dying.
2 The date on which the request was signed by the patient or by another person who met the requirements set out in subsection 241.2(4) of the Code.
SCHEDULE 5(Subsections 7(1) and (2))Prescribing or Providing a Substance
1 The date on which the practitioner prescribed or provided the substance to the patient.
2 The place where the patient was staying when the practitioner prescribed or provided the substance to the patient.
3 The following information:
(a) an indication of whether the patient self-administered the substance, if known;
(b) in the case where the practitioner knows that the patient self-administered the substance,
(i) an indication of whether the practitioner was present when the patient self-administered the substance,
(ii) the date on which the patient self-administered the substance, if known, and
(iii) the place where the patient self-administered the substance, if known;
(c) in the case where, to the best of the practitioner’s knowledge or belief, the patient did not self-administer the substance,
(i) an indication of whether the patient has died, if known, and
(ii) in the case where the patient has died, the date of death, if known.
SCHEDULE 6(Section 8)Administering a Substance
1 The date on which the practitioner administered the substance to the patient.
2 The place where the practitioner administered the substance to the patient.
SCHEDULE 7(Section 11 and subsection 16(1))Dispensing a Substance
1 The following information in respect of the patient for whom the substance was dispensed:
(a) date of birth;
(b) health insurance number and the province or territory that issued it or, in the case where they do not have a health insurance number or the pharmacist does not know the patient’s health insurance number, the province or territory of their usual place of residence on the day on which the pharmacist dispensed the substance.
2 The following information in respect of the pharmacist:
(a) name;
(b) the province or territory in which they practise and, if they practise in more than one province or territory, the province or territory in which they dispensed the substance;
(c) the licence or registration number assigned to the pharmacist in the province or territory in which they dispensed the substance;
(d) the mailing address and email address that the pharmacist uses for work.
3 The following information in respect of the practitioner who prescribed the substance or obtained the substance from the pharmacist:
(a) name;
(b) the licence or registration number assigned to the practitioner in the province or territory in which they received the request.
4 The following information in respect of the dispensing of the substance:
(a) the date on which the substance was dispensed;
(b) an indication of which of the following places describes where the pharmacist dispensed the substance or, if they dispensed the substance elsewhere, a description of that place:
(i) hospital pharmacy,
(ii) community pharmacy.
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