Focus: Medical Assistance in Dying (MAiD)
The College’s advisory statement on Medical Assistance in Dying (MAiD): Considerations for Occupational Therapists was released on June 25th, 2020. The following scenario and question were developed to encourage further reflection and application of the information contained in the advisory statement.
Scenario
A 47-year-old female is diagnosed with a glioblastoma multiforme brain tumour. Four months ago she had a tumour resection, with subsequent chemotherapy and palliative radiation. She has ongoing symptoms including headache, nausea, dysphagia and left sided hemiplegia. Her prognosis is now less than six months. She is admitted to hospital for symptom management and wishes to pursue medical assistance in dying (MAiD).
Question
The client’s spouse is a physiotherapist and has been caring for the client at home. She approaches the occupational therapist and expresses concern, as she is worried the client is cognitively impaired and not competent to make medical decisions. She is not supportive of the client’s wish to have an assisted death. She asks the occupational therapist to assess the client’s cognition because she does not feel her spouse has the capacity to consent to MAiD.
How should the occupational therapist best proceed? (Select 1)
- Agree to assess the client’s cognition using a standardized assessment tool and provide a clinical opinion about the client’s capacity to provide consent for MAiD.
- Inform the spouse that a physician or nurse practitioner conducts the assessment process to determine the client’s capacity to provide consent for MAiD.
- Direct the spouse to the client’s physician to request an occupational therapy referral for a cognitive assessment to determine the client’s capacity to consent to MAiD.
- Observe the client’s cognition informally during an assessment of activities of daily living and provide a clinical opinion about the client’s capacity to consent to MAiD.
Answer Rationale
The College’s preferred response is B.
In order to enable clients to make informed decisions, occupational therapists must be able to provide accurate, objective information in a respectful and thoughtful manner on the legal provision of MAiD.
Once a person requests MAiD, the current eligibility process in BC requires the opinion of two independent medical assessors, one of whom must also be the prescriber and/or administrator of the lethal substances. Only a physician or nurse practitioner may be a medical assessor.
Both medical assessors must be satisfied that the person requesting MAiD is mentally capable of making a free and informed decision at the time of the request and throughout the process. If either medical assessor is unsure that the person has capacity to consent to MAiD, they will request a capability assessment from a third assessor or specialist (College of Physicians and Surgeons, 2020).
Answers A, C and D are incorrect in this scenario because under the current legislation, occupational therapists are not permitted to determine client eligibility for MAiD, however, as described on page 4 of the advisory statement on Medical Assistance in Dying (MAiD): Considerations for Occupational Therapists (COTBC, 2020), occupational therapists working as part of an interprofessional team may be asked to assist in this regard, given their knowledge, skill, and experience in assessing the functional abilities of clients as it pertains to capacity for decision-making.
References & Resources
British Columbia Ministry of Health. (n.d.) Medical Assistance in Dying – Information for Health Care Providers. https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care/medical-assistance-in-dying/information-for-providers
College of Occupational Therapists of British Columbia. (2020). Advisory Statement on Medical Assistance in Dying (MAiD): Considerations for Occupational Therapists. https://cotbc.org/wp-content/uploads/COTBC-Advisory-Statement-MAiD-FINAL-June-2020.pdf
College of Physicians and Surgeons of British Columbia. (2020). Practice Standard: Medical Assistance in Dying. https://www.cpsbc.ca/files/pdf/PSG-Medical-Assistance-in-Dying.pdf
Government of Canada. Statues of Canada. (2016) Chapter 3, Bill C-14. https://www.parl.ca/DocumentViewer/en/42-1/bill/C-14/royal-assent
