Updated: April 1, 2020
Reviewed:
Introduction
In June 2016, the federal government amended the Criminal Code and passed Bill C-14, providing legal protection for persons who aid physicians and nurse practitioners who supply services for medical assistance in dying (MAiD).
This new legislation includes the protection of paramedic practitioners. Paramedics and EMRs are categorized alongside other healthcare professionals and are provided further protection under sections 241 (5.1) and 227 (2) of the Criminal Code: 241(5.1).
Definitions:
Medical assistance in dying is defined as:
Medical assistance in dying occurs when an authorized doctor or nurse practitioner provides or administers medication that intentionally brings about a person’s death, at that person’s request. This procedure is only available to eligible patients.
Bill C-14 defines a medical practitioner as a person who is entitled to practice medicine under the laws of the province (e.g., physician).
Liability:
Only physicians or nurse practitioners are enabled to determine and confirm that a patient is eligible for the MAiD program. The patient must meet all the criteria in order to receive MAiD:
Be eligible for health services publicly funded by a government in Canada;
Be at least 18 years old and capable of making decisions about their health;
Have made a voluntary request for MAID that, in particular, was not made as a result of external pressure;
Have given informed consent to receive MAiD after being informed of the means that are available to relieve their suffering, including palliative care; and
Have a grievous and irremediable medical condition
Guidelines
Under Bill C-14, paramedics and EMRs are categorized alongside other healthcare professionals and are provided further protection under sections 241 (5.1) and 227 (2) of the Criminal Code: 241(5.1). For greater certainty, no social worker, psychologist, psychiatrist, therapist, medical practitioner, nurse practitioner, or other healthcare professional commits an offence if they provide information to a person on the lawful provision of medical assistance in dying: 227(2). No person is party to a culpable homicide if they do anything for the purpose of aiding a medical practitioner or nurse practitioner to provide a person with medical assistance in dying in accordance with section 241.2.
Under the Emergency Health Services Act, the Emergency Medical Assistants Licensing Board (EMALB) is responsible for examining, registering, and licensing all EMAs in British Columbia. The Board, under the authority of the Emergency Health Services Act, sets license terms and conditions. The EMALB policy is that a qualified EMA may initiate an intravenous line that has been ordered by a physician or nurse practitioner for MAiD. An EMA may not administer medication for MAID under any circumstance.
Given the nature of paramedic practice, it is anticipated that BCEHS paramedics will be called to assist with a MAiD event. In these circumstances, it is expected that the paramedic practices within their defined scope of practice and in accordance with the Code and all legislations, EMALB policies, and BCEHS operational scope of practice. BCEHS recognizes the complexity of MAiD and encourages the use of this guideline in conjunction with all legislation and current regulations.
It is also anticipated that patients may inquire about MAiD with paramedics or EMRs. In these circumstances, it is expected that paramedics and EMRs will refer such patients to their primary health care professionals for further information.
Specific situations where paramedics or EMRs may be called to assist in a MAiD event include the following:
Paramedics and EMRs are NOT considered health professionals for the purposes of witnessing an eligibility assessment, nor for death confirmation.
BCEHS recognizes that the MAiD program may conflict with an individual paramedic or EMR's belief or value system and will attempt to make suitable arrangements where this occurs. Paramedics and EMRs are expected to take all reasonable steps to ensure that the continuity and quality of care is not compromised.
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