THE REGULATORY FRAMEWORK FOR PHYSICIAN-ASSISTED … · the regulatory framework for...

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MÉNARD, MARTIN, AVOCATS

www.vosdroitsensante.com

THE REGULATORY FRAMEWORK FOR

PHYSICIAN-ASSISTED DEATH:

THE EXAMPLE OF QUEBEC

By: Me Jean-Pierre Ménard, Ad. E.

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CONTENT

- CARTER v. CANADA DECISION

- AN ACT RESPECTING END-OF-LIFE CARE

- CONCLUSIONS AS TO THE REGULATORY

FRAMEWORK

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CARTER v. CANADA

Physician-assisted Death

(Physician-assisted Dying (Paragraph 40))

- A PHYSICIAN

- PROVIDES

- ADMINISTERS

- MEDICATION THAT INTENTIONALLY BRINGS ABOUT

- THE PATIENT’S DEATH

- AT THE PATIENT’S REQUEST

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LEGISLATION

(Section 14 Criminal Code of Canada)

- NO PERSON IS ENTITLED TO CONSENT TO HAVE

DEATH INFLICTED ON HIM, AND SUCH CONSENT

DOES NOT AFFECT THE CRIMINAL RESPONSIBILITY

OF ANY PERSON BY WHOM DEATH MAY BE

INFLICTED ON THE PERSON BY WHOM CONSENT IS

GIVEN

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LEGISLATION

(Section 241 CCC)

- EVERY ONE WHO

- …

b)AIDS OR ABETS A PERSON TO COMMIT

SUICIDE, WHETHER SUICIDE ENSUES

OR NOT,

IS GUILTY OF AN INDICTABLE OFFENCE AND

LIABLE TO IMPRISONMENT FOR A TERM NOT

EXCEEDING FOURTEEN YEARS

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LEGISLATION

(Section 7 Canadian Charter of Rights and Freedoms)

Everyone has the right to life, liberty and security of the

person and the right not to be deprived thereof except in

accordance with the principles of fundamental justice.

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LEGISLATION

(Section 15 Canadian Charter of Rights and

Freedoms)

(1) Every individual is equal before and under the law and has

the right to the equal protection and equal benefit of the law

without discrimination and, in particular, without discrimination

based on race, national or ethnic origin, colour, religion, sex, age

or mental or physical disability.

Descriptive title: Affirmative action programs

(2) Subsection (1) does not preclude any law, program or activity

that has as its object the amelioration of conditions of

disadvantaged individuals or groups including those that are

disadvantaged because of race, national or ethnic origin, colour,

religion, sex, age or mental or physical disability.

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- DOES THE PROHIBITION ON PHYSICIAN-

ASSISTED DYING FOUND IN SECTION 241 OF THE

CRIMINAL CODE OF CANADA VIOLATE THE

RIGHTS GUARANTEED TO THE CLAIMANTS BY

SECTIONS 7 AND 15 OF THE CHARTER?

SCOPE OF THE ISSUE

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- PROTECTS THE RIGHT TO MAKE FUNDAMENTAL

PERSONAL CHOICES FREE FROM STATE

INTERFERENCE

LIBERTY OF THE PERSON

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- ENCOMPASSES A MARGIN OF PERSONAL AUTONOMY

INVOLVING CONTROL OVER ONE’S PERSON FREE

FROM STATE INTERFERENCE

- COMES INTO PLAY WHEN THE STATE INTERFERES

WITH AN INDIVIDUAL’S PHYSICAL OR

PSYCHOLOGICAL INTEGRITY, INCLUDING ANY

STATE ACTION THAT CAUSES PHYSICAL OR SERIOUS

PSYCHOLOGICAL SUFFERING

SECURITY OF THE PERSON

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- THE PROHIBITION ON PHYSICIAN-ASSISTED

DYING HAS THE EFFECT OF FORCING SOME

INDIVIDUALS TO PREMATURELY TAKE

THEIR OWN LIVES FOR FEAR OF BEING

UNABLE TO DO SO WHEN THEIR SUFFERING

BECOMES INTOLERABLE

- THE PROHIBITION DEPRIVES CERTAIN

INDIVIDUALS OF LIFE

INFRINGEMENT ON THE RIGHT TO LIFE

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- THE LAW INTERFERES WITH THE ABILITY OF

INDIVIDUALS TO MAKE DECISIONS CONCERNING

THEIR BODILY INTEGRITY AND MEDICAL CARE

AND THEREBY INFRINGES ON THEIR LIBERTY

- BY LEAVING PEOPLE LIKE MS. TAYLOR TO

ENDURE INTOLERABLE SUFFERING, IT IMPINGES

ON THEIR SECURITY OF THE PERSON

DEPRIVATION OF THE RIGHT TO LIBERTY

AND SECURITY

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CARTER v. CANADA

Supreme Court of Canada Decision

- THE LAWS PROHIBITING A PHYSICIAN’S

ASSISTANCE IN TERMINATING LIFE (Section 14 and

Subsection 241 (b) of the Criminal Code) INFRINGE THE

RIGHTS TO LIFE, LIBERTY AND SECURITY OF THE

PERSON IN A MANNER THAT IS NOT IN

ACCORDANCE WITH THE PRINCIPLES OF

FUNDAMENTAL JUSTICE, AND THE INFRINGEMENT

IS NOT JUSTIFIED UNDER SECTION 1 OF THE

CHARTER

- SECTION 14 AND SUBSECTION 241 (b) OF THE

CRIMINAL CODE ARE VOID INSOFAR AS THEY

PROHIBIT PHYSICIAN-ASSISTED DEATH UNDER THE

CONDITIONS DEFINED BY THE COURT.

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CARTER v. CANADA

Conditions for Physician-assisted Death

(Paragraph 127)

- ADULT

- COMPETENT

- WHO CLEARLY CONSENTS TO THE TERMINATION

OF LIFE

- HAS A GRIEVOUS AND IRREMEDIABLE MEDICAL

CONDITION (INCLUDING AN ILLNESS, DISEASE OR

DISABILITY)

- THAT CAUSES ENDURING SUFFERING THAT IS

INTOLERABLE TO THE INDIVIDUAL IN THE

CIRCUMSTANCES OF HIS OR HER CONDITION

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CARTER v. CANADA

Additional Rules

(Paragraph 132)

- THE SUPREME COURT HAS SIMPLY RENDERED

INVALID THE CRIMINAL PROHIBITION ON

PHYSICIAN-ASSISTED DEATH

- THE PARLIAMENT OF CANADA, PROVINCIAL

LEGISLATURES AND PHYSICIANS’ COLLEGES

MAY ADD OTHER STANDARDS WITHIN THEIR

AREAS OF AUTHORITY

- HOWEVER, THESE RULES MUST RECONCILE

WITH THE CANADIAN CHARTER

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- HEALTH IS AN AREA OF CONCURRENT JURISDICTION

- BOTH PARLIAMENT AND THE PROVINCES MAY

VALIDLY LEGISLATE ON THE MATTER

- ASPECTS OF PHYSICIAN-ASSISTED DYING MAY BE

SUBJECT TO VALID LEGISLATION OF BOTH LEVELS

OF GOVERNMENT, DEPENDING ON THE

CIRCUMSTANCES AND FOCUS OF THE LEGISLATION

- INTERJURISDICTIONAL IMMUNITY CANNOT BE

CLAIMED

CONSTITUTIONAL JURISDICTION

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END-OF-LIFE CARE

(AN ACT RESPECTING END-OF-LIFE CARE,

RSQ c. S-32.0001)

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RIGHT OF END-OF-LIFE PATIENTS

RIGHT TO SERVICES

(SECTION 4)

-RIGHT TO RECEIVE END-OF-LIFE CARE, SUBJECT

TO THE SPECIFIC REQUIREMENTS ESTABLISHED BY

THE ACT

- WITHIN THE FRAMEWORK OF THE

LEGISLATIVE AND REGULATORY

PROVISIONS RELATING TO THE

ORGANIZATIONAL AND OPERATIONAL

STRUCTURE OF INSTITUTIONS

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RIGHT TO SERVICES

(SECTION 4) (CONTINUED)

- WITHIN THE FRAMEWORK OF THE POLICY

DIRECTIONS, POLICIES AND APPROACHES

OF PALLIATIVE CARE CENTRES

- WITHIN THE LIMITS OF THE HUMAN,

MATERIAL AND FINANCIAL RESOURCES AT

THE DISPOSAL OF PALLIATIVE CARE

CENTRES

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RIGHT TO REFUSE OR WITHDRAW CONSENT

(SECTION 5)

- ANY PERSON OF FULL AGE WHO IS CAPABLE OF

GIVING CONSENT TO CARE MAY AT ANY TIME

- REFUSE TO RECEIVE OR

- WITHDRAW CONSENT TO

- LIFE-SUSTAINING CARE

- THE REFUSAL OF CARE OR WITHDRAWAL OF

CONSENT TO CARE MAY BE EXPRESSED BY ANY

MEANS

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ABILITY TO GIVE CONSENT

(CONTINUED)

NOVA SCOTIA CRITERIA 1. DOES THE PATIENT UNDERSTAND THE NATURE OF THE

CONDITION FOR WHICH THE TREATMENT IS PROPOSED?

2. DOES THE PATIENT UNDERSTAND THE NATURE AND

PURPOSE OF THE TREATMENT?

3. DOES THE PATIENT UNDERSTAND THE RISKS INVOLVED

IN UNDERGOING THIS TREATMENT?

4. DOES THE PATIENT UNDERSTAND THE RISKS INVOLVED

IN NOT UNDERGOING THE TREATMENT?

5. DOES THE PATIENT’S CONDITION AFFECT HIS OR HER

ABILITY TO GIVE CONSENT?

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(CONTINUED)

- THE PHYSICIAN MUST:

- MAKE SURE THAT THE DECISION IS MADE

FREELY

- PROVIDE THE PERSON WITH ALL

INFORMATION NEEDED TO MAKE AN

INFORMED DECISION, IN PARTICULAR

INFORMATION ABOUT OTHER THERAPEUTIC

POSSIBILITIES, INCLUDING PALLIATIVE

CARE

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(SECTION 6)

- A PERSON MAY NOT BE DENIED END-OF-LIFE CARE

FOR PREVIOUSLY HAVING REFUSED TO RECEIVE

CERTAIN CARE OR HAVING WITHDRAWN CONSENT

TO CERTAIN CARE

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END-OF-LIFE CARE

CONSEQUENCES OF A PATIENT’S DECISIONS

(SECTION 49)

- Decision of a patient to:

- Refuse life-sustaining care

- Withdraw consent to life-sustaining care

- Request terminal palliative sedation or medical aid in

dying

- May not be invoked as a reason to refuse to pay a benefit or

any other sum due under a contract.

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END-OF-LIFE CARE

PALLIATIVE CARE AND

CONTINUOUS PALLIATIVE SEDATION

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PALLIATIVE CARE

- OBLIGATION OF ALL HEALTHCARE FACILITIES TO

OFFER PALLIATIVE CARE

- RIGHT TO PALLIATIVE CARE FOR

CITIZENS/PATIENTS

- DUTY TO REPORT

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END-OF-LIFE CARE


(SECTIONS 24-25)

- CONSENT GIVEN BY THE PATIENT OR BY THE

PATIENT’S REPRESENTATIVE

- DUTY TO INFORM:

- PROGNOSIS

- TERMINAL AND IRREVERSIBLE NATURE OF

THIS SEDATION

- ANTICIPATED DURATION OF THE SEDATION

- GIVEN IN WRITING ON THE FORM PRESCRIBED

BY THE MINISTER

- FILED IN THE PATIENT’S RECORD

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(SECTIONS 24-28)

- THE PHYSICIAN MUST MAKE SURE THAT THE REQUEST IS

BEING MADE FREELY, IN PARTICULAR BY ASCERTAINING

THAT IT IS NOT BEING MADE AS A RESULT OF EXTERNAL

PRESSURE

- IF THE PATIENT GIVING CONSENT CANNOT DATE AND

SIGN THE FORM BECAUSE THE PATIENT CANNOT WRITE

OR IS PHYSICALLY INCAPABLE OF DOING SO, A THIRD

PERSON MAY DO SO IN THE PATIENT’S PRESENCE

- THE THIRD PERSON MAY NOT:

- BE A MEMBER OF THE TEAM RESPONSIBLE FOR

CARING FOR THE PATIENT

- BE A MINOR OR A PERSON OF FULL AGE

INCAPABLE OF GIVING CONSENT

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END-OF-LIFE CARE

MEDICAL AID IN DYING

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Conditions (Section 26)

- THE PATIENT IS AT THE END OF LIFE

- PERSON OF FULL AGE AND CAPABLE OF GIVING

CONSENT TO CARE (C)

- INSURED PERSON WITHIN THE MEANING OF THE

HEALTH INSURANCE ACT

- SUFFERING FROM A SERIOUS AND INCURABLE ILLNESS

(C)

- ADVANCED STATE OF IRREVERSIBLE DECLINE IN

CAPABILITY

- EXPERIENCING CONSTANT AND UNBEARABLE PHYSICAL

OR PSYCHOLOGICAL SUFFERING THAT CANNOT BE

RELIEVED IN A MANNER THE PATIENT DEEMS

TOLERABLE (C)

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Form of the Request - Subsection 26(2)

- THE PATIENT MUST REQUEST MEDICAL AID IN DYING

THEMSELVES, BY MEANS OF THE FORM PRESCRIBED BY

THE MINISTER

- THE FORM MUST BE:

- DATED

- SIGNED BY THE PATIENT OR IF PHYSICALLY

UNABLE, BY A THIRD PERSON

- THE THIRD PERSON MAY NOT BE A MINOR, A

PERSON OF FULL AGE INCAPABLE OF GIVING

CONSENT, OR A MEMBER OF THE TEAM

RESPONSIBLE FOR CARING FOR THE PATIENT

(SECTION 27)

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Form of the Request (continued)

- THE FORM MUST BE SIGNED IN THE PRESENCE OF

AND COUNTERSIGNED BY A HEALTH OR SOCIAL

SERVICES PROFESSIONAL; IF THE PROFESSIONAL IS

NOT THE ATTENDING PHYSICIAN, THE SIGNED FORM

IS TO BE GIVEN TO THE ATTENDING PHYSICIAN

- A PATIENT MAY, AT ANY TIME AND BY ANY MEANS,

WITHDRAW HIS OR HER REQUEST (SUBSECTION 28(1))

- A PATIENT MAY, AT ANY TIME AND BY ANY MEANS,

REQUEST THAT THE ADMINISTRATION OF MEDICAL

AID IN DYING BE PUT OFF (SUBSECTION 28(2))

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PROCEDURE

(Section 29)

Before administering medical aid in dying, the physician must:

a) be of the opinion that the patient meets all the criteria of the Act

b) make sure that the request is being made freely, and without any

external pressure

c) make sure that the request is an informed one, in particular by

informing the patient of the prognosis for the illness and of other

therapeutic possibilities and their consequences (C)

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PROCEDURE (continued)

(Section 29)

d) verify the persistence of suffering and that the wish to

obtain medical aid in dying remains unchanged, by talking

with the patient at reasonably spaced intervals given the

progress of the patient’s condition

e) discuss the patient’s request with any members of the care

team who are in regular contact with the patient

f) make sure that the patient has had the opportunity to

discuss the request with the persons he or she wished to

contact

g) obtain the opinion of a second physician confirming that

the medical conditions and consent criteria set out in the Act

have been met.

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OBLIGATION OF THE SECOND PHYSICIAN

(Subsection 29(2))

- Independent of both:

- the patient requesting medical aid in dying and

- the physician seeking the second medical opinion

- Consult the patient’s record

- Examine the patient

- Provide the opinion in writing

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PROCEDURE

(Section 30)

- If a physician determines that medical aid in dying may be

administered to a patient requesting it, the physician must

administer such aid personally and take care of and stay

with the patient until death ensues.

- If the physician determines that medical aid in dying

cannot be administered, the physician must inform the

patient of the reasons for that decision.

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CONSCIENCE CLAUSE

(Section 50)

- A PHYSICIAN MAY REFUSE TO ADMINISTER

MEDICAL AID IN DYING BECAUSE OF PERSONAL

CONVICTIONS

- A HEALTH PROFESSIONAL MAY REFUSE TO TAKE

PART IN ADMINISTERING IT FOR THE SAME

REASON

- THEY MUST NEVERTHELESS ENSURE THAT

CONTINUITY OF CARE IS PROVIDED TO THE

PATIENT, IN ACCORDANCE WITH THEIR CODE OF

ETHICS AND THE PATIENT’S WISHES

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PROCEDURE IN THE EVENT OF REFUSAL BASED

ON THE CONSCIENCE CLAUSE (SECTION 31)

- The physician must, as soon as possible, notify the president and chief

executive officer of the institution or any other person designated by the

president and chief executive officer and forward the request form for

medical aid in dying

- The president and chief executive officer of the institution or another

designated person must take the necessary steps to find another

physician willing to deal with the request

- Same procedure for a physician who practices in a private health care

facility that is not associated with a CISSS (integrated health and social

services centre) and who receives a request for medical aid in dying

- The physician must notify the the president and chief executive officer

of the institution that serves the territory in which the patient making

such request resides

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PATIENT’S RECORD

(Section 32)

- The following must be recorded or filed in the patient’s record:

- All information and documents in connection with a

request for medical aid in dying

- Regardless of whether the physician administers it or not

- Including the form used to request such aid, the reasons

for the physician’s decision and, where applicable, the

opinion of the physician consulted

- Any decision to withdraw a request for medical aid in

dying or to put off the administration of such aid must

also be recorded in the patient’s record

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END-OF-LIFE CARE

MONITORING

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NOTICE TO THE

COMMISSION SUR LES SOINS DE FIN DE VIE

- A PHYSICIAN WHO ADMINISTERS MEDICAL AID IN DYING

MUST GIVE NOTICE TO COMMISSION SUR LES SOINS DE FIN DE

VIE WITHIN THE NEXT 10 DAYS

- THE PHYSICIAN MUST SEND THE COMMISSION, IN THE

MANNER DETERMINED BY GOVERNMENT REGULATION, THE

INFORMATION REQUIRED BY THE COMMISSION

- SUCH INFORMATION IS CONFIDENTIAL AND MAY NOT BE

DISCLOSED TO ANY OTHER PERSON, EXCEPT TO THE EXTENT

THAT IS NECESSARY FOR THE PURPOSES OF IMPLEMENTING

THE ACT

- ANY PERSON WHO NOTES THAT A PHYSICIAN HAS

CONTRAVENED THIS SECTION MUST BRING THE BREACH TO

THE ATTENTION OF COLLÈGE DES MÉDECINS DU QUÉBEC SO

THAT IT CAN TAKE APPROPRIATE MEASURES

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THE COMMISSION’S OVERSIGHT ROLE

(Section 47) - On receiving the notice from the physician, the Commission

assesses compliance with the Act

- On completion of the assessment, if two-thirds of the members

present are of the opinion that the Act’s provisions have not

been respected, the Commission sends a summary of its

conclusions to:

- the concerned institution

- Collège des médecins du Québec

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FUNCTIONS OF THE COUNCIL OF PHYSICIANS, DENTISTS

AND PHARMACISTS

(Section 32)

- The council of physicians, dentists and pharmacists must, in

collaboration with the council of nurses of the institution, adopt

clinical protocols for continuous palliative sedation and

medical aid in dying.

- The protocols must comply with the clinical standards

developed by the professional orders concerned.

- The council must receive notification from the physician who

provides continuous palliative sedation or medical aid in dying

within 10 days, whether such care is administered in an

institution, in a palliative care centre or at the patient’s home.

- The council of physicians, dentists and pharmacists must assess

the quality of the care provided.

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END-OF-LIFE CARE

COMMISSION SUR LES SOINS DE

FIN DE VIE

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END-OF-LIFE CARE


COMPOSITION (SECTION 39)

- Eleven members, appointed by the Government as follows:

- Five (5) members are to be health or social services professionals

- Two (2) members appointed after consultation with Collège

des médecins du Québec

- One (1) member appointed after consultation with Ordre des

infirmières et infirmiers du Québec

- One (1) member appointed after consultation with Ordre des

pharmaciens du Québec

- One (1) member appointed after consultation with Ordre

professionnel des travailleurs sociaux et des thérapeutes

conjugaux et familiaux du Québec

- One (1) of the members above must come from the palliative

care community

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END-OF-LIFE CARE


COMPOSITION (SECTION 39)

- Two (2) members are to be jurists, appointed after

consultation with Barreau du Québec and Chambre des

notaires du Québec

- Two (2) members are to be users of institutions, appointed

after consultation with bodies representing the users

committees of institutions

- One (1) member is to be from the ethics community,

appointed after consultation with the universities

- One (1) member is to be appointed after consultation with

bodies representing institutions

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ORGANIZATION

- Appointed for a term of not more than five years

- May be renewed consecutively only once

- The Government:

- Designates a chair and vice-chair from among the

members of the Commission

- Fixes the allowances and indemnities

- Quorum: 7 members, including the chair or vice-chair

- Decisions are made by a majority vote of the members present

- In the case of a tie vote, the person presiding at the meeting

casts the deciding vote

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ORGANIZATION (CONT.) (Section 40)

- The Commission has the power to issue regulation

concerning its internal management

- Annual activity report submitted to the Minister no later

than September 30 each year (Subsection 42(3) )

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END-OF-LIFE CARE


MANDATE (SECTION 42)

- Advise the Minister on any matter put before it by the

Minister

- Evaluate the implementation of legislation with regard to

end-of-life care

- Refer to the Minister any matter relating to end-of-life care

that needs the attention of or action by the Government, and

submit its recommendations to the Minister

- Submit a report to the Minister every five years on the status

of end-of-life care in Québec

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END-OF-LIFE CARE


MANDATE (CONTINUED)

- Carry out any other mandate given to it by the Minister

- Oversee the application of the specific requirements relating

to medical aid in dying

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END-OF-LIFE CARE


POWERS (SECTION 44)

The Commission may:

-Solicit the opinion of individuals or groups on any end-of-life

care issue

-Conduct or commission studies and research it deems necessary

-Call on outside experts to report to it on one or more specific

points

-The reports are submitted to the National Assembly

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END-OF-LIFE CARE

ADVANCE MEDICAL

DIRECTIVES

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END-OF-LIFE CARE

ADVANCE MEDICAL DIRECTIVES

(SECTION 51)

- Any person

- of full age

- capable of giving consent to care

- May, by means of advance medical directives, specify

- Whether or not they consent to care that may be required by

their state of health, in the event they become incapable of

giving consent

- This includes end-of-life care, except medical aid in dying

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END-OF-LIFE CARE

COMPLAINTS

(SECTION 48)

- Any complaints regarding end-of-life care must be given

priority treatment by

- The local or regional service quality complaints

commissioner

- The syndic of Collège des médecins du Québec

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END-OF-LIFE CARE

SPECIAL FUNCTIONS OF THE

COLLÈGE DES MÉDECINS DU QUÉBEC

- Receives the report from a physician practicing in a private

healthcare facility that provides continuous palliative sedation

or medical aid in dying at the patient’s home or on the premises

of a palliative care centre

- Within 10 days following its administration

- The report must contain all information set out by the College

- Upon receipt, the College or its competent committee assesses

the quality of the care provided, particularly with regard to

applicable clinical standards of care

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END-OF-LIFE CARE

SPECIAL FUNCTIONS OF THE

COLLÈGE DES MÉDECINS DU QUÉBEC

(SECTION 37)

- Must prepare a yearly report on the end-of-life care provided

by physicians practicing in private healthcare facilities

- The report must state the number of times continuous palliative

sedation and medical aid in dying were administered by such

physicians at a patient’s home or on the premises of a palliative

care centre

- The information must be grouped by local health and social

services network territory and by integrated health and social

services centre territory

- The report must be published on the website of the College and

sent to Commission sur les soins de fin de vie no later than

June 30 each year

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QUEBEC’S LEGISLATION

- COMPREHENSIVE APPROACH TO END-OF-LIFE CARE

- ACCORDING TO THE CONCEPT OF A CONTINUUM OF

CARE AVAILABLE IN INSTITUTIONS, IN PALLIATIVE

CARE CENTRES AND AT HOME

- INTEGRATED STRUCTURE FOR END-OF-LIFE CARE

- IN THE HEALTHCARE SYSTEM

- A REGULATORY FRAMEWORK THAT SEEKS TO

PROTECT VULNERABLE PERSONS AND ENSURE

THEIR AUTONOMY

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REGULATIONS

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SAFEGUARDS

- THE RISKS ASSOCIATED WITH PHYSICIAN-ASSISTED

DEATH CAN BE LIMITED THROUGH A CAREFULLY

DESIGNED AND MONITORED SYSTEM OF SAFEGUARDS

(CARTER, paragraphs 105 and 117)

- THE CARTER DECISION PROPOSES SAFEGUARDS

- THE CANADIAN PARLIAMENT, THE PROVINCES AND

PHYSICIANS’ COLLEGES MAY ADD TO THESE

SAFEGUARDS

- ADDITIONAL SAFEGUARDS MUST NOT HAVE THE

EFFECT OF COMPROMISING CITIZENS’

FUNDAMENTAL RIGHT TO MEDICAL AID IN DYING

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WHAT ARE THE REGULATIONS?

(NOT RESTRICTIVE)

- WITH REGARD TO MEDICAL AID IN DYING

- RESIDENT STATUS

- HEALTH INSURANCE COVERAGE

- FORM OF THE REQUEST (WRITTEN, FORM)

- CONTENT OF INFORMED CONSENT

- MONITORING VOLUNTARY CONSENT

- REQUEST PROCESS ADMINISTRATIVE PROCEDURE

- OPTIONAL OR MANDATORY CONSULTATION

- REQUEST REITERATED OR NOT

- IF CONSULTATION IS MANDATORY, WHO, WHEN

AND HOW

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WHAT ARE THE REGULATIONS?

- DOCUMENTATION OF THE PATIENT’S MEDICAL

RECORD

- MEDICAL PROTOCOL FOR THE APPLICATION OF


- ROLE OF THE PHYSICIANS’ COLLEGE

- MONITORING AND REPORTS ON THE APPLICATION

OF MEDICAL AID IN DYING

- OTHER TYPES OF REGULATION

- PALLIATIVE CARE

- CONTINUOUS PALLIATIVE SEDATION

- CARE DELIVERY STRUCTURES

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