Handling MAiD Enquiries
Posted by dkwinter
  • Clarify what the patient is asking
    • Sometimes we say things we may not mean: Think about a time when you had severe pain and/or discomfort, you may have expressed wishes that were never meant to materialize.
  • Begin with Validating the Enquiry
    • Thank you for trusting me enough to ask that question. It seems very important to you, can you tell me more?
    • I'm glad you asked me about this, but before I answer may I ask more about what led you to ask this question?
    • I am honored that you felt comfortable enough to talk to me about this. I think it might be better if I ask {team member} to explore this with you.
    • Thank you for trusting me enough to ask that question. It seems very important to you, can I finish {task} and com back so we have more time to talk about this?
  • Identify expectations and fears
    • What do you understand about your situation?
    • What do you expect will happen next?
    • How do you think your own death will go?
    • What is the worst thing that could happen to you as you die?
  • Ask about options for End of Life
    • What do you understand about your options for end of life care?
    • How specifically would you like me to assist you?
  • Examples of options include:
    • Palliative Sedation Therapy is used to alleviate intolerable symptoms in the last weeks or days of life
    • Initiating a g-tube for managing a bowel obstruction to give the patient relief and better quality of life
    • The use of opioids adequately to alleviate the fear of not being able to breathe
    • Referring to members of the interprofessional team to deal with anxiety
    • The patient has the control to stop all treatments to prolong life at anytime in the course of end stage disease
  • Establish the Patient's Goals of Care
    • When you think about the future, what are you hoping for?
    • What is most important to you in the time you have?
    • What can we do to help you life the life you want to live?
    • If you were to die now, what would be left undone?
  • Encourage the patient to have conversations with their loved ones.
    • Have you shared your thoughts about MAiD with your family?
    • What does your family think of this decision?
    • How has your illness affected your family?
  • Clarifying questions may include:
    • Are you suffering now?
    • What kind of suffering concerns you most?
    • What is your most troublesome symptom?
  • Try to have the patient share about their values and overall sense of personal meaning:
    • What is your present quality of life?
    • What gives you meaning in your life right now?
  • Rule out Depression and/or Suicide Ideation (refer to psychiatry or psychology if required)
    • Have you ha a good life?
    • What things in life still give you pleasure?
    • Are you depressed?
    • Have you thought about suicide?
    • Do you have a plan?
  • Collaborative Enquiry
    • The MRP, in collaboration with the interprofessional team will consider questions and assessments such as:
      • Have all other alternatives for care (that are acceptable to the patient) been explored?
      • Has the patient been informed of alternatives for care and likely associated outcomes?
      • How urgent is the patient's condition? For example, is the patient's death or loss of capacity imminent?
      • Have the perspectives of all appropriate individuals been involved? (with patient consent)
      • Has a referral to palliative care and other appropriate health care team members been made to explore options for symptom management?
      • Has input from ethics, legal, and/or spiritual care been considered?
      • Provide the patient with MAiD Frequently Asked Questions (FAQ) document and ensure there is an opportunity for discussion