Medical Assistance in Dying (MAiD)

The unit I manage has been identified as a location where clients will be admitted for medical assistance in dying (MAiD). Some of the RNs have expressed the ethical conflict they experience in relation to caring for a client who is choosing to end their life. What am I responsible for? What are RNs responsible for?

• MAiD is an emotion-filled topic that has an impact on many RNs. Discussing the topic with your staff in an open and respectful manner ahead of a planned instance of MAiD will assist your staff to express ethical conflicts and come to a resolution on how to address requests when they are made.
• Organizational policies created by direct care providers and other health care professionals should be in place to clearly articulate the role of the RN when being involved with MAiD.
• RNs have the right to conscientiously object to being involved with MAiD. Steps to declaring a conflict can be found in the CNA Code of Ethics (1). Ideally, the declaration should be made proactively and well ahead of an actual situation to facilitate ethically safe care for the client.
• Ethically, RNs are accountable for ensuring a client’s care needs are met and that the RN does not abandon those in need of registered nursing care. This means the RN is responsible for caring for the client until other care arrangements can be made (2).
• There is no legal or regulatory requirement for an RN or NP to participate in MAiD (3).
• RNs identify the effect of their own values, beliefs and experiences in relationships with clients, recognizing and addressing potential conflicts and using an ethical and reasoned decision-making process to address situations of ethical distress and dilemmas (4).
• RNs are responsible for promoting and protecting a client’s right to autonomy, respect, privacy, dignity and access to information (5).
• RNs incorporate knowledge about ethical, legal and regulatory implications of MAiD when providing nursing care (6).

What is the role of the RN who receives a request for MAiD?

The RN’s role is:

• to listen to the client’s request;
• to discuss MAiD with clients who have questions and are seeking information;
• to appropriately connect the person to a medical practitioner or Nurse Practitioner (NP), or the provincial program to obtain the necessary information about MAiD; and,
• to document the conversation objectively (7).

If an RN refers a client to a medical practitioner or NP with the intent of arranging for MAiD, is the RN a collaborator in homicide or suicide?

No. Bill C-14 provides exemptions to the Criminal Code for persons aiding in MAiD. This means an RN will not be held criminally responsible for assisting with MAiD. This protects the RNs who are at the bedside actively assisting in the procedure and those who assist a client in accessing information (7 & 8).

Can an NP administer MAiD?

Yes. NPs have been named in Bill C-14 as practitioners who are able to administer MAiD. NPs are required to follow provincial protocols, meet CRNS practice standards and ensure they have the competence to administer MAiD (9).

CRNS Resources

Code of Ethics for Registered Nurses (2017)

Registered Nurse Practice Standards (2019)

Registered Nurse Entry-Level Competencies (2019)

Medical Assistance in Dying Guideline (2024)

External Resources

Bill C-14

Criminal Code