Embed Size (px)
Citation preview
Medical Assistance in Dying: Update Stakeholder Presentation
Ministry of Health and Long-Term Care and Ministry of the Attorney General Week of July 18, 2016
Phase 1 Implementation - Overview and Status Update
2
Tool Purpose Implementation Date (Approx.)
Regulatory college guidance (CPSO, CNO, OCP)
Provide specific guidance to clinicians on professional obligations and protocols for MAID
All colleges have posted new
guidance in line w/ Bill C14
Launch Clinician Referral Service To help clinicians (physicians and NPs) needing assistance in finding a willing clinician
Operational (see next slide)
Landing Page – Ontario.ca To provide high-level MAID specific communications for the general public, patients and stakeholders
Operational
Launch drug funding system To ensure drugs are accessible and publicly-funded Operational
MOHLTC Landing Page To provide the general public , patients and providers with MAID-specific information, guidance and resources
July 22
Voluntary Clinician Aids Patient Request Provider Assessment Aids
(Primary and Secondary)
To supplement medical record-keeping To aid clinicians in ensuring processes were followed
Operational
Provider-Facing FAQs To provide physician and institutional guidance on MAID protocol, process and resources
July 22
Patient/Public-Facing FAQs To provide patient information and guidance on MAID protocol, process and resources
July 22
Patient pathway Patient tool July 28
Centre for Effective Practice (CEP) Tool
Clinician guidance on MAID provision and process Late August
Canadian Medical Association module and training information for clinicians
Clinician education on MAID protocol and process (online version and offline version)
July 2016, exact date TBD
Nee
d to
be align
ed w
ith fin
al version
of B
ill C-1
4,
wh
ich w
as pu
blish
ed Ju
ne 2
2
3
• Clinician Aid A – Patient Request for Medical Assistance in Dying
• The purpose of this aid is to assist patients in making a written request for MAID that complies with the legal requirements. Once completed, the form is to be collected by the patient’s physician or nurse practitioner, and should be included in the patient’s medical records. The use of this aid is voluntary. This aid may be found here: http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&SRCH=1&ENV=WWE&TIT=3889&NO=014-3889-22E http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&SRCH=&ENV=WWF&TIT=3889&NO=014-3889-22F
• Clinician Aid B – (Primary) “Medical Practitioner” or “Nurse Practitioner” Medical Assistance in Dying Aid
• The purpose of this aid is to assist in maintaining records of requests for MAID. This aid is meant for physicians or
nurse practitioners to use when a patient requests MAID and it is in the clinician’s intention to provide MAID to the patient. The completed aid should be included in the patient’s medical records. The use of this aid is voluntary. This aid may be found here: http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&SRCH=1&ENV=WWE&TIT=3890&NO=014-3890-22E http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&SRCH=&ENV=WWF&TIT=3890&NO=014-3890-22F
• Clinician Aid C – (Secondary) “Medical Practitioner” or “Nurse Practitioner” Medical Assistance in Dying Aid
• This aid is to be completed by a physician or nurse practitioner to provide a written opinion confirming that the patient meets the eligibility criteria to receive MAID. The completed aid should be included in the patient’s medical records. The use of this aid is voluntary. This aid may be found here: http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&SRCH=&ENV=WWE&TIT=3891&NO=014-3891-22E http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&SRCH=&ENV=WWF&TIT=3891&NO=014-3891-22F
Now Available: Clinician Aids
Clinician Referral Service - Update
• More than 100 physicians and 20 NPs have registered as willing to participate in MAID, and 45 referral requests have been received.
• As of July 15, 2016, 41 referral matches have been made and there are 2 pending matches. A match is considered complete once a willing physician has been contacted and has verbally confirmed they will connect with the requesting practitioner.
• Matches are being made in the following order: 1) physicians/NPs with closest geographic match, 2) physicians/NPs with OTN access, or 3) any willing physician/NP.
• There is good coverage across the province (i.e., not all willing clinicians are clustered in one geographical area); and all LHINs have representation.
• Clinicians are calling the service with general questions about MAID. They are being re-directed to regulatory colleges, as appropriate.
• The CRS phone line [1-844-243-5880] is staffed from Monday-Friday, 9am-5pm. Voicemail is available after hours. An e-mail inbox is also operational ([email protected]).
4
5
• There are no changes currently contemplated to the Health Care Consent Act (HCCA) with respect to the role of the Consent and Capacity Board (CCB).
• If a patient applied under section 32 of the HCCA to the CCB for a review of a physician’s finding that he or she is incapable with respect to MAID, it is likely that the CCB would not be able to deal with such applications.
• Typically the CCB deals with cases wherein a physician has recommended a course of treatment for the patient, finds the patient to be incapable, and the patient has challenged the finding of incapacity. The CCB is asked whether or not the physician’s findings of incapacity can be confirmed or not in accordance with the HCCA.
• Because MAID requests will be patient-initiated, and the physician is not proposing the treatment in this circumstance, it is unclear whether the CCB would find that it has jurisdiction to hear applications and, if they do hear the application, whether the CBB is able to provide an effective remedy for patients as the Board is unable to require the physician to provide MAID to that patient.
• The CCB would not have the ability to address the other criteria required by the Carter decision.
Role of Consent and Capacity Board
6
1. Education materials: “I request that the information / guidance docs being developed and aimed at sectors/orgs be clear about any sector specific nuances, particularly the LTC sector where the depth of the information in the slides may not be sufficient. I also suggest that sector associations and other stakeholders be able to review and provide feedback on docs.”
o There will be additional guidance about LTC-specific implications coming soon via the provider
FAQs. o We have been working closely with program area leads across the ministry on the FAQs to
ensure sector-specific information is included. o We welcome your feedback on any and all documents once posted and are happy to consider
changes/amendments to any of our documents based on your feedback. Unfortunately, full sector consultation on these documents was not possible given the timelines.
o We also encourage sector associations to consider creating their own guidance documents if needed.
2. Co-location of hospitals and long-term care homes: “Will guidance be provided about how hospitals with co-located long-term care homes should proceed with respect to any organization-wide conscientious objection?”
o We are working through this question, and will engage stakeholders as required.
Implementation Questions: What We Heard From You
7
3. Clinician Referral Network: “Will it or does it have functionality to provide support for practitioners assessing eligibility?”
o At this time, the clinician referral service is only intended to facilitate referrals between
clinicians and is not staffed by a clinician. o We are monitoring implementation of MAID, and are open to hearing of any clinical
knowledge or competency gaps that could benefit from additional supports/tools. We are gathering a list of possible additional future supports for consideration.
o It is also important to note that the CEP tool and the CMA module are forthcoming and intended to provide additional guidance to clinicians with respect to the delivery of MAID.
4. Clinician Referral Network: “Has any progress been made in establishing a registry of pharmacists willing to dispense these MAID medications?”
o At this time, the clinician referral service is only for physicians and nurse practitioners. o Including pharmacy professionals as part of the Clinician Referral Service is an option being
explored but at this time, no decision has been made.
Implementation Questions: What We Heard From You Cont’d
8
5. Bill C-14: “The enacted Federal Bill notes that the request should be signed and dated after the practitioner finds someone has a grievous and irremediable condition. In practice, it seems that the request would come first and the assessment of eligibility by practitioner would follow.”
o At this time, the Criminal Code requires that a request for MAID be made in writing, and
signed and dated after the person was informed by a physician and nurse practitioner that the person has a grievous and irremediable medical condition. Any issues with this requirement would best be addressed by the federal government.
6. Bill C-14: “Could you address the impact for health care providers related to the Criminal Code of Canada, Section 241 that indicates counselling or aiding suicide is an indictable offense. I am concerned that as health care providers we educate, provide counselling and if a person asks about MAID, we are vulnerable as this section has not changed with the new legislation.”
o As part of Bill C-14, an amendment was made to the Criminal Code (see s.241(5.1)), which
provides that, “no social worker, psychologist, or psychiatrist, therapist, medical practitioner, nurse practitioner or other health care professional commits an offence if they provide information to a person on the lawful provision of MAID.
7. Charter challenge: “Where is the Charter challenge at?”
o Ontario does not have any information on this to share at this time.
Implementation Questions: What We Heard From You Cont’d
9
8. MAID provision: “Is a nurse considered aiding if the person requesting MAID has been assessed, approved and ordered medication to self-administer by a physician at home but needs assistance to physically take the medication?”
o It is not possible to provide a general answer to this question without a detailed
understanding of the facts. However, we would suggest that if a nurse has any questions about their role in providing MAID, or assisting in the provision of MAID in a particular circumstance, that they refer to any guidance issued by the College of Nurses of Ontario.
9. Access to MAID medications: “Has this been resolved?”
o The regulatory colleges have drug protocol information that can be provided directly to members.
o Ontario does have access to medications for both self-administered or clinician-administered MAID.
o MAID drugs administered in the hospital setting would be dispensed by the inpatient pharmacy and covered by hospital global budgets.
o For outpatient administration of MAID in the community or long-term care home, MAID drugs would be dispensed through retail pharmacies at no charge to the patient.
o When a pharmacy receives and fills a prescription for MAID drugs for an eligible patient, the pharmacy is to submit an online claim to the ministry for the full cost of the MAID drugs and a dispensing fee through the Health Network System (HNS), the claims adjudication system that supports the Ontario Drug Benefit (ODB) Program.
o Clinicians should make arrangements with pharmacies as early as possible to ensure avoid delays in processing a prescription for MAID.
Implementation Questions: What We Heard From You Cont’d
10
10. Data capture and reporting requirements: “Will there be sector consultations? Timing? Expectations of 2016?”
o The ministry plans to implement a robust reporting regime effective January 1, 2017. o Details about this are still being finalized, and approval will be sought in late summer/early
fall. o Any reporting regime that Ontario creates will need to align with future federal reporting
regulations. We are working closely with out federal counterparts as their plans unfold.
11. Operationalization of MAID in the community setting: “Has the Ministry considered this? Wouldn’t this be an logical role for the LHINs?”
o Any guidance on MAID issued by health regulatory colleges would apply to professionals in
both institutional and community settings. In addition, we have taken steps to make MAID drugs available in the community.
o We recognize that community organizations and individual clinicians may not have the same support as a clinician in a major hospital but we are working to bring online additional training and support materials as we proceed with implementation.
o We are monitoring implementation closely, and will consider appropriate action to address concerns as they arise. To-date we have not heard of any serious implementation issues with MAID in the community.
o We, and the LHINS, are open to hearing specific proposals on how the role of the LHINs could be best leveraged.
Implementation Questions: What We Heard From You Cont’d
11
• Long-Term Care Homes
• Update from the Chief Coroner
• Planned Legislative Amendments (late summer/early fall)
Future Webinar Updates
Key Contacts / Information Sharing Mechanisms
1. MOHLTC will continue to have these webinar sessions on a bi-weekly or as-needed
basis. Future meetings will be coordinated by MOHLTC.
2. For clinicians who have any questions about the Clinician Referral Service: ‒ E-mail: [email protected] ‒ To access the service, phone: 1-844-243-5880
3. For any public inquiries or general questions about MAID in Ontario: ‒ E-mail: [email protected] ‒ This is the email address that should be shared with your
stakeholders/members for general inquiries
12
13
Appendix A: Clinician Aid A – Patient Request for Medical Assistance in Dying
14
Appendix A: Clinician Aid A – Patient Request for Medical Assistance in Dying – Cont’d
15
Appendix A: Clinician Aid A – Patient Request for Medical Assistance in Dying – Cont’d
16
Appendix A: Clinician Aid A – Patient Request for Medical Assistance in Dying – Cont’d
17
Appendix B: Clinician Aid B – (Primary) “Medical Practitioner” or “Nurse Practitioner” Medical Assistance in Dying
18
Appendix B: Clinician Aid B – (Primary) “Medical Practitioner” or “Nurse Practitioner” Medical Assistance in Dying – Cont’d
19
Appendix B: Clinician Aid B – (Primary) “Medical Practitioner” or “Nurse Practitioner” Medical Assistance in Dying – Cont’d
20
Appendix B: Clinician Aid B – (Primary) “Medical Practitioner” or “Nurse Practitioner” Medical Assistance in Dying – Cont’d
21
Appendix B: Clinician Aid B – (Primary) “Medical Practitioner” or “Nurse Practitioner” Medical Assistance in Dying – Cont’d
22
Appendix C: Clinician Aid C – (Secondary) “Medical Practitioner” or “Nurse Practitioner” Medical Assistance in Dying
23
Appendix C: Clinician Aid C – (Secondary) “Medical Practitioner” or “Nurse Practitioner” Medical Assistance in Dying – Cont’d
24
Appendix C: Clinician Aid C – (Secondary) “Medical Practitioner” or “Nurse Practitioner” Medical Assistance in Dying – Cont’d
