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Policies and Standards

REQUEST FOR MEDICAL ASSISTANCE in DYING (MAiD) POLICY

PURPOSE

To provide a consistent ethical and compassionate approach in keeping with the faith-based mission of Salem Home when addressing the issue of medical assistance in dying (MAiD).

DEFINITIONS

Advance Care Planning: a process where individuals indicate their treatment goals and preferences for their care at the end of life.  This can be in a written directive or advance care plan, also known as a living will.

Medical Aid in Dying:  A medical practitioner or nurse practitioner knowingly and intentionally provides a person with the knowledge or means, or both, required to end their own life, including counseling about and/or administering lethal doses of drugs, prescribing such lethal doses or supplying the drugs. (MAiD)

Palliative Care:  an approach that improves the quality of life of a person and their family facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain and other symptoms, physical, psychosocial and spiritual.

 

STATEMENT OF BELIEFS AND CONVICTION REGARDING THE SANCTITY OF LIFE

  1. We believe that all life originates as a creative expression of God.
  2. We believe that all human life is sacred from the moment of conception until the day we die.
  3. We believe that God has the ultimate authority and determinative power in regards to the time of our conception and birth, and our death.
  4. We recognize that pain and suffering can be a very real and ongoing condition for some people. Medical knowledge should be used to provide remediation and comfort.
  5. We believe that using medical means to intentionally hasten death is not ethically or morally appropriate, whether determined by the individual, or others involved in their care, or collaboratively.
(Genesis 1: 26, 27, 28; Genesis 2:7, 22; Genesis 9:6; Genesis 27:2; Deuteronomy 32:39; Joshua 1:5; Job 14:5; Job 27:2-4; Job 33:4; Psalm 8:3-6; Psalm 90:1 – 12; Psalm 139:14,16,17; Isaiah 40:31; Isaiah 64:8; Jeremiah 1:5; Micah 6:8; Matthew 5:3-7; Matthew 25:40; Matthew 28:16-20; John 11:4; Acts 17:24,25; Romans 5:5; Romans 8:28; Romans 14:18; I Corinthians 3:16, 17; I Corinthians 6:19-20; I Corinthians 11:7; I Corinthians 15:54; II Corinthians 4:17; Galatians 2:20; Ephesians 2:8-10; Philippians 1:21; Philippians 3:20; Hebrews 2:14, 15; Hebrews 9:27; Hebrews 13:5, 14; James 3:9; Revelation 1:8; Revelation 21:4)

 

COMMITMENT

  1. Salem Home personnel, which includes employees, board members, contractors and volunteers, will not, in their capacity as personnel, of Salem Home, express their approval of, participate in, or condone, residents’ medical practitioners, nurse practitioners, or other agents who are prepared to carry out MAiD at Salem Home.
  2. Salem Home personnel, including employees, board members, contractors and volunteers will not, in their capacity as personnel of Salem Home refer residents or families to medical practitioners, nurse practitioners, or other agents for the express purpose of performing MAiD, or counsel those residents or families to seek medical practitioners, nurse practitioners, or other agents for the expressed purpose of performing MAiD.
  3. Salem Home reaffirms its commitment to provide quality palliative and end-of-life care, as well as compassionate support for dying persons and their families through all stages of life including:
    1. Providing and honoring resident self-determination through the use of advance care planning, goals of care designation, and/or personal directives, including the role of substitute decision-makers/agents acting on behalf of the resident;
    2. Offering quality palliative and end-of-life care that addresses physical, psychological and spiritual needs to residents who are dying and their families;
    3. Delivering effective and timely pain and symptom management by health care professionals who are knowledgeable in pain and symptom management to lessen pain and suffering. The goal is to alleviate pain and suffering while minimizing the potential side effects of medication.
    4. Should a resident or family member of a resident of Salem Home inquire about the availability of MAiD, the Director of Resident Care Services of Salem Home will provide the individual with contact information relating to the MAiD team and/or Health Links-info Sante in a timely manner.
  4. Salem Home will not make referrals for MAiD or assist in making arrangements of any nature to assist with MAiD.

POLICY

  1. Salem Home, in the interest of self-disclosure, declares to all its residents of its institutional position as an “Abstaining Facility” regarding MAiD, i.e. the prohibition on the counseling,assessment for, and the provision of MAiD at the facility. 
  2. Salem Home and its employees, directors, board members, volunteers or contractors will not sanction, condone, or assist in MAiD as individuals, or as a corporation.
  3. As a Mennonite health care organization rooted in the Christian faith, Salem Home is committed to the inherent dignity of every person throughout the entire continuum of life from conception to natural death.
  4. The intentional taking of a resident’s life will not be practiced by anyone associated with Salem Home. This includes employees, physicians, pharmacist, or other disciplines involved in providing care.
  5. Salem Home’s own ethical and moral opposition to MAiD needs to be recognized and respected by all persons served by, or working within the organization, including but not limited to funders, regulatory bodies, and advocacy groups. Anyone working with Salem Home who wishes to speak or act in an incompatible manner outside of their connections with Salem Home is required to ensure that there is no reasonable apprehension that these words or conduct reflects the policies and practices of Salem Home.
  6. All associated with Salem Home are prohibited from participating in any actions or omissions directly intended to cause death, and from assisting in such actions or omission in their capacity as employees, directors, board members, volunteers or contractors of Salem Home.
  7. Suffering is a human experience which occurs throughout life and is not directly related to dying. A person in deep anguish needs to be appropriately supported so their suffering is addressed and dignity affirmed. The goal of care is to reduce suffering and promoting the wellbeing of the patient.
  8. Salem Home has an institutional right to uphold its mission of providing Christ centred care as recognized by the Principles of Faith signed by the provincial government, Regional Health Authority, and Salem Home; and the Service Purchase Agreement signed between Salem Home and Southern Health – Santé Sud. Salem Home recognizes that persons in our care and the personnel serving them may be conflicted when responding to a request.
  9. Salem Home is morally and legally bound to work together with both residents and staff to resolve potential conflict around the goals of care to find proactive solutions that respect the wishes and integrity of all.
  10. Salem Home is committed to ensure that residents are informed on what is permitted within the facility regarding MAiD so they can make an informed decision as to becoming a resident at Salem Home, or seek an alternative facility.
  11. Residents who wish to seek MAID will NOT be impeded from seeking referrals outside of Salem Home, keeping in mind that Salem Home employees, contractors, etc. are prohibited from participating in the assessment for or the provision of MAiD, or counseling residents for the express purpose of seeking MAiD.
  12. Residents expressing their wish to seek MAiD, will have the right to have the MAiD Team come in to initially assess the individual for the purposes of obtaining consent and information, and discussion of all appropriate and available therapeutic options available to the individual to address their health and medical needs.
  13. In accordance with The Personal Health Information Act, upon request and consent from the resident, the MAiD Team will be provided with personal health information about the resident, including access to their electronic health record. The MAiD Team will document their assessment in the resident’s health record.
  14. Salem Home is committed, in a non-discriminatory manner, to uphold its duty for care and will NOT abandon any resident in its facility.

 

RESPONSIBILITIES

 LEADERSHIP

  1. The Governing Board will sign the Board Member Agreement GB Form 3.01-01 which indicates agreement with Salem Home’s policy in relation to a request for MAiD.
  2. The CEO, Directors, Managers, and allied professions are required to sign GB Form 3.01-02 indicating their agreement with Salem Home’s policy in relation to a request for MAiD. Completed employee agreements will be filed in personnel files, allied professional agreements will be filed in Director of Resident Care Services office.
  3. Senior leadership is responsible to ensure that educational resources are in place to ensure that staff have the necessary skills and tools to provide palliative and end of life care.
  4. Senior Leadership is responsible to ensure excellence in the delivery of palliative and end-of life care.
  5. The organization recognizes its legal requirement to advise of and/or direct residents of Salem Home to sources for more information on MAiD if so required. The Senior Leadership Team will ensure a procedure is in place to meet this requirement, with the understanding that Salem Home will NOT participate in the process for that purpose.
  6. The Leadership Group is committed to provide spiritual care, emotional support and other counselling services for residents who express a wish to die and may be requesting MAiD.
  7. In situations when a resident pursues MAiD with a non-abstaining facility, Salem Home will make arrangements for an effective transfer of all relevant records to the non-abstaining facility.
  8. Residents requesting MAiD will be advised that they may NOT be able to access MAiD if:
    • An individual is too ill or frail to be transferred to a non-abstaining facility.
    • An individual resides in an abstaining facility and declines to be transferred to a non-abstaining facility.

OPERATIONAL

  1. The Social Worker will inform all residents/families on admission to Salem Home that residents receiving care have the right to make decisions concerning their medical care if they are able to do so. This includes the right to accept or withdraw medical or surgical treatment, and the right to formulate an Advance Directive.
  2. The Social Worker/Resident Care Manager will provide information to all individuals on its policy related to MAiD. Same will be documented in the resident’s electronic health record.
  3. Salem Home respects the rights of all residents/families and physicians to discuss and explore those treatment options, that are consistent with our Mission Statement along with Salem Home’s policies and fully expects residents, physicians, and caregivers to respect and adhere to Salem Home’s policies.
  4. Notice regarding Salem Home is an abstaining facility will be posted on its website.

All Staff will:

  1. Notify their Manager in the event they wish to be considered as a Conscientious Objector.
  2. Direct inquires related to MAiD to the Director of Resident Care Services/Designate, or the attending physician, or the Provincial Clinical Team responsible for MAiD which is currently located in the WRHA and can be contacted by emailing maid@wrha.mb.ca or by phone at 204-926-1380.
  3. The Director of Resident Care Services/Designate will ensure this information is received within 24 hours of the request.
  4. Comply with any requirements of their professional regulatory body, if applicable, in relation to the expression of interest or request.
  5. Salem Home will connect with Southern Health – Santé Sud to determine the appropriate facility to transfer the resident for the provision of MAiD services, if required.
  6. Salem Home respects this is the resident’s home, and as such, the resident may return to the facility, should there be a waiting period of any kind.

************ References ************ 

  • Corporate Member Written Statements on Physician Assisted Suicide 2015
  • Canadian Medical Association: Definitions (2014), note the italicized words have been added by Salem Home Inc.
  • Randy Smart, Pastor, Bethel Bergthaler Mennonite Church: Statement of Beliefs and Conviction Regarding the Sanctity of Life (2015)
  • Catholic Health Association of Canada: Prototype Policy: Responding to Requests for Physician Assisted Suicide 2014
  • HavenGroup Policy P6-153: Medical Assistance in Dying: October 2017
  • Southern Health – Santé Sud Policy CLI.4110.PL.006: Medical Assistance in Dying (MAiD); October 2017

 Cross Reference General Manual
Communication Process Governing Boar dAll Employees Physicians Pharmacist Allied Health Professions

  GOVERNING BOARD MANUAL No. GB 4.30
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