Physicians and nurse practitioners are legally permitted to assist in the death of a competent and consenting adult with a grievous and irremediable medical condition who is suffering intolerably and whose death is reasonably foreseeable. The federal government's Bill C-14 received royal assent and became law on June 17, 2016.

The College of Physicians and Surgeons of Ontario (CPSO) has issued guidance for medical assistance in dying (Policy Statement # 4-16) that complies with the federal legislation. It outlines professional and legal obligations that apply to medical-assistance in dying, eligibility criteria for patients, and guidance for physicians on practice-related elements. The CPSO guidance is the primary document for all physicians in Ontario and the CPSO's Physician Advisory Services is available to discuss any questions (1.800.268.7096 ext. 606 or 416.967.2606). The public and patients can address questions to the CPSO at 1.800.268.7096 ext. 603.

What does this mean for you in your practice?

In the days and weeks ahead we will likely see an increase in questions from patients about medical assistance in dying. If this is the first time a patient has raised end-of-life wishes, it is important for us to engage the person and their family first in a broader discussion about palliative care and end-of-life care support. As you know, there are palliative and end-of-life options that address pain, symptom management and issues of isolation and fear of dying.

For many people, a palliative approach to care can help manage their medical and psychosocial concerns. For patients who want to ensure that the option of assisted death is available to them, the CPSO's Guidance outlines the necessary process for you to follow.

The Ministry of Health and Long-Term Care (MOHLTC) launched a clinical referral service to support physicians and nurse practitioners. The service is intended to support clinicians who are not able to refer within his or her own professional networks or through their local hospital. For more information, to register or request support contact: [email protected] / 1-866-286-4023 | 1-844-953-3350.

This is certainly a challenging time for patients and for us as family physicians as Canadians navigate these uncharted waters. Many organizations, including the OCFP, are developing education and support resources to assist us in supporting our patients as they consider their end-of-life plans, whether that is to address questions, seek a referral, or support the patient directly through the process. Please visit the OCFP online resources section for links to available resources. New resources will be added as they come available.

It is worth noting that further changes may come through provincial legislation later this year that could lead to further changes to medical assistance in dying in Ontario. We will keep you updated.

In the meantime, as Ontario family physicians we will continue to work in partnership with our patients to ensure they receive high-quality palliative and end-of-life care, and that their treatment wishes in this regard are valued and respected. The OCFP is committed to working with family physicians, with hospitals and other health-care partner organizations to ensure that palliative and end-of-life care, and medical assistance in dying, is delivered in a coordinated way across the province.

Links and Resources

These and other resources can be found below:

• College of Physicians and Surgeons of Ontario - Medical Assistance in Dying (Policy Statement # 4-16)
• Ministry of Health and Long-term Care:
• Care Coordination Service: [email protected] / 1.866-286-4023 | TTY 1-844-953-3350
• Canadian Medical Association: A Canadian Approach to Assisted Dying: A CMA Member Dialogue Summary
• Health Canada: End-of-Life Care
• Government of Canada: Bill C-14 (Royal Assent)