Patients and Families

Accessing medical assistance in dying

Frequently asked questions

Is medical assistance in dying legal?
Yes, medical assistance in dying is legal in Canada as long as the criteria established in the federal law are followed.

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Is medical assistance in dying ‘euthanasia’ or ‘suicide’?
It is both. There are two types of medical assistance in dying. They include where a physician:

  1. directly administers medication (intravenously) that causes death - commonly called voluntary euthanasia or clinician-assisted medical assistance in dying
  2. provides or prescribes medication that the patient takes themselves (orally) to cause their own death - commonly known as assisted suicide or self-administered medical assistance in dying
    • NOTE: At present only intravenous medications are available in Manitoba for medical assistance in dying

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How is medical assistance in dying different from withholding or withdrawing life-sustaining treatment?
Medical assistance in dying is an intervention intended to cause death. Withholding and withdrawing life-sustaining treatments are decisions made to stop or not start interventions that would prevent an individual from dying.  Withholding/withdrawing life sustaining treatments has occurred for many years in Manitoba and is not affected by this decision.

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If a patient wants more information about medical assistance in dying, who should they contact?
Patients should speak with their physician and/or health care team.  Patients may also contact the provincial medical assistance in dying clinical team who can provide more information and assist patients in accessing services.

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Where is medical assistance in dying available in Manitoba?
Medical assistance in dying is available throughout Manitoba.  There is a provincial medical assistance in dying clinical team available to help patients access this service.  Patients may speak with their health care provider or local health authority or contact the provincial medical assistance in dying clinical team regarding accessing medical assistance in dying in their region.

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Is medical assistance in dying available in rural and remote areas?
Yes. Medical assistance in dying is available throughout Manitoba.

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Is there a cost to patients for medical assistance in dying?
No, Manitoba residents eligible for insured medical services can access medical assistance in dying at no cost in Manitoba. For more information on Manitoba health coverage, visit: http://www.gov.mb.ca/health/mhsip/index.html#Q1.

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Must the illness, disease or disability be fatal or terminal for the patient to be eligible?
No. The medical condition need not be fatal or terminal.  However the condition must be serious and incurable and the patient must be in an advanced state of irreversible decline with their natural death reasonably foreseeable.

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Can a person with mental illness receive medical assistance in dying?
Patients with mental illness may be eligible for medical assistance in dying as long as they meet all of the criteria listed in the law, including their natural death being reasonably foreseeable, and having the capacity to make medical decisions for themselves.

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How long will it take to process a request for medical assistance in dying?
The approximate minimum time from the initial inquiry to administration of medications that result in death is 2-3 weeks. This is a prediction and the circumstances of each case will be unique.

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Can a health care provider, friend or family member make the request for medical assistance in dying on behalf of a patient?
No. The request must be made by the patient, who must meet all the eligibility criteria. However, if the patient is physically unable to initiate a request, a friend or family member or health care provider may initiate the request on their behalf.

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What if a patient has difficulty communicating verbally?
Difficulty with communication, including speech, does not prevent patients from participating in the medical assistance in dying process. The provincial medical assistance in dying clinical team includes a speech-language pathologist who works alongside patients to ensure an effective and reliable means of communication during assessments for eligibility and at the time medical assistance in dying is provided.

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What if a patient is unable to sign the request form?
For patients who are unable to sign and date the request form, a person who meets the criteria for a proxy may do so in the patient’s presence as directed by the patient.

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Who can be a proxy for the patient’s written request for medical assistance in dying?
A proxy must be someone who:

  1. is at least 18 years old
  2. understands the nature of the request for medical assistance in dying
  3. does not know or believe that they will benefit in any way financially or materially from the patient’s death

The proxy cannot be either of the two independent witnesses.

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What is an independent witness? Who can witness the patient’s written request for medical assistance in dying?
To meet the legal criteria for independent witness the person must:

  1. be 18 years of age or older
  2. understand the nature of the request for medical assistance in dying
  3. not know or believe that they will benefit in any way financially or materially from the patient’s death
  4. not be an owner or operator of any health care facility at which the patient is being treated or resides
  5. not be directly involved in providing health care or personal care to the patient

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Can a patient request medical assistance in dying in advance of experiencing suffering or receiving a diagnosis?
No.  Medical assistance in dying cannot be provided based on an advance request or directive.  Only the patient can request and consent to medical assistance in dying.  Medical assistance in dying cannot be provided at the request of a substitute decision maker.  In addition, the patient must be mentally competent and capable of giving consent at the time medical assistance in dying is provided.

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Must the family of a patient requesting medical assistance in dying be consulted?
No. As with any other medical treatment, consulting with or informing others is at the patient’s discretion. Eligible patients who meet criteria and obtain approval from the health professionals involved do not need consent from or to discuss their decision with any other person.

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What if a patient’s request for medical assistance in dying is not supported by their spiritual or religious group or their family?
The patient’s physician, health care team or the provincial medical assistance in dying clinical team can discuss this with the patient and connect the patient with a spiritual care provider and/or other support as needed.

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Who can provide medical assistance in dying?
The federal law allows for physicians and nurse practitioners to assess for eligibility and provide medical assistance in dying. Currently, only physicians can provide medical assistance in dying within Regional Health Authority facilities in Manitoba because nurse practitioners are not authorized to complete the Registration of Death documentation. Nurse practitioners may fully participate in discussions involving suffering and end of life care including medical assistance in dying.

Those who can help the physician in providing medical assistance in dying include: pharmacists, nurses, other health care providers, family members and other people the patient may ask to help.

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What if a physician won’t provide medical assistance in dying?
Not all physicians will choose to participate in medical assistance in dying and no one will be required to do so.  All health care providers have a responsibility to continue to provide other medically required care and ensure any patient requesting information about medical assistance in dying has timely access to a resource with accurate information about medical assistance in dying.

In addition, there is a provincial medical assistance in dying clinical team available to help patients access this service.  Patients may contact the provincial medical assistance in dying clinical team who can provide more information and assist patients in accessing services.

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Can people choose the medical team involved with their medical assistance in dying?
Yes, as long as the health care professionals are qualified and agree to be involved. Currently only the provincial medical assistance in dying clinical team is authorized to provide medical assistance in dying in regional health authority facilities. The provincial medical assistance in dying clinical team can work with your existing health care team.

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If a patient is eligible, do they have to proceed?  Do they have to proceed right away?
No.  There is no obligation to proceed with a medical assistance in dying at any time.  If a patient is deemed eligible and wishes to proceed, they may determine their preferred timeline.

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Who can be present at the time medical assistance in dying is provided?
The patient, in consultation with the involved physician(s), may decide who is present.   A minimum of two (2) medical professionals will be in attendance and often a social worker is asked to be present as well.

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Where can medical assistance in dying occur?
Medical assistance in dying can be provided in most health care facilities*, at the patient’s home or at another location agreed to by the patient and the involved physician. 

* (This may differ if the patient is in a faith-based facility.)

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What are the medications that will be administered to cause death?
That information will not be provided publicly. However, the medications including their risks and effects will be explained to patients during the assessment process.

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Once the medication is administered how long will it take for the patient to die?
Experience indicates that most patients lose consciousness quickly and time of death can vary from minutes (with intravenous clinician-administered medical assistance in dying) to hours (with oral self-administered medical assistance in dying).

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What happens after the patient has died?
Once the physician has confirmed that the patient has died, the wishes of the patient regarding cremation or burial would be carried out as they would with any other form of death. For more information, visit http://residents.gov.mb.ca/death.html

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What information goes on the death certificate?
The form commonly known as the death certificate is actually two forms, the Registration of Death and the Medical Certificate of Death.

The first page, the Registration of Death includes only demographic information: name, time and place of death, usual residence, marital status etc. This is the page that will go to the funeral home.

The second page, the Medical Certificate of Death, will list the cause of death as the patient’s underlying illness (cancer, ALS etc.) with the manner of death listed as natural.  At present "medical assistance in dying was provided" is also written on this page. This is the page that is sent to Vital Statistics.

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Are there any issues with pension or life insurance if a patient receives medical assistance in dying?
Several amendments to pension and insurance policies have occurred to ensure policies remain valid when a patient receives medical assistance in dying.  It is recommended that patients requesting medical assistance in dying contact their pension and/or life insurance provider for specific information.

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Can a person who receives medical assistance in dying donate their organs?
It may be possible for some patients who receive medical assistance in dying to be an organ and/or tissue donor. This would need to be reviewed and determined on a case by case basis.