Formal network of docs offering medical assistance in dying is in the works for northeastern Ontario

For those in Sudbury and District seeking a doctor's help to die, it may soon get a little easier to find one who is trained.

About 40 doctors and nurse practitioners in the region are now trained to offer Medical Assistance in Dying (MAID), after they had specialized training last fall in Sudbury from the Canadian Medical Association.

The Supreme Court of Canada ruled in June, 2016  that medical assistance in dying is a constitutional right, under Bill C-14.

Between then and now, there has only been an informal network for people seeking medically assisted death, said Dr. Paul Preston, Vice President of Clinical for the North East Local Health Integration Network, and an advocate for access for those seeking a doctor's help with dying.

Referrals happen when family practitioners who may be uncomfortable with the request, direct the patient to another doctor.

"I think most communities, if their doc wasn't involved personally, then they would know of a doc that was," Preston says.

The North East LHIN is in the initial stages of creating a formal network for these referrals.

"There's going to be more of a local [network], and an evolving thing will be recognizing these very local referral networks that have been informal so far," he said. "So that the LHIN can be involved in helping access these providers."

He adds that many doctors and nurses who help people with dying don't want their names on a published list, nor do they want to provide service outside their catchment area. So the LHIN still needs to work out the details for how the network will operate or who will have access to it.

Doc-to-doc mentorship

Dr. Preston has been offering assisted-dying to patients since it became a constitutional right almost two years ago.

Since then he says he's offered advice to other providers, including a physician who had few options.

"A doc that really wanted to help provide this service for his patient in a remote community, that had otherwise no access. I just helped point out all the logistical little steps that they have to consider, that aren't in the paperwork."

Preston says the Ontario College of Family Physicians (OCFP) is also setting up a formal mentorship program for doctors new to providing medically assisted death.

"There will be a mentor and a mentee. There will be obviously some baseline education, and then some one-on-one discussions and close inter-connectedness, trying to do it on a regional or an approximate as possible level," he says.

OCFP has experience with mentorship programs for other conditions.

Health care changing to include MAID

According to Health Canada, a patient who would like medical assistance in dying must be assessed by two independent physicians or nurse practitioners to determine if they are eligible. The patient's quality of life has to be reduced by a terminal disease.

Preston says most who seek out assisted-dying don't do it because of pain, but rather for emotional relief.

"The first step is for people to talk to their family doctor."

He added that if that doesn't work, there is a provincial call line to connect to the LHIN care coordination service: 1-866-286-4023.

"We're getting there. [Medical assistance in dying] is a brand new thing so it's a lot of change in the [health care] system to make it be connected to the system and be sustainable."