Medical Assistance in Dying

Position Statement: The Government of Ontario should establish a province-wide funding mechanism for NPs to deliver MAID services.

Current Issue

There are several issues related to NPs providing MAID services in Ontario:

1. Access to MAID services: Access to MAID services for patients requesting this service exists in urban, rural and remote areas. Medical professionals are not required to participate and therefore access is limited to areas where willing and experienced providers exist.
2. Increasing demand: Since MAID legislation began in Canada in 2016 demand has grown each year.  According to the First Annual Report on MAID in Canada (2019, Government of Canada) in Ontario, MAID deaths have more than doubled from 2017 (839) to 2019 (1,788).    Recently changed federal legislation, increases the size of the pool of Canadians eligibile for MAID services, which will further increase demand.  
3. Lack of compensation: We have NPs in this province currently providing MAID services  and are doing so without compensation, out of professional obligation and compassion.  There are NPs who are willing to provide MAID services to address the geographic gaps, but the lack of a compensation mechanism is a significant barrier.

Evidence

Demand for MAID services continues to grow and eligibility has been increased with recent federal legislation changes.  MAID deaths currently represent 2% of all deaths in Ontario (~2,200). In countries where MAID has been in existence longer, that number is 4.6% of all deaths. Ontario should expect to reach a similar number in the not-too-distant future (~5,000).

Currently, 45% of MAID provisions occur in the hospital taking up valuable hospital capacity with higher costs. Costs for MAID services can be significantly reduced by providing them at patients’ private residences, which is also the preferred location for patients.  Engaging NPs in the delivery of MIAD can facilitate at home provision.

A recent survey of NPs in Ontario with 171 responses provided the following results:

• 66% of those respondents that ARE authorized by their employer (n=62) and have provided MAID services are NOT fully compensated for their MAID services
• 63% of those authorized by their employers to provide MAID services are restricted in who they can provide MAID services to (i.e. restricted to clients on patient roster)
• 59% of respondents indicated they have provided MAID services for a patient and were not compensated for this work
• Reasons for the lack of compensation included:
  • 42% of responses indicated that it was not on their case-load or a patient registered with their employer
  • 19% indicated they had to make up for the time they spent providing MAID services with unpaid overtime (i.e. uncompensated MAID services)
  • 14% indicated that it was not authorized by employer and done outside of employment/contract
  • 5% indicated it was outside of the geographic area of their employer
• 89% of the survey respondents (134) that are not currently providing MAID services, would be interested in doing so, if compensation were available

As at August 31, 2020, 7% of unique providers of MAID services in Ontario were NPs.  By adding 100 NPs to that list, they would make up 25% of the unique providers.  The result would be:

– Close gap between supply and growing demand

– Improve access to MAID across the province

– Increase MAID services provided in the Community and reducing costs of hospital based administration

– Reduce costs for MAID by having more NPs providing MAID services rather than Physicians

Of the 134 respondents to the NPAO MAID survey who indicated they were not currently providing MAID services, 119 indicated they would provide MAID services if compensation were available. Ontario NPs represent an opportunity to close that gap by providing an NP-Led MAID Program for NPs.

Expected Outcomes

Outcomes that should result from engaging NPs to provide MAID services by establishing a province-wide compensation mechanism include:

1. Increased access to MAID services for Ontario patients.
   1. Increase provincial coverage of MAID services.
      1. The current gaps in coverage can be closed by activating NPs to provide MAID services.

2. Increased number of NPs involved in providing MAID services.
   1. Efficient use of healthcare professionals is enhanced.
3. Decreased Costs in the provision of MAID services.
   1. By increasing the number of providers through a compensation mechanism for NPs, gaps in service provision will be closed reducing the costs associated with travel to provide the MAID compensation.
4. Increased opportunity for MAID services to be provided for patients at their desired location, usually in their own homes or where they reside.
   1. Decreased costs to the Ministry of Health.
5. Significantly improved stability and consistency of MAID services in Ontario.