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Medical Assistance in Dying Assessment Record (Assessor/Prescriber) Page 1 of 3 PATIENT LABEL Retain with related forms in the health record. Prescriber to submit copies to an agency tasked with completing

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How to fill out medical assistance in dying

01

Step 1: Determine if you qualify for medical assistance in dying

02

Step 2: Seek medical and legal advice

03

Step 3: Assess your mental capacity

04

Step 4: Complete the request form

05

Step 5: Obtain the required assessments

06

Step 6: Wait for the minimum reflection period

07

Step 7: Administer medical assistance in dying

Who needs medical assistance in dying?

01

Individuals suffering from a terminal illness with a prognosis of a foreseeable death

02

Individuals experiencing unbearable physical or psychological suffering that cannot be relieved

03

Individuals who have made a voluntary and informed request for medical assistance in dying

04

Individuals who are eligible under the relevant legislation and regulations

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What is medical assistance in dying?

Medical assistance in dying is the practice whereby a competent adult with a grievous and irremediable medical condition, who is suffering intolerably, can request a medical practitioner to provide medications that the person can self-administer to end their life.

Who is required to file medical assistance in dying?

The medical practitioner who provides the medical assistance in dying is required to submit the necessary documentation.

How to fill out medical assistance in dying?

To fill out medical assistance in dying, the medical practitioner must follow the guidelines and requirements set out by the applicable laws and regulations.

What is the purpose of medical assistance in dying?

The purpose of medical assistance in dying is to provide individuals with a means to end their suffering when they are facing a grievous and irremediable medical condition.

What information must be reported on medical assistance in dying?

The information that must be reported on medical assistance in dying includes the details of the patient, the medical condition, the medications administered, and any other relevant information.

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