Registed Nurses' Association of Ontario

Care coordination service for medical assistance in dying

Care coordination service for medical assistance in dying

Dear John,

It was a pleasure to meet with you and discuss medical assistance in dying (MAID), following RNAO's presentation before the Standing Committee on Finance and Economic Affairs on March 23, 2017. As the professional association representing registered nurses (RN), nurse practitioners (NP) and nursing students in Ontario, we are seeking to ensure that Ontarians have access to MAID while respecting conscientious objections of health providers.

As we have seen though the hearings before committee, medical assistance in dying is a very sensitive topic that has resulted in much debate and divisions. RNAO's position, as stated in our submission to Bill 84, is that MAID is now law and part of our publicly funded health system and services. As such, it is a service that must be available across Ontario and delivered in accordance with the law.

RNAO respects the right of health professionals and institutions to opt out of providing assisted dying services. RNAO urges that in cases of conflict of beliefs or "conscientious objection," there must be a mandatory duty to refer for physicians, nurse practitioners and health organizations. These referrals must be timely and not cumbersome, so as not to add undue burden on persons seeking MAID services.  

John, during the hearings, you mentioned the province is creating a care coordination service in which Ontarians can access MAID. Having a single point of contact for patients, their families, and health providers can improve the availability and access to MAID services in the absence of duty to refer. However, our members are concerned that care coordination services will not be adequate to facilitate equitable and timely access to MAID.

It would seem to be a major challenge for the province to disseminate information regarding care coordination to patients who are gravely ill and at end-of-life. We are even more concerned about access to this resource for Ontario's vulnerable populations, such as frail, elderly, disadvantaged persons, as well as those who do not have family caregivers and/or speak English.
Another issue that must be addressed is availability of MAID providers. We are interested in knowing the province's plan to ensure that there will be enough health practitioners who can provide MAID, and coordinate care for individuals across all regions of the province.

We are gravely concerned that Ontarians will not have timely access to this critical health service as the legislation now stands. If the duty to refer is omitted from Bill 84, it is critical that the province implement a series of measures to enable Ontarians to equitable and timely access to MAID services

We look forward to your response so that we can share with our members, with more than 1,200 who have already written to Premier Wynne, Minister Hoskins and you, urging that Bill 84 include a duty to refer clause.  

Warmest regards,

Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT.
Chief Executive Officer
Registered Nurses' Association of Ontario

Cc: Hon. Kathleen Wynne, Premier of Ontario
Hon. Dr. Eric Hoskins, Minister of Health and Long-Term Care
Patrick Brown, Leader, Official Opposition
Andrea Horwath, Leader, New Democratic Party of Ontario
Jeff Yurek, Progressive Conservative Health Critic
France Gélinas, New Democratic Party Health Critic


Registered Nurses’ Association of Ontario (2017). RNAO Submission on Bill 84: Medical Assistance in Dying Statue Law Amendment Act, 2016, March 23, 2017.

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Letter to John Fraser: care coordination service for MAiD343.17 Ko
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