The College of Physicians wants "super nurses"
to practice medical aid in dying
The Collège des médecins du Québec requests the Legault government to allow specialized nurse practitioners
- known as "super nurses" - to practice medical aid in dying .
Specialized nurse practitioners (IPS) have the "professional skills required" to "administer the medication" and give "advice regarding compliance with the conditions" allowing a patient to obtain medical assistance in dying, says Dr. Mauril Gaudreault, President of the College of Physicians of Quebec (CMQ).
Currently, Quebecers requesting medical assistance in dying must obtain the favorable opinion of two doctors, under the Act respecting end-of-life care.
"Two weeks ago, we proposed to the Minister [of Health Danielle McCann] to take advantage of Bill 43 to authorize specialized nurse practitioners to administer medical assistance in dying," said Dr. Mauril Gaudreault.
If adopted in its current form, Bill 43 will allow some 550 Quebec IPSs to diagnose common (otitis, sinusitis, etc.)
and chronic (diabetes, hypertension, etc.) diseases. However, they will not be able to offer medical assistance in dying.
The Association of specialized nurse practitioners of Quebec (AIPSQ) wishes its members to have such power.
She also pointed it out to the government during consultations on Bill 43 last November.
"It's really for the good of the patient," says the president of the AIPSQ, Christine Laliberté. Specialized nurse practitioners can follow a patient
for long periods. They then establish a relationship of trust with him, she explains.
"It's a bit of continuity with the patient," remarks Christine Laliberté. It is a mark of mutual recognition to be able to complete the treatment. "
A skill recognized elsewhere in Canada
In other Canadian provinces, PHIs can offer medical assistance in dying. Federal law, adopted in 2016,
also allows “doctors” or “nurse practitioners” to administer such care.
"It is time that IPSs in Quebec be given the same status as in the rest of Canada", thinks Dr. Alain Naud, a family doctor
.and palliative care at the CHU de Quebec, who practices medical aid in dying.
Federal law requires two health professionals to assess the request. However,
it does not require that the opinion of an IPS be seconded by that of a doctor.
For Dr Naud, all combinations should also be possible in Quebec. “A doctor and an IPS; two doctors; two IPS; a doctor, an IPS…
whatever. It can only improve access. "
- known as "super nurses" - to practice medical aid in dying .
Specialized nurse practitioners (IPS) have the "professional skills required" to "administer the medication" and give "advice regarding compliance with the conditions" allowing a patient to obtain medical assistance in dying, says Dr. Mauril Gaudreault, President of the College of Physicians of Quebec (CMQ).
Currently, Quebecers requesting medical assistance in dying must obtain the favorable opinion of two doctors, under the Act respecting end-of-life care.
"Two weeks ago, we proposed to the Minister [of Health Danielle McCann] to take advantage of Bill 43 to authorize specialized nurse practitioners to administer medical assistance in dying," said Dr. Mauril Gaudreault.
If adopted in its current form, Bill 43 will allow some 550 Quebec IPSs to diagnose common (otitis, sinusitis, etc.)
and chronic (diabetes, hypertension, etc.) diseases. However, they will not be able to offer medical assistance in dying.
The Association of specialized nurse practitioners of Quebec (AIPSQ) wishes its members to have such power.
She also pointed it out to the government during consultations on Bill 43 last November.
"It's really for the good of the patient," says the president of the AIPSQ, Christine Laliberté. Specialized nurse practitioners can follow a patient
for long periods. They then establish a relationship of trust with him, she explains.
"It's a bit of continuity with the patient," remarks Christine Laliberté. It is a mark of mutual recognition to be able to complete the treatment. "
A skill recognized elsewhere in Canada
In other Canadian provinces, PHIs can offer medical assistance in dying. Federal law, adopted in 2016,
also allows “doctors” or “nurse practitioners” to administer such care.
"It is time that IPSs in Quebec be given the same status as in the rest of Canada", thinks Dr. Alain Naud, a family doctor
.and palliative care at the CHU de Quebec, who practices medical aid in dying.
Federal law requires two health professionals to assess the request. However,
it does not require that the opinion of an IPS be seconded by that of a doctor.
For Dr Naud, all combinations should also be possible in Quebec. “A doctor and an IPS; two doctors; two IPS; a doctor, an IPS…
whatever. It can only improve access. "
It's a bit of continuity with the patient. It is a mark of mutual recognition to be able to complete the treatment.
- Christine Laliberté
- Christine Laliberté
The Quebec Order of Nurses (OIIQ) is working on this issue. "We are in favor of studying the possibility of this happening," says Joël Brodeur,
nurse and director of development and professional support at the OIIQ. But it is certain that there are clinical and legal issues. "He pointed out that currently, specialized nurse practitioners still cannot make a diagnosis in Quebec.
"An IPS cannot draw up a death certificate," adds Joël Brodeur. Only a doctor can do this. It is written in the Civil Code. It is a little paradoxical
to carry out the medical aid in dying and that then, the IPS must call a doctor to evaluate the effectiveness [of this one]. "
The Act respecting end-of-life care will also have to be amended, according to the OIIQ. It says that the opinion of a
“second doctor” is required to obtain medical aid in dying. The words "specialist nurse practitioner" do not appear.
Obstacles, says the OIIQ, which are not insurmountable, however. The Law concerning end-of-life care will have to be
"reopened in the medium term", believes Joël Brodeur.
nurse and director of development and professional support at the OIIQ. But it is certain that there are clinical and legal issues. "He pointed out that currently, specialized nurse practitioners still cannot make a diagnosis in Quebec.
"An IPS cannot draw up a death certificate," adds Joël Brodeur. Only a doctor can do this. It is written in the Civil Code. It is a little paradoxical
to carry out the medical aid in dying and that then, the IPS must call a doctor to evaluate the effectiveness [of this one]. "
The Act respecting end-of-life care will also have to be amended, according to the OIIQ. It says that the opinion of a
“second doctor” is required to obtain medical aid in dying. The words "specialist nurse practitioner" do not appear.
Obstacles, says the OIIQ, which are not insurmountable, however. The Law concerning end-of-life care will have to be
"reopened in the medium term", believes Joël Brodeur.
Consultations
Last September, the Quebec Superior Court ruled that the criteria for "end of life" in Quebec law and "reasonably foreseeable"
natural death in the Federal Criminal Code were invalid.
Following this judgment, the Legault government decided to make this end-of-life criterion inoperative as of March 12. He has been conducting
various consultations on the expansion of medical assistance in dying, particularly in the context of incapacity.
In the office of the Minister of Health and Social Services Danielle McCann, we say that we are "open" so that specialized nurse practitioners can administer medical aid in dying "eventually". "If we end up having to modify the Law concerning end-of-life care,
there is an openness on our part to include IPSs," we add.
Dr. Alain Naud believes that action must be taken now, within the framework of Bill 43 currently under study in parliamentary committee. The doctor is convinced that "one day", Quebec will allow people who have just been diagnosed with Alzheimer to express in advance their wish to obtain medical aid in dying when they are no longer able to consent. "At that point, we will need the IPS", concludes Dr Naud.
Last September, the Quebec Superior Court ruled that the criteria for "end of life" in Quebec law and "reasonably foreseeable"
natural death in the Federal Criminal Code were invalid.
Following this judgment, the Legault government decided to make this end-of-life criterion inoperative as of March 12. He has been conducting
various consultations on the expansion of medical assistance in dying, particularly in the context of incapacity.
In the office of the Minister of Health and Social Services Danielle McCann, we say that we are "open" so that specialized nurse practitioners can administer medical aid in dying "eventually". "If we end up having to modify the Law concerning end-of-life care,
there is an openness on our part to include IPSs," we add.
Dr. Alain Naud believes that action must be taken now, within the framework of Bill 43 currently under study in parliamentary committee. The doctor is convinced that "one day", Quebec will allow people who have just been diagnosed with Alzheimer to express in advance their wish to obtain medical aid in dying when they are no longer able to consent. "At that point, we will need the IPS", concludes Dr Naud.
