Rationale
Physicians frequently care for patients dying from incurable or untreatable diseases, many of which cause significant physical and psychological pain. The physician’s role is to address and treat symptoms and provide support to patients and their families.
Key Objectives
Given a dying patient, the candidate will develop an appropriate goals-of-care plan that optimally controls pain and other symptoms, maintains human dignity, and recognizes the importance of family, social supports, and the varied roles of the health care team. The candidate must know the provisions in Canadian law on medical assistance in dying (MAID), be prepared to discuss them with patients, and respond appropriately to such requests.
Enabling Objectives
Given a patient who is dying, the candidate will
- determine whether the patient has the cognitive capacity to discuss and provide informed consent for end-of-life care; if the patient does not have decision-making capacity, the candidate will determine whether advance provisions have been made for goals of care, including the designation of a substitute decision-maker; and
- develop an appropriate management plan, including
- discussing with the patient or substitute decision-maker the patient’s wishes for their care (e.g., full resuscitation) at the appropriate time,
- using pharmacologic and nonpharmacologic measures for symptom control (e.g., pain, respiratory distress, delirium, agitation) while recognizing appropriate indications, adverse effects, and possible complications,
- providing a compassionate response to any request for MAID and taking appropriate steps to ensure the patient has access to this intervention if they meet the eligibility criteria (e.g., make a referral),
- ensuring a culturally sensitive approach to emotional, physical, and spiritual supports for the patient and their family,
- treating the patient, their family, and significant others with dignity and respect throughout end-of-life care, and
- referring the patient to other professionals as needed.