Referrals for Medical Assistance in Dying to Champlain Regional MAID Network

Please complete the Regional Referral for Medical Assistance in Dying.
Fax completed forms and any supporting documentation to (613) 761-4351, or email to
You will be contacted within 5 business days of receiving the completed form to discuss the referral.
Questions? Contact the Champlain Regional MAID Network @ 613-798-5555, ext. 1-0352 or

Referrals may also be directed to the Ontario MAID Care Coordination Service at 1-866-286-4023 for support in meeting any referral requirements. The care coordination service information line is available 24 hours a day, 7 days a week. Referral services are available Monday to Friday 9 a.m. – 5 p.m. EST in English and French (translations for other languages can also be requested). TTY (voice-to-text and text-to-voice) services are also available at 1-844-953-3350.


Clinician Aid A - for patients
Clinician Aid B - for primary physician assessment
Clinician Aid C - for secondary physician assessment

Bridge C-14

Bridge C-14 is a non-profit organization dedicated to providing meaningful connections of support for families and loved ones throughout all stages of assisted death. They are committed to creating a culture where dignity, choice, and grief, are honoured and valued. To read more about what Bridge C-14 can offer you or your loved ones, or to access their services, please see their website.

Medical Assistance in Dying: Information for Patients & Families

What is Medical Assistance In Dying?

Medical Assistance In Dying (MAID) means that a Physician or Nurse Practitioner provides or administers medication that intentionally brings about a patient’s death, at the request of the patient. Medical Assistance In Dying has also been called “assistance in dying”, or “Physician-assisted death”.


Why is Medical Assistance In Dying now allowed in Canada?

In February 2015, the Supreme Court of Canada struck down sections of the Criminal Code that made medical assistance in dying illegal for patients who meet specific criteria in Canada. On June 6, 2016, it will no longer be illegal to provide medical assistance in dying to patients who meet specific eligibility criteria.


Why is it important for Queensway Carleton Hospital to support Medical Assistance In Dying?

QCH is committed to providing compassionate, patient-centered care to all its’ patients. Offering Medical Assistance In Dying as one of the possible options for end-of-life care to qualifying patients is about offering compassionate and high-quality care at a difficult time for QCH patients and their families.


What are the criteria for Medical Assistance In Dying?

To be eligible for medical assistance in dying, patients must:

  • Be a capable adult who is at least 18 years old
  • Provide clear informed consent to medical assistance in dying after having made a voluntary request this means that patients must be informed of alternative options for care, such as palliative care. Patients may withdraw their request at any time.
  • Have a grievous and irremediable medical condition, which means:
    • They have a serious and incurable illness, disease or disability.
    • They are in an advanced state of irreversible decline in capability.
    • They are experiencing enduring physical or psychological suffering that is intolerable and that cannot be relieved under conditions that they consider acceptable.
    • Their natural death has become reasonably foreseeable.
  • Be eligible for health services funded by the Government in Canada.

What does capable mean?

A capable person has decision-making capacity. This means that person is able to:

  • Understand information that is relevant to making a decision about treatment.
  • Appreciate the reasonably foreseeable consequences of a decision.


What does it mean to clearly consent?

The person requesting medical assistance in dying will need to make two requests for the procedure; one of these requests must be in writing. This is so the hospital knows that the requestor is sure about their decision, that they have not been forced into the decision, and that they have all of the information they need to make an informed decision.

How will requests be assessed?

The person requesting Medical Assistance In Dying will be assessed by at least two independent Physicians or Nurse Practitioners. Both assessors must agree that the requestor meets the criteria above.



Does the requesting person have to undergo treatment first?

No, it is not required to undergo treatment before requesting medical assistance in dying. However, patients should be made aware of all of their options for care as part of the informed consent process.


What if a Physician or Nurse Practitioner objects to Medical Assistance In Dying?

Healthcare providers have the right to conscientiously refuse to participate in Medical Assistance In Dying based on moral or religious beliefs. Queensway Carleton Hospital is respectful of this right. If a request for Medical Assistance In Dying is made to a Physician or Nurse Practitioner who objects, the requestor will be referred quickly to a Physician or Nurse Practitioner who is willing to participate. 


Can a patient write down their wishes for Medical Assistance In Dying in case they lose capacity to make decisions? Or, can family members make the decision to pursue Medical Assistance In Dying on their behalf?

The person requesting Medical Assistance In Dying must be able to ask for it at the time of the request. The request cannot be written down ahead of time and no one else – including family – can make the request on the patient’s behalf.
It is, however, a good idea to discuss and record wishes for end of life care with loved ones so that they understand what is important in a patient’s care. Medical assistance in dying is only one of many options that may be considered when caring for patients at the end of life.


Can the person requesting Medical Assistance In Dying change their mind?

Yes. Anyone who requests medical assistance in dying can change their mind at any time, for any reason. The requestor should tell the Physician, Nurse Practitioner, or other member of the healthcare team that they have changed their mind. The Physician or Nurse Practitioner will discuss what other options there are for care. The patient can be assured that all alternative options will be of high-quality and compassionate.


Where can a person go if they have other questions?

If there are additional questions, patients should discuss them with their Physician, Nurse Practitioner or other member of the healthcare team.