A map for the road less travelled

A MAP FOR THE ROAD LESS TRAVELLED

Guidelines for Medical Assistance in Dying (MAiD)

BY KARLA BOND, PROFESSIONAL STANDARDS COMMITTEE CHAIR

The anticipated decriminalization of medical assistance in dying led to the formation of a NSCSW Professional Standards Committee to develop guidelines for social workers in Nova Scotia. The College recognized the importance and highly polarized nature of this legislation would require social workers in the province to have guidance to work within the confines of MAiD. The committee was formed in June 2017, shortly after the passing of federal legislation in June 2016 allowing eligible adults to request medical assistance in dying. The aim of the committee was to create clear and comprehensive guidelines that reflected the standards of practice and code of ethics of social workers in Nova Scotia.

Early in our initial research, committee members identified that both Alberta and Manitoba were leading the way for medical assistance in dying. We carefully reviewed other provinces’ information for their MAiD standards of practice and their guidelines, along with an examination of our own Standards of Practice and Code of Ethics to examine whether and how MAiD fit within our guidelines of practice. Terms of reference were approved and the project plan slowly evolved.

The committee was diverse and energetic. We had social workers working in various capacities — including adult protection and acute care - across the province from Eastern Cape Breton to the South Shore. Members brought their front line experiences to the table, and contributed to engaging discussions during our monthly meetings, as numerous cases were highlighted within media reports showcasing gaps and disparities within the legislation. We heard about Cape Breton man Weldon Bona’s struggle to find a clinician to perform the service, and Audrey Parker, who was forced to have her MAiD service performed earlier than anticipated due to fears of losing capacity.

We followed these stories closely as our work unfolded, to critically reflect on our personal social work practice and the structures we worked within, including the Nova Scotia Health Authority.

Key contacts in the province who were associated with MAiD services were identified for further engagement. In June 2017, Loni Doucette, MSW, RSW, and Dr. Gordon Gubitz (neurologist) provided presentations to the committee members, showcasing how those on the front line were working within MAiD, and provided insight into how assessments are completed, gaps, and the role of social work.

Each committee member played in a part in the ongoing development of the guidelines. Sections were divided up, to be reviewed, scrutinized, re-reviewed, and then assembled into a rough draft. This document would require approval from the NSCSW Council to be passed into governance. We relied heavily on referencing other provinces throughout the development process, to avoid re-inventing the wheel.

Our guidelines were passed in the fall 2018, and we immediately began working towards the development of an information session to present to social workers across Nova Scotia. The committee felt that we needed to present the guidelines to social workers across the province in a constructive and meaningful way. We also knew that social workers had questions, concerns, and thoughts building up since the passing of Bill C-14, and we wanted to create a space for their voices.

We continued to meet via teleconference to develop a half-day session that would be delivered in Halifax and aired live on Facebook, to allow any social worker who could not attend in person to watch online. The planning during those few months included securing speakers, content to present, and delegating tasks for the day. John McCarthy, Medical Affairs Advisor with the NSHA, was identified as a key player within the process of MAiD, and he agreed to be the main presenter.

The day finally arrived. On February 9, 2019, approximately 70 social workers took time from their weekends that could have been spent with family and friends, or perhaps doing self-care, and came together at Mount Saint Vincent University.

We on the committee left that day feeling as if we had accomplished our primary goals, and further spoke of how we could keep the discussion on MAiD moving forward. There was a lot of information teased out of those who were attending that day, including lack of education and training on capacity, why social workers have not been invited to sit at the table in terms of program development for MAiD with the NSHA, and the role Nova Scotia social workers will take in the future. As an audience, we were assured by John McCarthy that the role of social workers is one of importance within MAiD services in the province, and that we have an invaluable role to play within the context of service delivery.

This was also the first time that the committee had all met face-to-face. I was excited to finally be together in the same room as my fellow social workers, some of whom I had been collaborating with for over two years without ever meeting in person until that day. A bond has formed over the these years between myself, Dan, Rod, Sherry and Terri-Lynn. It didn’t seem like work; it was more like a calling.

I suggest joining a committee at the College, especially for social workers who have recently begun their practice. My fellow committee members offered engaging discussions, and kept me on my toes to meet the responsibilities of my role. Yet at the end of the day, I was accountable to myself. I had to prioritize my daily work along with my assigned committee tasks, which included taking and distributing minutes. I was also offered a wealth of knowledge on the process of guideline development, and the sheer amount of blood, sweat, and tears it takes to create a document that may seem short and simple at first glance, but in reality embodies the passion, time, patience, and dedication of a group of people working towards a shared goal.

Thank you to all those involved in the work of this committee.

COMMITTEE MEMBERS:

Karla Bond (Chair), Rod McCarron, Dan Dolan, Terri Lynn Smith, Glenna Emmett-Reashor, Sherry Battiste (staff liaison).