H15 A multidisciplinary huntington disease clinic’s experience with the new canadian legislation allowing medical assistance in dying

Background On June 17, 2016 Canada passed a law making medical assistance in dying (MAID) legal. To be eligible for MAID, the requestor must have a serious illness, be in an advanced state of decline that cannot be reversed, be experiencing unbearable physical or mental suffering that cannot be relieved and natural death must be reasonably foreseeable. The requestor also needs the mental competency to be able to give informed consent which requires an understanding of their medical diagnosis, available forms of treatments and options available to relieve suffering. Under the current legislation, advanced directives are not permitted for MAID requests. Cases: Case 1 – A 34 year old with moderate/severe motor symptoms and mild cognitive impairment. This individual experienced significant decline of ADLs over the past two years. All MAID requirements were met and MAID was completed. Case 2 – A 72 year old with moderate motor symptoms and declining cognitive abilities. This individual expressed an interest having MAID in the near future when quality of life deteriorated. Case 3 – A 48 year old with severe motor symptoms and significant cognitive impairment. For the past ten years, this individual has expressed the plan to pursue medical assisted death but was not able to fulfil the capacity requirements at the time of the MAID request. Case 4 – A 54 year old with mild motor symptoms and mild cognitive impairment. Last year, this individual sustained an injury that affected mobility and quality of life. The individual requested MAID and met the requirements but changed the scheduled date for MAID twice. Conclusion These cases highlight the clinical and emotional challenges for patients, families and professional staff related to assessing the MAID eligibility criteria of being in an advanced state of decline with reasonably foreseeable death while still possessing the cognitive ability needed to request and consent to MAID.