A request for medical assistance in dying can expose confusion about who decides, whether a long-term care home must participate and what a family is allowed to do. The resident’s own wishes are central. A relative cannot create a request on someone else’s behalf, and a diagnosis or residence in long-term care does not establish eligibility. The useful task is to understand the pathway without turning the home into the decision-maker.
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Separate a request from an eligibility decision
A resident may ask for information or an assessment, but only authorized physicians or nurse practitioners assess the federal eligibility criteria under the applicable provincial process. The home does not approve MAID, and family agreement is not a legal criterion. Avoid language such as “we have decided for her.” Record the resident’s own words and ask privately whether they want information, an assessment, symptom support or simply to be heard.
Capacity is specific to this decision and this time
Dementia, depression, communication difficulty or a substitute decision-maker for other matters does not automatically answer whether a person can make a MAID request. Assessors consider whether the person understands relevant information and can make the required voluntary, informed decisions. Staff should not use a cognitive label as a shortcut. Equally, a family should not coach answers or conceal pressure, conflict, fear or unmet care needs.
Map the provincial access route before a crisis
Delivery is organized by provinces and territories, so referral contacts, forms and coordination vary. Ask the home for its written policy and the provincial access contact. Clarify whether assessments can happen in the resident’s room, who arranges records and whether a transfer would ever be proposed. Federal law does not compel an individual clinician to provide MAID, while provincial rules may impose referral or access duties.
- Name of the provincial or territorial MAID coordination service
- Process for a private conversation with an assessor
- How records, medication lists and diagnoses are shared with consent
- What happens if the facility or a clinician does not participate
Do not confuse MAID with advance care planning
A do-not-resuscitate order, goals-of-care form, advance directive and MAID request serve different purposes. Refusing hospitalization or burdensome treatment does not mean requesting MAID. A power of attorney or substitute decision-maker may guide other treatment decisions when authorized, but cannot originate and consent to MAID for an incapable person. Keep each document named and discussed separately to prevent serious assumptions.
Check whether suffering reflects a correctable failure
Eligibility assessments include information about available ways to relieve suffering, including palliative care. That does not give relatives a veto, nor does it require someone to accept every treatment. It does mean untreated pain, isolation, inaccessible communication, medication effects or fear deserve prompt attention. Ask for a clinical review without framing it as a test the resident must pass before their request is respected.
Plan privacy, visitors and the day itself carefully
If the process advances, the resident decides who is informed and present, subject to capacity and privacy law. Discuss room privacy, cultural or spiritual wishes, medication delivery, after-death procedures and support for a roommate. Staff scheduling and documentation should be discreet. Family disagreement can be intense; the home should protect the resident from pressure while directing relatives to counselling, ethics or bereavement support where available.
Keep a neutral timeline of requests and responses
Record when the resident first raised the subject, the words they used, who was present, what information they requested and what staff did next. A neutral timeline protects the resident from having to repeat a private conversation and helps identify delay without turning relatives into assessors. Avoid conclusions such as “she was not herself” unless you also document the observable reason for concern and report it to the qualified assessor.
Include parallel care actions. Note requests for pain review, spiritual support, interpreter access, palliative consultation or a private meeting. These supports are not alternatives imposed to derail MAID; they are part of informed, person-centred care and may be wanted whether the request proceeds or not. Do not make comfort contingent on withdrawing the request, and do not portray MAID as the remedy for poor basic care.
If time or capacity may change, ask the provincial coordinator which steps are time-sensitive and who owns each one. The family’s role can be practical—finding identification, helping arrange a private call, transporting a trusted person—while maintaining the resident’s voluntary voice. Where family members disagree, use separate support conversations so the resident is not made responsible for resolving everyone else’s grief.
Keep financial and inheritance conversations away from the request process unless the resident chooses otherwise. Assessors consider voluntariness, and even well-meant comments about cost, caregiver burden or “not wanting to be a problem” can create pressure. If the resident expresses those fears, report them accurately and ask the care team to address practical support. The goal is neither to encourage nor obstruct a lawful request, but to make sure the person can speak freely with qualified professionals and continue receiving respectful care throughout.
Can the family stop or authorize the request?
A family member cannot authorize MAID for another adult and cannot replace the resident’s voluntary consent. Concerns about coercion, capacity or safety should be given directly to the assessors, not used to intimidate the resident. The resident may withdraw a request at any time and in any manner. Specific federal safeguards and limited waiver provisions require professional assessment; do not infer them from another care document.
Can a home refuse to let anyone discuss MAID?
Policies and obligations differ, and individual providers may object to participating. Ask for the written policy, the external coordination route and how timely, private access to information is protected. A vague verbal statement is not enough when time and capacity may change. An advocate, provincial access service or regulator can clarify the current local process if the response is obstructive.
What must be verified for the individual resident?
Confirm current federal eligibility rules, provincial forms, facility policy, assessor availability and any transfer arrangements directly with the provincial MAID service and qualified clinicians. This guide cannot determine eligibility, capacity or timing. The resident’s care team and assessors must evaluate the actual request, while the home confirms what can occur on site.