Name: Peter Godor
Practice Area: ICU, STARS and Medical Assistance in Dying (MAiD)
Number of Years in Practice: 13 years as an NP, 25 years as as RN
Describe your entire practice area.
- STARS fight nurse for 20 years. First 8 years at Calgary Base, then once I moved to Edmonton for RAH ICU, I eventually transferred to the Edmonton Base when there was an opening.
- RAH ICU NP. One of 6 ICU NPs providing Tier One Coverage to the ICU 24/7/365.
- Medical Assistance in Dying. Since 2016, I have been a MAiD Assessor and Provider in the Edmonton Zone, but frequently assist with the Central and North Zone. My role is two pronged: I assess individuals for eligibility for MAiD, which I find is the more important of the roles. I also do the actual provision if the patient meets criteria and they decide to go through with MAiD.
How did you become involved in MAiD specifically?
Throughout my ICU career I have always been interested in end-of-life care and issues, as a great deal of our work revolves around death and dying. However, prior to decriminalization of medical assistance in dying, I was not specifically interested in it other than being aware that ‘it was out there’ in some countries. I did not consider myself a ‘strong proponent’, but certainly was not an opponent. Once the Supreme Court decision in 2015 and the subsequent Criminal Code of Canada changes in 2016, I educated myself on the topic. Shortly after the June 2016 launch of AHS’ MAiD program, I contacted the program and inquired about being a participant. I have been an Assessor and Provider ever since.
Describe the MAiD process for patients from enquiry about eligibility to procedure.
- The patients, usually with assistance of family, friend or caregiver, contacts the MAiD Navigation Service. The Navigator will assist with directions as to how to fill out the application form, also referred to as the Record of Request (ROR).
- Once the ROR is received in a properly formatted state, the Navigator contacts two of the Assessor/Providers and requests that one of us be the Provider and one of us be the Assessor. Assessors and Providers can be NPs and MDs.
- Both the Assessor and the Provider make contact with the patient and conduct an interview and assessment including a thorough review of the patient’s medical records. This review of medical record sometimes includes contacting the patient’s other care providers such as their oncologist, family physician, pulmonologist or other provider that has relevant information regarding the patient’s health status. The two assessments are independent from one another and they are identical in nature and scope. At times either one or both Assessors request a third assessment by a specialist should there be specific questions that need to be addressed, for example: capacity of the patient or their opinion about the patient’s health status and probable disease progression.
- If both the Assessor and the Provider find the patient to be eligible for MAiD, then a plan is formulated collaboratively by the patient/family and the Provider. This plan includes the ‘when’ and ‘where’ and other specifics like the attendees and what method will be chosen for the Provision.
- The Navigation Team will be involved in facilitating the specifics of the Provision, such as patient transfer, pharmacy services and supplying an RN for support.
- Provision takes place at the predetermined time and place. This can be the patient’s home, or a clinical setting such as an inpatient unit.
How does your role differ from physician roles in MAiD?
The role itself is identical to physicians when it comes to MAiD. We provide the exact same service and care without exception. The differences between ‘us’ and ‘them’ are more at the individual level, and not so much along professional lines. Some of us only do assessments, some of us do both assessment and provision. Some of us only chose to be involved with our ‘own’ patients and some of us are willing to see other patients as well. The care we provide is identical. All the previous steps described in process are identical.
Describe the challenges you face in your role.
The challenges we face are truly also the reason I enjoy the role.
- We need to navigate the healthcare system, which is at times particularly challenging. Hospitals, LTC facilities, AHS, Covenant, different programs, different cities and towns… we must have a solid understanding of the healthcare system’s geography and inner workings. Relationships that have been built by us over the decades come in very handy in this navigation.
- We need to be extremely adaptable to changing circumstances. It is very common to have patient, family, facility, transportation, IV access and other unforeseen elements change on a very short notice. Sometimes these need to be dealt with urgently or emergently. Flexibility and adaptability in this role is an absolute must.
- Continuing competence. Laws, professional guidelines, system policies and procedures and other logistics are constantly changing in order to better serve our patients and families. We, Providers/Assessors, must stay at all times engaged, informed and educated on the changes. Any lapse in our continuing competence can result in devastating effects such as delay or cancellation of provision. Flaws in our process can result in severe professional and legal jeopardy as well as ending a life without the protection of the Criminal Code of Canada.
How do you cope with working in such an emotionally intense area?
I feel that working with patients that are considering MAiD to be less emotionally intense and taxing than working in ICU and for STARS. In ICU and STARS, we are working with patients and families that are experiencing acute tragedies with entire lives being turned upside down, not to mention the moral distress of looking after patients in the ICU that are suffering. Sometimes the suffering is without any hope or chance of recovery. In contrast, working with individuals considering MAiD, as sad and tragic as it is, is associated with no moral distress whatsoever. With the exception of when patients are deemed ineligible for MAiD, our work at focuses on the patient gaining back dignity and autonomy as well as ending their suffering. There is nothing distressing about that. Of all my roles over decades in healthcare, MAiD is what I lose the least amount of sleep over.
How do you deal with healthcare professionals that disagree with MAiD?
Educate. Educate. Educate. Occasionally ignore.
Do you have any advice for NPs looking to work with the MAiD program?
Educate yourself with the multiple layers of the medical-legal and practice environment.
- Criminal Code of Canada
- Provincial Guidelines
- Professional Organizational Position Statements and Guidelines, such as CARNA
- Alberta Health Services Policies
- Zonal differences in care delivery
- Facility specific differences
Interested in learning more about MAiD? Check out these resources: