Medical Assistance in Dying (MAID)

End of Life Care/Medical Assistance in Dying: The Case of T. Eckert

This actor simulation is about Medical Assistance in Dying (MAID). The target group of the simulation is for senior level undergraduate nursing students or nurse practitioner students. The simulation integrates MAID concepts specific to Ontario, Canada.

Brief Summary of the Case

T. Eckert is a 78-year-old client in palliative care. Approximately eight months ago the client developed discomfort in their lower abdomen accompanied by nausea that worsened over a two-month period. Following testing and diagnostic imaging the client was diagnosed with a stage IV pancreatic cancer diagnosis and a prognosis of six-eight months. The client was referred to an oncology team and underwent 8 cycles of chemotherapy. Folfirinox was administered via IV infusion at home over 2 days, every 14 days. It wasn’t helping and the client suffered side effects of nausea, vomiting, diarrhea, severe fatigue, and decided not to continue treatment. The client was aware that the treatment might not be effective, and follow-up revealed that the cancer had metastasized to the liver, lungs, and spine. The client was admitted to hospital one month ago for worsening pain, nausea, weakness, loss of appetite and extreme fatigue. At the time of admission, the client had a discussion with their oncologist who shared that there were no active treatment options and referred the client to the Palliative Care Team for symptom management and exploration of end of life options.

The client expressed the desire and was approved for Medical Assistance in Dying (MAiD). The client’s partner does not feel comfortable with pursuing MAiD but is supportive of the client’s decision. The client has decided to carry out MAiD in the hospital and the procedure is planned for two days from now.

Scenario Learning Objectives and Outcomes

• Establish a therapeutic relationship with a client and/or family member
• Identify roles and scope of practice within a healthcare team
• Demonstrate understanding of end-of-life care options
• Reflect on own valued, beliefs and biases regarding end-of-life care

Simulation Documents

MAID template for simulationist: https://docs.google.com/document/d/1eNg5rn-TTI4CZnO_k0WABVp8tDjECk0W/edit?usp=sharing&ouid=105364327047473196795&rtpof=true&sd=true

MAID template for learners: https://docs.google.com/document/d/1z-PSCM-eDCqFgwpIzmuRc9fZEIO2gHDS/edit?usp=sharing&ouid=105364327047473196795&rtpof=true&sd=true

MAID simulated participant roles: https://docs.google.com/document/d/1jNUz3Zv43oi92CL7H3v9XoEeCkDVNgNF/edit?usp=sharing&ouid=105364327047473196795&rtpof=true&sd=true

MAID patient chart with MAR: https://docs.google.com/document/d/1pDpkjw0-h4WeOgUSCosxrd8CaA1s5OzC/edit?usp=sharing&ouid=105364327047473196795&rtpof=true&sd=true

MAID supplementary document, filming locations: https://docs.google.com/document/d/1gJcnn0Mqm1xV5cThqy5zuKzBTx2enFbS/edit?usp=sharing&ouid=105364327047473196795&rtpof=true&sd=true

For more information on this actor simulation, please contact:

Dr. Donald Rose, Associate Professor, Daphne Cockwell School of Nursing, Toronto Metropolitan University, donrose@torontomu.ca

Dr. Nancy Walton, Associate Professor, Daphne Cockwell School of Nursing, Toronto Metropolitan University, nwalton@torontomu.ca

Funding for this project was provided by the Daphne Cockwell School of Nursing-FDC Simulation Grant