Overview of process

As per legislative requirements, the Office of the Chief Coroner (OCC) must be notified of and review all MAiD deaths in Ontario. The MAiD Death Review Team is available 24/7. The process you can expect is:

  1. MAiD providers will report all MAiD Deaths by completing an electronic form (MAiD Death Report or MDR) when a MAiD death has occurred. This form is available on the Central Forms Repository. Once the MDR is successfully submitted, an email confirmation will be sent to the MAiD provider’s email address listed on the MDR. If email confirmation is not received, the MAiD provider must follow-up to confirm the submission was received (e.g., troubleshoot MDR or call to speak with a MAiD coroner Investigator).

  2. The death must be reported by completion and submission of the MDR by the end of the next business day after the MAiD death.

    1. Medical records pertaining to the MAiD provision do not need to be automatically sent to the Office of the Chief Coroner following submission of the MDR. However, pursuant to section 10.1(2) of the Coroners Act, the MAiD Provider must provide the OCC with any information about the facts and circumstances relating to the death that is considered necessary by the MAiD Coroner Investigator to form an opinion about whether the death ought to be investigated. Upon review of the MDR, the MAiD coroner investigator may request further documents if needed for review. Medical documents must be submitted within 48 hours of request from the Office of the Chief Coroner. Please see below for documents typically requested.
    2. The MAiD provider should complete the Medical Certificate of Death immediately except in cases where they have been instructed by the MAiD coroner investigator not to (injury, accident). See below (#3).
      1. When completing the Medical Certificate of Death, please note that the illness, disease or disability leading to the request for medical assistance in dying is to be recorded as the cause of death.
      2. No reference to MAiD or the drugs administered for the purposes of MAiD should be included on the Medical Certificate of Death.
    3. In consultation with the MAiD requestor prior to death, please inform family or next of kin that they will be contacted by a MAiD Coroner Investigator approximately 72 hours after the MAiD provision.

    Please note, in the following circumstances, “No next of kin” should be indicated on the MDR:

    1. If no next of kin/representative is involved during the MAiD assessment process or present during the MAiD provision
    2. MAiD requestor did not want next of kin/representative contacted or made aware of the MAiD request

    If there is no next of kin/representative, please ensure that the aftercare arrangements have been made by the MAiD requestor prior to the MAiD procedure.

  3. The MAiD provider must call the Office of the Chief Coroner (Dispatch: 416-314-4100/1-855-299-4100) immediately after a MAiD death occurs in any of the following circumstances:

    1. The requestor has a history of recent, acute injury (fall/fracture/accident), e.g., acute clinical deterioration associated with a hip fracture.
    2. The requestor has a history of remote injury that began a trajectory to conditions that prompted the request for MAID, e.g., a MAID request and eligibility arising from complications of a previous spinal cord injury.

    3. If the provider is of the opinion that an injury should be listed on the Medical Certificate of Death (MCoD) as an immediate cause of death or contributing condition.

      Do not complete the MCoD until the case has been discussed with the MAiD Coroner Investigator. Further instructions will be provided by the MAiD Coroner Investigator during the call.

    Please note, after speaking with the MAiD Coroner Investigator the MAiD provider must still complete and electronically submit the full MAiD Death Report (MDR) to the Office of the Chief Coroner by the next business day after the MAiD provision.

    For all MAiD Deaths where there is or may be injury involvement in the cause of death, all relevant medical records must be submitted within 24 hours. Please see below for a list of documents routinely requested by the Office of the Chief Coroner.

Information required when reporting of a MAiD death

Where there is history of injury or accident the following must be provided

Provider information

  • name
  • contact information – cell phone number preferable, email address

Patient and provision information

  • Patient demographic information: full name, date of birth, home address, diagnosis, and reason for seeking MAiD.
  • Date and time of death, location of death.
  • Reasonably foreseeable natural death (RFND) or non-reasonably foreseeable death (NRFND)?
  • History of illness/reason for seeking MAiD.
  • Nature of the accident/injury or recent fall that caused an injury - date of injury, location of injury, circumstances of injury, surgical intervention, recovery.
  • Any concerns regarding the procedure (if applicable)?
  • Any care concerns?
  • Family/representative contact and contact numbers.
  • Any family/representative concerns that provider is aware of?
  • Is the injury planned to be listed on the Medical Certificate of Death?
  • Funeral arrangements and next of kin information for follow up call.
Documents that may be requested by OCC:
  • Patient’s written request for MAiD – Clinician Aid A can be used as a written request.
  • First MAiD Eligibility Assessment, including clinical documentation prepared by the first assessor that provides detailed history, rationale & criteria demonstrating the patient’s eligibility for MAiD.
  • Second MAiD Eligibility Assessment, including clinical documentation prepared by the second assessor that provides detailed history, rationale & criteria supporting the patient’s eligibility for MAiD.
  • Clinician Aid C if completed by the secondary assessor.
  • For NRFND (Track 2) cases, consults/records received for the purpose of obtaining an expert opinion (if neither assessor has the expertise) and documentation of the discussions between assessors and the requestor regarding consideration of all available means to alleviate suffering.
    • Where applicable, documentation by both eligibility assessors that demonstrates & supports the rationale for a shortened reflection period of a NRFND (Track 2).
  • Where applicable, the waiver of final consent when invoked (Clinician Aid D-1 or Clinician Aid D-2).
  • Documentation of the MAiD procedure, including location, the medication protocol utilized (i.e., drug type(s) and dosages), the time of the patient’s death and any complications encountered during the procedure. If waiver invoked, include confirmation that there was no evidence of resistance or refusal to the procedure by the requestor.
Supportive documents:
  • Where available, any recent and/or relevant consultation reports (e.g., from oncology, palliative care, psychiatry, etc..); admission or discharge notes from recent hospitalizations.
  • Any consultation reports or documentation regarding potential capacity concerns (e.g., documentation supporting decisional capabilities, additional capacity assessments obtained, psychiatric consultations etc..)
  • Any other information that may support the formation of a complete picture of the patient’s condition and/or the events that led to the request for MAiD.

Where to send documents