This Ontario clinician aid is the written arrangement between a patient and the physician or nurse practitioner who will provide MAID, waiving the Criminal Code requirement for express consent immediately before MAID is provided. It applies only when natural death is reasonably foreseeable and the patient may lose capacity before a specified date. It is not valid until every other safeguard is met, including two independent eligibility assessments.
The MAID physician or nurse practitioner completes Section 3, initials the Section 4 terms and any Section 5 additional terms with the patient, and signs the Section 7 confirmation. The patient, or an authorized person signing in their presence and under their direction, completes Sections 1, 2 and 6.
Download the current version from the source each time; forms change without notice.
Clinician Aid D-1 - Waiver of Final Consent
Outil clinique D-1 – Renonciation au consentement final
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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Only for a patient whose natural death is reasonably foreseeable, who meets all eligibility criteria and other safeguards, and who has been told they risk losing capacity before the specified date. The arrangement must be in writing, with the patient consenting to MAID on or before that date if capacity is lost.
The patient signs Section 6, or an authorized person signs in the patient's presence, on their behalf and under their express direction. The physician or nurse practitioner who will provide MAID signs Section 7, agreeing to provide MAID under the arrangement if the patient loses capacity.
Yes. The French version, Outil clinique D-1, Renonciation au consentement final, is posted with the English ON00334E (2023/02) in Ontario's Central Forms Repository. It is an XFA-based form that works correctly only in Adobe Acrobat or Reader.