MAID Aid D-2: Advance Consent for Self-Administration

Patients in Ontario who will self-administer MAID can use this clinician aid to make a written advance consent arrangement. The physician or nurse practitioner agrees to be present at self-administration and, if the patient loses capacity and does not die within a specified period, to administer a backup drug protocol under section 241.2(3.5) of the Criminal Code. It is valid only after all other safeguards, including two independent eligibility assessments, are met.

Who completes it

The practitioner prescribing or providing the self-administration protocol completes Section 3, initials the Section 4 terms with the patient, and signs Section 7. The patient, or an authorized person signing in their presence and under their direction, completes Sections 1, 2 and 6.

Submitting and payment

How to submit it
The form has no submission address: it is the written arrangement itself, and it may be completed at the same time as Clinician Aid B when that practitioner will prescribe or provide the self-administration protocol.

Good to know

  • Section 4 sets the specified date of self-administration and the specified period, in minutes, after which the backup protocol may be given.
  • The patient is told the self-administration protocol might not work as expected and could leave them unconscious and unable to consent to the backup protocol.
  • Advance consent is voluntary and not required to receive a self-administration protocol; if both parties do not agree to every term, the form is invalid.
  • Additional terms may name other practitioners who personally found the patient eligible while capable, will ensure the safeguards are met, and agreed to the arrangement.

Get the official form

Download the current version from the source each time; forms change without notice.

Clinician Aid D-2 - Advance Consent - Self-Administration

Outil clinique D-2 – Consentement préalable – Autoadministration

Fill it with Vero

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.

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

What does Clinician Aid D-2 allow?

It lets a physician or nurse practitioner administer a second, backup substance if a patient who self-administered MAID loses capacity and does not die within the period set in the arrangement. The patient's advance consent waives the requirement to give express consent immediately before that second substance.

Does the practitioner have to be present for self-administration?

Under this arrangement, yes. The patient agrees that the physician or nurse practitioner will be present when they self-administer the MAID drug protocol, which is one of the Criminal Code conditions for giving the backup substance.

Is Clinician Aid D-2 the same as the waiver of final consent?

No. Clinician Aid D-1, the waiver of final consent, covers MAID administered by the practitioner when natural death is reasonably foreseeable, under section 241.2(3.2). D-2 covers self-administration and the backup protocol only, under section 241.2(3.5) of the Criminal Code.