Annex A - Record of Veterans’ communications with VAC staff
Note: The information that follows is VAC’s current policy with respect to recording conversations between Veterans and case managers or Veteran Service Agents (VSA). As noted in the report, in 2023 the Department commits to engage with Veterans and stakeholders to gather feedback on recording calls.
1. Policy and procedures
VAC does not have a policy on recording phone interactions between Veterans and case managers or VSAs because it does not record such interactions due to the sensitive nature of their conversations. It is believed that recording interactions between Veterans and their case managers or VSAs could harm the building of a trusting relationship and prevent Veterans from sharing important information. It does not record phone interactions the same way, it does not record home visits, transition interviews and in-person services to all of its Veterans.
The only conversations with Veterans that VAC records are calls to its National Contact Centre Network (NCCN) as this is a common practice of call centers in order to monitor the quality of services. As well, these conversations are less sensitive since Veterans are mostly calling to receive information or be directed to other services.
2. Standard and procedure of notetaking and file-keeping
After an interaction with a Veterans has occurred, documentation must follow in their file. For the VSA’s role, the documentation would most often be found in CSDN through the screening tool or in client notes or GCcase. For Case Managers, the information would be documented in GCcase under the Veterans’ plan or in the case management assessment.
If Area Office staff need to follow-up in writing with the Veteran following a conversation, MyVAC Account can be used if the Veteran is registered, and they would use official decision letters if it is related to VAC program related decisions (letters would be available in CSDN and GCcase). These letters would be uploaded to MyVAC Account or mailed out if the Veteran is not registered with MyVAC Account.
Annex B - Directive: Role of the Veteran Service Team regarding Medical Assistance in Dying (MAiD)
Note: This guidance/directive was distributed to VAC’s frontline staff on 23 August 2022 and posted on the internal website. Subsequently, five Q&A sessions were held with staff to ensure the guidance was understood and to give staff an opportunity to ask questions.
Medical Assistance in Dying (MAiD) is a deeply complex and personal medical issue that is out of the jurisdiction of Veterans Affairs Canada staff.
MAiD is discussed and administered by a treating physician or a nurse practitioner directly to the Veteran or is prescribed to the Veteran for self-administration. A Veteran must be eligible for government-funded health insurance for MAiD, and this decision must be discussed and made directly with the Veteran’s physician or nurse practitioner. (See: Dying with Dignity Canada).
Veterans Affairs Canada (VAC) employees shall not provide advice or suggestions to Veterans on the issue of MAiD. If a Veteran is seeking advice or assistance with MAiD, the employee must refer the Veteran to their primary care provider.
Any mention of MAiD by a Veteran must be reported to the Area Director of the responsible area who will advise the Director General of Field Operations.
If a Veteran has chosen to pursue MAiD with their primary care provider and shares this information with a member of the Veteran Service Team (VST), VAC can support the Veteran in navigating VAC benefits and services available. Veterans may consider the following potential benefits and services, including but not limited to: VAC Assistance Service, Pastoral Outreach, Disability Benefits, Additional Pain and Suffering Compensation, Critical Injury Benefit, Veterans Independence Program (VIP), Allowances, War Veterans Allowance, Caregiver Recognition Benefit, and associated treatment benefits, if applicable. Support can include resource coordination and navigation such as connecting a Veteran and their family to community resources, mental health practitioners, grief counsellors, pastoral outreach or other local resources. The VST should never provide advice, suggestions, or options relating to the MAiD process itself, as this should only occur between the Veteran and their primary care provider.
The VST can support the survivor and dependents with potential VAC services and support available to them, including the VAC Assistance Service, Disability Benefits in Respect of Death for Survivors and Dependent Children, Veterans Independence Program (VIP), Funeral and Burial Assistance, or Educational Assistance for Children, and the Hope Program.
The VST member supporting a Veteran who has chosen to pursue MAiD with their primary care provider is strongly encouraged to consult with:
- a Standards Training and Evaluation Officer (STEO) for assistance in navigating the benefits and services available to the Veteran and their family, and/or;
- a Case Management Practice Consultant (CMPC) for support or debrief when they are having a conversation with a Veteran and their family surrounding this sensitive topic.
Additional guidelines and business processes that may assist the VST in supporting a Veteran who has chosen to pursue MAiD with their primary care provider include: Guidelines for Caring Carefully, Guidelines for Engaging Families and Mental Health Resources Available to Veterans’ Family Member.
Annex C – Presentation deck: Role of the VST regarding Medical Assistance in Dying (MAiD)
Q & A Session
August, 2022
What is MAiD?
Medical assistance in dying is the name of Canada’s assisted dying legislation.
It refers to the administering of medications by a physician or nurse practitioner that – at the person’s request – causes their death;
Or the prescribing of medications by a physician or nurse practitioner that a person can take to cause their own death.
MAiD / AMM
Medical Assistance in Dying (MAiD) is a deeply complex and personal medical issue that is out of the jurisdiction of Veterans Affairs Canada staff.
Dying with Dignity Canada
VAC Role
Medical Assistance in Dying
Employees:
Shall not provide advice or suggestions to Veterans on the issue of MAiD.
Must refer the Veteran to their primary care provider.
Must report any mention of MAiD to the Area Director of the responsible area who will advise the Director General of Field Operations.
Can support the Veteran in navigating VAC benefits and services available if the Veteran has chosen to pursue MAiD with their primary care provider.
Consultation
The VST member supporting a Veteran who has chosen to pursue MAiD with their primary care provider is strongly encouraged to consult with:
- a STEO for assistance in navigating the benefits and services available to the Veteran and their family and/or;
- a CMPC for support or debrief when they are having a conversation with Veteran and their family surrounding this sensitive topic.
Guidelines and Business Processes
Guidelines for Caring Carefully
Guidelines for Engaging Families
Mental Health Resources Available to Veterans’ Family Member
Questions
Annex D - Questions & answers on MAiD directive
The following Questions and Answers are not intended to deepen your understanding regarding Medical Assistance in Dying but rather clarifies impact to Veterans Affairs Canada employees as it relates to your role and responsibilities.
Question 1: What is Medical Assistance in Dying (MAiD)?
Answer 1: Medical Assistance in Dying is seeking an approved assisted death where the requestor is well-informed throughout the process and includes safeguards in place to ensure they are informed and know their options and truly, voluntarily seek approval for this remedy. The requestor retains until the very last moment, the right to change their mind on proceeding with MAiD. MAiD can be received by:
- the administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death; or
- the prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person, at their request, so that they may self-administer the substance and in doing so cause their own death.
MAiD legislation is the removal of such acts as criminal acts for which prosecution would occur.
Question 2: What should I do if a Veteran does not have a primary care provider such as a physician or nurse practitioner and has questions about MAiD?
Answer 2: If a Veteran does not have a primary care provider, the Veteran Service Team (VST) member can support the Veteran in connecting with their local health authority who can assist them in obtaining a primary care provider to have their questions answered. As indicated in the Directive, it is not the responsibility of the VST (or any VAC employee) to provide advice, guidance or suggestions to Veterans relating to a client’s considering or seeking MAiD.
Question 3: What should I do if a Veteran is considering or has chosen MAiD and would like to understand the impact to their VAC benefits and services?
Answer 3: Veterans who explore the possibility of MAiD may approach VAC to learn the potential impact on their benefits. They may also wish to learn how this could impact VAC benefits for their families. VAC continues to offer support to Veterans in understanding the impact on their benefits and services when are considering or have chosen to pursue MAiD. Case specific objective information can be provided to the client by the VST member about VAC benefits, services and programs. Please refer to the Condolence and Benefit Information Letter Process for additional information on various scenarios and consultation with a Standards Training and Evaluation Officer (STEO) is encouraged as each situation should be examined on case-by-case basis.
Question 4: A Veteran I am working with is expressing interest in pursuing MAiD and is also experiencing thoughts of suicide. What should I do?
Answer 4: The MAiD process, including procedural safeguards to ensure there is informed consent for the person pursuing MAiD is clearly outlined in the Criminal Code of Canada and under its supporting regulations. If you are concerned the Veteran who has expressed interest in pursuing MAiD may also be experiencing thoughts of suicide, please refer to the Suicide Awareness and Intervention Protocol and you may consult with your manager and a Subject Matter Expert (SME) such as Mental Health Officer (MHO) to support you with this protocol.
Question 5: As a VAC employee, I am feeling impacted by a conversation with a Veteran who is exploring or has chosen to pursue MAiD. What supports are available to me?
Answer 5: It is important that you feel supported when a Veteran you are working with has decided to pursue MAiD with their primary care provider. You are encouraged to consult with your Case Management Practice Consultant (CMPC), or your manager for support in navigating this situation. Guidelines for Caring Carefully provides helpful strategies and information for you relating to self-care, navigating work-induced stress and others. In addition, the Employee Assistance Program (EAP) provides the support of a confidential counsellor for all VAC employees.
Question 6: What is the role of VAC Health Professionals with respect to MAiD?
Answer 6: Canada’s MAiD legislation is part of the Criminal Code of Canada and is outside of the jurisdiction of VAC. VAC has no role in the assessment of Veterans for the purpose of MAiD. Veterans should contact their primary care provider, or their local or regional health authority if they wish to learn more about and/or pursue MAiD.
Question 7: A Veteran I am working with has pursued MAiD with their primary care provider. Do I follow the Suicide Notification Process?
Answer 7: According to Veterans Affairs Canada, if a Veteran pursues MAiD with their primary care provider, they are not considered to have completed suicide. Please follow the Condolence and Benefit Information Letter Process.
Question 8: What and how do I document a discussion of MAiD with a Veteran?
Answer 8: If a client has brought up the topic of MAiD to a Veteran Service Team member, you should document the facts of the conversation as you would for any other Veteran contact. Please see Service Delivery Documentation Guidelines - Training for more information on documentation.
Question 9: What and how should I report information when I have had a discussion of MAiD with a Veteran?
Answer 9: The Veteran Service Team member should report that a discussion of MAiD occurred with a Veteran directly to their manager and the date of the discussion. Identifiers such as name or file number are not required. The information will be provided to the Area Director and subsequently to the Director General of Field Operations.
Question 10: Why am I reporting to management information regarding discussions of MAiD with a Veteran?
Answer 10: Reporting information regarding discussions of MAiD allows the Department to understand trends and explore possible training needs and for you to be supported following these discussions with Veterans.
Question 11: Where can we direct media inquiries on the topic of MAiD?
Answer 11: If a VAC employee receives a media inquiry, they are to follow the following operational process: General Public or Media Inquiries. VAC employees are not to comment on the media inquiry, and are to provide the caller with the general inquiries phone number (613-992-7468).