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  VCH Medical Assistance in Dying (MAiD) Program- Request for Feedback

At Vancouver Coastal Health (VCH) we know that the decision to request a medically assisted death is a deeply personal choice. This survey is about your experience with the MAiD process. Its purpose is to provide information to help VCH to monitor and improve the quality of MAiD services for future patients and their families. 

Who should complete the survey? The person who has requested MAiD. The answers should be given from your point-of-view, and not the point-of-view of the person who was helping you.  

Completing the survey: For each question please tick inside the box that is closest to your view. Don't worry if you make a mistake; you can click the answer that is most appropriate for you. Also, you can provide further details in the comment boxes, especially if you have answered disagree or strongly disagree, we would like if you could expand on your answer.

Important Information:

·       Answering questions is optional, if you feel uncomfortable answering any question, or the question does not apply to you, simply skip to the next question.

·       If you want to add additional information to your response, the majority of questions have an option for comments. There is also space at the end of the survey for you to add any additional comments.

·       Your personal details and some information about your request have been used to identify you as a potential participant in this survey. That information will be used to analyze the survey results, however, your answers are anonymous. Please do not provide any names or dates in your responses.

·       VCH MAiD Program collects, uses and shares personal information only in accordance with the BC Freedom of Information and Protection of Privacy Act.


Consent:By completing this survey you are giving your consent for the information you provide, to be used for the above purposes. Your personal information will not be released. If you want your survey to be removed from our database, please contact us.


Taking part in this survey is voluntary. Your decision to participate in this survey, will in no way impact the care you receive.



If you would like to discuss in more detail your experience or have any questions, please contact the Quality Improvement Coordinator for this study: Felor Javadi Bashar   or    (236) 688-4217