This post is also available in: français (French)
Project Overview and Status
The Law Commission of Ontario’s Last Stages of Life project considers how the law shapes the rights, choices, and quality of life for persons who are dying and those who support them. The “last stages of life” is an adopted term that gives the project scope to look at legal issues arising in relation to palliative care, end-of-life care, and medical assistance in dying in Ontario.
The goal of the project is to develop authoritative law reform recommendations based on extensive province-wide consultations and additional advice from an external expert Advisory Committee. The LCO has also developed a distinct process and Advisory Group to engage with Inuit, Métis, and First Nation members in Ontario.
The LCO is currently reviewing the results of our provincial consultation process and formulating draft law reform recommendations. These will be reviewed with key informants over the spring and summer 2020, leading up to the release of a Final Report in later 2020. Should you have any questions contact Ryan Fritsch, Project Lead, at firstname.lastname@example.org.
Public Consultation Documents
LCO’s public consultations were conducted between May 2017 to September 2018 and included 73 consultation sessions involving over 800 Ontarians (see below for a detailed list of project milestones). A detailed exploration of the legal issues was provided in an Executive Summary and Discussion Paper. We also summarized these issues in a Consultation Issues Map and brief Issue Backgrounders covering each of the major discussion issues. The LCO additionally published seven research papers commissioned from external experts across Canada (see below for links to each of these).
The LCO established a distinct process and materials to engage with Inuit, Métis, and First Nation members in Ontario. The first phase of that engagement took place with visits to, and conversations with, over a dozen communities and groups between January and June 2019.
What issues are being looked at?
LCO’s consultations heard how the law directly shapes the experience of people in several critical areas that arise in the last stages of life. Each of these are summarized in the LCO’s Consultation Issues Map and brief Issue Backgrounders covering each of the major discussion issues, which include:
- caregiver and family supports
- withholding and withdrawing treatment
- resolving healthcare disputes
- consent and advance care planning
- transitions in care
- palliative sedation
- medical assistance in dying
- planned deaths at home
- access for communities with unmet needs, including inmates; persons with HIV; faith and spiritual communities; homeless and underhoused; and others
- cultural and religious needs
- supports for professionals and practice tools
- public health approach
- Between August 2019 and continuing to today the LCO is hosting a series of draft law reform recommendation review meetings with the external project Advisory Group. This work will support drafting the Final Report and Law Reform Recommendations, expected for public release in later 2020
- In July 2019 a first set of draft law reform recommendations were developed based on LCO’s provincial consultations and reviewed by LCO’s Board of Directors and the external project Advisory Group
- Between January-June 2019 the LCO commenced the first phase of indigenous engagement with visits to and conversations with over a dozen communities and groups between January and June 2019. More information is available on the LCO Inuit, Métis, and First Nation members website
- In October 2018 the LCO established an external Indigenous Engagement Advisory Group and retained an Indigenous Engagement Lead to oversee an indigenous engagement process
- In September 2018 we concluded the 10-month province-wide public consultation process, hosting 73 consultation sessions involving over 750 participants
- In March 2018 the LCO hosted a roundtable to discuss Inuit, Métis, and First Nation experiences with the last stages of life, and to explore the potential development of a distinct engagement process
- In March 2018 the LCO also released a detailed public survey on experiences with the last stages of life
- In January 2018, the LCO partnered with the HIV/AIDS Legal Clinic of Ontario and Casey House to co-host a full-day roundtable consultation with HIV advocates, supporters and service providers
- In December 2017, we partnered with Prof. Jocelyn Downie to co-host a 1.5-day consultation with a dozen experts in palliative sedation
- During November and December 2017, the LCO hosted a 4-part consultation series with members of the Ontario Palliative Care Network
- In September 2017 the LCO hosted a focus group with families and caregivers of palliative patients in St. Catharine’s with over a dozen participants.
- In September of 2017 the LCO also presented at the 2nd International Conference on End of Life Law, Ethics and Policy in Halifax, and participates in the Symposium on Palliative Care in Federal and Provincial Detention hosted by Dalhousie University
- In July 2017, we partnered with the Joint Centre for Bioethics at the University of Toronto to host a roundtable consultation with over a dozen bioethicists from across the GTA
- In June 2017, the LCO’s Last Stages of Life project partnered with Ryerson’s Diversity Institute to co-host a multi-faith roundtable on the issues particular to faith and spiritual needs in the last stages of life. The roundtable brought together a broad diversity of two dozen faith leaders, spiritual advisers and chaplains, academics, legal advocates, and health practitioners in conversation about these issues, with the goal of identifying issues and practical recommendations for law reform.
- Between August 2016 and April 2017, the LCO released seven research papers commissioned from external experts across Canada. Each paper considers a specific aspect of the last stages of life.
- In June 2016, the LCO hosted the Roundtable on Legal Ethics and Practice for the Last Stage of Life at the Law Society of Upper Canada. The roundtable brought together legal professionals from diverse backgrounds to discuss the practice and ethical challenges they face in this area of the law, including private practitioners, academics, government counsel and lawyers working in policy.
- In January 2016, the Board of Governors approved the project methodology, which includes a project scope statement describing the issues to be addressed in the project.
- Between April and September 2015, the LCO conducted about 70 preliminary consultations with groups that included health professionals, ethicists, lawyers who give advice on these issues, and representatives of professional regulatory bodies, administrative tribunals, community organizations and government. In September 2015 the LCO convened an Advisory Group to advice on the development of the project.
Project Reports and Documents
- Discussion Paper
- Project Scope and Statement
- Advisory Group
- Dr. Arne Stinchcombe, Dr. Katherine Kortes-Miller & Dr. Kimberley Wilson: Perspectives on the final stages of life from LGBT elders living in Ontario
- Dr. Mary Chiu, Dr. Adrian Grek, Sonia Meerai, LJ Nelles, Dr. Joel Sadavoy & Dr. Virginia Wesson: Understanding the lived experience of individuals, caregivers and families touched by frailty, chronic illness and dementia in Ontario
- Dr. Donna Wilson & Dr. Stephen Birch: Improved care setting transitions in the last year of life
- Judith A. Wahl, Mary Jane Dykeman, Tara Walton: Health Care Consent, Advance Care Planning, and Goals of Care Practice Tools: The Challenge to Get it Right
- Rosario G. Cartagena, Alison K. Thompson, Kaveh Katebian, Trudo Lemmens, Rose Geist, Harvey Schipper, Sandy Buchman, Heesoo Kim, Mark Handelman: Understanding the Relationship between Suffering and Capacity at the End-Of-Life: A Pilot Study
- James Downar, Laura Hawryluck, Alexi Wood, Susan Brown, Joy Richards, Robert Sibbald, Jennifer Gibson, & Csilla Kalocsai: Balancing The Interests Of Patients, Substitute Decision-Makers, Family And Health Care Providers In Decision-Making Over The Withdrawal And Withholding Of Life-Sustaining Treatment
- Omar Ha-Redeye, Ruby Latif, & Kashif Pirzada: Integrating Religious and Cultural Supports into Quality Care in the Last Stages of Life in Ontario