On September 18, 2014, the Law Commission of Ontario’s (LCO) Board of Governors approved a project to consider improving the last stages of people’s lives as they approach death. The project will consider the identities, rights and values of persons who are transitioning through the last stages of life as well as those of their caregivers, families and friends. It asks questions about the role of the law in providing care based on principles such as dignity, autonomy, participation and security, as reflected in the frameworks created by the LCO in its projects relating to older adults and persons with disabilities, and what it means to achieve quality of life in the process of dying.
In recent years, there has been mounting attention to issues relating to palliative and end-of-life care. Expected demographic changes from our aging population have led to the critical reevaluation of support for older adults. There are ongoing debates about treatment options and decision-making for persons with serious illness. Moreover, institutional coordination in the health care sector is being explored to reduce difficulties with navigating the current system.
The LCO’s project situates these and related issues within Ontario’s legal framework, and examines the opportunities for reform. Our review addresses a range of issues, including equitable access to palliative care, caregiver benefits, aspects of medical assistance in dying, decision-making over the withdrawal and withholding of treatment, supports for faith and cultural communities, and dispute resolution.
In addition to the LCO’s framework projects, this project will be informed by our project on Legal Capacity, Decision-Making and Guardianship.
- In June 2016, we 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 August 2016, the LCO released three research papers as part of our series of commissioned research from external experts across Canada.
What We Have Done So Far
- In April 2015, we began preliminary research in order to determine the parameters of the project
- We held approximately 70 consultations throughout summer 2015 with stakeholder groups including, 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, we convened an Advisory Group that will assist the LCO throughout the project. The first Advisory Group meeting was held in November 2015.
- In December 2015, we disseminated a Call for Research Papers that describes the LCO’s intention to fund several research papers as well as the criteria and terms for funding. The deadline for submissions was January 22, 2016.
- 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.
- In February 2016, we announced which proposals were successful in our competitive process for research funding. Seven multidisciplinary teams were selected to undertake research that will provide new sources of qualitative information for the LCO’s project. The final research papers will be posted on our website in summer 2016.
- The LCO has begun to prepare a discussion paper that will address a range of issues and options for reform, and will form the basis for dedicated consultations to take place in 2016
- 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