This post is also available in: Français (French)
The Law Commission of Ontario’s Improving the 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 Law Commission of Ontario’s Improving the 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 project seeks to address the experiences of everyone involved in the dying process, including: individuals, caregivers and other family and friends, health care institutions and professionals, government, other professionals and community organizations.
Our goal is to hear from these groups to better identify and recommend law reforms that are concrete, precise, and responsive to the experience of persons in the last stages of life.
What do we mean by “last stages of life”?
The “last stages of life” is the broad and inclusive term we use in this project to capture the experience of dying as a process or a continuity of events, whether as a result of terminal illness, chronic conditions or serious frailties. This inclusive term allows us to look at issues that arise in relation to end-of-life care and planning, palliative care, and medical assistance in dying. Our focus is on the experience of persons who are dying; we do not consider any particular medical procedure or medical model of care.
What issues are being looked at?
The LCO’s project is looking at a broad range of issues identified including:
- caregiver and family needs
- 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
- cultural and religious needs
- supports for professionals and practice tools
- public health approach
A full explanation of these topics and the related legal aspects is found in our Executive Summary and Discussion Paper. We’ve also summarized these issues in a Consultation Issues Map and Issue Backgrounders. The LCO also published seven research papers commissioned from external experts across Canada.
- In April 2018 we concluded the 10-month province-wide public consultation process, hosting 60 consultation sessions involving over 650 participants
- In March 2018 we 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. We 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.
We are now in the process of analyzing all of the consultation feedback and preparing draft law reform recommendations. The public will be invited to comment on these draft recommendations.
The LCO is also developing a distinct process to engage Inuit, Métis, and First Nation members.
Project Reports and Documents
- Discussion Paper
- Project Scope and Statement
- Advisory Group
- Commissioned Papers
- 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