[1] See for example: “Palliative Care” in Auditor General of Ontario, Annual Report 2014 (Toronto: Queen’s Printer for Ontario, 2014), 260 [AG 2014], which reports that: “People aged 85 and over constituted the fastest-growing segment of Ontario’s population between 2006 and 2011, with their number increasing by 29% over that period. The number of people aged 65 and over is expected to more than double from 2 million in 2012, when baby boomers began to turn 65, to over 4 million by 2036, when seniors will constitute 24% of Ontario’s population.”

[2] See for example: Allison Williams, Mary Lou Kelley, Sarah Dykeman & Lily DeMiglio, A Timeline of Hospice Palliative Care Policy and Practice in Ontario, Canada (Canadian Institute of Health Research, February 2010), 3 [Williams]; Francois-Pierre Gauvin, Julia Abelson, John N. Lavis, Citizen Brief: Improving Access to Palliative Care in Ontario (Hamilton, Canada: McMaster Health Forum, 16 November 2013), 2 [Gauvin].

[3] Statistics Canada, “Deaths, estimates, by province and territory, 2011/12 – 2015/16”, online: http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo07a-eng.htm (last accessed January 13, 2017).

[4] Ontario Ministry of Health and Long-term Care, “Hospitals: Questions and Answers”, online: http://www.health.gov.on.ca/en/common/system/services/hosp/faq.aspx#hospitals (last accessed January 13, 2017). The propotion of Ontarian’s dying in hospital is found in Donna Wilson & Steven Birch, Improving End-of-Life Care Setting Transitions: A Mixed-Method Research Report (report commissioned by the Law Commission of Ontario, 2016), 31 [Wilson & Birch].

[5] S Baidoobonso, Effect of Supportive Interventions on Informal Caregivers of People at the End of Life: A Rapid Review (Toronto: Health Quality Ontario, 2014) [Baidoobonso], 7.

[6] Ontario Long-term Care Association, “Sector Dashboard – Ontario (updated October 2016),” online: http://www.oltca.com/OLTCA/Documents/Sector%20Dashboards/Ontario_Dashboard_1016.pdf (last accessed January 13, 2017).

[7] CTV News, “At least 744 assisted-deaths in Canada since law passed: CTV News analysis” (December 28, 2016), online: http://www.ctvnews.ca/health/at-least-744-assisted-deaths-in-canada-since-law-passed-ctv-news-analysis-1.3220382 (last accessed January 13, 2017).

[8] Law Commission of Ontario, “Improving the Last Stages of Life: Project Scope Statement”, online: http://www.lco-cdo.org/en/last-stages-of-life-project-scope (last accessed 25 July 2016).

[9] On the adequacy of palliative care in Ontario, see AG 2014, note 1, ch. 3. There are also centres of excellence in Ontario and many initiatives that are ongoing to strengthen palliative care as discussed later in this discussion paper. On centres of excellence, see: Canadian Medical Association, Palliative Care: Canadian Medical Association’s National Call to Action (May 2015), online: https://www.cma.ca/Assets/assets-library/document/en/advocacy/palliative-care-report-online-e.pdf (last accessed March 21, 2017). For information on ongoing initiatives in Ontario, see chapter 4, “Ontario’s Laws Policies and Programs”.

[10] Carter v. Canada (Attorney General), [2015] 1 SCR 331 [Carter].

[11] Parliament of Canada, Bill C-14, An Act to Amend the Criminal Code and to Make Related Amendments to Other Acts (Medical Assistance in Dying), 1st Sess., 42nd Parliament, 2015-2016 (assented to June 16, 2016) [Bill C-14], online: http://www.parl.gc.ca/LegisInfo/BillDetails.aspx?Language=E&Mode=1&billId=8177165 (last accessed 25 July 2016).

[12] Government of Ontario, “Province Strengthens End-of-Life Care with $75 Million Investment” [Ontario 2016], online: https://news.ontario.ca/mohltc/en/2016/03/province-strengthens-end-of-life-care-with-75-million-investment.html (last accessed 25 July 2016).

[13] Ontario 2016, note 12. See also Cancer Care Ontario, “The Ontario Palliative Care Network”, online: https://www.cancercare.on.ca/pcs/palliative/opcn/ (last accessed 25 July 2016).

[14] Government of Ontario, Bill 84, Medical Assistance in Dying Statute Law Amendment Act, 2017, 2nd Sess., 41st Parliament, 2016-2017 (first reading December 7, 2016), online: http://www.ontla.on.ca/web/bills/bills_detail.do?locale=en&BillID=4460&detailPage=bills_detail_status (last accessed March 13, 2017).

[15] Law Commission of Ontario, Increasing Access to Family Justice through Comprehensive Entry Points and

Inclusivity (Toronto: February 2013), 15, online: http://www.lco-cdo.org/family-law-reform-final-report.pdf (last accessed 25 July 2016).

[16] Health Care Consent Act, 1996, S.O. 1996, c.2 [HCCA]; Substitute Decisions Act, 1992, S.O. 1992, c.30 [SDA]; Mental Health Act, R.S.O. 1990, Ch. M.7 [MHA].

[17] Law Commission of Ontario, Legal Capacity, Decision-making and Guardianship: Interim Report (Toronto: Law Commission of Ontario, October 2015), online: http://lco-cdo.org/en/capacity-guardianship-interim-report (last accessed 25 July 2016).

[18] Law Commission of Ontario, A Framework for the Law as It Affects Older Adults: Advancing Substantive Equality for Older Persons through Law, Policy and Practice (Toronto: April 2012), online: http://lco-cdo.org/en/content/older-adults (last accessed 25 July 2016).

[19] Law Commission of Ontario, A Framework for the Law as It Affects Persons with Disabilities: Advancing Substantive Equality for Older Persons through Law, Policy and Practice (Toronto: April 2012), online: http://lco-cdo.org/en/content/persons-disabilities (last accessed: 25 July 2016).

[20] See for instance: Nadia Incardona, Sally Bean, Kevin Reel & Frank Wagner, An Ethics-based Analysis and Recommendations for Implementing Physician-Assisted Dying in Canada (Toronto: Joint Centre for Bioethics, University of Toronto, 2016); Cuthbertson v. Rasouli, [2013] 3 SCR 341 [Rasouli]; Carter, note 10; Canadian Medical Association, Principles-based Recommendations for a Canadian Approach to Assisted Dying (January 2016), online: https://www.cma.ca/Assets/assets-library/document/en/advocacy/cma-framework_assisted-dying_final-jan2016-edited-20160412.pdf (last accessed 25 July 2016); Canadian Hospice Palliative Care Association, Quality End-of-Life Care Coalition of Canada & Government of Canada, The Way Forward: A Roadmap for an Integrated Palliative Approach to Care (March 2015), 13 [The Way Forward].

[21] Dr. Katherine Arnup, Death, Dying and Canadian Families (Ottawa: Vanier Institute of the Family, 2013), 4-9; Gauvin, note 2, 2.

[22] Yves Decady & Lawson Greenberg, Ninety Years of Change in Life Expectancy (Statistics Canada, 2014), 1.

[23] Decady & Greenberg, note 22, 7.

[24] For information on the baby boom, see: Statistics Canada, Generations in Canada: Age and Sex, 2011 Census (Statistics Canada, 2012), 1-3. The number of persons aged 65 and above in Ontario is projected to more than double by 2036, when there will be 1 older adult for every 4 people. See Ontario Ministry of Finance, Ontario Population Projections Update: 2012-2036 (Ontario Ministry of Finance: Queen’s Printer for Ontario, 2013); AG 2014, note 1, 260.

[25] AG 2014, note 1, 260; Williams, note 2; François-Pierre Gauvin & John N. Lavis, Improving End-of-Life Communication, Decision-Making and Care in Ontario: Evidence Brief (Prepared for the McMaster Health Forum, September 11, 2013).

[26] Canadian Hospice Palliative Care Association, What Canadians Say: the Way Forward Survey Report (Canadian Hospice Palliative Care Association, December 2013). See also: Maire Sinha & Amanda Bleakney, Receiving Care at Home (Statistics Canada, 2014), 2. According to one survey, almost 80 per cent of Canadians surveyed believed that aging at home offers a better quality of life, citing greater comfort, independence and the opportunity to be closer to family. The older the survey respondents, the more strongly they expressed their preference to remain at home as they age. Acrobat Research, National Survey on Aging in Place (Living Assistance Services: December 2009).

[27] Health Quality Ontario, “Health Care for People Approaching the End of Life: An Evidentiary Framework” (2014) 14:14 Ontario Health Technology Assessment Series 1 [HQO 2014], 9, citing Deborah Cook & Graeme Rocker “End of Life Care in Canada: A Report from the Canadian Academy of Health Sciences Forum” (2013) 36:3 Clin Invest Med. E112-E113.

[28] Jennifer S. Temel, Joseph A. Greer, Alona Muzikansky and others, “Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer” (2010) 363 New England Journal of Medicine 733, 739 [Temel].

[29] Temel, note 28, 739.

[30] Yves Carriere, Laurent Martel, Jacques Legare and others, The Contribution of Immigration to the Size and Ethnocultural Diversity of Future Cohorts of Seniors (Statistics Canada, 2016), 4, 7.

[31] Carter, note 10; Bill C-14, note 11, Preamble.

[32] See for example: Netherlands, Termination of Life on Request and Assisted Suicide (Review Procedures) Act (2002); Belgium, 28 May 2002 Act on Euthanasia (2002) as amended by the Law of 13 February 2014; Luxembourg, Law of 16 March 2009 on Euthanasia and Assisted Suicide (2009).

[33] See for example: Criminal Code, 1985, R.S.C. 1985, c. C-46, s.241.2(2) [Criminal Code]; Quebec, An Act Respecting End-of-Life Care (2014, ch. 2); Jean-Pierre Ménard, Michelle Giroux & Jean-Claude Hébert, Mettre en Oeuvre les Recommendations de la Commission Spéciale de l’Assemblée Nationale sur la Question de Mourir dans la Dignité: Rapport du Comité de Juristes Experts (Janvier 2013); Select Committee on Dying with Dignity of the National Assembly, Dying with Dignity: Report (March 2012); California, End of Life Option Act, AB-15, Ch.1 (approved by Governor on October 5, 2015); Oregon, Death with Dignity Act (1997); Vermont, Patient Choice and Control at End of Life Act (2013); Washington, Death with Dignity Act (2009).

[34] Criminal Code, note 33, s.241.2(3); Quebec, An Act Respecting End-of-Life Care, note 33, s.26(1).

[35] Bill C-14, note 11.

[36] See for instance: Special Joint Committee on Physician-Assisted Dying, Medical Assistance in Dying: A Patient-Centred Approach. Report of the Special Joint Committee on Physician-Assisted Dying (Ottawa: Parliament of Canada, February 2016); Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying: Final Report (November 30, 2015) [Provincial-Territorial Expert Advisory Group].

[37] Provincial-Territorial Expert Advisory Group, note 36, 3.

[38] See for instance: