Endnotes2017-05-29T01:26:59+00:00

[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: Ontario Local Health Integration Networks and Quality Hospice Palliative Care Coalition of Ontario, Advancing High Quality, High Value Palliative Care in Ontario: A Declaration of Partnership and Commitment Action (December 2011) [Declaration of Partnership], online: http://health.gov.on.ca/en/public/programs/ltc/docs/palliative%20care_report.pdf (last accessed March 21, 2017); World Health Organization & Worldwide Palliative Care Alliance, Global Atlas of Palliative Care at the End of Life (Geneva: World Health Organization, 2014) [WHO Global Atlas].

[39] The Way Forward, note 20, 13-14. See also: Declaration of Partnership, note 38; World Health Organization, “WHO Definition of Palliative Care”, online: http://www.who.int/cancer/palliative/definition/en/ (last accessed 25 July 2016).

[40] See for instance: Declaration of Partnership, note 38.

[41] See for instance: Declaration of Partnership, note 38, 1-2, 58; WHO Global Atlas, note 39; The Way Forward, note 20; Gauvin, note 2, 10-11.

[42] For a definition of “knowledge translation” in health care, see: Sharon E Straus, Jacqueline Tetroe, & Ian D Graham, “Knowledge to Action: What It Is and What It Isn’t” in Sharon E Straus, Jacqueline Tetroe, & Ian D Graham, eds, Knowledge Translation in Health Care: Moving from Evidence to Practice (2nd ed.) (London: BMJ Books, 2013).

[43] See for example: Manitoba Law Reform Commission, Withholding or Withdrawing Life Sustaining Medical Treatment (Winnipeg, Canada: December 2003); Commission de Reflexion sur la Fin de Vie en France, Penser solidairement la fin de vie: rapport a Francois Hollande, President de la Republique Francaise (18 Decembre 2012), The Commission on Assisted Dying, Final Report of the Commission on Assisted Dying (London: Demos, January 2012).

[44] Judith Wahl, Mary Jane Dykeman & Brendan Gray, Health Care Consent and Advance Care Planning in Ontario (Commissioned by the Law Commission of Ontario, 2014) [Wahl 2014]; Judith Wahl, Mary Jane Dykeman & Tara Walton, Health Care Consent, Advance Care Planning, and Goals of Care Practice Tools: The Challenge to Get It Right (Commissioned by the Law Commission of Ontario, December 2016) [Wahl 2016].

[45] We discuss the relationship of equity to legal equality in chapter 5 of this discussion paper.

[46] Government of Ontario, Palliative and End-of-Life Care Provincial Roundtable Report: A Report from Parliamentary Assistant John Fraser to the Minister of Health and Long-Term Care (Ontario: Queen’s Printer for Ontario, March 2016) [Fraser Report].

[47] For Ontario’s strategy to improve home and community care, see: Government of Ontario, Patients First: A Roadmap to Strengthen Home and Community Care (Toronto: Ministry of Health and Long-Term Care, 2015).

[48] HQO 2014, note 27, 11.

[49] AG 2014, note 1, 262.

[50] Statistics Canada, The 10 Leading Causes of Death, 2012 (Ottawa: Statistics Canada, 2015).

[51] Canadian Cancer Society’s Advisory Committee on Cancer Statistics, Canadian Cancer Statistics 2015 (Toronto: 2015), 6, 10 [CCS 2015].

[52] CCS 2015, note 51, 6.

[53] CCS 2015, note 51, 11.

[54] CCS 2015, note 51, 11.

[55] On the proportion of deaths, see: Statistics Canada, note 50. On the public acknowledgement of the need to better serves persons with chronic conditions in addition to cancer, see: AG 2014, note 1, 262; Declaration of Partnership, note 38; The Way Forward, note 20.

[56] CCS 2015, note 51, 10, based on Statistics Canada, Leading Causes of Death in Canada, 2011 (Ottawa: Statistics Canada, 2014) & CANSIM Table 102-0522.

[57] The Ontario HIV Treatment Network, Striving for Excellence, Achieving Impact: Strategic Plan to 2015 (Toronto: The Ontario HIV Treatment Network, 2015), 2 [HIVTN].

[58] Ontario Ministry of Health and Long-Term Care, “Ontario HIV/AIDS Infection Rates”, online: http://www.health.gov.on.ca/en/public/programs/hivaids/charact_epidemic.aspx (last accessed 25 July 2016).

[59] HIVTN, note 57, 2.

[60] Ontario HIV Treatment Network, “Neurocognitive disorders”, online: http://www.ohtn.on.ca/research-portals/co-morbidities/neurocognitive-disorders/ (last accessed December 6, 2016).

[61]Alzheimer Society of Canada, Rising Tide: The Impact of Dementia on Canadian Society (Alzheimer Society of Canada, 2010), 6-7, 10.

[62] HQO 2014, note 27, 10, citing Statistics Canada, Leading Causes of Death in Canada, 2009 (Statistics Canada , 2012.

[63] Medical Advisory Secretariat, Aging in the Community: Summary Evidence-Based Analysis (2008) 8:1 Ontario Health Technology Assessment Series, 19.

[64] Medical Advisory Secretariat, note 63, 19.

[65] Martin Turcotte, Family Caregiving: What Are the Consequences? (Ottawa: Statistics Canada, 2013), 1; The Change Foundation, Out of the Shadows and into the Circle: Partnering with Family Caregivers (The Change Foundation: Toronto, 2015).

[66] Health Quality Ontario, Measuring Up: A Yearly Report on How Ontario’s Health System is Performing (Toronto: Queen’s Printer for Ontario, 2015) [HQO 2015], 68; The Change Foundation, note 65, 7; Canadian Institute for Health Information, Home Care Reporting System Quick Stats 2013-2014 [CIHI Quick Stats], online: https://www.cihi.ca/sites/default/files/document/stats_hcrs_2013_14_en.xlsx (last accessed March 21, 2017). See also: A. Paul Williams, Janet Lum, Frances Morton-Chang and others, “Integrating Long-Term Care into a Community-Based Continuum: Shifting from ‘Beds’ to ‘Places,’” IRPP Study No.59 (Montreal: Institute for Research on Public Policy, February 2016), 3.

[67] The Change Foundation, note 65, 6.

[68] The Change Foundation, note 65, 6. See also: HQO 2015, note 66; Maire Sinha, Portrait of Caregivers, 2012 (Statistics Canada, 2013) [Sinha], 4.

[69] Sinha, note 68, 4

[70] Baidoobonso, note 5, 7.

[71] Baidoobonso, note 5, 6-7, citing Karl A. Lorenz, Joanne Lynn, Sally C. Morton and others, “Methodological Approaches for a Systematic Review of End-of-Life Care” (2005) 8:1 Journal of Palliative Medicine S-4.

[72] HQO 2015, note 66, 68; Sinha, note 68, 3. Also see: Baidoobonso, note 5, 7, noting that caregivers provide support in long-term care homes; CIHI Quick Stats, note 66, demonstrating that a caregiver was present for 97.7% of home care clients while in hospital.

[73] Law Commission of Ontario, Legal Capacity, Decision-making and Guardianship: Discussion Paper (Toronto: May 2014) [LCO Capacity Discussion Paper], 55, citing Linda Duxbury, Christopher Higgins & Bonnie Schroeder, Balancing Paid Work and Caregiving Responsibilities: A Closer Look at Family Caregivers in Canada (January 2009), 9 (based on a survey of family caregivers).

[74] LCO Capacity Discussion Paper, note 73, 55, citing Carole A. Cohen, Angela Colantonio & Lee Vernich, “Positive Aspects of Caregiving: Rounding out the Caregiver Experience” (2002) 17:2 International Journal of Geriatric Psychiatry 184. See also: Sinha, note 68, 14, stating that 92% of caregivers felt that the experience of providing care was rewarding and that 70% expressed that their relationship with the care receiver had strengthened over the last 12 months.

[75] The Change Foundation, note 65, 12.

[76] Baidoobonso, note 5, 7.

[77] O.Reg. 79/10, s.42, a regulation made under the Long-Term Care Homes Act, 2007, S.O. 2007, c. 8 [LTCHA].

[78] Paul Barker, “Local Health Integration Networks: The Arrival of Regional Health Authorities In Ontario”(Paper prepared for presentation at the Annual Meeting of the Canadian Political Science Association, University of Saskatchewan, May 2007).

[79] Ontario 2016, note 12.

[80] Patients First Act, 2016, S.O. 2016, c 30, online: http://www.ontla.on.ca/web/bills/bills_detail.do?locale=en&BillID=4215&isCurrent=false&detailPage=bills_detail_the_bill (last accessed December 22, 2016).

[81] See for instance: Home Care and Community Services Act, 1994, S.O. 1994, c 26, s. 1; Expert Group on Home and Community Care, Bringing Care Home: Report of the Expert Group on Home and Community Care (March 2015), 6.

[82] Provincial End-of-Life Network, “Ontario Hospice Palliative Care Networks”, online: http://www.hospicenorthwest.ca/wp-content/uploads/2015/10/ontario-hospice-palliative-care-networks.pdf (last accessed 25 July 2016); Declaration of Partnership, note 38, 58; Erie St. Clair Hospice Palliative Care Network, “About Us”, online: http://esceolcn.ca/apps/about_us_history.html (last accessed 25 July 2016).

[83] AG 2014, note 1, 269-270; Cancer Care Ontario, “Palliative Care Collaborative Care Plans (CCPs)” (April 2013); Cancer Care Ontario, Regional Models of Care for Palliative Cancer Care: Recommendations for the Organization and Delivery of Palliative Cancer Care in Ontario – Provincial Palliative Care Program (December 2009).

[84] Ontario Ministry of Health and Long-Term Care, “Excellent Care for All: Health Quality Ontario”, online: http://www.health.gov.on.ca/en/pro/programs/ecfa/legislation/hqo.aspx (last accessed 25 July 2016).

[85] HQO 2014, note 27, 1, 9.

[86] College of Physicians and Surgeons of Ontario, “Planning for and Providing Quality End-of-Life Care” Policy No. 6-16 (updated 2016); Ontario Medical Association, “End of Life Care Strategy”, online: https://www.oma.org/resources/documents/EOLCStrategyFramework.pdf (last accessed 25 July 2016); Registered Nurses’ Association of Ontario, “RN Voice in National Discussion Regarding End-of-Life Care” RNAO Board of Directors Resolution and Backgrounder, online: http://rnao.ca/sites/rnao-ca/files/1_End_of_Life_Care_Resolution.pdf (last accessed 25 July 2016); Registered Nurses Association of Ontario, End-of-Life Care During the Last Days and Hours (RNAO Clinical Guideline, 2011), online: http://rnao.ca/bpg/guidelines/endoflife-care-during-last-days-and-hours (last accessed 25 July 2016).

[87] Government of Ontario, “Ontario Selects Christine Elliot as First-Ever Patient Ombudsman” (December 10, 2015), online: https://news.ontario.ca/mohltc/en/2015/12/ontario-selects-christine-elliott-as-first-ever-patient-ombudsman.html (last accessed March 21, 2017).

[88] Excellent Care for All Act, 2010, S.O. 2010, c. 14, ss.1, 13.1(2) [ECAA]. See also: Government of Ontario, note 87.

[89] ECAA, note 88, s.13.1(2). See also: Government of Ontario, note 87.

[90] Regulated Health Professions Act, 1991, S.O. 1991, c.18, Schedule 1 [RHPA].

[91] Human Rights Code, R.S.O. 1990, c.H.19 [HRCode].

[92] See for instance: Canadian Medical Protective Association, “Clinical Practice Guidelines: What Is Their Role in Legal Proceedings?” (CMPA, September 2011), online: https://www.cmpa-acpm.ca/-/clinical-practice-guidelines-what-is-their-role-in-legal-proceedings- (last accessed July 26, 2016).

[93] Theories of “legal pluralism” highlight the coexistence of multiple formal and informal legal systems – Aboriginal legal traditions, religious laws and immigrants’ experiences, for example. See: Howard Kislowicz, “Sacred Laws in Earthly Courts: Legal Pluralism in Canadian Religious Freedom Litigation” (2013) 39:1 Queen’s Law Journal 175; Amar Bhatia, “We Are All Here to Stay? Indigeneity, Migration and ‘Decolonizing’ the Treaty Right to Be Here” (2013) 31 Windsor Year Book of Access to Justice 39.

[94] Constitution Act, 1982, being Schedule B to the Canada Act, 1982, 1982 c.11 (UK), s.35 & Part I, Canadian Charter of Rights and Freedoms (“Charter”), s. 2(a). We refer to the Constitution Act, 1867, (UK), 30 & 31 Vict, c.3, reprinted in RSC 1985, App.II, No.5 and Constitution Act, 1982 together as the Canadian “Constitution”; HRCode, note 91, s.1.

[95] Charter, note 94, ss. 7, 15, 16.

[96] Canada Health Act, R.S.C. 1985, c. C-6 [CHA]; William Lahey, “Medicare and the Law: Contours of an Evolving Relationship” in Jocelyn Downie, Timothy Caulfield & Colleen Flood, eds., Canadian Health Law and Policy (3rd ed) (Markham, Ont.: LexisNexis Canada Inc., 2007), 25-26.

[97] Lahey, note 96, 25.

[98] Auton (Guardian ad litem of) v. British Columbia (Attorney General), [2004] 3 SCR 657 [Auton], para. 43.

[99] Lahey, note 96.

[100] Nola Ries, “Charter Challenges” in Downie, note 96, 540. See also: Odette Madore, The Canada Health Act: Overview and Options (Ottawa: Parliamentary Information and Research Service of the Library of Parliament, 2005), 8; Commission on the Future of Health Care in Canada, Medically Necessary: What is it and who decides? Issue/Survey Paper (July 2002); J.C. Herbert Emery & Ronald Kneebone, “The Challenge of Defining Medicare Coverage in Canada” (2013) 6:32 SPP Research Papers, University of Calgary School of Public Policy; Colleen Flood, Mark Bernard Stabile & Carolyn Hughes Tuony, Defining the Medicare “Basket” (Ottawa: Canadian Health Services Research Foundation, 2008).

[101] CHA, note 96, s.2; Madore, note 100; Flood, note 100.

[102] Section 2 of the CHA, note 96, explicitly excludes nursing home intermediate care services, adult residential care services, home care services, and ambulatory health care services. For a discussion about amending the CHA to improve palliative care, see: External Panel on Options for a Legislative Response to Carter v. Canada, Consultations on Physician-Assisted Dying: Summary of Results and Key Findings Final Report (Government of Canada, 2015), 128-131.

[103] Lahey, note 96, 25; Auton, note 98, paras. 33, 35.

[104] Ontario Ministry of Health and Long-Term Care, “The Ontario Drug Benefit (ODB) Program”, online: http://www.health.gov.on.ca/en/public/programs/drugs/programs/odb/odb.aspx (last accessed July 26, 2016).

[105] Flood, note 100.

[106] Chaoulli v. Quebec (Attorney General), (2005) 1 SCR 791, para. 104 [Chaoulli].

[107] Eldridge v. British Columbia (Attorney General), [1997] 3 SCR 624 [Eldridge].

[108] Eldridge, note 107, paras. 79-80.

[109] Ries, note 100, 553. Notably, in Auton, note 98, the Supreme Court dismissed a request that the government be required to fund a specific therapy for children with autism, stating “the legislative scheme…does not have as its purpose the meeting of all medical needs”. Auton, note 98, para. 43.

[110] See for instance: R. v. Parker, 2000 CanLII 5762 (ONCA) [Parker]; Carter, note 10; R. v. Morgentaler [1998] 1 SCR 30.

[111] Carter, note 10, para. 66.

[112] Carter, note 10, para. 68.

[113] Parker, note 110, para. 85; Ries, note 100, 543-548.

[114] Chaoulli, note 106; Ries, note 100, 547.

[115] Ries, note 100, 547; Charter, note 94.

[116] Ries, note 100, 548.

[117] An Act Respecting End-of-Life Care, note 33, s.4.

[118] See for instance: BakerLaw, “The Right to Palliative Care in Canada: Think Paper”, online: http://www.bakerlaw.ca/wp-content/uploads/The-Right-to-Palliative-Care-Think-Paper.pdf (last accessed July 26, 2016).

[119] See for instance: Hamilton Health Sciences Corp. v. D.H., 2014 ONCJ 603; Rasouli, note 20; A.C. v. Manitoba (Director of Child and Family Services), [2009] 2 SCR 181.

[120] See for instance: Declaration of Partnership, note 38, 80, 84; Holly Prince, Dr. Mary Lou Kelley, Dr. Kevin Brazil and others, Provision of Palliative and End-of-Life Care Services to Ontario First Nations Communities: An Environmental Scan of Ontario Health Care Provider Organizations (April 2013), 19. Also note that the Supreme Court of Canada has declared Métis and non-status Indians to be “Indians” under s.91(24) of the Constitution Act, 1867. In so doing, the Supreme Court explained in Daniels v. Canada (Indian Affairs and Northern Development), 2016 SCC 12, that federal and provincial governments had both denied having legislative authority over these Aboriginal communities, and that this new clarity “has the undeniably salutary benefit of ending a jurisdictional tug-of-war” (at para. 15). For the LCO’s project, questions remain as to what the impacts of this declaration could have on care in the last stages of life.

[121] Home Care and Community Services Act, 1994, note 81, s.26; LTCHA, note 77.

[122] An Act Respecting End-of-Life Care, note 33; Government of British Columbia, The Provincial End-of-Life Care Action Plan for British Columbia (Ministry of Health, 2013); Government of British Columbia, A Provincial Framework for End-of-Life Care (Ministry of Health, 2006); Albert Health Services, Palliative and End of Life Care: Alberta Provincial Framework (Albert Health Services, 2014); Ontario 2016, note 12.

[123] ECAA, note 88, Preamble.

[124] ECAA, note 88, Preamble.

[125] ECAA, note 88, Preamble.

[126] HRCode, note 91, ss.9, 47(1), 47(2).

[127] HRCode, note 91, 47(2).

[128] HRCode, note 91, s.1.

[129] See for instance: Ontario Human Rights Commission, Policy on Preventing Discrimination Based on Creed, ch.9 “The Duty to Accommodate”, (Toronto: Ontario Human Rights Commission, 2015).

[130] HRCode, note 91, Preamble.

[131] Government of Ontario, Ontario Seniors’ Secretariat, Independence, Activity and Good Health: Ontario’s Action Plan for Seniors (Toronto: Queen’s Printer for Ontario, 2013); Accessibility for Ontarians with Disabilities Act, 2005, S.O. 2005, c.11; Government of Ontario, Ministry of Community and Social Services, About the Accessibility for Ontarians with Disabilities Act, 2005 (AODA) (Toronto: Queen’s Printer for Ontario, 2008).

[132] Another crosscutting area of the law is privacy; however, we do not consider privacy law in the project because, although it is relevant, it was not identified as a major issue for the LCO’s project in our preliminary research and consultations.

[133] The HCCA recognizes a presumption of capacity and requires health care providers who propose treatment to obtain consent before doing so. HCCA, note 16, ss.4(2), 10.

[134] HCCA, note 16, ss.5, 21.

[135] HCCA, note 16, ss. 10, 25.

[136] Fleming v. Reid, [1991] 4 OR (3d) 74, para.29.

[137] For an example of a standard of care in statute see: RHPA, note 90, s.30.

[138] Crits v. Sylvester, [1956] OR 132 (CA), aff’d SCR 991; Canadian Medical Protective Association, note 92.

[139] HCCA, note 16, s.10; Patricia Peppin, “Informed Consent” in Downie, note 96; Ellen Picard & Gerald Robertson, Legal Liability of Doctors and Hospitals in Canada (Toronto: Thomson Carswell, 2007).

[140] See for instance: Canadian Medical Protective Association, note 92.

[141] RHPA, note 90, Schedule 2 “Health Professions Procedural Code”; Law Society Act, R.S.O. 1990, c.L.8.

[142] RHPA, note 90, Schedule 1 “Self-Governing Health Professions.”

[143] College of Physicians and Surgeons of Ontario, “The Complaints Process”, online: http://www.cpso.on.ca/policies-publications/make-a-complaint/the-complaints-process (last accessed July 26, 2016); RHPA, note 90, s.10 & Schedule 2, ss.25-28; Law Society of Upper Canada, “The Complaints Process: How it Works,” online: https://www.lsuc.on.ca/complaints/ (last accessed July 26, 2016).

[144] RHPA, note 90, Schedule 2, ss. 29-35, 70; CPSO, note 143.

[145] Ontario Ministry of Health and Long-Term Care, “Hospital Chronic Care Co-Payment/Questions and Answers” (July 2016), online: http://www.health.gov.on.ca/en/public/publications/chronic/chronic.aspx#chroniccare (last accessed July 26, 2016).

[146] See: LTCHA, note 77, s.91; O.Reg. 79/10, note 77, ss. 247, 253.

[147] Retirement Homes Act, 2010, S.O. 2010, c.11 [RHA]; Residential Tenancies Act, 2006, S.O. 2006, c.17 [RTA].

[148] RHA, note 147, s.2; O. Reg. 166/11, s.2, a regulation made under the RHA.

[149] For more detailed information on how residential hospices and services provided within their walls are funded, see: Residential Hospice Working Group of the Hospice Palliative Care Provincial Steering Committee, Environmental Scan for Strengthening Residential Hospice Care in Ontario (March 2015), 16 -18.

[150] AG 2014, note 1, 259; Health Insurance Act, R.S.O. 1990, c.H.6, s.2, 11.2; R.R.O. 1990, Reg. 552, ss.7, 37.1; Ministry of Health and Long-Term Care, “Ontario Public Drug Programs”, online: http://www.health.gov.on.ca/en/public/programs/drugs/# (last accessed July 26, 2016).

[151] Government of Ontario, “Public Health in Ontario”, online: https://www.ontario.ca/page/public-health-ontario (last accessed July 26, 2016).

[152] Paul Barker, “Local Health Integration Networks: The Arrival of Regional Health Authorities in Ontario”(Paper prepared for presentation at the Annual Meeting of the Canadian Political Science Association, University of Saskatchewan, May 2007).

[153] Local Health System Integration Act, 2006, S.O. 2006, c. 4, ss. 1, 4; Komal Bhasin & A Paul Williams, Understanding the LHINs: A Review of the Health System Integration Act and the Integrated Health Services (Canadian Research Network for Care in the Community & Ontario Community Support Association, 2007).

[154] See for instance: Sunnybrook Health Sciences Centre, “Palliative Care Consult Team”, online: http://sunnybrook.ca/content/?page=palliative-care-consult-team (last accessed July 26, 2016); Hamilton Health Sciences, “Palliative Care Consultation Teams”, online: http://www.hamiltonhealthsciences.ca/body.cfm?id=2269 (last accessed July 26, 2016).

[155] See for instance: Sunnybrook Health Sciences Centre, note 154; Mount Sinai Hospital, “What is the Temmy Latner Centre?”, online: http://www.tlcpc.org/tlcpc/about-us (last accessed July 26, 2016); William Osler Health System, “Supportive Palliative Care”, online: http://www.williamoslerhs.ca/health-care-professionals/programs-services/palliative-care (last accessed July 26, 2016).

[156] Public Hospitals Act, R.S.O. 1990, c.P.40.

[157] HQO 2015, note 66, 86, reports that “today, residents of long-term care homes have much higher needs than ever before. The number of long-term care residents who are older than 75 years of age is growing rapidly. So too is the proportion of residents with chronic conditions…and approximately 70% of Ontarians in long-term care have some type of dementia.” See also: Ontario Long-Term Care Home Association, This is Long-Term Care 2015 (November 2015).

[158] Daryl Bainbridge, Hsien Seow, Jonathan Sussman and others, “Factors Associated with Acute Care Use among Nursing Home Residents Dying of Cancer: A Population-based Study” (2015) 21:7 International Journal of Palliative Nursing 349, 349. The proportion of deaths each year has been estimated as high as 50%. See: Quality Palliative Care in Long Term Care Alliance, Long-Term Care Homes: Hospices of the Future (prepared as a submission to the Canadian Nursing Association Expert Commission), online: www.palliativealliance.ca/assets/files/CNA-Final.pdf (last accessed July 26, 2016).

[159] LTCHA, note 77, s.76(7).

[160] O.Reg. 79/10, note 77, s.42.

[161] Expert Group on Home and Community Care, note 81, 6; Home Care and Community Services Act, 1994, note 81, s. 2(4).

[162] See for instance: Hospice Toronto, “Services and Programs”, online: http://www.hospicetoronto.ca/Page.asp?IdPage=6777&WebAddress=hospice (last accessed July 26, 2016).

[163] Home Care and Community Services Act, 1994, note 81.

[164] Ministry of Health and Long-Term Care, “Community Care Access Centres”, online: http://www.health.gov.on.ca/en/public/contact/ccac/ (last accessed July 26, 2016).

[165] O. Reg. 386/99, Provision of Community Services, a regulation made under the Home Care and Community Services Act, note 81, s.3(1).

[166] This is done through the creation of a plan of service, which may not necessarily provide for maximum level of services. Home Care and Community Services Act, note 81, s.22.

[167] Ministry of Health and Long-Term Care, Community Care Access Centres: Client Services Policy Manual (January 2007), 7.2.1; O. Reg 386/99, note 165, ss. 3(3), 4(1.1).

[168] Cancer Act, R.S.O. 1990, c. C.1; Cancer Care Ontario, “Who We Are”, online: https://www.cancercare.on.ca/about/who/ (last accessed July 26, 2016); AG 2014, note 1, 259.

[169] CCO, note 168.

[170] PFA note 80. See also: discussion at chapter 2.C.4; Government of Ontario, Patients First: Reporting Back on the Proposal to Strengthen Patient-Centred Health Care in Ontario (Government of Ontario, June 2016). The MOHLTC’s action plan responds to the findings of an expert report that it had previously commissioned to review the sector and make recommendations for reform. Expert Group on Home and Community Care, note 81.

[171] WHO Global Atlas, note 38.

[172] Declaration of Partnership, note 38, 58.

[173] Lily DeMiglio, Sarah Dykeman, Allison Williams and others, “Evolution of Palliative Care in Ontario: The Impact of Geography, Funding and Advocacy” (2012) 7(4) Journal of Rural and Community Development 109, 112; AG 2014, note 1, 260.

[174] DeMiglio, note 173.

[175] DeMiglio, note 173, 113, 115; Emma Ferguson, “End of Life Care from 1970 to 2005: Development of Hospice Palliative Care Nursing” (2010) University of Ottawa, 8, online: www.med.uottawa.ca/historyofmedicine/hetenyi/assets/documents/End_Life_Care.pdf (last accessed July 26, 2016); Allison Williams, note 2, 4, 5.

[176] Among others, Dr. Frank Ferris and Dr. Larry Librach were pioneers in programmatic and home-based palliative care services in Ontario. See: Temmy Latner Centre for Palliative Care, “History of the Temmy Latner Centre for Palliative Care”, online: http://www.tlcpc.org/tlcpc/history-document (last accessed July 26, 2016).

[177] Furthermore, social advocates fostered targeted care for new patient groups, such as Ontarians with HIV/AIDS, who were not represented among many proposals for hospices in the 1980s and who endured considerable social stigma. Ferguson, note 175, 16, 17; Casey House, “25 Years of Giving Compassion a Home” (2013), online: http://www.caseyhouse.com/about-casey-house/our-history/25-years/ (last accessed July 26, 2016). See also: Bruce House, “History”, online: http://brucehouse.ca/history/ (last accessed July 26, 2016).

[178] DeMiglio, note 173, 113-116; Williams, note 2, 5-6.

[179] DeMiglio, note 173, 113; Williams, note 2, 5-6.

[180] The Special Committee on Euthanasia and Assisted Suicide, Of Life and Death (June 1995); Subcomittee to update “Of Life and Death”, Quality End-of-Life Care: The Right of Every Canadian (June 2000); Still Not There (June 2005). See also: Senator Carstair’s account of her involvement in studying palliative care on the Senate from 1995 to 2010 in The Senate of Canada, Raising the Bar: A Roadmap for the Future of Palliative Care in Canada (June 2010), 5.

[181] Government of Ontario, 2004 Ontario Budget: Budget Papers (Queen’s Printer for Ontario, 2004), 17; Government of Ontario, 2005 Ontario Budget: Budget Papers (Queen’s Printer for Ontario, 2005), 21, 61.

[182] Hsien Seow, Lisa Barbera, Doris Howell and others, “Did Ontario’s End-of-Life Care Strategy Reduce Acute Care Service Use?” (2010) 13:1 Healthcare Quarterly 93 [Seow & Barbera]; Hsien Seow, Susan King & Vida Vaitonis, “The Impact of Ontario’s End-of-Life Care Strategy on End-of-Life Care in the Community” (2008) 11:1 Healthcare Quarterly 56; Ministry of Health and Long-Term Care, “McGuinty Government Improving End-Of-Life Care” (4 October 2005), online: http://news.ontario.ca/archive/en/2005/10/04/McGuinty-Government-Improving-EndOfLife-Care.html(last accessed 17 May 2016).

[183] Provincial End-of-Life Network, note 82; Declaration of Partnership, note 38, 58.

[184] Seow & Barbera, note 182, 99.

[185] Declaration of Partnership, note 38, 6.

[186] Declaration of Partnership, note 38, 3.

[187] Declaration of Partnership, note 38, 12.

[188] AG 2014, note 1, 280.

[189] Hospice Palliative Care Provincial Steering Committee, “Advancing High Quality and High Value Palliative Care: Update 4” (February 2014); Denise Marshall, “Palliative Care in Ontario and the Declaration of Partnership and Commitment to Action” (Prepared for the Canadian Association of Health Services and Policy Research Conference, May 2014), online: https://www.cahspr.ca/en/presentation/5384b53937dee8ac2fd50194 (last accessed July 26, 2016).

[190] See for instance: Clinical Council of the Hospice Palliative Care Provincial Steering Committee, Essential Minimum Clinical Standards for Hospice Palliative Care in Ontario (January 2015); Residential Hospice Working Group, note 149; Residential Hospice Working Group of the Hospice Palliative Care Provincial Steering Committee, Strengthening Ontario’s End-of-Life Continuum: Advice Regarding the Role of Residential Hospices- Final Report of the Residential Hospices Working Group (March 2015).

[191] AG 2014, note 1, 260.

[192] AG 2014, note 1, 260.

[193] AG 2014, note 1, 280.

[194] Government of Ontario, “2014 Parliamentary Assistant Mandate Letter: Health and Long-Term Care (Health)”, online: http://www.ontario.ca/page/2014-parliamentary-assistant-mandate-letter-health-and-long-term-care-health (last accessed July 26, 2016).

[195] Ontario 2016, note 12.

[196] Fraser Report, note 46, 2; Ontario 2016, note 12.

[197] Ontario 2016, note 12.

[198] As mentioned above, the LTCHA already requires all facility licensees to train staff on palliative care and requires them to ensure that residents receive end-of-life care in a manner that meets their needs. However, the LCO has heard that residents still face significant barriers accessing palliative care in long-term care homes. LTCHA, note 77, s.76(7); O.Reg. 79/10, note 77, s.42.

[199] Ontario 2016, note 12.

[200] Ontario 2016, note 12

[201] RNAO, note 86; CPSO, note 86. See also: RNAO, “RN Voice in National Discussion Regarding End-of-Life Care” RNAO Board of Governors Resolution and Backgrounder, online: http://rnao.ca/sites/rnao-ca/files/1_End_of_Life_Care_Resolution.pdf (last accessed July 26, 2016).

[202] For the strategy framework and other documents from the OMA on end-of-life care, see: http://www.ontariosdoctors.com/end-of-life-planning-care/ (last accessed July 26, 2016).

[203] Hospice Palliative Care Ontario (HPCO), Health Care Consent Advance Care Planning Community of Practice Glossary [HPCO 2016], online: http://www.speakupontario.ca/wp-content/uploads/2016/04/HCC-ACP-Glossary-of-Terms-April-2016.pdf (last accessed July 26, 2016).

[204] Colleen Dempers & Merryn Gott, “Which Public Health Approach to Palliative Care?” (2016) Progress in Palliative Care 1, 2.

[205] Libby Sallnow & Sally Paul, “Understanding Community Engagement in End-of-Life Care: Developing Conceptual Clarity” (2015) 25:2 Critical Public Health 231, 232.

[206] On linkages between palliative care and the public health approach, see: Sallnow & Paul, note 205, 232; John Rosenberg, “’But we’re already doing it!’: Examining Conceptual Blurring between Health Promotion and Palliative Care” in Libby Sallnow, Suresh Kumar & Allan Kellehear, eds, International Perspectives on Public Health and Palliative Care (Abingdon, Oxon: Routledge, 2012).

[207] See for instance: Michelle Gillies, Palliative and End of Life Care in Scotland: The Rationale for a Public Health Approach (Scottish Public Health Network, 2016).

[208] Allan Kellehear, “Compassionate Communities: End-of-Life Care as Everyone’s Responsibility” (2013) 106 Q J Medicine 1071, 1071. See also: John P. Rosenberg, Jason Mills & Bruce Rumbold, “Putting the ‘Public’ into Public Health: Community Engagement in Palliative and End of Life Care” (2016) 24:1 Progress in Palliative Care 1.

[209] Sallnow & Paul, note 205, 232; Gillies, note 207, 49.

[210] For a history and overview of the public health approach to palliative care see: Sallnow, note 206. For more information on the public health approach, see the 2016 special issue on the subject in Progress in Palliative Care with contributions from Libby Sallnow, Joachim Cohen, Allan Kellehaer and others. Special Issue: Public Health (2016) 24:1 Progress in Palliative Care, online: http://www.tandfonline.com/toc/yppc20/24/1 (last accessed 5 August 2016).

[211] Kellehear, note 208.

[212] Sallnow & Paul, note 205, 232.

[213] Kellehear, note 208, 1072.

[214] Kellehear, note 208, 1072.

[215] Kellehear, note 208, 1072.

[216] Kellehear, note 208, 1074

[217] Sallnow & Paul, note 205, 233.

[218] Pallium Canada, “Pallium Canada’s Compassionate Communities Community of Practice”, online: http://pallium.ca/compassionate-communities-2/community-of-practice/ (last accessed July 26, 2016). The HPCO will be launching its Provincial Compassionate Communities Community of Practice and will work closely and in alignment with the national Pallium Canada initiative.

[219] Pallium Canada, “Windsor-Essex Compassionate Community Initiative: Compassionate, Citizen-Driven Community Care”, online: http://pallium.ca/compassionate-communities-2/canadian-compassionate-communities-projects/cc-windsor-essex/ (last accessed July 26, 2016).

[220] Bruce Rumbold, “Public Health Approaches to Palliative Care in Australia” in Sallnow, note 205.

[221] Rumbold, note 206.

[222] Allan Kellehear, “The Compassionate City Charter” in Klaus Wegleitner, Katharina Heimerl & Allan Kellehear, eds, Compassionate Communities: Case Studies from Britain and Europe (London: Routledge, 2016).

[223] Kellehear, note 222.

[224] Windsor-Essex Compassionate Community Coalition, “Resources”, online: http://compassionatecarecommunity.com/resources/ (last accessed July 26, 2016).

[225] Sallnow & Paul, note 205, 231.

[226] See for instance: “What Does a Public Health Perspective Bring to Understandings of Ageing and End of Life”, Chapters 7 to 11 in Merryn Gott & Christine Ingleton, eds, Living with Ageing and Dying: Palliative and End of Life Care for Older People (Oxford: Oxford University Press, 2011).

[227] We discuss this model more in this discussion paper in chapter 6. See generally: “Improving End-of-Life Care in First Nations Communities”, online: http://eolfn.lakeheadu.ca/ (last accessed July 26, 2016).

[228] Fraser Report, note 46, 17.

[229] AG 2014, note 1, 276.

[230] Fraser Report, note 46, 17.

[231] Fraser Report, note 46, 17.

[232] See generally: Gillies, note 207.

[233] Gillies, note 207, 43. See also: Allan Kellehear, Health Promoting Palliative Care (Melbourne: Oxford University Press, 1999).

[234] See also: Fraser Report, note 46, 18.

[235] See for instance: Kellehear, note 208.

[236] Shyla Mills & Jason Mills, “Future Directions for Community Engagement as a Public Helath Approach to Palliative Care in Australia” (2016) 24:1 Progress in Palliative Care 15. See also: Kellehear, note 208.

[237] See for instance: K. McLoughlin, S. McGilloway, R. Lloyd, M. O’Connor, J. Rhatigan, M. Shanahan, M. Richardson & A. Keevey, “Walls, Wisdom, Worries, and Wishes: Engaging Communities in Discussion about Death, Dying, Loss, and Care Using Café Conversation” (2016) 24:1 Progress in Palliative Care 9; Eman Hassan, The Public Health Approach to Palliative Care: Principles, Models and International Perspectives (White Paper prepared for the British Columbia Centre for Palliative Care, August 2015).

[238] Fraser Report, note 46, 14, 17-18.

[239] Erie St. Clair Hospice Palliative Care Network & Local Health Integration Network, Hospice Palliative Care in Erie St. Clair: Strategic Plan (February 2015), iv, 9, 12, 57, 59.

[240] See also: Dempers & Gott, note 204, 5.

[241] Government of Scotland, Strategic Framework for Action on Palliative and End of Life Care: 2016 to 2021 (December 2015), 7, 12; National Health System England, NHS England’s Actions for End of Life Care: 2014 to 2016 (November 2014), 5, 20,

[242] Gillies, note 207, 15.

[243] Ontario Ministry of Health and Long-Term Care, Ontario Public Health Standards 2008 (revised October 2015), 4 (Public Health Standards).

[244] Public Health Standards, note 243, 4.

[245] Public Health Standards, note 243, 27-31.

[246] Public Health Standards, note 243, 43-72

[247] Public Health Standards, note 243, 4-10. See also Health Protection and Promotion Act, R.S.O. 1990, c.H.7; Government of Ontario, note 151.

[248] For a short history of these reform efforts, see: Law Commission of Ontario, note 73, Ch.3.B “A Little History: Advocacy, Law Reform and the Current Legislative Scheme”.

[249] Law Commission of Ontario, note 73, 4; Law Commission of Ontario, note 73, 55.

[250] HCCA, note 16, ss. 10, 25.

[251] HCCA, note 16, s. 2.

[252] HCCA, note 16,, s.4(2).

[253] HCCA, note 16,, s.4(3).

[254] HCCA, note 16,, s. 4(1).

[255] Law Commission of Ontario, note 73, 14.

[256] HCCA, note 16, s.15.

[257] HCCA, note 16, ss. 11, 25.

[258] HCCA, note 16, ss. 20(1).

[259] SDA, note 16, s. 55.

[260] SDA, note 16, s.46; HPCO, note 203, “Power of Attorney”, 6.

[261] HCCA, note 16, s. 20(2).

[262] HCCA, note 16, s. 20(5).

[263] HCCA, note 16, s. 21(1).

[264] HCCA, note 16, ss. 21(1), 21(2).

[265] HCCA, note 16, ss.11(2), 22.

[266] HCCA, note 16, s.10(1)(b).

[267] HPCO, note 203, “Advance Care Planning”, 1.

[268] HPCO, note 203, “Advance Care Plan, Living Will, Advance Directive”, 1.

[269] HPCO, note 203, “Advance Care Plan, Living Will, Advance Directive”, 1.

[270] HPCO, note 203, “Advance Care Plan, Living Will, Advance Directive”, 1.

[271] Law Commission of Ontario, note 73, 19.

[272] HPCO, note 203 , “Advance Care Plan, Living Will, Advance Directive”, 1.

[273] HCCA, note 16, s.2. See also: Wahl 2014, note 44, 20, 49-50.

[274] HCCA, note 16, s.2.

[275] Wahl 2014, note 44, 50.

[276] Wahl 2014, note 44, 20.

[277] A summary of the recommendations are available in the “Executive Summary” to the Law Commission of Ontario, Final Report on Legal Capacity, Decision-making and Guardianship (LCO, March 2017), online: http://www.lco-cdo.org/en/our-current-projects/legal-capacity-decision-making-and-guardianship/ (last accessed March 21, 2017).

[278] Carter, note 10, para. 127.

[279] Carter, note 10, para. 128.

[280] Carter v. Canada (Attorney General) 2016 SCC 4.

[281] Bill C-14, note 11.

[282] Criminal Code, note 33, ss.241(2)-(3).

[283] Criminal Code, note 33, s.241(5).

[284] Criminal Code, note 33, s.241(4).

[285] Criminal Code, note 33, s.241.2(3).

[286] Bill C-14, note 11, s.9.1(1).

[287] Government of Canada, “Government of Canada Initiates Studies Related to Medical Assistance in Dying” (December 13, 2016), online: http://news.gc.ca/web/article-en.do?nid=1167919&tp=1 (last accessed December 22, 2016).

[288] Criminal Code, note 33, ss.241.2(1)(e), 241.2(3).

[289] Criminal Code, note 33, ss.241.31(3).

[290] Bill C-14, note 11, s.10.

[291] Government of Ontario, “Statement by Ontario’s Ministers of Health and Long-Term Care and Attorney General on Medical Assistance in Dying”, online: https://news.ontario.ca/mohltc/en/2016/06/statement-by-ontarios-minister-of-health-and-long-term-care-and-attorney-general-on-medical-assistan.html (last accessed July 26, 2016).

[292] Government of Ontario, note 291; College of Nurses of Ontario, Guidance on Nurses’ Roles in Medical Assistance in Dying (June 23, 2016); College of Physicians and Surgeons of Ontario, Medical Assistance in Dying (Policy Statement #4-16, June 2016); Ontario College of Pharmacists, Medical Assistance in Dying: Guidance to Pharmacists & Pharmacy Technicians (June 27, 2016).

[293] Government of Ontario, note 291.

[294] University of Toronto, Joint Centre for Bioethics, Medical Assistance in Dying Policy Template (October 11, 2016), online: http://www.jcb.utoronto.ca/news/maid-policy-template.shtml (last accessed December 22, 2016).

[295] CPSO, note 292, 5; CNO, note 292, 3; Government of Ontario, note 291.

[296] Ministry of Health and Long-term Care, “Medical Assistance in Dying: Proposed Legislative Amendments (Bill 84), Stakeholder Presentation” (December 9, 2016) at slide 15.

[297] Bill 84, note 14.

[298] See for instance: Special Joint Committee on Physician-Assisted Dying, note 36; Provincial-Territorial Expert Advisory Group, note 36.

[299] See for instance: Hilary Young, “Physician Conscientious Professional Discretion in Canada and the United Kingdom” (forthcoming, McGill Journal of Law and Health, 2017); Bruce Ryder, “Physicians’ Rights to Conscientious Objection” in Benjamin Berger & Richard Moon, eds, Religion and the Exercise of Public Authority (Oxford: Hart Publishing, 2016).

[300] See for instance: Laura Stone & Sean Fine, The Globe and Mail, “Senate Backs Down, Passes Assisted-Dying Legislation” (June 17, 2016), online: http://www.theglobeandmail.com/news/politics/senate-passes-assisted-dying-legislation/article30507549/; Laura Stone, The Globe and Mail, “Senate Passes Amended Assisted-Dying Bill, Setting Stage for Showdown with House” (June 15, 2016), online: http://www.theglobeandmail.com/news/politics/assisted-dying-bill/article30482321/.

[301] Carter, note 280, para. 7. Also, when the Supreme Court’s declaration came into effect on June 6, before the federal law was passed, MAG and the MOHLTC encouraged patients and providers to continue to access the court system to clarify how Carter might apply to their circumstances, although a court application was no longer required. This process was intended to fill a temporary gap in the absence of federal legislation. See Government of Ontario, note 291.

[302] I.J. v. Canada (Attorney General), 2016 ONSC 3380.

[303] Canadian Association for Community Living, Assessing Vulnerability in a System for Physician-Assisted Death in Canada (April 2016), online: http://www.sacl.org/fileadmin/user_upload/CACL_Vulnerability_Assessment_Apr_8_2016_-_Final.compressed.pdf (last accessed July 26, 2016).

[304] See generally: Law Commission of Ontario, note 73, 239-243.

[305] HCCA, note 16, s. 32.

[306] HCCA, note 16, ss. 33, 51, 66.

[307] HCCA, note 16, ss. 35, 53, 68.

[308] HCCA, note 16, ss. 37, 54, 69.

[309] HCCA, note 16, ss. 35, 52, 67.

[310] For the fiscal year 2011-2012, over 80 per cent of all applications fell into these categories: Consent and Capacity Board, Annual Report 2011 – 2012, 5, online: http://www.ccboard.on.ca/scripts/english/governance/Annual-Reports.asp (last accessed July 26, 2016).

[311] Paula Chidwick, Robert Sibbald, Laura Hawryluck, “Best Interests at End of Life: An Updated Review of Decisions Made by the Consent and Capacity Board of Ontario” (2013) 28 Journal of Critical Care 22.

[312] Chidwick, note 311, 23-24.

[313] Chidwick, note 311, 24.

[314] HCCA,note 16, s.37; Consent and Capacity Board, “Applying to Determine Whether or Not the Substitute Decision Maker Has Complied with the Rules for Substitute Decision-Making (Form G)”, online: http://www.ccboard.on.ca/scripts/english/publications/infosheets.asp#sdm (last accessed July 26, 2016).

[315] HCCA, note 16, s.35; Consent and Capacity Board, “Applying to the Board for Directions (Form D)”, online: http://www.ccboard.on.ca/scripts/english/publications/infosheets.asp#sdm (last accessed July 26, 2016).

[316] HCCA, note 16, ss.33(5), 33(7), 35(3), 37(3), 37(4).

[317] See generally: Chidwick, note 311.

[318] HCCA, note 16, s. 75.

[319] HCCA, note 16, s. 80.

[320] Government of Ontario, note 87.

[321] RHPA, note 90, Schedule 2, Health Professions Procedural Code, s.25.

[322] College of Nurses of Ontario, Addressing Complaints at the College of Nurses of Ontario: Process Guide (October, 2015), online: http://www.cno.org/globalassets/docs/ih/42017_resolvingcomplaints.pdf.

[323] RHPA, note 90, Schedule 2 Health Professions Procedural Code, ss.25-56.

[324] See for instance: Health Professions Appeal and Review Board, “Health Professions Appeal and Review Board Complaint Reviews”, online: http://www.hparb.on.ca/scripts/english/default.asp (last accessed July 26, 2016); Health Professions Appeal and Review Board, “About Us”, online: http://www.hparb.on.ca/scripts/english/about.asp (last accessed July 26, 2016). HPARB also adjudicates other matters relating to health professionals registration within the regulatory colleges. See generally: Health Professions Appeal and Review Board, “Frequently Asked Questions”, online: http://www.hparb.on.ca/scripts/english/faq.asp (last accessed July 26, 2016).

[325] Health Professions and Health Services Appeal and Review Boards, Consolidated Rules of Practice and Procedure (effective May 1, 2013), Rule 17.

[326] Of most relevance to this project, HSARB has a review and appeal mandate under the Health Insurance Act, note 150; Home Care and Community Services Act, 1994, note 81; Long-Term Care Homes Act 2007, note 77. See: Health Services Appeal and Review Board, “About Us”, online: http://www.hsarb.on.ca/scripts/english/about.asp (last accessed July 26, 2016).

[327] Health Services Appeal and Review Board, “Welcome”, online: http://www.hsarb.on.ca/scripts/english/default.asp (last accessed July 26, 2016).

[328] Ministry of Health and Long-Term Care Appeal and Review Boards Act, 1998, S.O. 1998, c.18, Sch. H. Other sources of authority can be accessed on their websites along with legal sources for the administrative bodies that HPARB and HSARB review. Health Services Appeal and Review Board, “Legal”, online:

http://www.hsarb.on.ca/scripts/english/legal.asp (last accessed July 26, 2016); Health Professions Appeal and Review Board, “Legal”, online:

http://www.hparb.on.ca/scripts/english/legal.asp (last accessed July 26, 2016).

[329] The LCO has conducted case law research into the decisions of HPARB and HSARB. A search on CanLII using the terms “palliative, “end of life”, “do not resuscitate” and “DNR” produced a total of 132 results for HPARB of which 57 were deemed to be relevant, while a similar search produced only 8 relevant cases for HSARB.

[330] See for instance: A.D. v. A.R., 2013 CanLII 19385; J.D.S. v. E.G.D., 2013 CanLII 331; J.M. v. J.K., 2012 CanLII 37860; M.G. v. S.C., 2013 CanLII 97219; H.L. v. G.M., 2013 CanLII 28828; N.F. v. Y.B., 2014 CanLiI 25304.

[331] See for instance: D.M. v. F.G.S., 2016 CanLII 8871; R.S. v. S.K., 2015 CanLII 51943; H.T. v. B.S.P., 2015 CanLII 21986; E.G.J.W. v. M.G.C., 2014 CanLII 49888; R.R. v. G.R.N., 2014 CanLII 29254; J.T. v. D.L., 2013 CanLII 60999; C.H. v. K.R.M., 2013 CanLII 56307; C.A.H. v. M.S., 2012 CanLII 81785; M.C. v. J.M.J.L., 2012 CanLII 24422; E.P. v. L.M.H., 2012 CanLII 24450; C.S. v. S.K.D., 2012 CanLII 8649; J.R. v. D.B., 2012 CanLII 11358; C.H. v. M.S., 2011 CanLII 34788; T.F. v. T.J.B., 2010 CanLII 43571.

[332] Home Care and Community Services Act, 1994, note 81, ss.41(2), 48(3).

[333] Health Professions Appeal and Review Board, Health Services Appeal and Review Board & Ontario Hepatitis C Assistance Plan Review Committee, 2015 Annual Report (June 2015), 7.

[334] Law Commission of Ontario, note 73, 238.

[335] Bill 8, Public Sector and MPP Accountability and Transparency Act, 2014 (Royal Assent received 11 December 2014); Excellent Care for All Act, note 88, s.13.1.

[336] Government of Ontario, note 87.

[337] Government of Ontario, note 47 , 14.

[338] Excellent Care for All Act, note 88, s.13.1(9).

[339] Excellent Care for All Act, note 88, s.13.1(2). See also: Government of Ontario, note 87.

[340] Excellent Care for All Act, note 88, s.13.1(2), 13.3.

[341] Excellent Care for All Act, note 88, s.13.2(3).

[342] Government of Ontario, note 87.

[343] Employment Standards Act , 2000, S.O. 2000, c.41, ss. 49.1, 49.3, 49.4, 50.

[344] Occupational Health and Safety Act, R.S.O. 1990, c. O.1

[345] OHSA, note 344, ss.25-26, Part III.0.1.

[346] For example, the Standards Council of Canada has published a national standard psychological health and safety in the workplace. Standards Council of Canada, Psychological Health and Safety in the Workplace: Prevention, Promotion, and Guidance to Staged Implementation, National Standard of Canada Doc: CAN/CSA-Z1003-13/BNQ 9700-803/2013 (Ottawa: Standards Council of Canada, 2013).

[347] Ontario Ministry of Labour, “Roundtable of Traumatic Mental Stress: Ideas Generated”, online: http://www.labour.gov.on.ca/english/hs/pubs/tms/index.php (last accessed July 26, 2016); Ontario Ministry of Labour, Summit on Work-Related Traumatic Mental Stress: Summary Report (March 2015).

[348] Vital Statistics Act. R.S.O. 1990, c.V.4.

[349] AG 2014, note 1, 261.

[350] The Auditor General recommended that the MOHLTC link the Declaration of Partnership to a policy framework for approval by the government. AG 2014, note 1, 280. See also: Government of Ontario, note 194.

[351] For a discussion of the need for customization of palliative care for communities, see: Mary Lou Kelley & Holly Prince, A Framework to Guide Policy and Program Development for Palliative Care in First Nations Communities (January 2015), online: http://eolfn.lakeheadu.ca/project-results/reports (last accessed July 26, 2016). On the personalization of care, generally, see: Registered Nurses’ Association of Ontario, Person- and Family-Centred Care (Clinical Best Practice Guideline, 2015), online: http://rnao.ca/bpg/guidelines/person-and-family-centred-care (last accessed July 26, 2016).

[352] Fraser Report, note 46, 8.

[353] Fraser Report, note 46, 10-11.

[354] Declaration of Partnership, note 38, 19, 34.

[355] The World Health Organization has acknowledged that the terms “inequality” and “inequity” are synonymous in this context. Margaret Whitehead & Göran Dahlgren, Concepts and Principles for Tackling Social Inequities in Health: Levelling up Part 1, (Copenhagen: World Health Organization Regional Office for Europe, 2006), 4. For discussions about health inequity, also see: World Health Organization, “Social Determinants of Health: Key Concepts”, online: http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/ (last accessed 26 July June 2016); Paula Braveman, “What Are Health Disparities and Health Equity? We Need to Be Clear” (2014) 129:2 Public Health Reports 5; Mary Chiu, Adrian Grek, Sonia Meerai and others, “Understanding the lived experience of individuals, caregivers and families touched by frailty, chronic illness and dementia in Ontario” (Commissioned by the Law Commission of Ontario, 2016).

[356] To see a full list of the OHRC policies and guidelines and to access the same, see: Ontario Human Rights Commission, “Policies and Guidelines”, online: http://www.ohrc.on.ca/en/our_work/policies_guidelines (last accessed July 26, 2016).

[357] Ontario Human Rights Commission, Policy on Preventing Discrimination based on Creed (Ontario Human Rights Commission, 2015), 55.

[358] OHRC, note 357, 55.

[359] OHRC, note 357, 54-55, also citing Janssen v. Ontario Milk Marketing Board (1990), 13 C.H.R.R. D/397 (Ont. Bd. Inq.) at para. 30.

[360] See for instance: Corbiere v. Canada (Minister of Indian and Northern Affairs) [1999] 2 SCR 203, where the Supreme Court explored how new analogous grounds can be identified. In that case the Supreme Court found the following (at para. 13):

 

What then are the criteria by which we identify a ground of distinction as analogous?  The obvious answer is that we look for grounds of distinction that are analogous or like the grounds enumerated in s. 15 — race, national or ethnic origin, colour, religion, sex, age, or mental or physical disability.  It seems to us that what these grounds have in common is the fact that they often serve as the basis for stereotypical decisions made not on the basis of merit but on the basis of a personal characteristic that is immutable or changeable only at unacceptable cost to personal identity.  This suggests that the thrust of identification of analogous grounds at the second stage of the Law analysis is to reveal grounds based on characteristics that we cannot change or that the government has no legitimate interest in expecting us to change to receive equal treatment under the law.  To put it another way, s. 15 targets the denial of equal treatment on grounds that are actually immutable, like race, or constructively immutable, like religion.  Other factors identified in the cases as associated with the enumerated and analogous grounds, like the fact that the decision adversely impacts on a discrete and insular minority or a group that has been historically discriminated against, may be seen to flow from the central concept of immutable or constructively immutable personal characteristics, which too often have served as illegitimate and demeaning proxies for merit-based decision making.

 

[361] See for instance: Parker, note 110; Morgentaler, note 110.

[362] Carter, note 10, paras. 62, 64.

[363] Madore, note 100, 7.

[364] Madore, note 100, 7.

[365] See for instance: The Change Foundation, note 65, 6; HQO 2014, note 27; Sinha, note 68.

[366] The Change Foundation, note 65, 12; Law Commission of Ontario, note 73, 55; Carole A. Cohen, Angela Colantonio & Lee Vernich, “Positive Aspects of Caregiving: Rounding out the Caregiver Experience” (2002) 17:2 International Journal of Geriatric Psychiatry 184. See also: Sinha, note 68, 14, stating that 92% of caregivers felt that the experience of providing care was rewarding and that 70% expressed that their relationship with the care receiver had strengthened over the last 12 months.

[367] See for instance: Baidoobonso, note 5, 7.

[368] The Change Foundation, A Profile of Family Caregivers in Ontario (Toronto: The Change Foundation, 2016), 14.

[369] The Change Foundation, note 368, 15.

[370] The Change Foundation, note 368, 14.

[371] There are several types of leave protection under the Employment Standards Act that caregivers could potentially take advantage of, including Family Medical Leave, Family Caregiver Leave, Critically Ill Child Care Leave and Personal Emergency Leave. For a summary of these categories, including what they require and provide, see: Ontario Ministry of Labour, “Leaves of Absence”, online: https://www.labour.gov.on.ca/english/es/pubs/brochures/br_leaves.php (last accessed 28 July 2016). See also ESA, note 343, ss. 49.1, 49.3, 49.4, 50.

[372] ESA, note 343, ss. 49.1.

[373] See also: Fraser Report, note 46, 16-17.

[374] Employment Standards Amendment Act (Leaves to Help Families), 2014, S.O. 2014, c. 6; Government of Ontario, “Caregivers Leaves to Help Families Now in Effect”, online: https://news.ontario.ca/mol/en/2014/10/caregiver-leaves-to-help-families-now-in-effect.html (last accessed 28 July 2016).

[375] There are, however, different heads for leave under the federal regime just as there are in Ontario. The federal leave protections for critically ill children provide for fewer weeks than in Ontario. See: Canada Labour Code, R.S.C 1985, c.L-2, ss. 206.3, 206.4; Employment and Social Development Canada, “Information on Labour Standards No. 5A – Compassionate Care Leave,” LT-172-10-14E; Employment and Social Development Canada, “Information on Labour Standards No. 5B – Leave Related to Critical Illness,” LT-263-10-14E.

[376] Employment Insurance Act, 2010, S.C. 1996, c.23, ss.23.1 (2), 23.2 (1).

[377] There is a 2 week waiting period to receive EI benefits, which accounts for the difference between 28 weeks of leave and 26 weeks of benefits. ESA, note 343, s. 13.

[378] Samir Sinha, Bailey Griffin, Thom Ringer, and others, An Evidence-Informed National Seniors Strategy for Canada (January 2016), 121, 123. For information on challenges with federal caregiver benefits see the following (but note that these articles were published prior to recent changes in the duration of benefits from 6 to 26 weeks): British Columbia Law Institute & Canadian Centre for Elder Law, Care/Work: Law Reform to Support Family Caregivers to Balance Paid Work and Unpaid Caregiving (BCLI/CCEL Study Paper No. 4, February 2010); Jenny Flagler & Weizhen Dong, “The Uncompassionate Elements of the Compassionate Care Benefits Program: A Critical Analysis” (2010) 17:1 Global Health Promotion 50; Allison M. Williams, Jeanette Eby, Valorie Crooks and others, “Canada’s Compassionate Care Benefit: Is it an Adequate Public Health Response to Addressing the Issue of Caregiver Burden in End-of-Life Care?” (2011) 11:335 BMC Public Health 1; Melissa Giesbrechtetal., Valorie A Crooks, Allison Williams and others, “Critically examining diversity in end-of-life family caregiving: implications for equitable caregiver support and Canada’s Compassionate Care Benefit” (2012) 11 International Journal for Equity in Health 65; Valorie A Crooks, Allison Williams, Kelli I Stajduhar and others, “Family caregivers’ ideal expectations of Canada’s Compassionate Care Benefit” (2012) 20:2 Health and Social Care in the Community 172; Melissa, Giesbrecht, Valorie A Crooks, Allison, Williams, “Perspectives from the frontlines: palliative care providers’ expectations of Canada’s compassionate care benefits programme” (2010) 18:6 Health and Social Care in the Community 643.

[379] Regarding respite care, Ontario offers two types of services. One type provides home-based services (for example, homemaking services) to the person under care, giving the caregiver temporary relief. The legislation generally establishes maximum hours in any given period for which homemaking and personal support services may be provided to a qualifying person under care. These services would be paid by the government if the person under care qualifies. As well, it is possible to request that the person under care who otherwise lives at home, stay in an institution temporarily as respite for the caregiver, if certain qualifications are met. The duration of each short-term residency may general reach up to 60 days per visit to a maximum of 90 days per year. See also: Government of Ontario, “Temporary Respite Care for Caregivers”, online: https://www.ontario.ca/page/temporary-respite-care-caregivers (last accessed 28 July 2016); O. Reg. 386/99, note 165, ss. 2, 3. On tax credits, see: Income Tax Act, R.S.C 1985, c.1, ss. 118(1)(c.1), 118(1)(d); Taxation Act, 2007, S.O. 2007, c.11, Sch.A, ss.9(5). 9(6).

[380] Fraser Report, note 46, 16-17.

[381] Ontario Caregiver Coalition, “Where We Stand”, online: http://www.ontariocaregivercoalition.ca/the-work-we-do.html (last accessed 28 July 2016); Ontario Caregiver Coalition, “Caregiver Allowance”, online: http://www.ontariocaregivercoalition.ca/caregiver-allowance.html (last accessed 28 July 2016).

[382] Government of Nova Scotia, “Caregiver Benefit”, online: http://novascotia.ca/dhw/ccs/caregiver-benefit.asp (last accessed 28 July 2016); Department of Health and Wellness Continuing Care Branch, Government of Nova Scotia, “Caregiver Benefit Program Policy” (revised Oct. 2012).

[383] See for instance: Ontario Caregiver Coalition, note 381; Employment Rights Act, 1996, 1996, c. 18 (UK); Care Act 2014, 2014, c. 23 (UK); CarersUK, Supporting Working Carers: A Guide to Requesting Flexible Working, online: http://www.carersuk.org/files/helpandadvice/2612/supporting-working-carers-a-guide-to-requesting-flexible-working-june-2014.pdf (last accessed 28 July 2016); Teppo Kroger and Sue Yeandle, eds., Combining Paid Work and Family Care University of Bristol: Policy Press, 2014); Gov.UK, Flexible Working, online: https://www.gov.uk/flexible-working (last accessed 28 July 2016); Fair Work Act 2009, No. 28, 2009 (Australia); Australian Government, Sick and Carer’s Leave, online: https://www.fairwork.gov.au/leave/sick-and-carers-leave (last accessed 28 July 2016); Australian Government, Personal/Carer’s Leave, online: https://www.fairwork.gov.au/how-we-will-help/templates-and-guides/fact-sheets/minimum-workplace-entitlements/personal-leave-and-compassionate-leave#personal-carers-leave (last accessed 28 July 2016).

[384] Care Act 2014 (UK), note 383; Carer Recognition Act 2010 (Australia); Australian Government, “Carer Gateway”, online: https://www.carergateway.gov.au (last accessed 29 July 2016); United Kingdom Government, “CarersUK”, online: https://www.gov.uk/carers-uk (last accessed 28 July 2016). The UK Government’s website contains minimal information, but it sponsors the charity CarersUK.

[385] Declaration of Partnership, note 38, 38.

[386] Centre for Addition and Mental Health, “About Therapy”, online: http://www.camh.ca/en/hospital/visiting_camh/rights_and_policies/Pages/challenges_choices_abouttherapy.aspx (last accessed 29 July 2016).

[387] See for instance: Hospice Toronto, “Services and Programs”, online: http://www.hospicetoronto.ca/Page.asp?IdPage=6777&WebAddress=hospice (last accessed 29 July 2016).

[388] ESA, note 343, ss. 49.1(5).

[389] Fraser Report, note 46, 17.

[390] Daryl Bainbridge, Hsien Seow, Jonathan Sussman and others, “Factors Associated with Acute Care Use Among Nursing Home Residents Dying of Cancer: A Population-Based Study” (2015) 21:7 International Journal of Palliative Nursing 349, 349; J Kinley, K Froggatt, MI Bennett, “The Effect of Policy on End-Of-Life Care Practice within Nursing Care Homes: A Systematic Review (2013) 27:3 Palliative Medicine 209; Peter Brink & Mary Lou Kelley, “Death in Long-Term Care: A Brief Report Examining Factors Associated with Death within 31 Days of Assessment” (2015) 9 Palliative Care: Research and Treatment 1.

[391] Ontario Long-Term Care Association, note 157, 2, citing data from the Canadian Institute for Health Information, CCRS Continuing Care Reporting System: Profile of Residents in Continuing Care

Facilities 2014-2015, online: https://www.cihi.ca/en/ccrs-profile-of-residents-in-continuing-care-facilities-2014-2015-0 (last accessed March 21, 2017).

[392] Bainbridge, note 390, 349.

[393] LTCHA, note 77, s. 1.

[394] LTHCA, note 77, s. 6.

[395] LTHCA, note 77, s. 14.

[396] LTHCA, note 77, s. 9; O.Reg. 79/10, note 77, ss. 26, 27, 30, 48.

[397] LTCHA, note 77, s.76(7).

[398] O.Reg. 79/10, note 77, s.42.

[399] See for instance: Kevin Brazil, Michel Bédard, Paul Kreuger, and others, “Barriers to Providing Palliative Care in Long-Term Care Facilities” (2006) 52 Canadian Family Physician 472, based on a literature review and survey of 275 long-term care home medical directors in 302 facilities in Ontario. Also see: Bainbridge, note 390; Kevin Brazil, Peter Brink, Sharon Kaasalainen, and others, “Knowledge and Perceived Competence among Nurses Caring for the Dying in Long-Term Care Homes” (2012) 18:2 International Journal of Palliative Care 77.

[400] See for example: Health Quality Ontario, “Long-Term Care Home Residents Experiencing Pain, 2010-2016,” online: http://www.hqontario.ca/System-Performance/Long-Term-Care-Home-Performance/Pain (last accessed March 21, 2017).

[401] Brazil, note 399; Jill Marcella and Mary Lou Kelley, “’Death is Part of the Job” in Long-Term Care Homes: Supporting Direct Care Staff with their Grief and Bereavement” (2015) Sage Open Access 5; Bainbridge, note 390, 349.

[402] See for instance: R. Sean Morrison, “Research Priorities in Geriatric Palliative Care: An Introduction to a New Series” (2013) 16:7 Journal of Palliative Medicine 726; J Kapo, LJ Morrison & S Liao, “Palliative Care for the Older Adult” (2007) 10:1 Journal of Palliative Medicine 185; The World Health Organization, Palliative Care for Older People: Better Practices (WHO, 2011); Laura M. Pal & Lisa Manning, “Palliative Care for Frail Older People” (2014) 14:3 Clinical Medicine 292; Tanneguy Pialoux, Jean Goyard & Raymon Hermet, “When Frailty Should Mean Palliative Care” (2013) 3:7 Journal of Nursing Education and Practice 75. For an exploration of tools to assess frailty for clinical purposes, see: Chiu et al., note 355.

[403] LTCHA, note 77, s. 17, O. Reg. 79/10, note 77, s. 31.

[404] Sharon Kaasalainen, Kevin Brazil & Mary Lou Kelley, “Building Capacity in Palliative Care for Personal Support Workers in Long-Term Care through Experiential Learning” (2012) 9:2 International Journal of Older People Nursing 1; Brazil, note 399; Marcella & Kelley, note 401, 2.

[405] Bainbridge, note 390, 354.

[406] See also: Bainbridge, note 390, 355; Brazil, note 399.

[407] See for instance: Lisa Romano, “Legal Protections for Residents of Retirement Homes in Ontario,” Canadian Conference on Elder Law (Advocacy Center for the Elderly, October 2010), online: http://www.lco-cdo.org/ccel-papers/1B%20-%20Lisa%20Romano.pdf (last accessed 28 July 2016) [ACE, Retirement Homes].

[408] ACE, Retirement Homes, note 407, 1.

[409] RHA, note 147, s.2.

[410] RHA, note 147, s.2.

[411] See for instance: Brantford Expositor, “Couple Evicted from Retirement Home,” (July 2012), online: http://www.brantfordexpositor.ca/2012/07/17/couple-evicted-from-retirement-home (last accessed 28 July 2016); ACE, Retirement Homes, note 407, 8.

[412] RHA, note 147, s. 61. The Bill of Rights also contains similar provisions.

[413] RHA, note 147, Residents’ Bill of Rights; RTA, note 147, s.147.

[414] RTA, note 147, s.148(1).

[415] RTA, note 147, section 148.

[416] Retirement Homes Regulatory Authority, “Complaints”, online: http://www.rhra.ca/en/complaints/; RHA, note 147, ss.81-84; Social Justice Tribunals of Ontario, Landlord and Tenant Board, “Application and Hearing Process”, online: http://www.sjto.gov.on.ca/ltb/application-and-hearing-process/#step2; Residential Tenancies Act, 2006, note 147, ss.9, 29.

[417] The LCO received information to this effect in our consultation. See also: ACE, Retirement Homes, note 407, 1.

[418] National Aboriginal Health Organization “Discussion Paper on End of Life/ Palliative Care for Aboriginal Peoples” (2002), 1-7, online: http://www.naho.ca/documents/naho/english/publications/ReB_palliative_care.pdf (last accessed 28 July 2016)[National Aboriginal Health Organization]; Ministry of Health and Long-Term Care, “Ontario Launches $222M First Nations Action Health Plan” (2016) online: https://news.ontario.ca/mohltc/en/2016/05/ontario-launches-222-million-first-nations-health-action-plan.html (last accessed 28 July 2016) [Ontario First Nations Health Action Plan].

[419] National Aboriginal Health Organization, note 418, 1-7; Ontario First Nations Health Action Plan, note 418.

[420] Truth and Reconciliation Commission of Canada, Calls to Action (Winnipeg, 2015), Call to Action #18, online: http://www.trc.ca/websites/trcinstitution/File/2015/Findings/Calls_to_Action_English2.pdf (last accessed March 21, 2017).

[421] Department of Finance, “Growing the Middle Class”, Budget 2016 (March 2016), 143, online: http://www.budget.gc.ca/2016/docs/plan/budget2016-en.pdf (last accessed 28 July 2016); Ontario First Nations Health Action Plan, note 418.

[422]Ontario First Nations Health Action Plan, note 418.

[423] Ontario First Nations Health Action Plan, note 418.

[424] For example, the Meno Ya Win Health Centre in Sioux Lookout (which is being allocated funds under the Ontario First Nation Action Health Plan) offers long-term care beds, and palliative care services as part of a holistic health centre model. See: “William ‘Bill’ George Extended Care Centre Programs and Services” online: http://www.slmhc.on.ca/william-bill-george-extended-care (last accessed 28 July 2016).

[425] Ontario First Nations Health Action Plan, note 418.

[426] Health Canada, First Nations and Inuit Health Branch, “Roles and Responsibilities”, online: http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/fact-fiche-eng.php (last accessed 28 July 2016) [FNIHB].

[427] Health Insurance Act, note 150, s.10.

[428] National Aboriginal Health Organization, note 418, 5, 8-9.

[429] First Nations Child and Family Caring Society of Canada v Attorney General of Canada, 2016 CHRT 2.

[430] FNIHB, note 426.

[431] Community Access Care Centre Client Service Policy Manual, “Eligibility Criteria for CCAC Services” online: http://www.health.gov.on.ca/english/providers/pub/manuals/ccac/ccac_3.pdf (last accessed 3 August 2016).

[432] Centre for Education on Aging & Health, “Provision of Palliative and End of Life Services to First Nations Communities”(2013), online: http://eolfn.lakeheadu.ca/wp-content/uploads/2013/08/Provision_of_Palliative_Care_to_Ontario_FN_Communities_April_2013_FINAL.pdf (last accessed 3 August 2016).

[433] Aboriginal Health Access Centres, Our Health, Our Seventh Generation, Our Future: 2015 Aboriginal Health Access Centres Report (2015), 5, online: https://www.aohc.org/sites/default/files/documents/2015%20AHAC%20Report%20-%20Copy.pdf (last accessed 3 August 2016).

[434] Carrie Bourassa & Melissa Bendig, Experiences of First Nations, Inuit and Métis People with Advanced Cancer Illness and at the End of Life: KT Tools Project Literature Review and Current State (Winnipeg: Canadian Virtual Hospice, 2015), 10.

[435] Aboriginal Health Access Centres, note 433, 11.

[436] National Aboriginal Health Organization, note 418, 1-7; Ontario First Nations Health Action Plan, note 418.

[437] See also: Office of the Auditor General of Canada, “Access to Health for Remote First Nations Communities” (2015), 3, online: http://www.oag-bvg.gc.ca/internet/English/parl_oag_201504_04_e_40350.html (last accessed 3 August 2016); TRC, note 420, 18.

[438] Daniels v. Canada (Indian Affairs and Northern Development), 2016 SCC 12.

[439] Northwest LHIN, “Annual Report 2014/2015: Advancing Transformation Through Innovation and Collaboration”, 10, online: http://www.northwestlhin.com/accountability/AnnualReports.aspx (last accessed 3 August 2016).

[440] See for example: Webequie First Nation, “Nursing Station” online: http://www.webequie.ca/article/nursing-station-137.asp (last accessed August 4, 2016); Sioux Lookout First Nation Health Authority, “About” online: http://www.slfnha.com/ (last accessed August 4, 2016); Weeneebayko Area Health Authority, “About Us”, online: http://www.weeneebaykohealth.ca/ (last accessed August 4, 2016).

[441] Aboriginal Health Access Centres, note 433; Aboriginal Health Access Centres and Aboriginal Community Health Centres, Report to the Community (2016), 3, online: https://www.aohc.org/sites/default/files/documents/AHAC_Aboriginal_CHC_Report_2016.pdf (last accessed August 4, 2016).

[442] Bourassa & Bendig, note 434, 14-15.

[443] Bourassa & Bendig, note 434, 14-15; Lauren Baba, Cultural Safety in First Nations, Inuit and Métis Public Health (Prince George, BC: National Collaborating Centre for Aboriginal Health, 2013); National Collaborating Centre for Aboriginal Health, “Cultural Safety in Healthcare”, online: http://www.nccah-ccnsa.ca/368/Cultural_Safety_in_Healthcare.nccah (last accessed August 4, 2016).

[444] For instance: Len Kelly and Alana Minty, “End of Life Issues of Aboriginal Patients” (2007) 53:9 Canadian Family Physician 1459; Len Kelly, Barb Linkewich, Natalie St Pierre-Hansen, and others, “Palliative Care of First Nations People” (2009) 55:4 Canadian Family Physician 394; Thunder Bay Regional Health Sciences Centre, “Aboriginal Patient Navigators Provide Support to Aboriginal Patients” (2016) online: http://www.tbrhsc.net/aboriginal-health-at-tbrhsc/ (last accessed August 4, 2016); Joseph M. Kaufert, “Cultural Mediation in Cancer Diagnosis and End of Life Decision-Making: The Experience of Aboriginal Patients in Canada” (1999) 6:3 Anthropology & Medicine 405. See also: RNAO, “Embracing Cultural Diversity in Health Care: Developing Cultural Competence” (2007), online: http://rnao.ca/bpg/guidelines/embracing-cultural-diversity-health-care-developing-cultural-competence (last accessed August 4, 2016).

[445] National Aboriginal Health Organization, note 418, 1-7.

[446] Direct references to health services can be found in Treaties, such as in Treaty 6, which covers Central Alberta and Saskatchewan. Treaty 6 contains a ‘medicine chest provision’ and stipulates that medicines should be used “for the use and benefit of the Indians at the discretion of [the Indian agent]”. While no such explicit language is found in any of the numbered or historical Treaties in Ontario, the Nishnawbe Aski Nation (NAN) has taken the official position that there is a treaty right, or a fiduciary duty, on the part of the Crown to provide health services for Indigenous peoples. See: Nishawbe Aski Nation, “Political Bilateral Framework on Healthcare” (Resolution 01152, March 2001), online: http://www.slfnha.com/files/6113/9999/3848/NAN_01-52_Political_Bilateral_Framework_on_Health_Care.pdf (last accessed March 21, 2017). Further, the current Regional Chief of NAN argues that the First Nation treaty partnership with Ontario is not upheld by the current regional health scheme of the LHINs. He stated: “LHINS reduce local control of health delivery by existing First Nation health authorities, making the system even more ‘centralized’ and culturally insensitive than it already is”. See: KNet Media, “NAN Defends Treaty Rights to Health Services in Rejection of Provincial LHINs” (March 1, 2006), online: http://media.knet.ca/node/1881 (last accessed March 21, 2017). As for claims regarding Aboriginal rights to traditional healing, one Ontario case is illustrative. It reveals tensions at the interface of Aboriginal rights under the Constitution, decision-making laws under the HCCA and child protection laws. Hamilton Health Sciences Corp v D.H, 2014 ONCJ 603 [Hamilton Health Sciences Corp.], concerned a dispute over whether child with cancer from Six Nations of the Grand River (J.J.) should be treated with chemotherapy. Her mother considered chemotherapy to fall outside the bounds of traditional medicine, and refused to consent to treatment on J.J.’s behalf. The treating physician and health facility disputed the mother’s authority to make this decision as a matter of child protection and the Brant Family and Children’s Service became involved. In the first instance, the court recognized a section 35 Aboriginal right in the area of traditional healing practices and allowed for J.J.’s mother to reject treatment. However, this judgement raised serious concerns about the balance between child protection and Aboriginal rights, and the Attorney General for Ontario became involved in a motion before the presiding judge. The judge subsequently amended his reasons at Hamilton Health Sciences Corp. v. D.H., 2015 ONCJ 229, stating instead that “implicit in this decision is that recognition and implementation of the right to use traditional medicines must remain consistent with the principle that the best interests of the child remain paramount. The Aboriginal right to use traditional medicine must be respected, and must be considered, among other factors, in any analysis of the best interests of the child, and whether the child is in need of protection” (at para 83(a)).

[447] TRC, note 420.

[448] Centre for Education on Aging & Health, note 432; Northwest LHIN, note 439, 10; Northeast LHIN “Annual Report 2014/2015”, 25, online: http://www.nelhin.on.ca/accountability/annualreports.aspx (last accessed August 4, 2016).

[449] Canadian Observatory on Homelessness, “Canadian Definition of Homelessness” (2012), online: www.homelesshub.ca/sites/default/files/COHhomelessdefinition.pdf (last accessed March 21, 2017).

[450] Stephen Hwang, Manal Guirguis-Younger & Ryan McNeil, “Introduction” in Stephen Hwang, Manal Guirguis-Younger & Ryan McNeil, eds, Homelessness and Health in Canada (Ottawa: University of Ottawa Press, 2014), 1.

[451] Lise Huynh, Blair Henry & Naheed Dosani, “Minding the gap: access to palliative care and the homeless” (2015) 14:62 BMC Palliative Care 1, 2.

[452] Yonah Krakowsky, Miriam Gofine, Pnina Brown, and others, “Increasing Access – A Qualitative Study of Homelessness and Palliative Care in a Major Urban Center” (2013) 30:3 American J Hospice & Palliative Medicine 268, 268.

[453] For an excellent review of homelessness and palliative care see: Rafael Sumalinog, Katy Harrington, Naheed Dosani and others, “Advance Care Planning, Palliative Care and End-of-Life Care Interventions for Homeless People: A Systematic Review” (2016) Palliative Medicine 1, 1, online: http://pmj.sagepub.com/content/early/2016/06/01/0269216316649334.full.pdf?ijkey=PHGWMJnJbLRU3bL&keytype=finite.

[454] C. James Frankish, Stephen W. Hwang & Darryl Quantz, “Homelessness and Health in Canada: Research Lessons and Priorities” (2005) 96 Can J Public Health S23, S26.

[455] Vicky Stergiopoulous, “Collaborative Approaches to Community-Based Mental Health Care for Homeless People: Toronto’s Inner City Health Associates” in Stephen Hwang, Manal Guirguis-Younger & Ryan McNeil, eds, Homelessness and Health in Canada, (Ottawa: University of Ottawa Press, 2014), 277.

[456] Eleanor R Pineau, “Briefing Note: Palliative care for the homeless: an intervention to reduce the healthcare economic cost” (2014) 5 Western Undergraduate Research J: Health & Natural Sciences 1, 1.

[457] Stergiopoulous, note 455, 277.

[458] Hwang, note 450, 2; Frankish, note 454, S26.

[459] Frankish, note 454, S26.

[460] Frankish, note 454, S26.

[461] See also: Roger Collier, “Bringing palliative care to the homeless” (2011) 183:6 Can Medical Association J E317, E317.

[462] Lynn McDonald, Julie Dergal & Laura Cleghorn, “Homeless Older Adults Research Project: Executive Summary”, (2004), online: http://www.toronto.ca/legdocs/2005/agendas/committees/rse/rse050301/it005.pdf (last accessed August 4, 2016).

[463] Declaration of Partnership, note 38, 84.

[464] Fraser Report, note 46, 11.

[465] Huynh, note 451, 2.

[466] On street nurses, see for instance: Toronto Metro, “Toronto Street Nurse Becomes Tireless Advocate for Homeless” (May 9, 2011), online: http://www.metronews.ca/news/canada/2011/05/09/toronto-street-nurse-becomes-tireless-advocate-for-homeless.html (last accessed March 21, 2017).

[467] Sheryl Ubelacker, “Palliative care program helps homeless in their final days,” The Toronto Star (August 3, 2014), online: https://www.thestar.com/news/gta/2014/08/03/palliative_care_program_helps_homeless_in_their_final_days.html (last accessed August 4, 2016).

[468] Inner City Health Associates, PEACH online: http://www.icha-toronto.ca/programs/peach (last accessed August 4, 2016). See also: The Toronto Star, “Nurse Helps Homeless Die with Dignity” (May 6, 2016), online: https://www.thestar.com/life/nursing/2016/05/06/nurse-helps-homeless-die-with-dignity.html (last accessed August 4, 2016); Ubelacker, note 467.

[469] Ottawa Inner City Health, “Mission Hospice Program” online: http://ottawainnercityhealth.ca/uploads/files/Program_Desc_/OICH_Hospice_Program_Read_More_Document1.pdf (last accessed August 4, 2016).

[470] Tina Podymow, “Shelter-based palliative care for the homeless terminally ill” 20 Palliative Medicine 81, 84.

[471] Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008, S.O. 2008, c.14.

[472] Kathryn M. Yorkston, Kara A. McMullan, Ivan Molton and others, “Pathways of Change Experienced by People Aging with Disability: a Focus Group Study” (2010) 32:20 Disability and Rehabilitation 1697. For a discussion of intersections between aging and disability, see: Law Commission of Ontario, note 73, 50-52.

[473] Deborah Stienstra & Harvey Max Chochinov, “Vulnerability, Disability, and Palliative End-of-Life Care” (2006) 22:3 J Palliative Care 166, 168.

[474] Stienstra & Chochinov, note 473.

[475] Stienstra & Chochinov, note 473.

[476] Deborah Stienstra, April D’Aubin & Jim Derksen, “Heightened Vulnerabilities and Better Care for all: Disability and End-of-Life Care” (2012) 10 Palliative & Supportive Care 17, 20; Irene Tuffrey-Wijne, “The palliative care needs of people with intellectual disabilities: a literature review” (2003) 17 Palliative Medicine 55, 55.

[477] VP-Net, “Policy Issues – Palliative Care and People with Disabilities”, online: http://www.umanitoba.ca/outreach/vpnet/dpc.htm (last accessed August 4, 2016).

[478] Stienstra, note 476, 23.

[479] Stienstra, note 476, 18.

[480] Stienstra, note 476, 20.

[481] Jim Derksen & Harvey Max Chochinov, “Disability and End-of-Life Care: Let the Conversation Begin” (2006) 22:3 J of Palliative Care 175, 177; Stienstra & Chochinov, note 473, 171.

[482] Derksen & Chochinov, note 481, 177.

[483] Barbara Gibson, Barbara Secker, Debbie Rolfe, Frank Wagner, Bob Parke & Bhavnita Mistry, “Disability and Dignity-Enabling Home Environments” (2012) 74 Social Science & Medicine 211, 214, writing on younger persons with disabilities ; Irene Tuffrey-Wijne, “The palliative care needs of people with intellectual disabilities: a literature review” (2003) 17 Palliative Medicine 55, 55.

[484] Ontario Partnership on Aging & Developmental Disabilities, “About OPADD: Frequently Asked Questions”, online: http://opadd.on.ca (last accessed August 4, 2016).

[485] Ontario, Ministry of Community and Social Services, Opportunities and Action: Transforming Supports in Ontario for People Who Have a Developmental Disability (Toronto: Queen’s Printer for Ontario, 2006), 25, online: http://www.mcss.gov.on.ca/documents/en/mcss/publications/developmental/DSreport.pdf (last accessed August 4, 2016); Ontario, Legislative Assembly, Official Report of Debates (Hansard), 38th Parl, 2nd Sess, No L136 (13 December 2006) (Shelley Martel).

[486] Carter, note 10, para. 115.

[487] Wahl 2016, note 44, 4, citing Dr. Nadia Incardona & Dr. Jeff Myers, Advance Care Planning Conversation Guide: Clinician Primer (2016), 3, online: http://acpww.ca/wp-content/uploads/2016/01/ACP-Conversation-Guide-Clinician-Primer.pdf (last accessed August 18, 2016).

[488] Wahl 2016, note 44 4, citing Incardona & Myers, note 487, 3. See also: Daren K. Heyland, Doris Barwich, Deb Pichora and others, “Failure to Engage Hospitalized Elderly Patients and Their Families in Advance Care Planning” (2013) 173:9 JAMA Intern Med 778; Alexi A Wright, Baohui Zhang, Alaka Ray and others, “Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment” (2008) 300:14 JAMA 1665; Canadian Hospice Palliative Care Association. “Speak Up” (2013), online: http://www.advancecareplanning.ca (last accessed August 18, 2016); Karen M. Detering, Andrew D. Hancock, Michael C. Reade and others, “The impact of advance care planning on end of life care in elderly patients: randomised controlled trial” (2010) 340 BMJ 1; Baohui Zhang, Alexi A. Wright, Haiden A. Huskamp and others, “Health Care Costs in the Last Week of Life Associations with End-of-Life Conversations (Clinical Report)” (2009) 169:5 Arch Intern Med 480.

[489] Incardona & Myers, note 487, 3.

[490] Wahl 2016, note 44, 1.

[491] See also: Wahl 2016, note 44, Part IV “Findings;” Wahl 2014, note 44.

[492] Wahl 2016, note 44.

[493] HCCA, note 16, ss.10, 25.

[494] All persons are presumed to be capable of consent to treatment under the HCCA and health care providers are entitled to rely on that presumption, unless they have reasonable grounds to believe that the patient is incapable. HCCA, note 16, s.4.

[495] HCCA, note 16, s.21.

[496] HCCA, note 16, s.5.

[497] HCCA, note 16, s.21.

[498] HCCA, note 16, s.11.

[499] HCCA, note 16, s.2. See also: Wahl 2014, note 44, 20, 49-50.

[500] HCCA, note 16, s.2.

[501] Wahl 2014, note 44, 20.

[502] Wahl 2016, note 44, 27.

[503] Wahl 2016, note 44, 27-28, citing Jeff Myers, Leah Steinberg & Nadia Incardona, “The goals of care discussion” (unpublished paper).

[504] Wahl 2016, note 44, 27-28.

[505] See for instance, Alberta Health Services, “Goals of Care Designations”, online: https://myhealth.alberta.ca/Alberta/Pages/advance-care-planning-goals-of-care-designations.aspx (last accessed August 18, 2016).

[506] Myers, note 503.

[507] Myers, note 503.

[508] Wahl 2016, note 44, 28.

[509] Myers, note 503.

[510] Law Commission of Ontario, 73, 19.

[511] Government of Ontario, “Do Not Resuscitate Confirmation Form”, online: http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ENV=WWE&NO=014-4519-45 (last accessed August 18, 2016).

[512] Wahl 2016, note 44, Part IV.A.

[513] Wahl 2016, note 44, Part IV.A.

[514] Wahl 2016, note 44, Part V.C.

[515] Wahl 2016, note 44, 47.

[516] Wahl 2016, note 44, 77

[517] Wahl 2016, note 44, 60.

[518] Wahl 2016, note 44, 60.

[519] Wahl 2016, note 44, 33.

[520] Wahl 2016, note 44, vi.

[521] Wahl 2016, note 44, 4.

[522] Wahl 2016, note 44, 39.

[523] Wahl 2016, note 44, 60.

[524] Wahl 2016, note 44, 60.

[525] DNR Confirmation Forms were created as a practical solution to the limited scope of practice for emergency responders who must attempt resuscitation by law if a person has had a cardiac arrest. The DNR Confirmation Form, online: http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ENV=WWE&NO=014-4519-45 (last accessed August 18, 2016).

[526] Wahl 2016, note 44, 60.

[527] Wahl 2016, note 44, v.

[528] Wahl 2016, note 44, v.

[529] Wahl 2016, note 44, 52.

[530] Wahl 2016, note 44, 72.

[531] Wahl 2016, note 44, 34.

[532] Wahl 2016, note 44, 35.

[533] Wahl 2016, note 44, 36.

[534] Law Commission of Ontario, note 17, 92-94.

[535] Law Commission of Ontario, note 17, 93.

[536] Law Commission of Ontario, note 17, 98-102.

[537] Law Commission of Ontario, note 17, 110-111.

[538] Law Commission of Ontario, note 17, 113.

[539] Law Commission of Ontario, note 17, 317.

[540] Law Commission of Ontario, note 17, 319-321.

[541] Law Commission of Ontario, note 17, 320.

[542] Law Commission of Ontario, note 17, 320.

[543] Law Commission of Ontario, note 17, 314-316.

[544] Alberta Health, “Advance Care Planning: Tools and Checklists”, online: https://myhealth.alberta.ca/Alberta/Pages/advance-care-planning-tools-and-checklist.aspx (last accessed August 18, 2016).

[545] Wahl 2016, note 44, 78-79.

[546] Wahl 2016, note 44, 79-80.

[547] Wahl 2016, note 44, 81.

[548] Wahl 2016, note 44, 81.

[549] Hospice Palliative Care Ontario, “Advance Care Planning and Health Care Consent for Health Service Providers: Health Care Consent Advance Care Planning Community of Practice”, online: http://www.hpco.ca/acp-hcc-hsp/ (last accessed August 18, 2016).

[550] Hospice Palliative Care Ontario, note 549; Advocacy Centre for the Elderly, “Health Care Consent & Advance Care Planning”, online: http://www.advocacycentreelderly.org/advance_care_planning_-_introduction.php (last accessed August 18, 2016).

[551] Rosario G. Cartagena, Alison K. Thompson, Kaveh Katebian and others, “Understanding the Relationship between Suffering and Capacity at the End-of-Life: A Pilot Study” (Commissioned by the Law Commission of Ontario, December 2016), 34, online: http://www.lco-cdo.org/wp-content/uploads/2010/10/Cartagena%20et%20al.pdf (last accessed March 23, 2017).

[552] Cartagena, note 551, 34-35.

[553] Fleming, note 136.

[554] HCCA, note 16, s. 1(c).

[555] LCO, note 18.

[556] Manitoba Law Reform Commission, note 43, 37.

[557] Cartagena, note 551, 54.

[558] Cartagena, note 551, 53.

[559] See for instance: Molly L. Olsen, Keith M. Swetz & Paul S. Mueller, “Ethical Decision Making with End of Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments” (2010) 85:10 Mayo Clin Proc 949, 951.

[560] Manitoba Law Reform Commission, note 43, 92.

[561] Cartagena, note 551, 23-25.

[562] Manitoba Law Reform Commission, note 43, 15.

[563] Jocelyn Downie, Lindy Wilmott, Ben P White, “Next Up: A Proposal for Values-Based Law Reform on Unilateral Withholding and Withdrawal of Potentially Life-Sustaining Treatment” (2017) 54(3) Alberta Law Review (forthcoming).

[564] LCO, note 18, 74-75.

[565] Rodriguez v British Columbia (Attorney General) [1993] 3 SCR 519.

[566] Downie, note 563.

[567] Rasouli, note 20, paras. 64-68.

[568] Joan Gilmour, “Death, Dying and Decision-Making about End of Life Care”, in Jocelyn Downie, Timothy Caulfield & Colleen Flood, eds, Canadian Health Law and Policy (4th ed) (Markham, Ont.: LexisNexis Canada Inc., 2011), 387-388.

[569] Malette v. Shulman, (1990) 72 OR (2d) 417 (CA).

[570] Carter, note 10, paras. 63, 67.

[571] Carter, note 10, para. 67, citing Fleming, note 136. Also referring to: Ciarlariello v. Schacter [1993] 2 SCR 119; Malette, note 569; Nancy B. v. Hotel-Dieu de Quebec (1992) 86 DLR (4th) 385 (Que. Sup. Ct).

[572] The HCCA defines treatment as “anything that is done for a therapeutic, preventive, palliative, diagnostic, cosmetic or other health related-purpose and includes a… plan of treatment”. It also explicitly states that a plan of treatment may “provide for the withholding or withdrawal of treatment in light of the person’s current health condition”. HCCA, note 16, s.2.

[573] Young, note 299.

[574] James Downar, Laura Hawryluck, Alexi Wood and others, 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 (commissioned by the Law Commission of Ontario, March 2017), 41, online: http://www.lco-cdo.org/laststages (last accessed April 10, 2017).

[575] Downar, note 574.

[576] Downar, note 574.

[577] Manitoba Law Reform Commission, note 43, 4.

[578] Manitoba Law Reform Commission, note 43, 5.

[579] See also: Gilmour, note 568, 415; Jocelyn Downie & Karen McEwan, “The Manitoba College of Physicians and Surgeons Position Statement on Withholding and Withdrawal of Life-Sustaining Treatment (2008): Three Problems and a Solution” (2009) 17 Health Law Journal 115.

[580] See also: Jocelyn Downie, Lindy Willmott & Ben White, “Cutting the Gordian Knot of Futility: A Care for Law Reform on Unilateral Withholding and Withdrawal of Potentially Life-Sustaining Treatment” (2014) 26:1 New Zealand Universities Law Review 24; Manitoba Law Reform Commission, note 43, 8, 69-70.

[581] See also: Manitoba Law Reform Commission, note 43, 70-72.

[582] See for example: E (Re), 2009 CanLii 28625 (CCB); EJG (Re), 2007 CanLii 44704 (CCB); MN (Re), 2012 CanLii 18287 (CCB); CA (Re), 2013 CanLii 76685 (CCB); SR (Re), 2011 CanLii 79858 (CCB); P (Re), 2005 CanLii 56634 (CCB); SS (Re), 2012 CanLii 85612 (CCB). See also: Chidwick, note 311.

[583] See for example: C.H. v. M.S., 2011 CanLII 34788; C.A.H. v. M.S., 2012 CanLII 81785; T.F. v. T.J.B., 2010 CanLII 43571; T.F. v. R.G.M., 2010 CanLII 43570.

[584] See for example: M. v. F.G.S., 2016 CanLII 8871; R.S. v. S.K., 2015 CanLII 51943; H.T. v. B.S.P., 2015 CanLII 21986; E.G.J.W. v. M.G.C., 2014 CanLII 49888; R.R. v. G.R.N., 2014 CanLII 29254; J.T. v. D.L., 2013 CanLII 60999; C.H. v. K.R.M., 2013 CanLII 56307; C.A.H. v. M.S., 2012 CanLII 81785; M.C. v. J.M.J.L., 2012 CanLII 24422; E.P. v. L.M.H., 2012 CanLII 24450; C.S. v. S.K.D., 2012 CanLII 8649; J.R. v. D.B., 2012 CanLII 11358; C.H. v. M.S., 2011 CanLII 34788; T.F. v. T.J.B., 2010 CanLII 43571.

[585] Rasouli, note 20.

[586] CPSO, note 86, 8.

[587] Rasouli, note 20, para.116.

[588] Following the outcome in the case, Mr. Rasouli is still on life support at an Ontario hospital.

[589] Mark Handelman and Michael Gordon provide a good description of the Rasouli case in Mark Handelman & Michael Gordon, “Last Rights: Cuthbertson v. Rasouli What the Supreme Court Didn’t Say about End-of-Life Treatment Decisions” (2015) 35:2 Health Law in Canada 106.

[590] Handelman & Gordon, note 589, 109.

[591] HCCA, note 16, s.21.

[592] Young, note 299.

[593] See for instance: Chidwick, note 311, 22, 23.

[594] Rasouli, note 20, para. 4.

[595] Rasouli, note 20, paras. 73, 75.

[596] Handelman & Gordon, note 589, 109.

[597] Simon JW Oczkowski, Bram Rochwerg & Corey Sawchuck, “Withdrawing Versus not Offering Cardiopulmonary Resuscitation: Is there a Difference?” (2015) 22:1 Can Respir J 20.

[598] CPSO, note 86, 8.

[599] See for instance the Canadian Medical Association’s policy, Statement on Life-Saving and -Sustaining Interventions (December 2013), online: https://www.cma.ca/Assets/assets-library/document/en/advocacy/policy-research/CMA_Policy_CMA_Statement_on_Life-Saving_and_Sustaining_Interventions_Update_December_2013_PD14-01-e.pdf (last accessed March 23, 2017) which states that CPR is not clinically indicated in all cases; where there will be no medical benefit to treatment, intervention is inappropriate and there is no obligation to provide non-beneficial treatment. The policy also recognizes, “As a general rule a person should be involved in determining medical futility in his or her case,” and that in provinces with statutory mechanisms to resolve disagreements, “they must be adhered to.” See also Downar, note 574.

[600] EGJW v MGC, 2014 CanLII 49888 (ON HPARB).

[601] Downar, note 574, 41-42.

[602] Downar, note 574, 41-42.

[603] Downar, note 574, 41-42.

[604] CPSO, note 86, 7-8, 11.

[605] Downar, note 574, 22.

[606] Manitoba Law Reform Commission, note 43, 11.

[607] Queensland Government, End-of-Life Care: Decision-Making for Withholding and Withdrawing Life-Sustaining Measures from Adult Patients (Queensland Health, Implementation Guidelines).

[608] Queensland Government, note 607 , Part 1, 14-16.

[609] Queensland Government, note 607, Part 1, 16.

[610] Downar, note 574, 31-35; Young, note 299.

[611] United Kingdom Court of Protection Practice Rules, “Practice Direction 9E – Applications Relating to Serious Medical Treatment” (July 2015), online: https://www.judiciary.gov.uk/wp-content/uploads/2015/06/copd-pd-9e-serious-medical-treatment.pdf (last accessed March 23, 2017). Downar, note 574, 31-35.

[612] For a review of legal authority over withdrawal and withholding of treatment in the United Kingdom, United States and Canada, see: Gilmour, note 568, 408-418; Downar, note 574; Young, note 299.

[613] College of Physicians and Surgeons of Manitoba, “Withholding and Withdrawal of Life-Sustaining Treatment” as Schedule D to By-law 11, Standards of Practice of Medicine (effective December 14, 2015 with amendments to December 21, 2016), online: http://cpsm.mb.ca/cjj39alckF30a/wp-content/uploads/ByLaws/By-Law-11.pdf (last accessed March 20, 2017).

[614] Downar, note 574, 28. See also Young’s comments on whether Rasouli would apply in other Canadian jurisdictions: Young, note 299.

[615] Downar, note 574, 37.

[616] End-of-Life Planning Canada, “Refuse Food and Drink” in Patient Rights Booklet: Your Rights and Options at the End of Life (Revised April 10, 2016), 12, online: https://d3n8a8pro7vhmx.cloudfront.net/dwdcanada/pages/709/attachments/original/1474555815/patient-rights-booklet_2016_elpc1.pdf?1474555815 (last accessed March 23, 2017).

[617] Bentley v. Maplewood Seniors Care Society, 2014 BCSC 165, aff’d 2015 BCCA 91 [Bentley].

[618] National Initiative for the Care of the Elderly, “When someone close to you is dying – what you can expect and how you can help”, 9, online: http://www.nicenet.ca/files/When_Someone_Close_to_you_is_Dying_English_version.pdf (last accessed March 23, 2017).

[619] Bentley, note 617, para.2.

[620] Bentley, note 617, para.2.

[621] Bentley, note 617, para.7.

[622] HCCA, note 16, s.2.

[623] HCCA, note 16, s.2.

[624] HCCA, note 16, s.10.

[625] HCCA, note 16, ss.58-59.

[626] LTCHA, note 77, s.7.

[627] LTCHA, note 77, s. 3(1) 11

[628] LTCHA, note 77, s. 19(1)

[629] SDA, note 16, s. 45. The LTCHA also refers to “personal care”.

[630] SDA, note 16, s. 45.

[631] SDA, note 16, 46(7).

[632] Home Care and Community Services Act, 1994, note 81, s.24.

[633] CCAC Client Services Policy Manual, note 167, Ch.5, 52.

[634] See for example: RNAO End-of-Life Care, note 86, 33; College of Nurses of Ontario, “Practice Standard: Ethics” (updated June 2009), 6, 12, online: https://www.cno.org/globalassets/docs/prac/41034_ethics.pdf (last accessed March 23, 2017); Ontario Personal Support Worker Association, “Standard of Practice: Feeding,” 1, online: http://media.wix.com/ugd/207a84_0cc3c371aeb44836b3bfc937f18004ee.pdf (last accessed March 23, 2017).

[635] Ontario Association of Non-Profit Homes and Services for Seniors, “Nutrition and Hydration Program: Policy, Procedures and Training Package,” (2011), 17, online: https://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiE_9H57-zSAhVN02MKHbxyBAUQFggcMAA&url=https%3A%2F%2Fwww.oanhss.org%2Foanhssdocs%2FMembersOnly%2FFull%2520Members%2520Only%2520Pages%2FGovernmentAndMediaRelations%2FLTC%2520Homes%2520Act%2FNutrition_and_Hydration_PP_and_Training_Package.doc&usg=AFQjCNFAJtzgW6uhdkFzdVbOpNFoQaAvUw&sig2=G_EwEG0QB5Kb90mcBtWP-Q (last accessed March 23, 2017).

[636] Criminal Code, note 33, s.215.

[637] Honourable Marion Allan, “Will You Still Need Me? Will You Still Feed Me, When I’m 94?” 66 Advocate Vancouver (2008) 501, 507.

[638] Criminal Code, note 33, s.215

[639] In Bentley, the court did not decide the application of the Criminal Code. Bentley, note 617, para. 7.

[640] Jocelyn Downie, “Withholding the Necessaries of Life?” Impact Ethics (2013), online: https://impactethics.ca/2013/07/24/witholding-the-necessaries-of-life/ (last accessed August 18, 2016).

[641] LTCHA, note 77, 11(2); O. Reg. 79/10, note 77, 71(3).

[642] LTCHA, note 77, ss. 19-20.

[643] For more discussion of these issues, see Downie, note 640.

[644] M.M. Dean, V. Cellarius, B. Henry, and others, “Framework for Continuous Palliative Sedation Therapy in Canada” (2012) 15:8 Journal of Palliative Medicine 870, citing, N.I. Cherny, R.K. Portenoy, “Sedation in the Management of Refractory Symptoms: Guidelines for Evaluation and Treatment” (1994) 10 Journal of Palliative Medicine, 31-38. See also: Fraser Health, Refractory Symptoms and Palliative Sedation Therapy Guideline (2011), 4-5.

[645] Dean, note 644, 6.

[646] Dean, note 644, citing Cherny, note 644, 31-38. See also: MH Levy & SD Cohen, “Sedation for the Relied of Refractory Symptoms in the Imminently Dying: a Fine Intentional Line”(2005) 32:2 Seminars in Oncology 237.

[647] See for example: Fraser Health, note 644, 4-5.

[648] Fraser Health, note 644, 4-5.

[649] Dean, note 644, 871.

[650] Fraser Health, note 644, 4.

[651] See for instance, Gilmour, note 568, 408.

[652] Evelien Delbeke, “The Legal Permissibility of Continuous Deep Sedation at the End of Life: A Comparison of Laws in a Proposal” in Sigrid Sterckz, Kasper Raus, & Freddy Mortier, eds., Continuous Sedation at the End of Life: Ethical, Clinical and Legal Perspectives (Cambridge: Cambridge University Press, 2016).

[653] Delbeke, 652, 135.

[654] Levy & Cohen, note 646; NI Cherny, Sedation: Uses, Abuses and Ethics at the End of Life (Jerusalem: Shaare Zedek Medical Centre, 2003).

[655] See for instance. Dean, note 644, 8; Fraser Health, note 644, 8.

[656] Siuebe J Swart, Agnes Van Der Heide, Lia Van Zuylen, and others, “Continuous Palliative Sedation: Not Only a Response to Physical Suffering” (2014) 17 :1 Journal of Palliative Medicine 27, 27.

[657] Swart, note 656.

[658] CMA, note 9, 14.

[659] Kasper Raus, Sigrid Sterckz & Freddy Mortier, “Can the doctrine of double effect justify continuous deep sedation at the end of life?” in Sigrid Sterckx, Kasper Raus & Freddy Mortier, eds, Continuous Sedation at the end of Life: Ethical, Clinical and Legal Perspectives (Cambridge: Cambridge University Press, 2016) 177, 184.

[660] In France, there was substantial debate over the nature of continuous palliative sedation and its relationship to assisted suicide and euthanasia. In 2016, the National Assembly and Senate passed a law legalizing continuing palliative sedation until death. LOI n° 2016-87 du 2 février 2016 créant de nouveaux droits en faveur des malades et des personnes en fin de vie, online: https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000031970253&categorieLien=id (last accessed August 18, 2016); Le Monde, “La loi Claey-Leonetti sur la fin de vie définitivement adoptée” (27 Jan 2016), online: http://www.lemonde.fr/societe/article/2016/01/27/fin-de-vie-ce-que-va-changer-la-nouvelle-loi-claeys-leonetti_4854266_3224.html (last accessed August 18, 2016); The Guardian, “France Adopts Sedated Dying Law as Compromise on Euthanasia”, (29 Jan 2016), online: https://www.theguardian.com/society/2016/jan/28/france-adopts-sedated-dying-law-as-compromise-on-euthanasia (last accessed August 18, 2016).

[661] Dean, note 644, citing Alexander De Graeff & Mervyn Dean, “Palliative Sedation in the Last Weeks of Life: A Literature Review and Recommendations for Standards” (2007) 10:1 Journal of Palliative Medicine 67.

[662] On the legality of palliative sedation, see: Gilmour, note 568, 407.

[663] Carter, note 10. See also: Rodrigeuz v. British Columbia [1993] 3 SCR 519.

[664] Carter, note 10, para. 115.

[665] Dean, note 644, 13.

[666] HCCA, note 16, s.4(1).

[667] Bill C-14, note 11.

[668] Dean, note 644, 18.

[669] Dean, note 644, 13-15.

[670] CPSO, note 86; Registered Nurses’ Association of Ontario, Palliative Care Nurses Interest Group, “Position Statement on Palliative Sedation” (2010), online: http://pcnig.rnao.ca/sedation-palliative-care-position-statement (last accessed August 18, 2016).

[671] Champlain District End-of-Life Care Network, The Champlain District Palliative Care Resource Manual (2007), online: www.renfrewhosp.com/documents/health_resources/ChamplainHPCManualMarch-07-154pg.pdf (last accessed August 18, 2016); Champlain Palliative and End-of-Life Network, The Champlain Region – Palliative Sedation Therapy: Clinical Practice Guidelines and Protocols (2010), online: www.acclaimhealth.ca/wp-content/uploads/2013/11/Palliative-Sedation-Protocol-for-Champlain-Region-June-2010.pdf (last accessed August 18, 2016); Waterloo Wellington Interdisciplinary Hospice Palliative Care Education Committee, The Waterloo Wellington Palliative Sedation Protocol (2013), online: hpcconnection.ca/wp-content/uploads/2014/07/PalliativeSedationTherapyProtocolNovember2013.pdf (last accessed August 18, 2016); Mississauga Halton Region, The Mississauga Halton Palliative Sedation Therapy (PST) Sample Policy (2012), online: www.acclaimhealth.ca/wp-content/uploads/2013/11/Palliative-Sedation-Therapy-Sample-Policy.pdf (last accessed August 18, 2016).

[672] Fraser Health, note 644.

[673] A. Voeuk,C. Nekolaichuk, R.L Fainsinger, and others, “Palliative Sedation for Existential Distress? A Survey of Canadian Palliative Care Physicians’ Views,” (Covenant Health, 2015), online: www.virtualhospice.ca/Assets/PS%20Poster_Edited_FEB2015%20(3)%20(1)_20150305195646.pdf (last accessed August 18, 2016).

[674] M. McKinnon, C. Azevedo, S.H. Bush, and others, “Practice and documentation of palliative sedation: a quality improvement initiative” (2014) 21:2 Current Oncology 100.

[675] McKinnon, note 674, 100, 102.

[676] McKinnon, note 674, 102.

[677] Quebec, An Act Respecting End-of-Life Care, note 33, s.24.

[678] Alberta Health Services, Palliative and End of Life Care: Alberta Provincial Framework (2014), 29, 42, online: http://www.albertahealthservices.ca/assets/info/seniors/if-sen-provincial-palliative-end-of-life-care-framework.pdf (last accessed March 23, 2017).

[679] Donna M. Wilson, Joachim Cohen, Luc Deliens, and others, “The preferred place of last days: Results of a representative population-based public survey” (2013) 16:5 J Palliative Medicine 508.

[680] Wilson & Birch, note 4, 31.

[681] HQO 2014, note 27.

[682] College of Physicians and Surgeons, “Certifying Death at Home: Completing the Circle of Life” (2013) 3 Dialogue 21, 22, online: http://endoflife.cpso.on.ca/wp-content/uploads/2013/09/certifying-death-at-home.pdf (last accessed March 23, 2017).

[683] CPSO, note 682, 21-22.

[684] CPSO, note 682.

[685] Coroners Act, R.S.O. 1990, c. C. 37, s.10.

[686] Vital Statistics Act, note 348, s. 22(1).

[687] See for instance: R.R.O 1990, Reg. 1094, ss.35, 36, 39.

[688] R.R.O 1990, Reg. 1094, s.35.

[689] R.R.O 1990, Reg. 1094, s.35(2).

[690] CPSO, note 86, 9.

[691] R.R.O 1990, Reg. 1094, s.35(3).

[692] RNAO, note 86; College of Nurses of Ontario, “Nurse Practitioners: Practice Resources”, online: http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/nurse-practitioners/ (last accessed August 19, 2016); Office of the Registrar General, Ministry of Consumer and Business Services, Handbook on Certification of Death (August 2010).

[693] CPSO, note 86, 9.

[694] See for instance: Cancer Care Ontario, “Palliative Care Tools”, online: https://www.cancercare.on.ca/toolbox/pallcaretools/ (last accessed August 19, 2016); Hospice Palliative Care Teams for Central LHIN, Expected Death in the Home Protocol (EDITH) Guidelines Doc. GL-HPC-04 (October 2013), online: http://s245089275.onlinehome.us/images/GL-HPC-04%20EDITH%20Protocol%20Guidelines%20Oct%203%202013.3926cd70.pdf (last accessed August 19, 2016) [EDITH Protocol].

[695] EDITH Protocol, note 694.

[696] The Office of the Coroner guidelines are an internal policy.

[697] CPSO, note 86, 9.

[698] Government of British Columbia, Joint Protocol for Expected/Planned Home Deaths in British Columbia (December 2006). The protocol and other information can be found at Government of British Columbia, “Expected/Planned Home Deaths”, online: http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care/expected-planned-home-deaths (last accessed August 19, 2016).

[699] Government of British Columbia, note 698.

[700] Cremation, Interment and Funeral Services Act, SBC 2004, c.35.

[701] Cremation, Interment and Funeral Services Act, note 700, s.5.

[702] See for instance: Annalee Yassi, Mark Gilbert & Yuri Cvitovich, “Trends in Injuries, Illnesses, and Policies in Canadian Healthcare Workplaces” (2005) Can J of Public Health 333.

[703] A. Marine, J. Ruotsalainen, C. Serra & J. Verbeek , “Preventing occupational stress in healthcare workers (Review)” (2006) 18:4 Cochrane Database System Rev 1, 2. This definition is reproduced in this article from Wilmar B. Schaufeli & Bram P. Buunk, “Burnout: An Overview of 25 Years of Research and Theorizing” in Marc J. Schabracq, Jacques A.M Winnubst & Cary L. Cooper, eds., The Handbook of Work and Health Psychology, 2nd ed., (Chichester: John Wiley & Sons Ltd, 2002), 383–424.

[704] Marine, note 703.

[705] Arif H. Kamal, Janet H. Bull, Steven P. Wolf and others, “Prevalence and Predictors of Burnout Among Hospice and Palliative Care Clinicians in the U.S.” (2016) 51:4 Journal of Pain and Symptom Management 690; Anthony L. Back, Karen E. Steinhauser, Arif H. Kamal and others, “Building Resilience for Palliative Care Clinicians: An Approach to Burnout Prevention Based on Individual Skills and Workplace Factors” (2016) Journal of Pain and Symptom Management 1.

[706] Rebecca C. Hill, Martin Dempster, Michael Donnelly and others, “Improving the wellbeing of staff who work in palliative care settings: A systematic review of psychosocial interventions” (2016) Palliative Medicine 1, 2, online: http://pmj.sagepub.com/content/early/2016/03/09/0269216316637237.full.pdf+html (last accessed August 19, 2016).

[707] Hill, note 706, 2 citing C. Kamau, A. Medisauskait & B. Lopes, “Orientations can avert psychosocial risks to palliative staff” (2014) 23:6 Psycho-Oncology 716.

[708] Erin L. Woodhead, Lynn Northrop, Barry Edelstein, “Stress, Social Support and Burnout Among Long-Term Care Nursing Staff” (2016) 35:1 J Applied Gerontology 84, 86; Marcella & Kelley, note 401.

[709] Marcella & Kelley, note 401, 2.

[710] Marcella & Kelley, note 401, 3.

[711] Marcella & Kelley, note 401, 2.

[712] Hill, note 706; Marcella & Kelley, note 401.

[713] Occupational Health and Safety Act, note 344.

[714] See for instance: Ministry of Labour, Guide to the Occupational Health and Safety Act: Introduction (revised March 20, 2015), online: https://www.labour.gov.on.ca/english/hs/pubs/ohsa/ohsag_intro.php (last accessed March 23, 2017).

[715] Occupational Health and Safety Act, note 344, ss.25-26, Part III.0.1.

[716] Occupational Health and Safety Act, note 344, s.21(2).

[717] Standards Council of Canada, note 346.

[718] Government of Ontario, “2014 Mandate Letter: Labour” (Letter from Kathleen Wynne to Kevin Flynn, September 25, 2014), online: https://www.ontario.ca/page/2014-mandate-letter-labour?_ga=1.41756834.1404398556.1469546204 (last accessed March 23, 2017).

[719] Ontario Ministry of Labour, Summit on Work-Related Traumatic Mental Stress: Summary Report (March 2015). See also: Ontario Ministry of Labour, “Roundtable of Traumatic Mental Stress: Ideas Generated”, online: http://www.labour.gov.on.ca/english/hs/pubs/tms/index.php (last accessed August 19, 2016); Government of Ontario, “Ontario Aims to Prevent Traumatic Mental Stress in High-Risk Workplaces”, online: https://news.ontario.ca/mol/en/2014/10/ontario-aims-to-prevent-traumatic-mental-stress-in-high-risk-workplaces.html (last accessed August 19, 2016).

[720] Government of Ontario, “Supporting Ontario’s First Responders Act (Posttraumatic Stress Disorder), 2016”, online: https://news.ontario.ca/mol/en/2016/04/supporting-ontarios-first-responders-act-posttraumatic-stress-disorder-2016-1.html (last accessed August 19, 2016); Bill 163, Supporting Ontario’s First Responders Act (Posttraumatic Stress Disorder), 2016, online: http://www.ontla.on.ca/web/bills/bills_detail.do?locale=en&Intranet=&BillID=3713 (last accessed August 19, 2016).

[721] Workplace Safety and Insurance Board, “Presumption Legislation- First Responders and PTSD”, online: http://www.wsib.on.ca/WSIBPortal/faces/WSIBDetailPage?cGUID=WSIB065564&rDef=WSIB_RD_ARTICLE&_afrLoop=6232742282648919&_afrWindowMode=0&_afrWindowId=null#%40%3FcGUID%3DWSIB065564%26_afrWindowId%3Dnull%26_afrLoop%3D6232742282648919%26rDef%3DWSIB_RD_ARTICLE%26_afrWindowMode%3D0%26_adf.ctrl-state%3Dndf8ghgn3_4 (last accessed August 19, 2016).

[722] Supporting Ontario’s First Responders Act, note 720, s.9.1.

[723] See for instance: RNAO, “Nurses Suffer Post-Traumatic Stress Disorder: Sign Action Alert”, online: http://rnao.ca/news/nurses-suffer-post-traumatic-stress-disorder-sign-action-alert (last accessed August 19, 2016).

[724] Supporting Ontario’s First Responders Act, note 720.

[725] Ontario Human Rights Commission, Policy on Competing Rights (Toronto: January 2012), 3, online: http://www.ohrc.on.ca/sites/default/files/policy%20on%20competing%20human%20rights_accessible_2.pdf. [Policy on Competing Rights]

[726] Policy on Competing Rights, note 725, 3.

[727] See: Standards Council of Canada, note 346; Marcella & Kelley, note 401, 13; Ontario Ministry of Labour, Summit, note 719.

[728] The Ministry of Labour’s summary report from its 2015 summit on work-related trauma also suggests building on existing workplace programs for harassment, note 719, 7.

[729] Law Society Act, note 141.

[730] Law Society of Upper Canada, Rules of Professional Conduct, online: http://www.lsuc.on.ca/lawyer-conduct-rules/ (last accessed August 19, 2016) [LSUC Rules].

[731] Law Commission of Ontario, “Roundtable on Legal Ethics and Practice for the Last Stages of Life” (held June 24, 2016).

[732] LSUC Rules, note 730, r.5.1-1, 5.1-1(4).

[733] LSUC Rules, note 730, r.3.2-9.

[734] LSUC Rules, note 730, rr.3.4-1, 3.3-1.

[735] LSUC Rules, note 730, r.5.1-1(4).

[736] LSUC Rules, note 730, r.3.3-3.

[737] LSUC Rules, note 730, r.3.1-2.

[738] Harold Coward & Kelli Stajduhar, “Introduction” in Harold Coward & Kelli Stajduhar, eds, Religious Understandings of a Good Death in Hospice Palliative Care (Albany, NY: State University of New York Press, 2012), 1.

[739] Michael Wright & David Clark, “Cicely Saunders and the Development of Hospice Palliative Care” in Coward & Stajduhar, eds, note 738, 11.

[740] Coward & Stajduhar in Coward & Stajduhar, eds, note 738, 4.

[741] For a discussion of the term “spirituality” and its relationship to religion, see: Paul Bramadat, Harold Coward & Kelli Stajduhar, eds, Spirituality in Hospice Palliative Care (Albany, NY: State University of New York, 2013).

[742] Ruby Latif, Omar Ha-Redeye & Kashif Pirzada, “Integrating Religious and Cultural Supports into Quality Care in the Last Stages of Life in Ontario” (commissioned by the Law Commission of Ontario, March 2017), online: http://www.lco-cdo.org/laststages/ (last accessed April 10, 2017).

[743] Ontario Human Rights Commission, “Ground of Discrimination: Definitions and Scope of Protection” in Ontario Human Rights Commission, Human Rights at Work (2008), 3rd ed., online: http://www.ohrc.on.ca/en/iii-principles-and-concepts/3-grounds-discrimination-definitions-and-scope-protection (last accessed August 19, 2016).

[744] OHRC, note 357, 1.

[745] OHRC, note 357, 1-2.

[746] OHRC, note 357, 2.

[747] John Baldwin, Sandra Faulkner & Michael Hecht, “A Moving Target: The Illusive Definition of Culture” in John Baldwin, Sandra Faulkner, Michael Hecht & Sheryl Lindsley, Redefining Culture: Perspectives across the Disciplines (New Jersey: Lawrence Erlbaum Associates Inc. Publishers, 2006), 5.

[748] Charter, note 94, s.2(a).

[749] Paul Bramadat, Harold Coward & Kelli Stajduhar, “Introduction” in Bramadat et al, eds, note 741, 1-2.

[750] See: Kathleen Garces-Foley, “Hospice and the Politics of Spirituality” in Bramadat et al, eds, note 741; Paul Bramadat & Joseph Kaufert, “Religion, Spirituality, Medical Education and Hospice Palliative Care”, in Bramadat et al, eds, note 741; W. Wilson Will III, “Hospice Chaplains, Spirituality, and the Idea of a Good Death” in Bramadat et al, eds, note 741.

[751] Latif, note 742, 45.

[752] Fraser Report, note 46, 10.

[753] See for instance: Rasouli, note 20; A.C. v. Manitoba, note 119; B.R. v. Children’s Aid Society of Metropolitan Toronto [1995] 1 SCR 315 [B.R.]; CCB cases, note 582; Chidwick, note 311.

[754] Policy on Competing Rights, note 725.

[755] Latif, note 742, 62.

[756] See for example the wide array of beliefs examined in Latif, note 742.

[757] See for example the wide array of beliefs examined in Latif, note 742.

[758] Latif, note 742.

[759] Latif, note 742.

[760] Latif, note 742.

[761] Coward & Stajduhar, note 738.

[762] Bramadat, note 741.

[763] Canadian Multifaith Federation, “Multifaith Information Manual, 6th ed.” (October 6, 2012), online: http://omc.ca/product/hello-world/ (last accessed March 13, 2017).

[764] Simon Brascoupé & Catherine Water, “Cultural Safety: Exploring the Applicability of the Concept of Cultural Safety to Aboriginal Health and Community Wellness” (November 2009) 5:2 Journal of Aboriginal Health 6.

[765] Brascoupé & Water, note 764, 7.

[766] Roger Walker, Helen Cromarty, Barbara Linkewich and others, “Achieving Cultural Integration in Health Services: Design of Comprehensive Hospital Model for Traditional Healing, Medicines, Foods and Supports” (January 2010) 6:1 Journal of Aboriginal Health 58, 59.

[767] Brascoupé & Water, note 764, 10.

[768] Brascoupé & Water, note 764, 10-13.

[769] Brascoupé & Water, note 764, 16, citing Assembly of First Nations, First Nations Cultural Safety in Post-Secondary Education (2008), 2.

[770] National Collaborating Centre for Aboriginal Health, Cultural Safety in First Nations, Inuit and Métis Public Health: Environmental Scan of Cultural Competency and Safety in Education, Training and Health Services (Prince George, BC: National Collaborating Centre for Aboriginal Health, 2013), 8. See also: Brascoupé & Water, note 764; Walker, note 766.

[771] For a literature review of barriers, see Bourassa & Bendig, note 434. See also Mary Hampton, Angelina Baydala, Carrie Bourassa and others, “Completing the Circle: Elders Speak about End-of-Life Care with Aboriginal Families in Canada” (2010) 26:1 Journal of Palliative Care 6.

[772] Verna Fruch, Lori Monture, Holly Prince and others, “Coming Home to Die: Six Nations of the Grand River Territory Develops Community Based Palliative Care”, International Journal of Indigenous Health, Volume 11, Issue 1, 2016, 50 at 70.

[773] See: Walker, note 766; Improving End-of-Life Care in First Nations Communities, note 227; Sioux Lookout Meno Ya Win Health Centre, “About”, online: http://www.slmhc.on.ca/about (last accessed August 19, 2016).

[774] Charter, note 94, 2(a).

[775] The OHRC policy explains that the s.2(a) Charter guarantee “is primarily concerned with preserving individual liberty” in contrast to ensuring positive equality in access to services. OHRC, note 357, 24-25.

[776] Rasouli, note 20; A.C, note 119; B.R., note 753.

[777] In Rasouli this was only indirectly addressed, as freedom of religion was not argued. See also the reasons for judgment of Abella J. (LeBel, Deschamps and Charron JJ. concurring) in A.C., note 119, paras. 112-117.

[778] A.C., note 119; B.R., note 753.

[779] A.C., note 119; B.R., note 753.

[780] OHRC, note 357, 24-25.

[781] OHRC, note 357, 24-25.

[782] Substantial costs and significant health and safety risks could indicate undue hardship. OHRC, note 357, 54, 69-72.

[783] OHRC, note 357, Ch.9.

[784] OHRC, note 357, 123.

[785] Hamilton Health Sciences Corp, note 446. For more information, see also the explanation of the case at note 446.

[786] Nishawbe Aski Nation, note 446; Constance MacIntosh, “Indigenous Peoples and Health Law and Policy: Responsibilities and Obligations” in Downie, eds, note 568.

[787] Grassy Narrows First Nation v. Ontario (Natural Resources) [2014] 2 SCR 447, para. 50.

[788] Department of Finance, Budget 2016, note 421; Ontario First Nations Health Action Plan, note 418.

[789] OHRC, note 357, 103-119.

[790] United Nations, United Nations Declaration on the Rights of Indigenous Peoples (March 2008), Arts.21, 23, 24, 29, online: http://www.un.org/esa/socdev/unpfii/documents/DRIPS_en.pdf (last accessed August 19, 2016).

[791] LTCHA, note 77, ss.1, 23, Home Care and Community Services Act, note 81, s. 3(1)

[792] LTCHA, note 77, s.6(3), Home Care and Community Services Act, note 81, s. 22(6).

[793] LTCHA, note 77, s.44(4).

[794] HRCode, note 91, s. 18.

[795] Seong-gee Um, “The Cost of Waiting for Care” (April 2016) Wellesley Institute, 5, online: http://www.wellesleyinstitute.com/wp-content/uploads/2016/05/The-Cost-of-Waiting-For-Care.pdf (last accessed August 19, 2016).

[796] RHA, note 147, s. 51(1)(9).

[797] RHA, note 147, s. 51(1)(9).

[798] RNAO, note 444; CPSO, note 86; College of Physicians and Surgeons of Ontario, “Professional Obligations and Human Rights” (September 2008; revised March 2015), online: http://www.cpso.on.ca/Policies-Publications/Policy/Professional-Obligations-and-Human-Rights (last accessed March 13, 2017).

[799] Latif, note 742, 50.

[800] Latif, note 742, 40.

[801] Latif, note 742, 32, 34-36.

[802] Latif, note 742, 34-36.

[803] Latif, note 742, 35.

[804] Latif, note 742, 40.

[805] Latif, note 742, 46.

[806] Latif, note 742, 58.

[807] Wilson & Birch, note 4.

[808] Wilson & Birch, note 4, referencing the WHO Definition of Palliative Care, note 39. See also: Bina Mistry, Daryl Bainbridge, Deanna Bryant and others, “What matters most for end-of-life care? Perspectives from community-based palliative care providers and administrators” (2015) 5:e007492 BMJ Open 1.

[809] Wilson & Birch, note 4.

[810] Wilson & Birch note 4, 1.

[811] See also: Seow & King, note 182; Chiu, note 355.

[812] Wilson & Birch, note 4, 60.

[813] Fraser Report, note 46, 9.

[814] LTCHA, note 77, s. 44(11). For a discussion of issues related to discharge from hospital to long-term care, see Jane E,Meadus, “Discharge from Hospital to Long-Term Care: Issues In Ontario” (Advocacy Centre for the Elderly, February 2014) online: http://www.advocacycentreelderly.org/appimages/file/Discharge_from_Hospital_to_LTC%20February%202014.pdf.

[815] Wilson & Birch, note 4, 19.

[816] Wilson & Birch, note 4, 33.

[817] Wilson & Birch, note 4, 34.

[818] LTCHA, note 77, s.76(7); O.Reg. 79/10, note 77, s.42.

[819] Wilson & Birch, note 4, 17-18, referencing H. Seow, L. Barbera, D. Howell and others, “Using more end

-of-life home care services is associated with using fewer acute care services: A population-based cohort study” (2010) 48:2 Medical Care 118, and H. Seow, K. Brazil, J. Sussman and others, “Impact of community based, specialist palliative care teams on hospitalisations and emergency department visits late in life and hospital deaths: a pooled analysis” (2014) British Medical Journal 348.

[820] Wilson & Birch, note 4, 48.

[821] Wilson & Birch, note 4, 48.

[822] Wilson & Birch, note 4, 63.

[823] Wilson & Birch, note 4, 48.

[824] See for instance: Chiu, note 355, ch.IV.

[825] Wilson & Birch, note 4, 41, 42; Fraser Report, note 46, 9.

[826] Fraser Report, note 46, 9.

[827] Wilson and Birch, note 4, 59.

[828] Government of Ontario, note 47.

[829] Government of Ontario, note 47, 7.

[830] Government of Ontario, note 47, 10.

[831] Government of Ontario, note 47, 14.

[832] Government of Ontario, note 170, 5.

[833] Government of Ontario, note 170, 6-7.

[834] Excellent Care for All Act, note 88, s.13.1(2), 13.3.

[835] S.H.E. Harmon, “Consent and Conflict in Medico-Legal Decision-Making at the End of Life: A Critical Issue in the Canadian Context” (2010) UNB LJ 208, 208. See also: K.W. Bowman, “Communication, Negotiation, and Mediation: Dealing with Conflict in End-of-Life Decisions” (2000) 16 J Palliative Care S17, S20.

[836] Bowman, note 835.

[837] See also: Chidwick, note 311, 26; Bowman, note 835, 20-21; Robert Sibbald, James Downar & Laura Hawryluck, “Perceptions of “futile care” among caregivers in intensive care units” (2007) 177:10 Can Medical Association J 1201.

[838] For discussions about these types of disputes nearing the end of life see: Bowman, note 835, S20.

[839] HCCA, note 16, ss. 32,33,35,37,51-54,66-69.

[840] See also: Downar, note 574, 51, 57-58.

[841] Law Commission of Ontario, note 73, 238. The RHPA also allows regulatory colleges to address complaints through alternative dispute resolution. See: RHPA, note 90, Schedule 2: Health Professions Procedural Code, s.25.1.

[842] See also: Downar, note 574, 38, 54; Kerry Knickle, Nancy McNaughton & James Downar, “Beyond winning: mediation, conflict resolution, and non-rational sources of conflict in the ICU” (2012) 16:308 Critical Care 1, 3.

[843] ECCA, note 88, s. 6(1); O. Reg. 188/15, “Patient Relations Process”, s. 2(1).

[844] Ontario Ministry of Health and Long-Term Care, “Excellent Care for All: Guidance on how to develop a patient relations process,” online: http://www.health.gov.on.ca/en/pro/programs/ecfa/legislation/patientrelation/update_20110304.pdf (last accessed August 19, 2016).

[845] See for instance: Brockville General Hospital, “Patient Relations”, online: http://www.bgh-on.ca/?_n=Patient_Relations&PGID=23; South Huron Hospital Association, “Patient Relations and Feedback”, online: http://www.shha.on.ca/about/attachments/Patient%20Relations%20and%20Feedback.pdf for less robust initiatives. See also: Hamilton Health Sciences, “Patient Experience” online: http://www.hamiltonhealthsciences.ca/workfiles/CLINICAL_ETHICS/Patientexperience.pdf; University Health Network, “Policy & Procedure Manual: Clinical – Patient Compliments & Complaints, Grievances & Conflicts”, online: https://www.oha.com/CurrentIssues/keyinitiatives/patientrelations/DepartmentalStructureandFunction/Documents/Examples%20of%20Policies,%20Flow%20Charts%20and%20Process%20Maps%20for%20Managing%20Feedback/Academic%20Hospitals/University%20Health%20Network.pdf (last accessed August 19, 2016).

[846] Paola Loriggio, “Q&A with a patient advocate” Toronto Star (November 20, 2012), online: https://www.thestar.com/life/2012/11/20/qa_with_a_patient_advocate.html (last accessed March 23, 2017).

[847] Loriggio, note 846. Some hospitals such as the Royal Victoria Regional Health Centre in Barrie also have “patient representatives”, which act as a liaison between patients, families, visitors and hospital staff, physicians and systems. The patient representatives at Royal Victoria are also responsible for receiving, investigating and responding to compliments, requests, inquiries or concerns regarding care or service at the hospital. Royal Victoria Regional Health Centre, “Patient Information: Office of the Patient Representative”, online: http://www.rvh.on.ca/pf/SitePages/patientrep.aspx (last accessed August 19, 2016).

[848] See for example: Francois E. Baylis, “Ethics Consultation: The Hospital for Sick Children Initiative [Toronto, Ontario]” (1991) 3:5 HEC Forum 285, 286.

[849] For instance, the Health Justice Program is a partnership between St. Micheal’s Hospital and legal clinics (ARCH Disability Law Centre, Aboriginal Legal Services Toronto, HIV & AIDS Legal Clinic of Ontario and Neighbourhood Legal Services). It is funded by Legal Aid Ontario and provides services that include legal information and advice, referrals to legal services, and advocacy. Health Justice Program at St. Michael’s, online: http://www.stmichaelshospital.com/pdf/programs/family-practice/health-justice-initiative-presentation.pdf (last accessed August 19, 2016).

[850] See for instance: Pro Bono Law Ontario at SickKids, online: http://www.sickkids.ca/patient-family-resources/child-family-centred-care/pro-bono-law/Pro-Bono-Law.html (last accessed August 19, 2016).

[851] CPSO, note 86.

[852] For example, Hamilton Health Services has the Office of Patient Experience, online: http://www.hamiltonhealthsciences.ca/workfiles/CLINICAL_ETHICS/Patientexperience.pdf; University Health Network has Patient Relations – Office of the Ombudsman, online: https://www.oha.com/CurrentIssues/keyinitiatives/patientrelations/DepartmentalStructureandFunction/Documents/Examples%20of%20Policies,%20Flow%20Charts%20and%20Process%20Maps%20for%20Managing%20Feedback/Academic%20Hospitals/University%20Health%20Network.pdf (last accessed August 19, 2016).

[853] Nancy Neveloff Dubler & Carol B. Liebman, “Bioethics: Mediating Conflict in the Hospital Environment” (2004) Dispute Resolution J 32, 37.

[854] Dubler & Liebman, note 853, 36.

[855] Bowman, note 835, S21, citing F.H. Brown, “The Impact of Death and Serious Illness on the Family Life Cycle” in Betty A Carter & Monica McGoldrick, eds, The Changing Family Life Cycle: A Framework for Family Therapy , 2nd ed., (Toronto: Pearson, 1990).

[856] Medical teams have claimed that someone experienced in medical matters can be beneficial. See for instance: Knickle, McNaughton & Downar, note 842, 3.

[857] LCO Interim Report, note 17, 219-220.

[858] LCO Interim Report, note 17, 228.

[859] ECAA, note 88, ss.13.1(2), 13.2, 13.3(1), 13.3(4), 13.4.

[860] The Patient Ombudsman can decline to address a complaint “Where the complaint relates to a matter that is within the jurisdiction of another person or body.” ECAA, note 88, s. 13.2(3).

[861] See for instance: ECAA, note 88, preamble; Expert Group on Home and Community Care, note 81; Government of Ontario, note 47.

[862] Community Legal Education Ontario, online: http://www.cleo.on.ca/en (last accessed August 19, 2016).

[863] Your Legal Rights, online: http://yourlegalrights.on.ca/ (August 19, 2016).

[864] Community Legal Education Ontario, “About CLEO”, online: http://www.cleo.on.ca/en/about/about-cleo (last accessed August 19, 2016).

[865] References to accompaniment can be found in documents including Véronique Blanchet & Marcel-Louis Viallard, “De l’accompagnement des mourants à la médecine palliative en passant par les soins palliatifs” (2012) 11 Médicine palliative – Soins de support – Accompagnement – Éthique 266; Bernard J. Lapointe & Dawn Allen “Hospital-Based Palliative Care” in Judith Stillion & Thomas Attig, eds, Death, Dying and Bereavement: Contemporary Perspectives, Institutions and Practices (New York : Springer Publishing, 2014), 158; Gouvernement du Québec, Pour une meilleure qualité de vie : Soins palliatifs et de fin de vie. Plan de développement 2015-2020 (Gouvernement du Québec, 2015).

[866] HPCO 2016, note 203, 1, “Advance Care Planning”.

[867] HPCO 2016, note 203, 1, “Advance Care Plan, Living Will, Advance Directive”.

[868] HPCO 2016, note 203, 1, “Advance Care Plan, Living Will, Advance Directive”.

[869] HPCO 2016, note 203, 1, “Advance Care Plan, Living Will, Advance Directive”.

[870] HCCA, note 16, s. 4.

[871] HCCA, note 16, ss. 10, 25.

[872] HCCA, note 16, ss. 11, 25.

[873] Declaration of Partnership, note 38, 3, 12, 57.

[874] For definitions of frailty, see: Leocradio Rodriguez-Manas & Linda Fried, “Frailty in the Clinical Scenario” (2015) 385:9968 The Lancet 7; Jeremy D. Walston & Karen Bandeen-Roche, “Frailty: a Tale of Two Concepts” (2015) 13:185 BMC Med 1; Allan Gustavo Brigola, Estefani Serafim Rossetti, Bruna Rodrigues dos Santos and others, “Relationship between Cognition and Frailty in the Elderly: A Systematic Review (2015) 9:2 Dementia & Neuropsychology 110.

[875] See for instance: Rachelle E. Bernacki & Susan D. Block, “Communication about Serious Illness Care Goals: A Review and Synthesis of Best Practices” (2014) 174:12 JAMA Internal Medicine 1994; Lauris C. Kaldjian, Ann E. Curtis, Laura A. Shinkunas and others, “Goals of Care Toward the End of Life: A Structured Literature Review” (2009) 25:6 American Journal of Hospice & Palliative Medicine 501; John J. You, James Downar, Robert Fowler and others, “Barriers to Goals of Care Discussions with Seriously Ill Hospitalized Patients and their Families: A Multicenter Survey of Clinicians (2015) 175:4 JAMA Internal Medicine 549.

[876] Kaldjian, note 875.

[877] HCCA, note 16, s. 20.

[878] See for instance: Declaration of Partnership, note 38, 1-2, 58; World Health Organization, note 39; The Way Forward, note 20, 13.

[879] M.M. Dean, V. Cellarius, B. Henry and others, “Framework for Continuous Palliative Sedation Therapy in Canada” (2012) 15:8 Journal of Palliative Medicine 870, citing, N.I. Cherny, R.K. Portenoy, “Sedation in the Management of Refractory Symptoms: Guidelines for Evaluation and Treatment” (1994) 10:2 Journal of Palliative Medicine 31. For further definitions, see also: Fraser Health, note 644.

[880] Carter, note 10, para. 40.

[881] HCCA, note 16, s.2. See also: Wahl 2014, note 44, 20, 49-50.

[882] HCCA, note 16, s.2.

[883] HCCA, note 16, s. 20; SDA, note 16, s. 49(1)(a).

[884] Residential Hospice Working Group of the Hospice Palliative Care Provincial Steering Committee, Environmental Scan for Strengthening Residential Hospice Care in Ontario: Evidence and Practice (March 2015), 2; Ministry of Health and Long-Term Care, Community Care Access Centres: Client Services Policy Manual (January 2007), 7.7.

[885] See for instance, the Canadian Virtual Hospice, online: www.virtualhospice.ca (last accessed August 19, 2016).

[886] HCCA, note 16, s.2.