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The Law Commission of Ontario’s Last Stages of Life: Final Report considers how Ontario’s legal and policy frameworks shape the rights, choices, and quality of life for persons who are dying and those who support them. The “last stages of life” is an adopted term that gives the project scope to look at legal issues arising in relation to palliative care, end-of-life care, and medical assistance in dying in Ontario.
Canadian and Ontarian approaches to these matters have changed profoundly in the last five years. The LCO’s Last Stages of Life: Final Report is a blueprint to ensure the law keeps pace with these changes and continues to meet the needs of all those impacted.
The LCO’s Final Report should additionally be read alongside our complementary report on the Last Stages of Life for First Nation, Métis and Inuit Peoples: Preliminary Recommendations for Law Reform (2023). The LCO developed and undertook this as a distinct process to engage with Inuit, Métis, and First Nation members in Ontario, with oversight from an Indigenous Engagement Advisory Group.
Key Areas for Reform
The report makes 56 law and policy reform recommendations across five major areas. These would:
- activate the earlier involvement of people in discussing and planning for their last stages of life, including through public health promotion mandate and formal supports for advance care planning and goals of care discussions (Recommendations 1-16);
- better support the professionals and paraprofessionals who provide care in the last stages of life through expanded workplace wellness supports (Recommendations 17-22);
- update and expand workplace wellness and leave provisions so families, friends and community members have flexible supports responsive to the unpredictable trajectory of care needs over time (Recommendations 23-30);
- increase access to equitable care for vulnerable communities with unmet needs, including prisoners, isolated individuals, children, and persons contemplating medical assistance in dying (Recommendations 31-49); and
- help resolve disputes by making rights-based information and mediation available earlier and expedite formal legal proceedings concerning the last stages of life (Recommendations 50-56).
The LCO’s extensive province-wide consultations confirm these recommendations as timely, thoughtful, and very much needed. Our work reflects the lived experience of the 850 Ontarians we heard from across the 74 consultation sessions we convened; the nearly 600 pages comments submitted by the public; the seven expert reports we commissioned; and from the oversight provided by an external expert Advisory Group.
Last Stages of Life: Final Report (2021, PDF)
Last Stages Of Life: Final Report (2021, DOC) – Accessible Word Version
Executive Summary to the Last Stages of Life: Final Report (2021, DOC) – Accessible Word Version
Les Derniers Moments de la Vie – Sommaire Rapport Final (2021, DOC) – Accessible Word Version
Additional Project Documents
- Dr. Arne Stinchcombe, Dr. Katherine Kortes-Miller & Dr. Kimberley Wilson: Perspectives on the final stages of life from LGBT elders living in Ontario
- Dr. Mary Chiu, Dr. Adrian Grek, Sonia Meerai, LJ Nelles, Dr. Joel Sadavoy & Dr. Virginia Wesson: Understanding the lived experience of individuals, caregivers and families touched by frailty, chronic illness and dementia in Ontario
- Dr. Donna Wilson & Dr. Stephen Birch: Improved care setting transitions in the last year of life
- Judith A. Wahl, Mary Jane Dykeman, Tara Walton: Health Care Consent, Advance Care Planning, and Goals of Care Practice Tools: The Challenge to Get it Right
- Rosario G. Cartagena, Alison K. Thompson, Kaveh Katebian, Trudo Lemmens, Rose Geist, Harvey Schipper, Sandy Buchman, Heesoo Kim, Mark Handelman: Understanding the Relationship between Suffering and Capacity at the End-Of-Life: A Pilot Study
- James Downar, Laura Hawryluck, Alexi Wood, Susan Brown, Joy Richards, Robert Sibbald, Jennifer Gibson, & Csilla Kalocsai: Balancing The Interests Of Patients, Substitute Decision-Makers, Family And Health Care Providers In Decision-Making Over The Withdrawal And Withholding Of Life-Sustaining Treatment
- Omar Ha-Redeye, Ruby Latif, & Kashif Pirzada: Integrating Religious and Cultural Supports into Quality Care in the Last Stages of Life in Ontario