NOTE

The deadline for submissions was January 22, 2016. In February 2016, we announced which proposals were successful in our competitive process for research funding. Seven multidisciplinary teams were selected to undertake research that will provide new sources of qualitative information for the LCO’s project. The final research papers will be posted on our website in summer 2016.

 

 

Research to be Funded

Submission Process

Terms of the Call for Research Papers

Frequently Asked Questions

 

The Law Commission of Ontario (LCO) is undertaking a project that reviews Ontario’s law and policy framework for providing care to persons who are approaching death and services for those who support them, including caregivers, family members, friends and health care providers. A general description of the project, the LCO’s mandate and associated resources may be found on the LCO’s website at www.lco-cdo.org and we urge applicants to carefully read the information presented there.

From May to September 2015, the LCO conducted preliminary research and consultations in order to understand the overall context in which the law operates and to identify core issues that the project will address. Based on this initial work and our ongoing research, the LCO is now developing a discussion paper that will review and analyse a range of issues and set out questions for public consultation. We expect to release the discussion paper and accompanying materials, including a discussion paper summary, in mid-2016. Together, these documents will form the foundation for dedicated public consultations that the LCO will lead in various locations throughout fall 2016.

As part of the development of the discussion paper, the LCO will fund a number of research papers that will inform our development of options for reform. A list of potential research paper topics, application requirements and terms for funding are set out below.
I.    RESEARCH TO BE FUNDED

i.    Objectives

The objective of this Call for Research Papers is to obtain expert input on complex issues of law and policy relating to care in the last stages of life. The resulting research will assist the LCO in making reasoned, evidence-based and practical reform recommendations. The Call for Research Papers also aims to create critical debate and promote scholarly work on the subject matters at issue.

The LCO takes a holistic approach to law reform and encourages multidisciplinary research and proposals from research teams. We encourage proposals from experts in relevant disciplines, including law, medicine and the social sciences, and from organizations representing or serving interested communities, such as patients, caregivers, health care providers, older adults and persons with disabilities.

Researchers are encouraged to leverage relevant quantitative or qualitative research that they have already completed or to undertake original quantitative or qualitative research, so long as it is feasible within the timelines set out below.

 

ii.    Research paper topics

The LCO will fund a number of research papers to be determined after considering all of the proposals we receive. We have identified ten potential research paper topics, described below. We will also consider proposals on other topics that would make a demonstrable contribution to our understanding of the issues identified in the description of the project on our website and that would benefit from external, expert knowledge that the LCO might not be able gain otherwise through internal research and consultations.

We encourage proposals that take into account how the issues under consideration may be affected by various aspects of diversity, including age, culture, faith, language, literacy, place of residence (both geographical and by type of care setting), economic status, gender identity and expression, sexual orientation, Aboriginal identity and disability, among others.

Detailed descriptions of the following research paper topics are provided further below:

  1. Integrating religious and cultural supports into quality care in the last stages of life: theoretical foundations and practicable models for Ontario’s health care system.
  2. A rights-based perspective on the delivery of medical aid in dying in Ontario care settings.
  3. Balancing the interests of patients, substitute decision-makers, family and health care providers in decision-making over the withholding and withdrawal of life-sustaining treatment.
  4. Policies and procedures to facilitate alternative dispute resolution for end-of-life decision-making, including preventative approaches.
  5. Understanding the lived experience of individuals, caregivers and family members with Ontario’s system for care in the last stages of life and possibilities for enhanced advocacy supports.
  6. Managing transitions within and between care settings for individuals, caregivers, family members and health care providers.
  7. Challenges and opportunities associated with integrating a palliative approach into services and supports for frail older adults, and persons with chronic and degenerative conditions from the early stages.
  8. Informed consent, advance care planning and substitute decision-making: using practice tools to ensure meaningful decision-making in the last stages of life.
  9. Challenges for personal support workers in delivering quality care in the last stages of life: understanding their roles, education, training and employment.
  10. Addressing law and policy barriers to the provision of appropriate medications for persons living in the community.
  11. Other paper topics requiring expert research that would make a demonstrable contribution to the LCO’s project.

 

1.    Integrating religious and cultural supports into quality care in the last stages of life: theoretical foundations and practicable models for Ontario’s health care system

Faith and cultural supports are an accepted element of care for persons who are approaching death, their family members and the broader communities to which they belong. Adherence to beliefs and practices may have strong importance at the end-of-life for a range of issues, including decision-making about personal care and life-sustaining treatments, feelings of comfort and overall well-being. However, the extent to which faith and cultural needs are met through accommodations or other supports and services varies. For instance, facility policies may limit the number of family and community members who can visit a patient at once and traditional practices, such as prayers in the final moments important in many religions, could be overlooked. Given the importance of faith and cultural supports in the last stages of life, the LCO wishes to understand existing needs, challenges and opportunities in this area to inform our consideration of improvements for quality care.

The LCO seeks a research paper that will review and analyze

  • examples of beliefs and practices from different faiths and cultures that are important during the dying process;
  • the role of faith and cultural supports in providing quality care at the end-of-life and, especially, in preventing, mediating and diffusing conflicts about treatment decisions;
  • common challenges with integrating faith and cultural supports into quality care;
  • related accommodations for patients, substitute decision-makers, caregivers, family and community members under the Charter of Rights and Freedoms and provincial human rights legislation;
  • policies to integrate proactive faith and cultural supports into quality care, for instance, educational training for health care providers, faith and cultural counselling and referrals to leaders in the community; and
  • other issues considered to be of significant relevance to a full analysis of this topic.

 

2.    A rights-based perspective on the delivery of medical aid in dying in Ontario care settings

Following the Supreme Court of Canada’s decision in Carter v. Canada (which found Criminal Code provisions prohibiting physician-assisted death to be unconstitutional), two expert panels were convened by the federal government, on the one hand, and by the Ministers of Health and Attorneys General for eleven provinces and territories, on the other, in order to consider regulatory options for their jurisdictions.

The LCO is seeking further, detailed expert information on the rights implications of medical aid in dying for patients, caregivers, family members, health care providers and facilities in Ontario. Specifically, the LCO wishes to understand how various rights and principles that have been developed in the context of other types of care, such as palliative care, could be translated into approaches to medical aid in dying. Examples include the provision of seamless, high quality care and support; equitable access for all Ontarians; and bereavement support for caregivers and family members. To the extent possible, research on this topic will maintain a practical focus on applied models for delivering services that builds on the expert panels’ recommendations (once released), government-initiated developments, approaches in comparable jurisdictions and a solid appreciation of Ontario’s institutional context.

The LCO seeks a research paper that will review and analyze

  • rights and principles associated with other types of care, such as palliative care, that could be translated into a foundation for rights and principles associated with delivering medical aid in dying;
  • challenges affecting vulnerable communities that may face difficulties accessing medical aid in dying based on factors such as place of residence;
  • the respective roles of physicians, nurses, facilities, caregivers and others;
  • issues relating to conscientious objection that are relevant (although this is not the primary focus of the research paper);
  • frameworks in jurisdictions that provide valuable comparators to Ontario; and
  • other issues considered to be of significant relevance to a full analysis of this topic.

 

3.    Balancing the interests of patients, substitute decision-makers, family and health care providers in decision-making over the withholding and withdrawal of life-sustaining treatment

The Health Care Consent Act, 1996 (HCCA) governs Ontario’s regime for informed consent, capacity and substitute decision-making for treatment. In Cuthbertson v. Rasouli, the Supreme Court of Canada interpreted what the HCCA requires where there are conflicting arguments about who should have the ultimate say in whether to withdraw life-sustaining treatment. However, individuals and organizations within the legal and health care community have expressed that they face challenges applying Rasouli to end-of-life decisions about the withdrawal and withholding of treatment in factual circumstances that are not analogous. Furthermore, there are ongoing debates about whether substitute decision-makers or health care providers ought to decide the course of treatment for an incapable person when, in the health care provider’s opinion, the treatment is of little or no “beneficial” value.

These debates raise very sensitive but important issues about quality of life, rights to autonomy in decision-making, resource allocation and the security of patients who cannot make end-of-life choices for themselves. A research paper that considers the full spectrum of legal, ethical and clinical aspects about competing interests would make a significant contribution to the LCO’s project. The research paper on this topic will draw on the LCO’s findings in our separate project on Legal Capacity, Decision-Making and Guardianship, in particular, the interim report to be released in January 2016. The LCO also particularly welcomes proposals on this topic that indicate the applicants will rely on completed or new qualitative or quantitative research on affected stakeholders’ perceptions.

The LCO seeks a research paper that will review and analyze