End of Life Law and Ethics in Canada

End of life care can raise legal and ethical questions and challenges for nurses caring for patients across the lifespan right from neonates to the elderly. In this presentation, the presenter will explain the legal status of the full spectrum of end of life care – withholding/withdrawal of potentially life-sustaining treatment, palliative interventions, and medical assistance in dying (MAiD). She will then engage with legal and ethical issues associated with elements of end of life care that are unclear and/or controversial. For example, can health care providers withhold or withdraw potentially life-sustaining treatment from patients against the wishes of the patient or their substitute decision-maker (e.g., parents of newborns)? Can health care providers provide deep and continuous sedation and withhold artificial hydration and nutrition from patients whose death is not imminent? Should mature minors be able to access medical assistance in dying? Should patients be able to access MAiD through requests made in advance of loss of capacity?

Learning Objectives:

• Understand the current legal status of the full spectrum of end of life care in Canada (withholding/withdrawal of potentially life-sustaining treatment, palliative interventions, and medical assistance in dying).
• Participate in legal, ethical, and clinical discussions re: palliative sedation and unilateral withholding/withdrawal of potentially life-sustaining treatment.
• Participate in legal, ethical, and clinical discussions re: access to medical assistance in dying for mature minors and individuals whose sole underlying condition is a mental illness who do not meet the legislative eligibility criteria and through requests made in advance of loss of capacity.

Presenter: Jocelyn Downie, SJD, FRSC, FCAHS, Fellow, Pierre Elliott Trudeau Foundation; University Research Professor, Faculties of Law and Medicine, Dalhousie University, Halifax NS

Jocelyn is a Fellow of the Royal Society of Canada and the Canadian Academy of Health Sciences.  She is also a Fellow of the Pierre Elliott Trudeau Foundation. She began her academic career in Philosophy (BA and MA at Queen's University and an MLitt at the University of Cambridge) and then switched to Law (LLB at the University of Toronto and LLM and SJD at the University of Michigan at Ann Arbor). After law school, she clerked for Chief Justice Lamer at the Supreme Court of Canada. After graduate school, she was the Director of the Health Law Institute at Dalhousie for ten years. She is now a University Research Professor in the Faculties of Law and Medicine at Dalhousie University and a Faculty Associate of the Dalhousie Health Law Institute. Her work on end of life law and ethics goes back many years and includes: articles, presentations, and policy development on issues across the entire range of end of life law and policy; Special Advisor to the Canadian Senate Committee on Euthanasia and Assisted Suicide; author of Dying Justice: A Case for the Decriminalizing Euthanasia and Assisted Suicide in Canada (winner of the AbbyAnn D. Lynch Medal in Bioethics from the Royal Society of Canada); member of the Royal Society of Canada Expert Panel on End-of-Life Decision-Making; member of the pro bono legal team in the case of Carter v. Canada (Attorney General); and member of the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying and the Canadian Council of Academies Expert Panel on Medical Assistance in Dying.