The Canadian Medical Association (CMA) has published the results of a national dialogue process designed to provide both the public and the medical profession with a societal perspective on end-of-life care. In collaboration with Macleans Magazine, the CMA held town halls and an online dialogue which assembled key observations that will guide the profession in the future and serve as input to the quickly-evolving public policy process around this vital issue. The dialogue process addressed three main issues: advance care directives, palliative care, and euthanasia and physician-assisted dying.

The town halls took place in St. John’s, NL (Feb.20), Vancouver, BC (Mar. 24), Whitehorse, Yukon (Apr. 16), Regina, Sask. (May 7), and Mississauga, Ont. (May 27). A live web chat was also held on May 12 on the Maclean’s website. Members of the public were also able to post their comments online during and after each town hall.

The CMA began the process by releasing useful and standardized terminology it has developed to discuss end-of-life care. It recommends that this terminology, laid out in its report, be widely communicated to health care providers, policy-makers and the public.

The 17-page report is worth reading in its entirety and shows exemplary leadership from the CMA on this important issue. Here are some of its main conclusions:

• All Canadians should discuss end-of-life wishes with their families or other loved ones.
• All Canadians should prepare advance care directives that are appropriate and binding for the jurisdiction in which they live.
• Canadians should revisit their end-of-life care wishes periodically, recognizing that health care providers will interpret these wishes on the basis of a number of variables, including written advance care directives, conversations with loved ones and, input from a substitute decision maker.
• A national palliative care strategy should be developed.
• All Canadians should have access to appropriate palliative care services.
• Funding for palliative and hospice care services should be increased.
• More education about palliative care approaches and as well as how to initiate discussions about advance care planning is required for medical students, residents and practising physicians.

The CMA recognizes that public opinion in Canada is divided on whether or not to maintain the current ban on euthanasia and physician-assisted dying in most Canadian jurisdictions. Quebec has just passed a law that sets strict conditions under which it is possible for patients to request medical assistance to die. The CMA recommends strict protocols and safeguards to protect vulnerable individuals and populations if the law in Canada is changed to allow euthanasia or physician-assisted dying.

It also recommends careful consideration and further study of the potential impact on the Canadian medical profession of legalizing physician-assisted dying.

The report’s findings will serve as the basis for the CMA’s public advocacy on end-of-life care going forward.