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End-of-life decision-making in Canada: the report by the Royal Society of Canada expert panel on end-of-life decision-making.
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MedLine Citation:
PMID:  22085416     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This report on end-of-life decision-making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters. Chapter 1 reviews what is known about end-of-life care and opinions about assisted dying in Canada. Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death. Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order. Chapter 4 reviews the experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form. Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document.
Authors:
Udo Schüklenk; Johannes J M van Delden; Jocelyn Downie; Sheila A M McLean; Ross Upshur; Daniel Weinstock
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Bioethics     Volume:  25 Suppl 1     ISSN:  1467-8519     ISO Abbreviation:  Bioethics     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-17     Completed Date:  2012-03-19     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  8704792     Medline TA:  Bioethics     Country:  England    
Other Details:
Languages:  eng     Pagination:  1-73     Citation Subset:  E; IM    
Copyright Information:
© 2011 Blackwell Publishing Ltd.
Affiliation:
Department of Philosophy, Queen's University, Canada. udo.schuklenk@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Advance Directives
Aged
Bioethical Issues
Canada
Child
Decision Making
Deep Sedation
Europe
Euthanasia, Active, Voluntary
Humans
Palliative Care
Public Opinion
Suicide, Assisted / legislation & jurisprudence
Terminal Care*
United States
Withholding Treatment
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Bioethics
Journal ID (publisher-id): bioe
ISSN: 0269-9702
ISSN: 1467-8519
Publisher: Blackwell Publishing Ltd, Oxford, UK
Article Information
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© 2011 Blackwell Publishing Ltd.
open-access:
Print publication date: Month: 11 Year: 2011
Volume: 25 Issue: Suppl 1
First Page: 1 Last Page: 4
ID: 3265521
PubMed Id: 22085416
DOI: 10.1111/j.1467-8519.2011.01939.x

End-of-Life Decision-Making in Canada: The Report by the Royal Society of Canada Expert Panel on End-of-Life Decision-Making
Udo Schüklenk1 Role: Ontario Research Chair in Bioethics and Professor
Johannes J M Van Delden2 Role: Professor of Medical Ethics
Jocelyn Downie3 Role: Canada Research Chair in Health Law and Policy and Professor at the Faculties of Law and Medicine
Sheila A M Mclean4 Role: Emeritus Professor of Law and Ethics in Medicine
Ross Upshur5 Role: Canada Research Chair in Primary Care Research and is a Professor at the Department of Family and Community Medicine
Daniel Weinstock6 Role: Canada Research Chair in Ethics and Political Philosophy
Department of Philosophy, Queen's UniversityCanada
UMC Utrecht, Julius CenterThe Netherlands
Faculties of Law and Medicine, Dalhousie UniversityCanada
University of GlasgowUK
Department of Family and Community Medicine University of TorontoCanada
Department of Philosophy, Université de MontréalCanada
Correspondence: Address for correspondence: Prof. Udo Schüklenk, Department of Philosophy, Queen's University, Kingston, Ontario K7l 2G3, Canada. E-mail: udo.schuklenk@gmail.com
Conflict of interest statement: No conflicts declared
Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonlinelibrary.com/onlineopen#OnlineOpen_Terms

TABLE OF CONTENTS
INTRODUCTION

  1. Introductory Remarks and Objectives
  2. Terminology
  3. Outline

CHAPTER ONE: END-OF-LIFE CARE IN CANADA

  1. Introduction
  2. Canadian Experience at the End of Life
    1. Mortality and Life Expectancy Trends in Canada
    2. Location of Death
    3. Quality of and Access to Palliative Care
  3. Expanding the Range of Palliative Care
    1. Dementia
    2. Chronic Kidney Disease
    3. Congestive Heart Failure
    4. Chronic Obstructive Pulmonary Disease
    5. Disability
  4. Demographic Transition in Canada
    1. Aging
    2. Diversity
    3. First Nations
  5. Advance Directives and Substitute Decision-Making
  6. Sedation Practices
  7. Paediatric End of Life Care
  8. Attitudes of Canadians Toward Voluntary Euthanasia and Assisted Suicide
    1. General Public
    2. Health Care Professionals
    3. Patients
  9. International Comparisons
  10. Conclusions

CHAPTER TWO: THE LEGAL LANDSCAPE

  1. Introduction
  2. Withholding and Withdrawal of Potentially Life-sustaining Treatment
    1. Relatively Clear and Uncontroversial
    2. Less Clear and More Controversial
    3. Very Unclear and Very Controversial
  3. Potentially Life-shortening Symptom Relief
    1. Somewhat Clear and Relatively Uncontroversial
  4. Terminal Sedation
    1. Very Unclear and Potentially Very Controversial
  5. Assisted Suicide
    1. Very Clear and Very Controversial
  6. Voluntary Euthanasia
    1. Very Clear and Very Controversial
  7. Conclusions

CHAPTER THREE: THE ETHICS OF END-OF-LIFE CARE

  1. Introduction
  2. Core Values
  3. Autonomy
  4. Moral and Legal Rights
  5. Autonomy and Assisted Death
  6. Limits to the Right to Medically Assisted Death
    1. No Inference from the Right to Refuse Treatment to the Right to Assisted Death
    2. A Priori Arguments: Suicide is not Choice-worthy
    3. A Priori Arguments: Suicide Offends against Human Dignity
  7. Arguments against the Legal Right to Assisted Death
    1. Medical Professionals
    2. Slippery Slopes and the Protection of the Vulnerable
  8. Conclusions

CHAPTER FOUR: INTERNATIONAL EXPERIENCE WITH LAWS ON ASSISTED DYING

  1. Introduction
  2. Mechanisms for Change to Law and/or Practice
    1. Judicial Decisions (Netherlands, Montana)
    2. Prosecutorial Charging Guidelines (Netherlands, United Kingdom)
    3. New or Revised Laws
      1. The Netherlands
      2. Belgium
      3. Luxemburg
      4. Oregon
      5. Washington State
    4. Evolution of Practice Without Legal Change (Switzerland)
  3. Elements of Regulated Permissive Regimes
  4. Practical Experience
    1. Data on Voluntary Euthanasia and Assisted Suicide
      1. Netherlands
      2. Belgium
      3. Switzerland
      4. Oregon
      5. Washington State
    2. Slippery Slopes?
  5. Conclusions

CHAPTER FIVE: PROPOSALS FOR REFORM

  1. Introduction
  2. Withholding and Withdrawal of Potentially Life-sustaining Treatment
    1. Valid Refusals by Competent Adults (or Legally Authorized Substitute Decision-makers)
    2. Mature Minors
    3. Unilateral Withholding and Withdrawal
  3. Advance Directives
  4. Palliative Care
  5. Potentially Life-shortening Symptom Relief
  6. Terminal Sedation
  7. Assisted Suicide and Voluntary Euthanasia
    1. Legal Mechanisms
      1. Criminal Code Reform
      2. Prosecutorial Charging Guidelines
      3. Diversion Programs
    2. Core Elements
      1. Assisted Suicide and/or Voluntary Euthanasia
      2. Features of the Person
      3. Features of the Decision
      4. Features of the Person's Condition
      5. Features of the Request for Assistance
      6. Features of the Provider
      7. Oversight and Control



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Keywords: Canada, Royal Society report, end-of-life, quality of life, assisted dying, palliative care, death.

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