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End of Life – definitions and policies

Advance directives and resuscitative intervention

Advance medical directives give incapacitated patients a way to make decisions about medical treatment. This is done by writing an advance directive or appointing a health-care proxy who will make decisions on behalf of the patient, should he or she become incapable of doing so.

Euthanasia and assisted suicide

Euthanasia actively ends the life of someone suffering from an incurable (usually end-stage) disease. In physician-assisted suicide, the physician provides the means to terminate life and the patient or their family carries out the action. Both are criminal acts in most countries, including Canada.

Physicians are committed to providing high quality care at the end of life. They are also committed to maintaining their patients’ quality of life. There are rare occasions where patients have such a degree of suffering, even with access to palliative and end of life care, that they request medical aid in dying. In such a case, and within legal constraints, medical aid in dying may be appropriate. The CMA supports patients’ access to the full spectrum of end of life care that is legal in Canada. The CMA supports the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether to provide medical aid in dying as defined in this policy.

Organ and tissue donation, transplantation

Organ and tissue donation involves consent to remove an organ or tissue from a patient's body to donate to another person who needs it to survive. Ethical concerns include consent, exploitation and remuneration, the sanctity of the human body, autonomy, human rights and resource allocation.

CMA policies

End-of-life care resolutions adopted by General Council, August 2014

Advance directives for resuscitation and other life-saving or sustaining measures (1992; most recent, currently under review)

CMA Statement on Life Saving and Sustaining Interventions (2013; most recent)

Euthanasia & assisted death (2014; most recent)

Organ and tissue donation and transplantation (2015; most recent)

Additional resources

Canadian Hospice Palliative Care Association

CMAJ collection: End-of-life decisions

JAMA collection: palliative care/end-of-life care

Journal of Medical Ethics collection: End of life decisions

World Health Organization: Human organ and tissue transplantation

CMAJ collection: Organ donation