End of life
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.
The public controversy that continues to swirl stems from the morality of the act, duty and liability of the physician, issues of informed consent, potentially conflicting wishes and the sanctity and quality of life. These issues should not be confused with medical decisions such as not initiating or discontinuing treatment which could be life-saving or sustaining, but is not clinically indicated or is not wanted by the patient or substitute decision-maker. There are also several important Canadian legal cases currently before the courts, and potentially legislation in Quebec, that would address these issues.
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.
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 (2014; most recent)
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