The Ethics of End-of-Life Care: Understanding the Moral Landscape of Medicalized Dying in Canada

Since the report of the Special Senate Committee on Euthanasia and Assisted Suicide was published in 1995, end-of-life care continues to be an important issue for many Canadians. Quebec, for example, recently revisited this issue with its own Select Committee on Dying with Dignity in 2009-2010. There are five medical practices in end-of-life care that remain ethically controversial among various stakeholders that include bioethicists, health care providers, policy makers, and individuals from vulnerable and marginalized communities. These practices are: withholding of treatment, withdrawal of treatment, terminal sedation, euthanasia, and physician-assisted suicide. The fact that various governments continue to repeatedly consult the public on these issues suggests that we still lack a comprehensive understanding of Canadians' moral beliefs on these practices and the values that underpin those beliefs. This lack of understanding has resulted in discrepant, and at times contested, end-of-life treatment and policies throughout Canada, creating ethical dilemmas for various stakeholders and undermining the accessibility provision of Canada Health Act. This three-year research project is designed: 1) to describe and analyse the diverse moral beliefs of Canadians through an examination of media reporting of these issues from 1995 to present; 2) to gain an ethical understanding of key stakeholders' reasons for holding particular positions on these issues through in-depth interviews; 3) to present a comprehensive analysis of these issues to policy makers so that they may engage the public more effectively in the future. We are a team of social scientists and bioethicists trained and knowledgeable in end-of-life care issues and qualitative research methods. Our analysis will inform the development of meaningful end-of-life care policy for Canadians and contribute to improving clinical end-of-life care for patients.