Complete guide to Canadian hospital end-of-life care — palliative care services, Medical Assistance in Dying (MAID), advance care planning, grief and bereavement support, and end-of-life software.
MAID has been legal in Canada since 2016 and expanded in 2021. Only ~15% of Canadians have access to quality palliative care. This guide covers Canadian end-of-life care.
Palliative Care Services
| Service | Description | Setting |
|---|---|---|
| Specialist palliative care | Specialist palliative care team | Inpatient + community |
| Hospital palliative care | Palliative care consultation for inpatients | Hospital |
| Community palliative care | Palliative care at home | Home |
| Hospice | Dedicated palliative care unit | Hospice |
| Respite palliative care | Respite for carers | Inpatient |
| Bereavement support | Grief support for families | Community |
MAID Process
- Patient request: Patient formally requests MAID (written or witnessed)
- First assessment: First independent physician/NP assesses eligibility
- Second assessment: Second independent physician/NP confirms eligibility
- Informed consent: Patient gives informed consent immediately before administration
- Administration: Physician/NP administers MAID (IV medication)
- Documentation: Document MAID and report to federal government
- Follow-up: Bereavement support for family
End-of-Life Care Pathway
- Recognition: Recognise patient approaching end of life
- Communication: Communicate openly with patient and family
- Advance care planning: Review or create advance directive
- Goals of care: Discuss and document goals (curative, palliative, terminal)
- Symptom management: Manage pain, nausea, dyspnoea, agitation
- Psychosocial support: Psychological and spiritual support
- Family support: Support family through dying process
- Bereavement: Bereavement support after death
Frequently Asked Questions
- What is MAID in Canada?
- MAID (Medical Assistance in Dying) has been legal in Canada since 2016 (Bill C-14). Expanded in 2021 (Bill C-7). Eligibility: 1) Adult (18+), 2. Canadian resident eligible for funded healthcare, 3. Grievous and irremediable medical condition, 4. Voluntary, 5. Informed consent. Two independent assessments required. Track 1: foreseeable death. Track 2: unforeseeable death. MAID for mental illness was delayed to 2027 pending review.
- What is advance care planning in Canada?
- Advance care planning in Canada allows patients to document future healthcare preferences. Components: 1) Advance directive — specifies treatment preferences, 2. Substitute decision-maker — appointed to make decisions if patient loses capacity, 3. Goals of care conversation. Legislation varies by province. Advance directives are legally binding. Hospitals should document advance directives in the patient record.
- What are Canadian palliative care standards?
- Canadian palliative care standards (Canadian Hospice Palliative Care Association — CHPCA): 1) Patient and family focused, 2. Accessible, 3. Coordinated, 4. Symptom management, 5. Bereavement support, 6. Education and research. Only ~15% of Canadians have access to quality palliative care. Federal framework on palliative care aims to improve access.