End-of-life care at the McGill University Health Centre

The Act respecting end-of-life care ensures that persons at the end of life are provided end-of-life care that is respectful of their dignity and their autonomy and appropriate to their needs, including prevention and relief of suffering. The act includes: palliative care (including continuous palliative sedation), medical aid in dying and advanced medical directives. To find out more about this act, please visit Quebec.ca.

The responsibilities of the McGill University Health Centre (MUHC) regarding end-of-life care are established in our End-of-Life Care Policy. Three fundamental values guide all end-of-life care:

• Respect: The respect of the intrinsic value of each person as a unique individual, the respect of the person’s dignity, as well as the recognition of the value of life and the inevitability of death;
• Participation: The participation of each person in all decisions that concern the person; to this end, all decisions require the person’s free and informed consent and must respect the person’s autonomy. In the event that a person does not have the capacity to make treatment decisions, a surrogate decision maker can consent to care, taking into account any previous wishes the person expressed, and if these wishes are unknown, by making decisions in the person’s best interest. In accordance with the person’s wishes, the person – or surrogate decision maker – shall be informed of everything that concerns him/her, including the person’s true state of health;
• Compassion: The right to compassionate services from caregivers, which shall respect the values that give meaning to the person’s existence and take into account the individual’s culture as well as religious beliefs and practices, within the limits of medical standard of practice and health system resources.

Supportive and Palliative Care

The MUHC’s Division of Supportive and Palliative Care offers compassionate specialized care to patients with life-limiting and terminal illnesses from across Quebec. Our experience and dedicated multidisciplinary team strives to improve the quality of life of patients and families, by ensuring that the services we provide meet their physical, psychological, informational and spiritual needs. These services include;

• Inpatient palliative care
• Supportive and palliative care consultation service, including continuous deep palliative sedation (please see below)
• Palliative care day hospital
• Cancer Pain Clinic: assessments by a multidisciplinary team of anesthesiologists, radiation oncologists, palliative care physicians, nurses, physiotherapists and occupational therapists
• Psychosocial oncology services: psychologists, psychiatrists, social workers and nurses help patients and families deal with and overcome feelings of defeat, anger, sadness, guilt and anxiety
• Cancer rehabilitation and cachexia clinic : services to patients experiencing loss of function, fatigue, malnutrition, psychological distress and other symptoms
• Lymphedema Clinic: assessments, consultations and referral services for cancer patients throughout Quebec and the Atlantic provinces
• Spiritual services: spiritual, emotional and religious support to patients and their families

Continuous deep palliative sedation is a controlled sedation to the point of unconsciousness in a patient very near death, with the purpose of relieving symptoms that cannot be controlled using other measures.

When should continuous deep palliative sedation be considered?

Although most patients at end of life exhibit suffering that can be controlled to a tolerable level, there are situations when physical and/or psychological distress, even with expert palliative care, precludes any hope for a peaceful death. Continuous deep palliative sedation is a treatment that may be offered as a last resort to dying patients, when all other treatments of suffering have failed. Common refractory physical reasons for the use of palliative sedation include delirium, dyspnea, pain, and vomiting.

Medical aid in dying

Medical aid in dying consists of a doctor administering medication to patients at the end of life, at their request, in order to relieve suffering by bringing about their death. Only a person of full age and capable of giving consent to care may request to receive medical aid in dying. No other person can do so for them. In addition, a patient at the end of life must meet all the criteria set out in the Act in order to receive this treatment.

Only a patient who meets all of the following criteria may obtain medical aid in dying:

1. be an insured person within the meaning of the Health Insurance Act (chapter A-29);
2. be of full age (over the age of 18) and capable of giving consent to care;
3. be at the end of life;
4. suffer from a serious and incurable illness;
5. be in an advanced state of irreversible decline in capability; and
6. experience constant and unbearable physical or psychological suffering which cannot be relieved in a manner the patient deems tolerable.

The patient must request medical aid in dying himself/herself, in a free and informed manner, by means of the form prescribed by the Minister. The form must be dated and signed by the patient.

The form must be signed in the presence of and countersigned by a health or social services professional as well as 2 independent witnesses; if the professional is not the attending physician, the signed form is to be given by the professional to the attending physician.