by Written on behalf of Wise Health Law February 15, 2018 3 min read

A new study published this week by the Institute for Clinical Evaluation Sciences (ICES) reveals that the majority of Ontario residents would prefer to die at home. Despite this, most (almost 70%) die in long-term care facilities or hospitals. Results of this new study can help inform policy and health care planning at a time where a large proportion of the province’s population is rapidly aging, and add to the ongoing debate around end of life care in Ontario.

The Study

The study reviewed more than 260,000 deaths in Ontario between April 2010 and March 2013. It was the largest study of its kind showing the link between home visits made by doctors and where people die. It is intended to assist policy makers and health planners to be able to foresee future needs and highlight areas where care can be optimized. The study systematically examined both usage and costs across a comprehensive set of healthcare sectors in Ontario, including acute care hospitalizations, physician visits, ER visits, long-term care, home care, and complex continuing care. The study’s lead author, Dr. Peter Tanuseputro(staff physician in the palliative care division at the Ottawa Hospital Research Institute, scientist at ICES, and researcher at the Bruyère Research Institute), notes that his research has shown that people who receive physician visits at home in their last year of life have their risk of dying in hospital reduced by half. He suggests that Ontario needs a structured palliative care strategy to ensure that people have the choice to die at home. Dr. Tanuseputro and his team found that currently:
Most people would be able to die at home if they had the supports in place to make that happen. Unfortunately in most areas across Canada, it’s quite arbitrary who gets palliative care in the home, depending on factors like if your family doctor does home visits, what neighborhood you live in, and what you’re dying of. Canada remains in the back of the pack in developed nations in terms of the percentage who die in hospital.
The study shows that about 38% of physicians in Ontario deliver palliative care, and only a small amount of those doctors offer home visits. Only one in five palliative care “encounters” occur in a patient’s home. Previous studies by Dr. Tanuseputro and his team indicate that patients with certain diagnoses, such as cancer, and those who live in wealthier neighbourhoods tend to have a higher chance of getting a home visit from a physician.

Some Conclusions

Dr. Tanuseputro and his team noted that the study’s results can improve understanding of end of life health-care use. The study highlights, for example, the proportion of the population that used long-term care of home care near the end of life, versus those who were admitted to hospital. This can, in turn, be used to inform discussions about end-of-life care here in Ontario. From a cost perspective, the study identifies those sectors which may be important to target for policymakers and health-care planners. The study notes that further research is needed into what type of care is appropriate or absent, particularly in the last four months of life (during which time there are rising acute care costs).

What Now?

This research provides interesting feedback during a time when governments and policymakers are working to address the reality of what the study has called “the baby boomer cohort effect coupled with an extension of life expectancy” and as the government has been called upon to improve end of life health care for Canadians. At Wise Health Law, we provide exceptional guidance on health law matters to public hospitals, long-term care homes, and other health-care organizations across the province. We monitor trends and developments in health so that we can provide forward-thinking legal and risk management advice to all our clients. Contact us online, or at 416-915-4234 for a consultation.


Also in Blog

Cases to Watch: Marchi v. Nelson

by Mina Karabit September 22, 2020 3 min read

In August 2020, the Supreme Court heard and granted leave to appeal in Marchi v. Nelson, a case from the British Columbia Court of Appeal. The decision is one to watch as it will likely result in a renewed discussion of the distinction of policy versus operational decisions and their impacts on liability in tort law. The discussion will likely impact many of the anticipated post-COVID-19 lawsuits against public and government institutions.
Judicial Review: New Time Limits and a Helpful Primer

by Mina Karabit September 17, 2020 4 min read

In December 2019, Ontario’s Attorney General introduced Bill 161, the Smarter and Stronger Justice Act (the “Act”), which became law on July 8, 2020. The Act hopes to simplify a complex and outdated justice system by bringing changes to how legal aid services are delivered, how class actions are handled, and how court processes are administered.

Of note, the Act has amended the Judicial Review Procedures Act (JRPA) to establish new rules as to when an application for judicial review may be brought.

Any decisions made on or after July 8, 2020 are now subject to a 30-day limit for bringing an application for judicial review unless another Act provides otherwise. Courts, however, retain powers to extend the time for making an application for judicial review if satisfied that there are apparent grounds for relief and that no prejudice or hardship will be incurred by the delay. Before these amendments, the JRPA did not set out any time limits for bringing an application, but courts had powers to extend the time to bring an application if another Act prescribed the limit.

Recent Exemptions for Psychedelic Therapy in Canada

by Mina Karabit August 14, 2020 3 min read

In early August 2020, the Federal Minister of Health granted an exemption under the Controlled Drugs and Substances Act (CDSA) to four terminally ill Canadians to use psilocybin in their end of life care.

Psilocybin is one of the active ingredients/chemicals in “magic mushrooms,” the other is psilocin. Both psilocybin and psilocin are controlled substances under Schedule III of the CDSA. The sale, possession, production, etc. are prohibited unless authorized for clinical trial or research purposes under Part J of the Food and Drug Regulations. Both have been illegal in Canada since 1974. According to Health Canada, there are no approved therapeutic products containing psilocybin in Canada. However, the purified active ingredient, i.e. psilocybin, is being studied in supervised clinical settings for its potential to treat various conditions such as anxiety and depression.