Independent research needed to inform end-of-life policy choices
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* Antoine Boivin
* Isabelle Marcoux
* Geneviève Garnon
* Evert van Leeuwen
* Nicholas Mays
* Raynald Pineault
* Marie-Claude Prémont
* Pascale Lehoux

In their *CMAJ* editorial, Flegel and Fletcher1 call for a national dialogue on end-of-life care, arguing that policy change should not be the result of a single court decision.1 In Canada, different medical end-of-life practices, such as treatment withdrawal, use of medication justified by symptom management and use of lethal drugs are being debated.2–4 Concerns about the effects of policies are central to the Canadian debate, and international evidence is quoted by proponents and opponents of legislative reforms.

We recently conducted a scoping review of international evidence on medical end-of-life practices, with a focus on the use of lethal drugs by physicians.5 Key findings from this review are currently relevant to public debate. We found no empirical study on the use of lethal drugs by physicians in Canada, which is surprising given frequent claims that “assisted suicide,” “euthanasia” or “medical aid in dying” are being practised illegally in Canada.

Policy-makers should therefore be careful in drawing conclusions about what is known, and not known, about the likely effects of policies.

Scientific evidence alone cannot provide simple answers to complex end-of-life care dilemmas. However, having robust knowledge publicly available is a precondition for informed democratic deliberation on end-of-life care in Canada.

## References

1.  Flegel K, Fletcher J. Choosing when and how to die: Are we ready to perform therapeutic homicide? CMAJ 2012;184:1227.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTg0LzExLzEyMjciO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTg2LzMvMjEzLjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  *Carter* v. *Canada*(Attorney General), 2012 BCSC886. No. S112688.
3.  Vogel L. Legal ambiguities surround authority to make end-of-life decisions. CMAJ 2011;183:E617–8.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTgzLzEwL0U2MTciO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTg2LzMvMjEzLjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

4.  Bill 52: An Act respecting the end-of-life. Quebec (QC): National Assembly of Québec; 2013.
    
    

5.  Boivin A, Marcoux I, Mays N, et al. What evidence is available about the medical practice of euthanasia in contexts of prohibition and legalization? A scoping review. Proceeding from the North American Primary Care Research Group conference;2013 Nov. 10–12; Ottawa (ON).