Medical assistance in dying and palliative care in Canada: clinical and ethical considerations in an evolving landscape

Medical Assistance in Dying and palliative care represent distinct yet intersecting approaches to addressing suffering at the end of life. Their intersection has generated ethical and clinical debates regarding medical responsibility and patient autonomy at the end-of-life. This review examines this intersection by synthesizing empirical research, clinical literature and health policy. Requests for hastened death are often linked with psychological distress, social vulnerability, and unmet psychosocial needs rather than physical pain alone. Evidence shows that palliative care enhances quality of life and mitigates psychological distress by addressing the physical, psychosocial, and existential domains. Significant disparities in access to timely and comprehensive palliative care persist, particularly among rural populations, Indigenous communities, individuals with non-cancer diagnoses, and persons with disabilities. By addressing both modifiable and non-physical dimensions of suffering, palliative care supports informed and autonomous decision-making while promoting patient dignity, meaning, and overall well-being. Early and integrated palliative care, supported by patient-centered policies and reporting frameworks, is critical to ensure that decisions regarding Medical Assistance in Dying occur within a context of ethically grounded end-of-life care.