 Hello, my name is Jocelyn Downey. I'm a professor in the faculties of law and medicine at Dalhousie University and a member of the Dalhousie Health Law Institute. In this module, I'll provide you with a very brief run-through of the definitions of the key terms that you need to be familiar with in order to understand end-of-life law and policy in Canada. It is essential to define the key terms. Much confusion and controversy in past discussions and debates about these issues has resulted from a lack of clarity about the terms being used. Two people may use the same term, but be referring to two different phenomena. Two people may use different terms, but be referring to the same phenomena. People may then appear to be at loggerheads, but actually be in agreement. To avoid such confusion, albeit not the controversy, I offer a set of definitions. In addition, it's not uncommon for charged or loaded language to be used in an effort to influence the listener or reader even before arguments and evidence have been advanced. I have therefore tried as much as possible to use the terms and their definitions from Canadian legislation. Where that is not possible, I've used the terms and definitions from the leading cases. And where that is not possible, expert panel reports. In respect of one subset of a category of interventions, that is, some palliative interventions, because of confusion in and between these sources, I've used my own definition based on a review of the literature and independent conceptual analysis. So first, withholding of potentially life-sustaining treatment. This means intentionally refraining from commencing treatment that has the potential to sustain the life of a person. For example, not attempting CPR when a patient's heart suddenly stops beating. The withdrawal of potentially life-sustaining treatment means ceasing treatment that has the potential to sustain a person's life. For example, stopping artificial hydration and nutrition for a patient in a persistent vegetative state. Advanced directives are directions given by a competent individual concerning what and or how and or by whom decisions should be made in the event that, at some time in the future, the individual becomes incompetent to make healthcare decisions. An example is a woman who has signed a document that states that should she fall into a persistent vegetative state, she does not wish to receive artificial hydration or nutrition. Or as another example, a man who has signed a document that states that when he is incompetent, he wishes his wife to make all healthcare decisions on his behalf. There are two kinds of advanced directives, instruction directives, which establish what and or how healthcare decisions are to be made, and proxy directives, which establish who is to make healthcare decisions. Palliative care means care provided to people of all ages who have a life-limiting illness with little or no prospect of cure and for whom the primary treatment goal is quality of life. The treatment is aimed at alleviating suffering, physical, emotional, psychological, or spiritual rather than curing. It aims neither to hasten nor to postpone death but affirms life and regards dying as a normal process. It recognizes the special needs of patients and families at the end of life and offers a support system to help them cope. Palliative interventions aim to relieve suffering and improve quality of life for those who are dying from an illness. Palliative interventions include medical practices that attempt to provide some relief from pain or other suffering at the end of life. While all palliative interventions aim to help the patient to be as comfortable as possible, some have the potential to cause death. There are two categories of potentially life-shortening palliative interventions, potentially life-shortening use of opioids and terminal sedation. One common palliative intervention for the treatment of pain is the potentially life-shortening use of opioids. Opioids can block pain, cause drowsiness, relax muscles, and depress respiration. It is this depression and respiration that can be fatal in rare circumstances, even where the opioids are being used appropriately. In some rare cases, the amount of medication or rate of administration necessary to control a person's suffering may cause such a reduction in respiration that it causes the person's death. In some rare cases, just how much of the drug or just how fast it can be administered without causing death is not known. Palliative sedation means the intentional administration of sedative medication to reduce a patient's level of consciousness with the intent to alleviate suffering at the end of life. It includes both intermittent and continuous sedation, as well as both superficial and deep sedation. It may be accompanied by the withdrawal of artificial hydration and nutrition. Terminal sedation is a subset of palliative sedation. It is the intentional administration of deep and continuous sedation combined with the withholding or withdrawal of artificial hydration and nutrition where the purpose is to alleviate suffering, where this is certain to shorten the life of the person. For example, a patient has a degenerative neurological condition, such as ALS, and her suffering has become intolerable, but she could continue to live with this disease for many months or even years. Terminal sedation will alleviate her suffering and will certainly cause her death. Now, assisted suicide means the act of intentionally killing oneself with the assistance of another person who provides the knowledge, means, or both. For example, a patient is bedridden in the late stages of ALS. His sister grinds up barbiturates and puts the powder in a glass of orange juice and brings it to him to drink. He drinks it, and it causes his death. Euthanasia means the intentional termination of the life of a person by another person in order to relieve the first person's suffering. Euthanasia can be voluntary, non-voluntary, or involuntary. Voluntary euthanasia means euthanasia performed in accordance with the wishes of a competent individual, whether those wishes have been made known personally or by a valid written, advanced directive. Non-voluntary euthanasia means euthanasia performed without knowledge of the wishes expressed by a competent person or through a valid advanced directive. Involuntary euthanasia means euthanasia performed against the wishes expressed by a competent person or through a valid advanced directive. For example, a patient is again bedridden in the late stages of ALS, only now he is incapable of drinking even through a straw and his physician gives him a lethal injection of a sedative, a braviturate and a neuromuscular block and this causes his death. Medical assistance in dying is an umbrella term capturing both assisted suicide and voluntary euthanasia. Medical assistance in dying means the administering via medical practitioner or nurse practitioner of a substance to a person at their request that causes their death or the prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person at their request so that they may self administer the substance and in doing so cause their own death. Informed consent means an intelligent choice as to treatment options made after the patient has been provided with sufficient information to evaluate the risks and benefits of the proposed treatment and other available options. Competence and capacity mean the ability to understand the subject matter in respect of which a decision must be made and the ability to appreciate the consequences of that decision. When a patient is competent, he or she is said to have decisional capacity which means the ability to make a subjective treatment decision based on an understanding of the medical facts provided by the doctor and on an assessment of one's own personal circumstance. And now with the meaning of our words clear, please go to the next module, a review of the legal status of end-of-life law and policy in Canada.