goals of care and MAID
in review
2 min read
Updated 2026-08-19
Contents
goals of care and MAID
Early palliative care identification using the surprise question and PPS, advance care planning principles, and Canadian MAID eligibility criteria.
early identification
surprise question (gold standards framework)
“Would you be surprised if this patient died in the next 6–12 months?”
- if no or unsure → evaluate for general and disease-specific decline indicators → initiate palliative approach
- palliative care alongside disease-modifying therapy from diagnosis, not reserved for the terminal phase
palliative performance scale (PPS)
| PPS | Functional status |
|---|---|
| 100% | fully ambulatory, normal intake, full consciousness |
| 70% | reduced ambulation, normal or reduced intake, full consciousness |
| 50% | mainly sit/lie, reduced intake, ± confusion |
| 30% | bedbound, minimal intake, drowsy ± confusion |
| 10–20% | bedbound, mouth care only, drowsy/coma |
PPS guides prognosis and care transitions — declining PPS over serial assessments triggers goals-of-care conversations.
ECOG performance status
| Score | Description |
|---|---|
| 0 | fully active, asymptomatic |
| 1 | symptomatic; restricted in strenuous activity but ambulatory |
| 2 | ambulatory, capable of all self-care; up >50% of waking hours |
| 3 | limited self-care; confined to bed/chair >50% of waking hours |
| 4 | completely disabled; bedbound |
Choosing Wisely Canada
Avoid chemotherapy in patients with ECOG 3–4 who are unlikely to benefit.
medical assistance in dying (MAID)
eligibility — all 5 criteria must be met
- eligible for Canadian health services (federal/provincial/territorial)
- ≥18 years old and mentally capable at time of request
- voluntary request, free from external pressure
- informed consent after being informed of alternatives (including palliative care)
- grievous and irremediable medical condition:
- serious and incurable illness, disease, or disability
- advanced state of irreversible decline in capability
- illness, disease, disability, or decline causes enduring and intolerable physical or psychological suffering that cannot be relieved under conditions the person considers acceptable
track 1 vs track 2
| Feature | Track 1 (natural death reasonably foreseeable) | Track 2 (natural death NOT reasonably foreseeable) |
|---|---|---|
| reflection period | waived if both assessors agree loss of capacity is imminent | minimum 90 days |
| number of independent witnesses | 1 | 1 |
| assessors | 2 independent physicians or NPs | 2, at least 1 with expertise in the condition |
capacity and exclusions
- consent must come from a capable patient — POA/SDMs cannot consent to MAID on behalf of an incapacitated patient
- mental illness as the sole underlying condition remains excluded (federal legislation)
- advance requests (waiver of final consent) available only for Track 1 patients at risk of losing capacity before their chosen date