Background Death at home has been identified as a key quality indicator for Canadian health care systems and is often assumed to reflect the wishes of the entire Canadian public. Although research in other countries has begun to question this assumption, there is a dearth of rigorous evidence of a national scope in Canada. This study addresses this gap and extends it by exploring three factors that moderate preferences for setting of death: situational severity (entailing both symptoms and supports), perceptions of family obligation, and respondent age. Methods Two thousand five hundred adult respondents from the general population were recruited using online panels between August 2019 and January 2020. The online survey included three vignettes, representing distinct dying scenarios which increased in severity based on symptom management alongside availability of formal and informal support. Following each vignette respondents rated their preference for each setting of death (home, acute/intensive care, palliative care unit, nursing home) for that scenario. They also provided sociodemographic information and completed a measure of beliefs about family obligations for end-of-life care. Results Home was the clearly preferred setting only for respondents in the mild severity scenario. As the dying scenario worsened, preferences fell for home death and increased for the other options, such that in the severe scenario, most respondents preferred a palliative care or hospice setting. This pattern was particularly distinct among respondents who also were less supportive of family obligation norms, and for adults 65 years of age and older. Conclusions Home is not universally the preferred setting for dying. The public, especially older persons and those expressing lower expectations of families in general, express greater preference for palliative care settings in situations where they might have less family or formal supports accompanied by more severe and uncontrolled symptoms. Findings suggest a) the need for public policy and health system quality indicators to reflect the nuances of public preferences, b) the need for adequate investment in hospices and palliative care settings, and c) continuing efforts to ensure that home-based formal services are available to help people manage symptoms and meet their preferences for setting of death.

This research note reports on the findings from a survey conducted in partnership with the Institute of Public Administration of Canada (IPAC). Despite robust debate among public administration experts about the role public servants should play in Canadian democracy, there has yet to be a systematic study of how public servants themselves view democracy and their role within it. We ask: What role do public servants play in democracy? The survey questions public servants about their views and contributions to democracy to gain a better understanding of what role they are playing in Canada’s system.

This article examines the Strategic and Operating Review (SOR) process used by the Government of Canada through a strategic management perspective. Initiated by the Harper government in the 2011 Budget as a one-year process, SOR is expected to secure savings of CDN$4 billion by 2014–15 from the CDN$80 billion operating budget of departments. Our article assesses to what degree the strategic operational cuts support the public policy priorities of the Harper government. Points for practitioners Using Canada as a case study to understand how budgetary cuts are handled, this article provides an opportunity to consider how policy makers align operational cuts with public policy priorities. While the budget cuts in this case study are operational in nature, they require direction from central government to support – not undermine – public policy priorities.

Dans le présent article, nous examinons le processus d’Examen stratégique et fonctionnel (ESF) utilisé par le gouvernement du Canada du point de vue de la gestion stratégique. Lancé par le gouvernement Harper dans le cadre du Budget 2011 sous forme de processus étendu sur un an, l’ESF est censé permettre d’économiser 4 milliards $ d’ici 2014-2015 dans le budget de fonctionnement des départements (80 milliards $). Dans cet article, nous examinons la mesure dans laquelle les réductions des dépenses de fonctionnement contribuent aux priorités du gouvernement Harper en matière de politiques publiques. Remarques à l’intention des praticiens Nous nous appuyons sur une étude de cas axée sur le Canada destinée à comprendre la manière dont sont gérées les réductions budgétaires pour examiner la manière dont les décideurs alignent les réductions fonctionnelles sur les priorités stratégiques. Si les réductions budgétaires dans cette étude de cas sont de nature fonctionnelle, le gouvernement central doit leur donner une orientation pour qu’elles contribuent aux priorités stratégiques (au lieu de les entraver).

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