BackgroundMedical aid in dying (MAiD) was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues.MethodsA retrospective chart review of all MAiD requests between December 2015 and June 2017 at two Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests.ResultsOf 80 patients requesting MAiD, 54% (43) received the intervention. The median number of days between the request for MAiD and the patient’s death was 6 days. The majority of palliative care consults (32%) came less than 7 days prior to the MAiD request and in another 25% of cases occurred the day of or after MAiD was requested. 35% of patients had no level of intervention form, or it was documented as 1 or 2 (prolongation of life remains a priority) at the time of the MAiD request and 19% were receiving life-prolonging interventions.InterpretationWe highlight ethical considerations relating to the timing of MAiD requests within the broader context of end-of-life care. Whether or not MAiD is conceptualised as morally distinct from other end-of-life options is likely to influence clinicians’ approach to requests for MAiD as well as the ethical importance of our findings. We suggest that in the wake of the 2015 legislation, requests for MAiD have not always appeared to come after an exploration of other options as professional practice guidelines recommend.

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Ethics guidelines and gene editing technology: the challenges of enforceability and legitimacy Ethics advisors, Centre for Applied Ethics, McGill University Health Centre "Our intelligence creates problems that our intelligence cannot handle. Come back Socrates, we're sorry about the hemlock." Richard Gordon, 1993 Recent advances in genetic technology have given rise to considerable excitement and debate. Genome editing tools such as CRISPR/Cas9 have made modifying the human genome more efficient, accurate, and less expensive. Gene editing presents promise for advancements in human health while simultaneously raising significant ethical concerns about its proper use and potential for misuse (1). For instance, should a line be drawn between genetic therapy and genetic enhancement? If so, where should the line be drawn-and who gets to decide?