Mary Ellen Macdonald – Dalhousie University; Nova Scotia Health, Canada
Mary Ellen is a Professor in Palliative Medicine at Dalhousie University in Halifax, Nova Scotia where she holds the J & W Murphy Foundation Endowed Chair in Palliative Care. She is an anthropologist, and her research focuses on public health and palliative care.
Featured Articles
Martisella, M., Marquis, M.-A., Perron, C., Bourque, C. J., & Bouthillier, M.-E. (2026). “Yes if… No but…”: A qualitative study of pediatric palliative care professionals and collaborators’ perspectives on medical assistance in dying. BMC Medical Ethics.
Medical Assistance in Dying (MAID) has been legal in Canada since 2016. The law governing this Act, Bill C-14, originally only included adults whose death was reasonably foreseeable, but then evolved to include other specific circumstances for adults. The original legislation also included a requirement that a future review would examine the potential for its extension to ‘mature minors.’ A recent parliamentary committee convened to conduct this review decided in favour of this extension to younger age groups. To date, however, there has been no legislation – nor a timeline or robust public conversation – permitting or operationalizing MAID for mature minors in Canada.
Martisella and team’s 2026 article is based in this context. Their work draws from a larger interview-based study examining the perspectives of pediatric palliative care (PPC) providers and collaborators (including health care practitioners, administrators, and parents in patient-partner roles; n=24) regarding ethical issues within one tertiary care institution in Quebec. The focus of their article is on participants’ thoughts regarding the potential legalization of MAID for mature minors, seeking especially to understand the clinical, ethical and organizational challenges that sit on the horizon for these participants in the event of new legislation. Data analysis was thematic and informed by an ethics of care framework.
Despite MAID not being yet permissible for pediatric populations, the study found that MAID is already an issue within pediatric clinical practice. For example, participants mentioned that patients and parents increasingly bring up the topic with their care teams. Further, participants were conscious of their roles as “facilitators of practices defined by broader institution and societal frameworks.” In other words, they felt a responsibility to engage this topic given the social (Quebec) context in which MAID is increasingly being discussed. As such, only one participant in the study clearly opposed MAID for minors. While the remainder did not express unequivocable support, their perspectives ranged from ambivalence to conditional acceptance. This acceptance, however, was weighted heavily by discussions about safeguards, especially regarding an evaluation of the maturity and decisional capacity of the minor seeking MAID, as well as their quality of life, prognosis, vulnerability, and suffering.
An important area of tension – and one that accompanies MAID more generally in Canada – is the already sparse and highly inequitable access to palliative care in the country (for a recent study on this, see Bailey et al., 2026). The authors make this point in their analysis: “From a justice and protection perspective, strengthening access to PPC should be considered a prerequisite for any potential extension of MAiD, to prevent the risk of MAiD becoming the only available option for suffering minors.”
I was drawn to this article from my own prior experience in Quebec where this research study was based. Because the title’s phrase, ‘Yes if…No but…,’ hints at the tenor of the results, I was both curious and also quite surprised. I was a researcher in Quebec when assisted dying was being publicly discussed in the early and mid-2010s, and I was a co-lead on one of the first national research grants to explore public discourses regarding MAID in Canada (at that point, mostly focused on care for adults). At the time, palliative care defenders in Quebec were staunchly resistant to the potential new legislation, concerned especially about how it would change the landscape of end-of-life care in Canada. This resistance was so strong that, when I was asked to sit on a national committee charged with taking seriously Bill C-14’s potential future inclusion of mature minors (The Council of Canadian Academies, 2018), I had colleagues who felt betrayed that I would even consider having an academic conversation about MAID generally, let alone for mature minors. Thus, when I saw this article’s title suggesting ‘Yes if…’, it was immediately apparent to me the needle must have moved substantially on this topic.
An important limitation of Martisella et al.’s article is acknowledged both by the authors and the participants: this study only provides professional (adult) reflections. Missing from this discussion are the voices of young people (minors) themselves and those of their chosen families. My team conducted a study on this limitation in 2023 (Liu et al., 2023). Further, I testified at the parliamentary panel mentioned above on this exact point, taking the stance that young people have the right to be involved whenever practice, policy, and research affects them, and that they have the epistemic authority to speak for themselves about these matters. In other words, ‘Nothing about young people without young people.’ Fortunately, that needle is also moving too: we are slowly seeing increasing work in Canada led by, and in conversation with, young people about dying and death, including MAID. Indeed, a final reflection by the authors states: “Several participants also expressed an explicit need for spaces of shared reflection, as well as involvement of parents and minors in these discussions.” I hope these and other authors pick up this essential thread in their future work with – and not about – mature minors and MAID.
References:
- Bailey, L., Hanes, L., Goodman, K., Wilcox, S., Wright, M., Colwell, S., & Macdonald, M. E. (2026). The evolving landscape of pediatric palliative care in Canada: a qualitative descriptive study. BMC Palliative Care.
- Council of Canadian Academies, 2018. The State of Knowledge on Medical Assistance in Dying for Mature Minors. Ottawa (ON): The Expert Panel Working Group on MAID for Mature Minors, Council of Canadian Academies.
- Liu K, Siedlikowski S, Mellett J, Carnevale F, Macdonald ME (2023). Young people’s perspectives on medical assistance in dying (MAID) and its potential extension to minors in Canada. Children & Society 37: 1081–1101.
TRENDS 2026; Issue #10
Click the links below to view this months full list in desired format.
Almahadeen, R., Uhm, S., Wright, D., Richardson, A., Wagland, R., Hunt, K., & Darlington, A. (2026). Bereaved Parents’ Perspectives on Quality Pediatric End‐of‐Life Care: A Scoping Review. Cochrane Evidence Synthesis and Methods, 4(5), e70103.
Almeida, M. L. D., de Vasconcelos, M. V. L., Pedrosa, C. M. S., Peixoto, A. L. V. A., & Tavares, C. H. F. (2026). Silences, voices and losses: Maternal experience in communicating bad news in a neonatal Intensive Care Unit. Interface: Communication, Health, Education, 30, e250169. (2038519418).
Alshamaa, F., Charlier, O., Humphrey, C., Taylor, L., & Firn, J. I. (2026). Characteristics and Timing of Dual Pediatric Palliative Care and Ethics Consultations. HEC Forum.
Ampar, F. B., Afukov, I. I., Vaganov, N. N., Eremin, D. B., Pikin, O. V., & Rozinov, V. M. (2026). Surgical interventions for children receiving palliative care: Organizational, clinical, and ethical aspects. RJPSAR, 16(2), 209–220.
Ariagno, S., Alami, V., Gao, D., Eisenman, K., Benson, M., Fabrizio, V. A., Hill, A. B., & Demedis, J. (2026). Perceptions of Proactive Palliative Care Integration Among Pediatric Hematopoietic Cell Transplant Providers: A Pilot Study. Children, 13(7), 854. (2047775240).
Barnett, N. R., Tanious, M., McCoy, N., Schlee, C., Clarke-Pounder, J., Wolf, B., Cahill, J., & Arenth, J. (2026). Trends in Palliative Care Consultation for Extremely Premature Neonate Nonsurvivors in the Intensive Care Unit. Palliative Medicine Reports, 7. (2048178004).
Benesova, H., Janouskova, M., & Loucka, M. (2026). Hope in Pediatric Palliative Care: A Systematic Review. Children, 13(8).
Buzelli, P., Oyesanya, T. O., Aguilar, A., & Gonzalez-Guarda, R. M. (2026). How Latine Families Navigate Pediatric Loss Amid Broken Systems: A Qualitative Study With Caregivers and Providers Using Liberation Psychology. Advances in Nursing Science.
Geffroy, H., Saucier, E., Serinet, M.-O., Plançon, M., Tarot, A., & Ridley, A. (2026). Initial pediatric palliative care provision in patients under 25 years of age classified in ACT/RCPCH group 4: A three-year multicenter retrospective study. BMC Palliative Care.
Gershfeld-Litvin, A., Einhorn-Plesser, C., & Siedner-Weintraub, Y. (2026). A qualitative study of Israeli parents’ experiences of child’s end-of-life care in a hospital setting. BMC Psychology.
Gouda, S. R., Upham, E. J., D’Anna, R., Dahlberg, S. E., Snaman, J. M., Rosenberg, A. R., & DeCourcey, D. D. (2026). Pediatric Palliative Care Utilization Following Out-of-Hospital Cardiac Arrest at a Large US Quaternary Hospital. Children, 13(9), 1142.
Hackett, J., Jarvis, S., McLorie, E. V., Barrett, L., Weatherly, H., Hinde, S., Walker, G., Noyes, J., Oddie, S., & Vasudevan, C. (2026). Parental experience of end-of-life care for their infant or child in the United Kingdom. BMC Palliative Care.
Hock, K. M., Dodenhoff, E., Clark, M. G., Patrician, P. A., Landier, W., Rice, M., & Shan, L. (2026). Feasibility and acceptability of prenatal parental palliative care in congenital heart disease: A pilot study. Pilot and Feasibility Studies.
Javadi, S., Espiritu, I., Leung, T. M., Karam, O., Siegel, L. B., Espiritu, I. S., & Siegel, L. (2026). Timing of Do-Not-Resuscitate Order Establishment Varies by Illness Trajectory and Clinical Context in Children Receiving Palliative Care: A Retrospective Cohort Study. Cureus, 18(8).
Karakaya, C. (2026). “It’s like a fireball dropped in my lap”: Experiences of social workers working in pediatric palliative care. Social Work in Health Care, 1–30. (651928082).
Kosolapova, A., Vlajnic, D., Kubek, L., Becker-Emden, C., Garske, D., Reuther, M., Wiesmann, D., Wager, J., Zernikow, B., & Schmidt, P. (2026). 12 years of specialized pediatric palliative inpatient care: Description of patients’ characteristics. Frontiers in Pediatrics, Volume 14-2026.
Landeen, K. C., Patel, K. G., & Tanious, M. K. (2026). Cleft lip repair in trisomy 18: Ethical considerations for aesthetic surgery in a life-limiting paediatric disease. BMJ Case Reports, 19(7).
Mariano-Menezes, M. B., & Reis-Pina, P. (2026). Before birth and beyond: Advance care planning in perinatal and neonatal palliative care—A scoping review. Palliative Medicine, 2692163261478449.
Martisella, M., Marquis, M.-A., Perron, C., Bourque, C. J., & Bouthillier, M.-E. (2026). “Yes if… No but…”: A qualitative study of pediatric palliative care professionals and collaborators’ perspectives on medical assistance in dying. BMC Medical Ethics.
Nardi, D., Baenziger, P., Haupt, K., Dillon, S., Harris, E., Cristea, A. I., & Zavadil, J. A. (2026). The Landscape of Hospice Care for Children in a Midwestern State. Palliative Medicine Reports, 7. (2048178061).
Pereira, D., Longo, M., & McElligott, F. (2026). “It Is Within the Gift of Filmmakers and TV Producers to Educate Society on the Living that Happens for People with Life-Limiting Conditions”: A Mixed-Method Study of Health Care Staff About the Portrayal of Children and Young People with Life-Limiting Co Journal of Palliative Medicine, 10966218261460946.
Preto, C. S. R., & Condeco, L. M. P. (2026). Unidentified paediatric palliative needs: Use of the Paediatric Palliative Screening Scale. International Journal of Palliative Nursing, 32(8). (2048699682).
Rowe, J., Hawley, M., Bloomer, M. J., & O’Neill, J. (2026). “It’s the fear of the unknown” clinicians’ perceptions on paediatric compassionate transport to preferred place of death: A qualitative descriptive study. Australian Critical Care, 39(5), 101680.
Takeda, K., Yamaji, N., Harrop, E., Holland, C., Nohavicka, L., Baba, M., Sakai, H., & Yotani, N. (2026). Communication and Relationships in Pediatric Palliative End-of-Life Decision Making in the United Kingdom and Japan: A Cross-Cultural Scoping Review. Journal of Palliative Medicine, 10966218261470487.
Treat, L., Silveira, L., & Ess, K. C. (2026). Pediatric Neuropalliative Medicine Clinic: Five-Year Data Characterizing a Novel Model of Outpatient Care. Annals of the Child Neurology Society, 4(2), 125–131.
Valencic, I., Guida, F., Andreozzi, L., Corsini, I., Battelli, E., Lanari, M., & Zama, D. (2026). From Triage to Outcome: How ED Parameters and Comorbidities Shape Pediatric Critical Illness Prognosis. Children, 13(9), 1151.
Wang, Y. E., Yang, W., Young, M., Padgett, K., Gabovitch, E., Zhang, N., Zhang, J., & Bateman, S. T. (2026). Cost Implication of a Community-Based Pediatric Palliative Care Program. Journal of Palliative Medicine, 10966218261481230.
Yu, J. A., Thompkins, J. D., Friebert, S., Grossoehme, D., Baker, J. N., Gordish-Dressman, H., & Lyon, M. E. (2026). FACE-Rare: Protocol of a randomized controlled trial of a family-centered advance care planning intervention for families of children with rare diseases. Contemporary Clinical Trials, 169, 108430. (2048357119)