Health committee  That is a fantastic question, and I think it speaks in a very poignant way to what we're talking about here. We often hear that the majority of Canadians, over 75%, want to die at home. It is true that we can improve the number of home deaths, given resources and processes that we can put in place, but we cannot forget the other components of the health care system.

Health committee  That is one of the problems, health care professionals working in silos. We have to break those silos. With our palliative course, for example, we bring people together from different professions and different settings to start speaking to each other and working with each other so we can start breaking those silos.

Health committee  I believe if we were to look at it from a regional perspective, from a large population basis, I would argue that some of those are in Edmonton, Calgary, and Fraser Health, and some in Nova Scotia. If we look at specific components of excellence—for example, community-based palliative care specialist teams who are supporting family doctors, etc., hospices, palliative care units, and even things like palliative rehabilitation programs—we would see that they are spread in different places in different parts of the country.

Health committee  I think it's always good to learn from what has been there before and what is currently in place elsewhere. There are frameworks under development, for example, in Scotland, the United Kingdom, Australia, and France. There are other countries that have some of these frameworks. It might be useful to learn from what is working there to see if any of it is adaptable.

Health committee  It's variable. Canada has many different health care systems provincially, so it varies a lot within Canada. There are different organizations that have looked at and tried to rank Canada according to different parameters. We rate sort of in the middle of the field in terms of the top 12 or 14 OECD countries, but in some areas it is much lower and in some areas it is higher.

Health committee  As a citizen with my own views on it, I will share my view that it's not right to legalize euthanasia and assisted suicide, but I also live in a democratic country and I respect the democratic processes. I, personally, will not do it. I want to focus on all the other work that I've been doing in terms of addressing the palliative care needs.

Health committee  As with any new program, some fantastic work was done, and there were also some failures. We need to learn from those failures. I'll give you an example of what I think was fantastic work. I happened to be co-chairing the education working group. There were five working groups in total, and I chaired the education one.

Health committee  I would strongly recommend that we re-establish a secretariat or office or framework—

Health committee  —building on the successes that we had earlier on—

Health committee  Certainly. There are two or three. One of them relates to identifying the patients who need palliative care going forward and tracking them on a large scale across a whole region to see where they are going, what services they are using, and what the impact is of different models .

Health committee  —but adding much more to that.

Health committee  I can spend the rest of the day providing examples of cases of a palliative care intervention saving someone from saying they wanted to end their life earlier. I worked for a few years in Switzerland, and one particular case comes to mind. A young man with advanced lung cancer came into the hospital in Lausanne saying that he couldn't live like this, that he wanted to end his life, and that he had the right of access to assisted suicide.

Health committee  I think there are many barriers, but let's not forget as well the examples of excellence across the country where they are able to overcome those barriers. We are known across the world as innovators. The problem is that we innovate a lot of pilot projects, and we need to scale them up.

Health committee  I really believe that we should harness whatever resources we have, and if it is everyone's business, then absolutely, a PSW or a paramedic can play a critical role in helping out. In fact, we're seeing this happening in Nova Scotia and P.E.I., where we went out and developed a LEAP paramedics course.

Health committee  Sure. It is well known that in any health care system we need a strong primary level base, and then a secondary and a tertiary level of care. The tertiary is the highly specialized care that a much smaller proportion of the population requires. You see that in the care of patients with hypertension, for example.