Framework on Palliative Care in Canada Act

An Act providing for the development of a framework on palliative care in Canada

This bill was last introduced in the 42nd Parliament, 1st Session, which ended in September 2019.


Marilyn Gladu  Conservative

Introduced as a private member’s bill.


This bill has received Royal Assent and is now law.


This is from the published bill. The Library of Parliament often publishes better independent summaries.

This enactment provides for the development of a framework designed to support improved access for Canadians to palliative care.


All sorts of information on this bill is available at LEGISinfo, an excellent resource from the Library of Parliament. You can also read the full text of the bill.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 5:30 p.m.
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Marilyn Gladu Conservative Sarnia—Lambton, ON

moved that Bill C-277, an act providing for the development of a framework on palliative care in Canada, be read the second time and referred to a committee.

Mr. Speaker, today, I am pleased to stand before the House to bring a private member's bill that would benefit not only my riding of Sarnia—Lambton, but all Canadians.

All of us will eventually come to the end of our lives. We all want to ensure that we live as well as we can for as long as we can. That is why Canadians need proper palliative and end-of-life care. Bill C-277 would provide a framework for palliative care in Canada.

Last parliamentary session, the Parliamentary Committee on Palliative and Compassionate Care studied the matter and came forward with recommendations. This bill is the result of those recommendations.

The committee published an excellent report outlining the current Canadian situation with respect to palliative care. The preamble for my bill is directly pulled from its report. This committee did a complete assessment of current palliative care options in Canada and identified specific areas and needs to be addressed. The report outlined the importance of strong and consistent palliative care options in Canada as well as the necessity of a framework under which to conduct these efforts.

This bill is also timely since, as a result of the Carter decision on assisted dying, the external committee report also recommended that palliative care be available to all Canadians.

The final report of the external committee on options for a legislative response to Carter v. Canada emphasized the importance of palliative care in the context of medically-assisted dying. It stated that a request for medically-assisted death could not be truly voluntary if the option of proper palliative care was not available to alleviate a person's suffering.

As we all can attest, each of the parties in the House has shown itself to be in favour of implementing a palliative care program in Canada, but very little has been formally announced. We can all agree on the importance of palliative care as well as the importance of making these measures accessible, in a consistent fashion, to all Canadians who need them.

Bill C-277 would define the services to be covered. It would establish standard training requirements for the various levels of service providers. It would come with a plan to achieve consistent access to palliative care for all Canadians. It would define the mechanism by which this is best achieved, with the measurements and data needed to track success.

Canada has an ever-growing number of individuals of all ages experiencing chronic and terminal conditions. Good palliative care covers a wide range of services, such as acute care, hospice care, home care, crisis care, and spiritual and psychological counselling.

A palliative philosophy of care is needed to address a whole variety of needs through an adapted and patient-centred process. The creation and implementation of a palliative care framework would give Canadians access to consistent, high-quality palliative care through hospitals, home care, long-term care facilities, as well as through residential hospices.

When we look at the current palliative care system, we can recognize the work that needs to be done. Current programs are evolving provincially and many are fragmented with little consistency and communication between the parts. A palliative care framework will bring these fragmented parts together in an effort to create a more cohesive, patient-based program, with a common definition of services covered, training standards, and a plan to ensure equal access for all.

There is a need for governance of the consistent implementation and monitoring of palliative and home care. This would require clear and open communication between federal and provincial governments as well as medical practitioners, institutions, and patients.

I would like to acknowledge the Canadian Medical Association, the Canadian Cancer Society, the Canadian Nurses Association, the Canadian Society of Palliative Care Physicians, Pallium Canada, ARPA, the Canadian Hospice Palliative Care Association, and many of their member hospices, like Bruyère Continuing Care, St. Joseph's Hospice, and West Island Palliative Care Residence, the Heart and Stroke Foundation of Canada, the Kidney Foundation, the ALS Society, the Canadian Association of Occupational Therapists, and the more than 50 organization members of the Quality End-of-Life Care Coalition of Canada for their ongoing promotion and support of this bill.

It is through organizations and groups like these that we can integrate palliative care into the current health care system and make a true difference in the lives of Canadians.

Support from across Canada is also evident in the 83 petitions on palliative care that have been presented to the House in this session alone. Thousands of letters have been received by members of Parliament on all sides of the House.

The current palliative care options in Canada are simply inadequate and do not meet the needs of Canadians.

In 2011, it is estimated that only 16% to 30% of those in need were receiving proper palliative and end-of-life care. Our current health care system favours short-term acute care, which it does extremely well. However, it lacks the capacity and the funding to properly, and consistently, provide quality long-term palliative and end-of-life care. The cost of acute care is four times that of hospice palliative care, so there is an opportunity to provide more of this kind of care for less money.

Regional accessibility is also an important issue. Currently, palliative care options are available in most heavily populated regions. However, the availability of palliative care in remote or less populated areas is often very limited or non-existent. There is a pressing need for a plan to address how to provide services to these areas. The region where you live should have no impact on whether palliative care is or is not available to you.

Palliative care would also offer an enhanced quality of life for those who, for various reasons, do not choose medically assisted dying. Data in countries that offer assisted dying shows that where good palliative care is available, 95% of people choose to live as well as they can for as long as they can. Palliative care will provide an option that would be preferable to many medical practitioners, nurse practitioners, and health care institutions that for religious and conscience reasons would prefer to help their patients live well.

With those 65 and older making up approximately 15% of the Canadian population, the geriatric and palliative care needs of Canadians will only increase. Palliative care can be cost efficiently delivered within the home or in community-based systems, such as hospices, nursing homes, and long-term care homes.

Funding palliative care in homes and in stand-alone facilities will alleviate pressure on hospitals and free up many much-needed hospital beds.

The proper training of medical practitioners and nurse practitioners is an important step in creating a comprehensive and well-equipped palliative care structure. On average, medical and nursing students spend as little as 20 hours of their four years of study learning about palliative and end-of-life care. In 2011, there were fewer than 200 geriatricians in Canada. Today, the estimated need is upwards of 600.

This bill will also have a positive impact on the lives of caregivers. In 2011, there were an estimated 4 million to 5 million family caregivers in Canada, who contribute $25 billion to the Canadian economy. These same caregivers often have a heavier financial burden and have to miss one or more months of work because of their duties. Family caregivers provide 80% of all home care in Canada, and 77% of these caregivers are women.

This might seem like a lot of statistics, but these numbers are not to be taken lightly. Caregivers experience financial, social, and physical burdens that can have lasting effects on their lives. I quote the Canadian Cancer Society when I say that “Canadian caregivers are the invisible backbone of the health care system, providing $25 billion in unpaid care”.

This added support will encourage palliative care in the home, which has been demonstrated to be beneficial for everyone involved. Allowing patients to stay in their homes for as long as possible is a wise and compassionate choice that should be offered to every Canadian.

As we can imagine, long-term data on the subject is hard to come by. What data we do have shows that Canada has a lot of work to do in the field of palliative care. Dr. Fred McGinn, of the Hospice Society of Halifax, calculated that in 2011 there were over 200 residential hospices in the United Kingdom and over 1,300 residential hospices in the United States. However, there were only 30 free-standing residential hospices in Canada.

Canada needs to develop its capacity for residential and hospice palliative care. In terms of actual spending, it costs between $600 and $800 a day to have a palliative care bed in a hospital. Comparatively, it costs only $55 a day to have palliative care beds at home. In-between these, it costs $200 to $300 a day to have a palliative care bed in hospice. In extreme cases, it could cost upward of $1,200 a day for beds in acute care in hospital while a patient is awaiting other accommodations, so it would be much more cost-effective to fund quality at-home and in-hospice palliative care beds over beds in hospitals.

Our lack of data and research on palliative care is why I believe it is essential we include further research and data collection in the bill. Many other UN countries have or have had laws in place with regard to palliative care.

A report from the United Nations and World Wide Palliative Care Alliance suggests that the cost of care at end of life, measures between 25% and 30% of all medical expenditures. Shockingly in Canada, 50% of palliative care funding currently has to come from charitable donations. This report determined that overall, the utilization of hospital based and in-home based hospice and palliative care services significantly reduced the cost of care, while providing equal if not better quality care for patients.

In this House, the government has stated it would allocate $3 billion to home care and to palliative care over the next four years.

This bill to create an overarching framework guaranteeing quality palliative care would provide an ideal complimentary legislation to Bill C-14 in the sense that it will take into account the concerns expressed by health professionals all while creating a quality palliative care strategy. Having end-of-life options gives patients a real choice in an already difficult situation.

Establishing a clear and comprehensive palliative care framework will allow patients to make well-informed decisions about how they spend their remaining time with family and friends.

I believe that my riding of Sarnia—Lambton is an excellent example of palliative care done right. One in five residents of Sarnia is 65 or over, and this number is on the rise. Sarnia is considered to be ahead of many communities with its 10-bed hospice and eight to 10-bed hospital palliative care unit. We have more than five palliative care specialists in our area, and as a community, Sarnia—Lambton has many institutions and groups that support and deliver palliative care, such as St. Joseph's Hospice, the Bluewater Health Palliative Care Unit, and the Erie St. Clair Community Care Access Centre and the VON.

Unfortunately, resources such as these are not abundant everywhere. This has been attributed to a lack of medical training and personnel in this field and a lack of funding. A very small number of Canadians in need of palliative care are able to receive it. With less than 30% of Canadians having access to quality palliative care, concrete changes need to be made.

As a large portion of our population approaches retirement, the issue will just continue to grow. I am looking to create a framework to implement consistent and quality palliative care across Canada. No Canadian should be denied these essential end of life programs and services because of their region or their finances. Every Canadian deserves the right to be able to end their life in peace and comfort knowing that they had the final choice. The bill will result in Canadians having that real choice.

I would once again like to thank the numerous groups, organizations and hospices for their support. After all, 95% of people who have good palliative choose to live as well as they can for as long as they can. I believe every Canadian should be given that option, so let us join together with one voice to call for quality palliative care as a right of all Canadians by supporting Bill C-277.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 5:45 p.m.
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London West Ontario


Kate Young LiberalParliamentary Secretary to the Minister of Transport

Mr. Speaker, it gives me great pleasure to stand in the House to say that I will be supporting this bill. I am very happy to because of my own personal experience watching my mother struggle at the end of her life 15 years ago. Even in a city the size of London, we did not have enough beds 15 years ago, and I would not want anyone to go through that.

I have a question about whether the member has considered aligning the bill with some of the best practices of the provinces that are well ahead of the federal government on this.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 5:45 p.m.
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Marilyn Gladu Conservative Sarnia—Lambton, ON

Mr. Speaker, now is the time to start to leverage the best practices the provinces are starting to implement. Some are further ahead than others. Organizations like Pallium Canada, the Canadian Society of Palliative Care Physicians, and the Canadian Nurses Association have best practices and are able to help leverage them. Now is the time to get the framework and define the services we would have and the standard training requirements and make sure that we roll this out in the most efficient way possible.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 5:45 p.m.
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Peter Julian NDP New Westminster—Burnaby, BC

Mr. Speaker, the member for Sarnia—Lambton makes a great contribution to this House of Commons. Certainly the New Democrats will be supportive of this bill as well.

That being said, I recall that just a few years ago in this House, the Conservative government cut the national Secretariat on Palliative and End-of-Life Care. I am hoping that this signifies a change in direction for the Conservative Party.

Can the member acknowledge that this is a change in direction for the Conservative Party and that all Conservative members will be supporting her bill?

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 5:45 p.m.
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Marilyn Gladu Conservative Sarnia—Lambton, ON

Mr. Speaker, as the member knows, I am bringing a fresh perspective to this place. All of the members of the Conservative Party will be supporting this bill, because we recognize that all Canadians need this.

When we studied Bill C-14 this year, we heard all of the witnesses and the people who were providing input say that we need to have good palliative care if we are going to have a true choice. To find out that 70% of Canadians have no access to any kind of palliative care was astounding to me. Therefore, I am happy to say that we will support this, and that is a change.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 5:45 p.m.
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Harold Albrecht Conservative Kitchener—Conestoga, ON

Mr. Speaker, I also want to add my congratulations to my colleague from Sarnia—Lambton for the incredible amount of work she has done in bringing us to this point today. She mentioned in her speech a number of national organizations that are supporting her bill.

In my own area, I have the privilege of having a number of hospices that provide excellent palliative care. We have Innisfree House and Lisaard House and the HopeSpring Cancer Support Centre. I am wondering if my colleague would expand a bit on her knowledge of the palliative care agency in her area, Bluewater Health, which provides excellent palliative care. I have had the privilege of visiting it, but I would like to hear a bit more about the kind of service it provides.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 5:45 p.m.
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Marilyn Gladu Conservative Sarnia—Lambton, ON

Mr. Speaker, I would like to thank the member, because he was one of the members of the parliamentary committee that first brought this forward. I appreciate all the work that committee did.

Definitely in my riding we have a very integrated approach. There is St. Joseph's Hospice, and there are palliative care beds in the hospital. There is also community care and the VON home care types of services. They are all working in partnership under five palliative care specialists, who are incredibly rare in Canada. For a community as small as Sarnia to have this kind of expertise and for them to be working that way together is a real model we want to leverage.

As I was putting the bill together, I talked to different hospices, excellent hospices, in other places in the country. Those best practice models are what we need to learn from and implement as we go ahead. There is an opportunity for the government, with a lot of flexibility, to determine how we will apply the solutions that are needed, how we will bring the infrastructure, and what the timing of all of those things will be.

I look forward to working with all my colleagues on all sides of the House to get a better solution for Canadians.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 5:50 p.m.
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Brampton West Ontario


Kamal Khera LiberalParliamentary Secretary to the Minister of Health

Mr. Speaker, I am pleased to stand today to discuss Bill C-277, an act providing for the development of a framework on palliative care in Canada. With the introduction of this bill, the member for Sarnia—Lambton has taken a significant step forward in our national dialogue on palliative and end of life care, and I want to thank the member for bringing this forward. I appreciate the opportunity to provide some reflections on this extremely important initiative.

Palliative care is an issue that is gaining increasing attention across our country. This was further magnified by discussions on end-of-life care options that occurred earlier this year when medical assistance in dying became a legal option. Views on this matter differ, but we can all agree that patients should have access to a full range of care options to treat pain and other symptoms at the end of their life.

Palliative care is an approach to health care that focuses on the needs of patients who live with life-threatening conditions as well as on their families. Research shows that it can have a significant impact on improving quality of life for patients, while reducing the stress and burden on their families. As demographics in Canada shift, the need for end-of-life care is increasing. Canadians have been loud and clear in calling for access to high-quality care for those who are approaching the end of their life.

Before being elected as a member of Parliament, I had the privilege of being an oncology nurse at St. Joseph's Health Centre. I have actively provided palliative care to many patients and I have seen first hand the impact that good quality palliative care has on patients at the end of their lives and their families.

While palliative care has been improving in Canada, we know there is still much work to be done. Some studies have reported that as few as 16% to 30% of dying Canadians have access to palliative care, depending on where they live in the country.

More recently, a study by Health Quality Ontario found that 40% of Ontarians who died in 2014-15 had not received a palliative care service. Access often depends on physician referrals, the availability of services, and the awareness of care options among patients and their families. The Ontario study found that most patients did not start receiving palliative care until the last months of their lives. This is a concern because early access can be critical, if not the most important, for maintaining the best possible quality of life for a patient. The study also found that fewer than half of the patients who received palliative care received it at home. Most of us want to stay in our homes and communities for as long as possible. When asked, the majority of Canadians said that they would prefer to spend their last days at home. In spite of this, close to two-thirds of deaths in our country are still happening in hospitals.

The Canadian Cancer Society issued a report this year called “Right to Care: Palliative care for all Canadians”. It highlighted a number of gaps, and barriers to palliative care in Canada, such as a lack of standards, limited data, insufficient training for providers, and inadequate support for caregivers.

This study and others like it show that now is the time to work together on addressing these gaps. As was said many times during the debate on Bill C-14, improving palliative care is a priority for our government. In fact, the preamble of this bill clearly signals our intent to support improvements to a range of end of life care services in Canada.

Canadians need real options that respect their plans and preferences for care in what is often a very difficult stage of life. It is obvious that Canadians are looking to their governments to make this happen. Stakeholders, including the Canadian Medical Association, the Canadian Hospice Palliative Care Association, the Quality End of Life Care Coalition of Canada, the Canadian Nurses Association, and the Canadian Cancer Society, have all called for national leadership in the area of palliative care, and we have been listening.

Our government believes that Bill C-277 would provide us with a timely opportunity to take a leadership role on this issue. We support the creation of a framework for palliative care.

I would like to recognize the efforts of the member for Sarnia—Lambton in putting forward such a thoughtful proposal for what this framework could look like. However, in considering this bill, I would urge each member to also consider the need to respect jurisdictional roles and responsibilities in this area. As we know, health is a shared responsibility in our country, with most of the responsibility for delivering care falling under the purview of the provinces and territories. Most provincial and territorial governments already have some form of a palliative care strategy, plan, or framework, or have policies or programs in place to support palliative care. Several provinces recently dedicated funding to improve palliative care services in their respective jurisdictions.

The bill needs to be better aligned with the scope of federal roles and responsibilities in relation to palliative care, and we will be introducing amendments to that effect. The government is well positioned to complement, bolster, and spread the important work under way across the country by provincial and territorial governments, as well as stakeholders across the health care sector.

I believe that amendments could be made that would achieve this objective while respecting the spirit of the bill. As we all know, the government provides provincial and territorial governments with long-term funding for health care. Our government made a platform commitment to provide $3 billion to provinces and territories to deliver more and better home care services for Canadians, including those who need palliative care. This commitment is being pursued in the context of the health accord. Negotiations with provinces and territories are ongoing, and I am optimistic that, in the future, there may be synergies with a proposed framework.

The division of responsibilities for health between the government and provinces and territories presents us with both challenges and opportunities. If we move forward with implementing this bill, it will be important to talk to provincial and territorial governments and key stakeholders on the appropriate scope of a palliative care framework.

It will also be important for us to learn from the significant body of work on palliative care that has been published in recent years. This includes reports from Parliament, provincial and territorial advisory bodies, and stakeholders, such as the Canadian Medical Association.

One key example is the Canadian Hospice Palliative Care Association's 2015 report, “The Way Forward,” which seeks to integrate a palliative approach to care throughout the health care system.

I would like to close by thanking the House for the opportunity to reflect on the importance of this bill, and to offer some considerations as we move forward, reviewing it in greater detail. I believe that a framework for palliative care is the right approach for Canada. I look forward to further discussion on what that framework should look like, so that we can all have better access to palliative care for all Canadians. Once again, I thank the member for bringing this extremely important piece of legislation to this House.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 5:55 p.m.
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Tracey Ramsey NDP Essex, ON

Mr. Speaker, I am pleased to be speaking about Bill C-277, an act for the development of a framework on palliative care in Canada. I will be supporting this bill at second reading.

The New Democrats have a dedicated history of supporting and advocating for a pan-Canadian palliative care strategy to deliver end-of-life services for Canadians. Now, more than ever, our advocacy is needed. As Canada's aging population puts unique stresses on our medical system, it is increasingly important that we have a coherent strategy for palliative and end-of-life care across Canada. This is an issue that touches every Canadian and leaves an impact on every single family.

When we have good options for palliative care, we can ease the many burdens of families so they are able to make these difficult transitions. When services are fragmented, too many people fall through the cracks right when they need the support the most.

Only 16% to 30% of Canadians today who require formalized end-of-life care have access to it. This is an extremely concerning figure. It means that the majority of Canadians who have spent their lives working hard, contributing to our economy, raising families, building communities, and working towards creating a Canada that we can all be proud of will not have the end-of-life care they deserve. Even fewer Canadians receive grief and bereavement services.

The time to act on this issue is long overdue. It is said that the mortality rate will increase by 33% by 2020, making the need for palliative care an urgent one, even more so within the context of the legalization of physician-assisted dying. The provision of high-quality palliative care services is all the more important, as it provides meaningful options for end-of-life decisions.

Currently, nearly 25% of the total cost of palliative care is borne by families, and significant disparities remain across Canada with respect to access to end-of-life care, quality of care, and those out-of-pocket expenses. At least 50% of hospice palliative care services are funded by charitable donations, which continues to restrict the size, scope, and access Canadians have to palliative programs.

Very few Canadian provinces have designated hospice palliative care as a core service under their provincial health plans, and in the remaining provinces, hospice palliative care may be included in provincial home care budgets or other health service budgets, leaving the funding vulnerable to redistribution and cuts. We must have a national strategy that can protect the palliative care of Canadians who have access to it, expand access to care for Canadians who do not have it, and improve the quality and affordability of care for all.

On average, it is estimated that Canadians spend 54 hours per week caring for a dying loved one at home. For most people, this is simply not feasible. Most people in my community need to work to support themselves and their families. Currently, family caregivers provide more than 80% of care to their loved ones, which takes an economic toll on them personally.

If the government provided support to an end-of-life strategy and replaced these family caregivers with specific palliative care professionals trained to provide the proper type of care for those who are at the end of their lives, it would take a huge financial strain off of our more expensive acute and emergency care facilities.

A national strategy for palliative care would also have positive effects on families across Canada beyond the financial costs. End-of-life care is a difficult and emotional time for families. Studies overwhelmingly suggest that women are more often affected as they tend to be the primary caregivers within families. The mental and physical strain of acting as a caregiver is linked to societal expectation of women to provide a greater degree of care at the end of life for family members.

I, like many others in the House, have a personal experience with this exact scenario. My 94-year-old grandmother, the matriarch of our family, Mary Murphy, passed away on October 22 this year. She was fortunate to have been in long-term care, but could not be placed in hospice care due to a lack of space.

My grandmother was blessed to have five angels, daughters who were selfless caregivers to help her through her end-of-life journey; and my mother, Linda, and her four sisters, Nancy, Janet, Kathy, and Debbie. Our family is eternally grateful to them for putting their lives on hold to ensure that my grandmother's dignity and comfort in her last days was a top priority. However, I cannot help but think of what hospice care options could have been provided to my family during this difficult time.

By supporting this legislation at second reading, we can promote a fuller discussion about the familial and gendered ramifications for a palliative care strategy.

The NDP has repeatedly called for the betterment of end-of-life care. On October 31, 2013, the member of Parliament for Timmins—James Bay, introduced Motion No. 456, which called for the establishment of a palliative and end-of-life care strategy. His motion called for the federal government to work in conjunction with the provinces and territories on a flexible and integrated model of palliative care. The motion passed with nearly unanimous support the following year, on May 28, 2014.

It is frustrating to once again have to advocate for something we all know Canadians would greatly benefit from. The government has made no substantial progress on this file, and this bill seems to essentially replicate the initiatives taken by the NDP nearly three years ago. It was the New Democrats who called for the dignity of Canadians at the end of their lives. The initiative for a pan-Canadian palliative strategy is an NDP one, not only due to the replication of Motion No. 456, but also due to the continued advocacy the New Democrats have given this issue.

Sadly, as we may recall, the Conservatives cut the national secretariat on palliative end-of-life care in 2006. For nearly 10 years, no action to implement a new strategy was taken. Although we continue to talk about moving forward for families and those needing a comprehensive national strategy for end-of-life care, Canadian families need action on this issue. I was pleased to hear the member indicate that the Conservatives will support this initiative.

I was proud of the work of my NDP colleague, the member for Victoria, during the meetings held by the special joint committee regarding the Carter decision by the Supreme Court of Canada. The member for Victoria fought hard to bring forward palliative care provisions to create a properly funded pan-Canadian strategy of palliative and end-of-life care, and to re-establish Health Canada's secretariat on palliative care.

The Standing Committee on Justice unanimously passed NDP amendments on palliative care, which were added to the preamble of the bill. While I was happy to know that our amendments were included, ultimately I was disappointed, as the preamble did not hold as much legal weight as the actual text of the legislation.

I would also like to remind this place that although we fought to incorporate palliative care into the Liberal majority joint committee report on physician-assisted dying, I was surprised to find this year's federal budget contained zero federal funds earmarked for palliative care. The budget this spring and the update this fall simply failed to deliver on these concrete recommendations.

Although my NDP colleagues have done so much work to bring forward a national strategy for palliative and end-of-life care, both in previous and within this current Parliament, neither the former Conservative government nor the current Liberal has government has helped those Canadians needing this essential care provision.

I believe it is common for us all to think we have more time. Especially when I was younger, I could not imagine planning into next month, let alone planning for my senior years, or thinking about my own end-of-life care. However, as I get a little older and I see family members and loved ones around me age, I hope I also get a little wiser. Part of that growing wisdom is acknowledging that as a community and as a nation, we need a vision and a plan.

People in Essex have told me that they believe in comprehensive health care systems, which include home care, long-term care and palliative care. In this vision and plan, it is vital that the government take into account Canada's vast diversity. Across the country, from urban to rural, Canadians have different needs, influences, and preferences to take into consideration when designing and implementing an end-of-life care plan. It must also respect the cultural, spiritual, and familial needs of all Canadians, including Canada's first nations, Inuit, and Métis peoples.

This is bigger than any of us individually. It is bigger than any of our individual parties. It is a moment when we have to try to work together to have that vision. I would like to think that we can stand together in the House, and do just that. Our worth as a society is measured by the support we give to those members who are most vulnerable. Let us provide them with more than just words and hyperbole. Let us work together to put forward a comprehensive pan-Canadian palliative and end-of-life care strategy that works for everyone.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 6:05 p.m.
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Harold Albrecht Conservative Kitchener—Conestoga, ON

Mr. Speaker, it is with great pleasure that I rise in the House today and speak in favour of Bill C-277, An Act providing for the development of a framework on palliative care in Canada.

Over the past 10 years I have served in this place, palliative care has been one of the issues that I have spent a lot of time on, and so I would like to thank my colleague, the hon. member for Sarnia—Lambton, for introducing this bill and taking up this great cause at this crucial time in Canadian history.

This legislation is essential for two fundamental reasons. First, it addresses a major gap in our Canadian health care system. The vast majority of Canadians do not have access to an essential health care service, palliative care. Second, in a post-Carter decision Canada, we need to understand the realities and questions Canadians now face when nearing the end of their lives.

My roles and experiences as co-founder of the parliamentary committee on palliative and compassionate care, as a member of the joint committee on assisted suicide and euthanasia, and as an advocate for suicide prevention throughout the last decade, inside the chamber and outside, have all ultimately shaped how I approach this subject, my deep conviction that we need to do better, and that we need to see this legislation passed and implemented as soon as possible.

I would also like to add that as a Christian, the value of life from conception until natural death, and the recognition that life is a sacred gift from God also shape how I approach the topic of sustaining comfortable living for those suffering in their last days.

I would like to begin with a quote from Jean Vanier, founder of L'Arche Canada, as recorded in the final report of the parliamentary committee on palliative and compassionate care entitled, “Not to be Forgotten”:

Each of us is fragile, with deep needs for both love and a sense of belonging. We begin and end our lives vulnerable and dependent, requiring others to care for us.... In our states of dependence, our need cries out for attention and care. If this need is well received, it calls forth the powers of love in others, and creates unity around us, the gifts of the vulnerable to our world. If our cry and our need are unmet, we remain alone and in anguish.... The danger in our culture of productivity and achievement is that we easily dismiss and ignore as unproductive the gifts and the beauty of our most vulnerable members, and we do so at our own peril, dehumanizing ourselves.

The question that we all need to ask ourselves is this: Will we now withhold from our society the love, the care, the attention for our most vulnerable, and in the process dehumanize not only those who need our care, but also ourselves, we, who should be providing that care?

As our committee report, “Not to be Forgotten”, states:

Adequate palliative and end-of-life care becomes more essential as the numbers of Canadians requiring these services grows. Canada is not providing adequate palliative and end-of-life care for all who need it.

In Canada, only 16% to 30% of those who need it, receive palliative care. If that is a failing grade in any ordinary exam, how much more so is it in the context of our dying fellow citizens, friends, and relatives? This is not merely a failing grade, this is a disastrous failing grade. Our report went on to say:

Despite efforts made by palliative care providers, Canadians have a long way to go to meet our goal of quality end-of-life care. Canadians in all parts of our country should be able to get effective palliation of their pain and symptoms, and have their psycho-social and spiritual needs addressed.

So the question is this. What quality of life do we want to provide for Canadians? The provision of proper palliative care is absolutely essential if we are truly serious about maximizing the quality of life of all Canadians, who find themselves in need of these additional supports at a time when they are most vulnerable.

As our report states:

We recommend that the federal government in collaboration with the provinces and territories implement a right to home care, long term care and palliative care, for all residents of Canada, equal to the current rights in the Canada Health Act, to those services defined as “insured health services”, including hospital services, physician services and surgical dental services.

Bill C-277 follows up that same expectation in stating:

The Minister of Health must, in consultation with the representatives of the provincial and territorial governments responsible for health, as well as with palliative care providers, develop and implement a framework designed to give Canadians access to palliative care—provided through hospitals, home care, long-term care facilities and residential hospices—that, among other things,

(f) evaluates the advisability of amending the Canada Health Act to include palliative care services provided through home care, long term care facilities and residential hospices.

In a post-Carter Canada, we need to realize that the environment in which people approach the end of life has changed drastically. According to researchers Tang and Crane, “The risk of suicide doubles for people with chronic pain”.

Now that people have access to medically-assisted suicide, I would argue that there is a high probability that this number may drastically increase as the Canadian population ages and experiences higher rates of chronic pain as outlined above. However, we know that good palliative care can eliminate 99% of all pain.

The heart of the issue, outlined well by the expert panel appointed by our previous Conservative government, is that a request for physician-assisted suicide cannot truly be voluntary if the option of proper palliative care is not readily available to alleviate a person's suffering. While palliative care is not exclusively for the terminally ill, terminally ill Canadians must be given the choice to live as well as they can for as long as they can.

The government has failed to address this gap in our medical system, either through Bill C-14 or budget 2016. Current provincial and territorial approaches to the delivery of palliative care are fragmented. Federal leadership is needed to ensure that all Canadians have access to the same services and quality of care.

There are almost always problems in gaining access to palliative, and a good part of the reason is the lack of medical practitioners who feel qualified to provide state-of-the-art palliative care. There are not enough opportunities to access proper training. Recently, a large medical school in Ontario had 169 applicants for elective time, specifically devoted to study palliative care, yet there was only room for 35 of those applicants to be placed in the program. This problem needs to be corrected.

Again, from the report Not to be Forgotten:

Dr. Valerie Schulz of the Schulich School of Medicine in London Ontario has developed a simple and effective way to get medical students interested in palliative care. Each year 12 students from the undergraduate program become hospice volunteers. Undergoing 30 hours of training, each being mentored by an experienced hospice volunteer; they visit clients in their homes. The experience is priceless for the future doctors, as it gives them a chance to meet and converse with people outside the clinical environment, and without the need to bring a clinical perspective to the relationship. They relate to the hospice clients as persons, learning how they feel and react to the prospect of dying. Friendships are formed, and lessons learned, which will be of lifelong value to the future doctors in terms of person centred care. The clients also are transformed, touched that a future doctor would care enough to spend time with them in a companion role. This program is worth emulation, and broader application.

If larger numbers of medical and other health care students across Canada were able to experience one-on-one relationships as hospice volunteers, the positive effects on our medical culture would be immense. However, we need our medical schools to increase available training options for those students who want access to the specialized training.

Bill C-277 is a step in the right direction in protecting vulnerable Canadians. It builds on the non-partisan unanimously supported work of previous parliamentarians, and I hope all parties will be supporting this historic legislation.

Finally, let me quote from an anonymous author as it relates to palliative care, “To cure sometimes, to relieve often, and to comfort always. This is our work”.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 6:15 p.m.
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Winnipeg North Manitoba


Kevin Lamoureux LiberalParliamentary Secretary to the Leader of the Government in the House of Commons

Mr. Speaker, it is a pleasure to rise to speak to this bill and to compliment the member across the way, who I know is a recipient of one of those parliamentarian awards.

This is indeed a very encouraging private member's bill. Just listening to the debate for the last 45 minutes, we get the sense of some momentum that could see the bill go to committee. I would like to see it go to committee. There seem to be some thoughts that maybe we could make some amendments to improve it. As members, we understand the need for furthering the cause of palliative care.

This has been an issue for me for many years. In fact, there was a time, when I was the health critic in the province of Manitoba, when I would go into a hospital facility and see patients waiting, because there was not enough palliative care. In some cases, they were sitting in hallways in hospitals, because there was not a facility or room, even for individuals who were in need of palliative care.

I do not know the severity today. I think there is a better appreciation of what palliative care is and how important palliative care is to all Canadians. It bridges all generations. One does not have to be seeing the end of life in a few weeks.

Where does one begin in trying to address this issue?

Many provinces would argue, and rightfully so, that we have to be careful about provincial jurisdiction.

What I respect about our current Minister of Health is her sense of passion that Canada needs to come to the table, in terms of strong national leadership, on a number of social health issues. Palliative care is one of those.

Just last spring we had a very, I would suggest, apolitical, passionate argument about assisted-dying legislation. During that debate, we saw members on all sides of the House moved to tears. Stories were told about why health care is so important.

Canada is at a critical time. We often hear about the financing of health care and that Ottawa needs to play that role. One of the things I respected so much about the Paul Martin government was that it established the health care accord in 2004 that put into place health care funding. It is the reason we had record amounts of financing going into health care in every region of our country. That health care accord expired in 2014.

We now have a Minister of Health who has reached out to the provinces, under the direction of the Prime Minister and the cabinet and I would like to think all members. I know that the Minister of Health is very much in tune with what is being said here today.

I would like to think that the message we should be sending to the Minister of Health is that Ottawa has to and must play a strong national leadership role in the future of palliative care and in ensuring that there is palliative care in every region of our country and some conformity. I understand and appreciate one of the questions that was posed to the sponsor of the bill, namely, what about the idea of looking for best practices? We need to acknowledge that some provinces are ahead of others on this very important issue.

From a Canadian perspective as someone who loves our country, it should not matter where we live, whether in Newfoundland and Labrador; the province of Quebec or Ontario; or in the city of Winnipeg, my favourite city; or out on the Pacific coast; or in many of our rural communities in every region, including up north, or wherever it might be. Wherever we live, we should have this sense of equality and equity. It should not be the case that if people want good palliative care, they have to live in this or that region of the country. We do not want to see that.

What we want to see and what I choose to believe the Minister of Health is looking for in terms of best practices is what role Ottawa can play in working with the different provinces in trying to make sure that those best practices are being implemented, and how Ottawa can best ensure that is taking place.

We need to ensure there is accountability. We all know that tax dollars are limited, and our taxpayers want us to spend wisely. As a former health care critic, I can say there is a lot of room for improvement of expenditures in health care and in the way in which health care is managed. I say that, knowing full well that in different provinces they approach things in different ways. That is why I argue, when we talk about palliative care, pharmaceuticals or medications, and even when we talk about emergency services, that we at least recognize in part that Ottawa has something to contribute to the debate. It is not just our responsibility to write cheques for billions and billions of dollars. We do that. We pump record amounts of money into our public health care system, and that is something we should do. Health care is part of our Canadian identity. We as Canadians love our health care system, but as Canadians we know there is room for improvement.

When I think of room for improvement, I think of things such as medications, mental health, and what we are debating here today, palliative care. From a personal perspective, I will be very up front in talking about the passing of my father and the fantastic work that our health care professionals, the backbone of our system, put in day in and day out. We cannot give them enough credit, the credit that is owed because of the loving and caring attitudes that so many of our health care professionals have. We owe it to them, we owe it to the patients, and we owe it to the clients and individuals to do the very best job we can as legislators. In other words, we need to get it right.

That is why I am pleased that the member has so openly acknowledged that, yes, this is her bill but that she is open to amendments at committee. I do believe that with amendments we can make this an even better piece of legislation. By doing that, all Canadians will benefit, which is something that all of us want to be able to achieve, especially on apolitical issues like palliative care, because we all care about palliative care.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 6:25 p.m.
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The Deputy Speaker Conservative Bruce Stanton

Before recognizing the hon. member for Abitibi—Témiscamingue, I must inform her that she will have about two minutes to begin her speech, which she will of course be able to finish when the House next resumes debate on the question.

The hon. member for Abitibi—Témiscamingue.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 6:25 p.m.
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Christine Moore NDP Abitibi—Témiscamingue, QC

Mr. Speaker, given the short amount of time I have, I would like to emphasize how important it is that we respect provincial jurisdiction over health care. I will therefore address my recommendations directly to the health critic in order to hopefully improve certain aspects of the bill.

The second thing I think is especially important in the bill and that she did not mention is the importance of talking about palliative care for first nation and indigenous communities. In the previous Parliament, my colleague from Timmins—James Bay moved an opposition motion, which I seconded. That motion was specifically about ensuring that indigenous communities have access to palliative care. When we talk about the federal and provincial governments coming to the table, for example, it is crucial that first nation representatives also be included, especially since the federal government is directly responsible for those communities, and it has the power to act now.

There is basically nothing going on in the area of palliative care for first nations communities. I visited a hospice in my riding, and the people there told me they were open to the idea of creating a room for first nations individuals, a room that respects their culture and the elements they want to integrate into palliative care.

Unfortunately, the hospice does not have the funding to do so. It welcomes first nations people when the need arises, and the people in charge are willing to move forward with such a project. There are opportunities to approve specific projects for first nations people that would ensure they have access to palliative care that meets their cultural needs surrounding death and grieving.

I believe it is very important to amend the bill to reflect the specific needs of first nations people and better understand the way their culture relates to death. We have to ensure that first nations people get funding for these projects right away so they can get them going, as many first nations communities are in remote and hard-to-reach areas.

I think this is an extremely important point, and I am going to talk to the bill's sponsor about it in view of the committee's work.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 6:30 p.m.
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The Deputy Speaker Conservative Bruce Stanton

The hon. member for Abitibi—Témiscamingue will have eight minutes left for her speech when the House resumes consideration of this motion.

The time provided for the consideration of private members' business has now expired, and the order is dropped to the bottom of the order of precedence on the Order Paper.

The House resumed from November 23, 2016 consideration of the motion that Bill C-277, An Act providing for the development of a framework on palliative care in Canada, be read the second time and referred to a committee.