Bill C-277 (Historical)

Framework on Palliative Care in Canada Act

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

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

Framework on Palliative Care in Canada Act

[Shannon Stubbs, Conservative, Lakeland, AB]

Madam Speaker, I am honoured to speak in favour of Bill C-277, an act providing for the development of a national framework for palliative care in Canada. This bill is important. It would benefit Canadians right across the country and also at home in Lakeland. I would like to congratulate the member for Sarnia-Lambton for her steadfast advocacy and for highlighting this priority need across the country. I know that this bill is the result of months and months of hard work and dedication by the member, and I congratulate her.

Canadians work hard, live busy lives, and expect one day to have the option of end-of-life care. The goal of this bill is to support improved access for Canadians to palliative care by creating a national framework, with the intent of expanding the availability and quality of front-line services in communities across Canada. That result would increase options and reduce the burden on family members by providing vital end-of-life care for their loved ones. This aim supports the dignity and comfort all Canadians deserve in the final stages of their lives.

This bill is also the distillation of the work of my colleagues on the Parliamentary Committee on Palliative and Compassionate Care. The committee published an excellent report, which outlined the current Canadian landscape with respect to palliative care. Through studies and assessments, the committee conducted a full review of current palliative care options in Canada while identifying specific areas that require improvement. All Canadians and all political parties can and should support this bill.

Right now there are only 200 hospices across Canada, so there is clearly a need for universal palliative care options. The framework provided in this bill would provide a definition of palliative care and identify the training needed for palliative care in Canada. It would also consider amending the Canada Health Act to include palliative care as a guaranteed health care option. Additionally, the act would outline periodic report releases from the Minister of Health highlighting gaps and recommendations for the framework of palliative care.

I am concerned about the Liberals' approach to palliative care in Canada so far. Although the Liberals are supportive of this initiative to date, they started their mandate by making a significant promise to Canadians: an immediate $3-billion investment for home care, including palliative care. However, the Liberals have changed course a bit. They are using the urgency of palliative care in communities as a bargaining tool, a stick, in negotiations with provinces. Those provinces that have agreed to the Liberals' terms when renegotiating the health accord were given funding for both mental health and home care, while others that had not yet agreed to those terms received nothing.

This priority is too important to use as political leverage like that, because the need for palliative care will never go away. In fact, 80% of Canadians receiving palliative care are cancer patients. Right now, two out of five Canadians will develop cancer in their lifetimes, and that statistic is expected to increase by 2030. These patients deserve a comfortable end-of-life option. The problem is that 30% of Canadians do not have access to palliative care services.

The Canadian Society of Palliative Care Physicians says that palliative care should be available in homes, hospices, hospitals, and long-term care centres throughout Canada, but it is not. Availability depends on where one lives, how old one is, and what one is dying from. This needs to change. The CSPCP goes on to say that strategic investments in palliative care have been shown to reduce the cost of delivering care by about 30%. Presently it costs about $1,200 a day to remain in the hospital, $400 a day to remain in hospice care, and $200 a day to receive home care. To reduce these costs by at least 30% would offer more opportunities for Canadians, free up scarce resources in health care facilities, and ultimately improve the quality of life and care for patients suffering from serious and terminal illnesses.

This is important, because Canadians are suffering from chronic and terminal conditions in growing numbers. Good palliative care covers a wide range of services, such as acute care, hospice care, home care, crisis care, and spiritual and psychological counselling.

Support from Canadians is evident across the country. There have been 83 petitions on palliative care presented in the House by members of Parliament in this session alone. Thousands of letters have been received by members of Parliament on all sides of the House. I personally have received dozens of letters from constituents across Lakeland outlining the need for palliative care options, particularly for seniors, who have limited options for end-of-life care. Right now, Statistics Canada confirms that there are more seniors in Canada than children. With an increased demand for health care, hospitals, and clinics, the option for hospice care has clearly never been more important.

Communities in Lakeland are fortunate to have access to health care and consultants in all regions of the riding, but more can be done and needs to be done to ensure greater access for everyone. Remote and rural regions of the country like Lakeland do not always offer the same robust services as urban centres and highly populated areas. Regional accessibility is an important consideration for a national strategy, and one we cannot ignore.

The current palliative care options in Canada are inadequate and do not meet the needs of Canadians. That is what this framework seeks to address.

In 2011, it is estimated that only 16% to 30% of those in need were receiving proper palliative and end-of-life care. The current health care system favours short-term acute care, which it does extremely well, but experts report that the system lacks the capacity and the funding to properly and consistently provide quality long-term palliative care. The cost of acute care is four times that of hospice palliative care, so clearly there is an opportunity to provide long-term, consistent care responsibly. It is a challenge that provincial governments and elected representatives at all levels face and must take on.

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.

Bill C-277 would also have a positive impact on the lives of caregivers. In 2011, there were an estimated four million to five million family caregivers in Canada. They contribute $25 billion to the health care system. These same selfless caregivers often bear 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.

These numbers are not to be taken lightly. Caregivers experience financial, social, and physical burdens that can have lasting effects on their lives. The Canadian Cancer Society says that Canadian caregivers are the invisible backbone of the health care system, providing $25 billion in unpaid care.

This added support would 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 compassionate choice that should be available to every Canadian. We have a duty to those Canadians.

Many Canadians who require palliative care are seniors or veterans. Seniors built our communities, founded our businesses, created opportunities for future generations, and supported our economy. Seniors built this great country, fought in wars, raised their kids, and laid the foundation for the free and prosperous Canada in which we are so fortunate to live.

It is our fundamental responsibility to ensure that the most vulnerable are taken care of, and when these individuals, who have done so much for us, need the most support, it is Canada's turn to give back to them. That is a core reason that I support this important bill. I encourage all members of the House to do the same.

I thank my colleague again for all of the good work she has done in bringing forward this pressing need.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, it is quite a privilege to speak to the important issue of palliative care. It is something I have dealt with in many different capacities, whether in the Manitoba legislature as a health care critic or here in Ottawa, both in opposition and now in government.

One of the most passionate collection of speeches that I have heard occurred when we had the debate on the medical assistance in dying legislation. I am sure you, Madam Speaker, and other colleagues on both sides of this House can recall the emotions that flowed in that particular debate as members stood in their place and articulated why it was so important that we move forward.

One of the greatest concerns that was expressed was that we needed to recognize that we can do so much more. It was not a partisan issue. It was not just Liberals, New Democrats, Conservatives—or the Green Party member, for that matter, or even quite possibly a Bloc member—who were saying it.

I applaud my colleague across the way for proposing her bill and for taking the initiative to continue the discussion that we had in the House on this very important issue. As an important issue, it goes far beyond the chamber or the House of Commons. I suspect that each and every one of us can relate to the importance of this issue. All we have to do is think about visits to our constituents. During elections and between elections there are some issues that gravitate to the top, and I suggest that this is one such issue.

The government is going to be supporting the bill—with amendments, as my colleague across the way has indicated—and I will pick up a bit on those amendments, but for now I want to talk about the principle.

As parliamentarians, we want to get a fairly good understanding of the needs of the constituents we represent, and this is definitely one of those needs. Every one of us can cite specific cases. I can tell of my own personal experience with my father.

My father was fortunate enough to have palliative care service provided to him, and what an incredible, loving, and caring environment he was able to be in for his dying days. I was so grateful that we had such quality health care providers and others who are associated with Riverview, who were there not only for him but for all individuals who were there. I can remember the very moment of his passing, which touched me personally.

However, it is not just because of my father. I go to many viewings or funerals. I knock on doors and I talk to many individuals. We often think that it is just seniors, but it is not, even though the vast majority would be of an older age. It provides a great deal of comfort, not only to the individual who is having to seek palliative care but also to family and friends. We all want to ensure that there is a sense of passing with dignity and we look at ways in which we can improve the system.

Through that debate that we had when we were talking about medical assistance in dying, numerous areas were advanced strongly by a number of members. We even saw petitions being introduced. When I talk about strong, I mean issues that we felt it was necessary to give more attention to. One was the issue that in the different regions from coast to coast to coast across the country, care experiences varied between urban centres and rural centres and in larger communities versus smaller ones.

It really varies in terms of the types of services available. When we think of end-of-life care, palliative care, hospice care, we like to think there is some sense of equity out there in the many different communities that make up our country, but what I learned and what was really hammered home during that debate was that there is a great deal of inequity and that there is a stronger role for us to play at the national level.

I suspect that the government is going to propose some amendments that would facilitate federal support for improved palliative care in relation to three pillars that are aligned with the objectives of this particular bill. Training for health care providers is of the utmost importance, as well as making sure that quality health care delivery is available in a tangible way.

That does not take away from the type of care that has been available over the years; the efforts that health care providers have been performing for many years are amazing.

We want to look at consistent data collection. Consistent data collection is critical, because it assists in research and innovation into palliative care. In other words, it is important that we do not stop here.

We need to continue to look at best practices. As an example, we need to look at where the demands are and how we can meet those demands going into the future, and of course provide support for caregivers.

When we look at making amendments, these are the areas we want to put some emphasis on. When the legislation goes to the standing committee, I suspect there will be a good opportunity to hear a number of ideas from other members that they believe might improve the legislation itself.

I appreciate the fact that the member who introduced the legislation has said that this is something that would in essence get the debate going. She is open to ways to improve the legislation. Our government, and even individual members, take the member at her word and look forward to the bill going to committee with the idea that some amendments will be brought to the table in anticipation of improving the issue.

I have often had the opportunity to talk about the importance of health care as a general topic of discussion. Home care is an important aspect of health care. When I think of issues that Canadians really identify with as part of our Canadian identity, I think they would identify our health care system and the services that we provide.

It is important that we respect jurisdictional responsibility. I recognize that Ottawa has a significant funding role, since we spend literally billions of dollars on health care every year.

It is with great pride that the current Minister of Health has gone out of her way, has worked overtime, trying to get all provinces and territories on side with the new health care accord. The last time we saw this was back in 2003 or 2004, when all provinces and territories signed up. That was a good initiative. We saw a commitment, a tangible commitment, to national funding of health care in return for other things. It was a commitment that saw federal funding for health care grow year after year, transferring a record amount of money to provincial and territorial jurisdictions to provide something Canadians feel passionately about, that being health care.

Let us fast-forward to today. There are a few things that come to my mind in regard to this issue.

The Minister of Health has been very aggressive and progressive in pushing several issues. One of those issues has the been palliative care. She has met with the provinces and has had that discussion. She also has met with individuals. Home care has been, and will continue to be, a priority for this government. Palliative care is really important, and we recognize that.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Madam Speaker, it is a honour to speak to Bill C-277. I want to congratulate the member for Sarnia—Lambton on her good work.

I was honoured to sit on the special legislative committee that dealt with assisted suicide and euthanasia in response to the Carter decision. From that came a number of witnesses who highlighted two prominent needs.

First, there has to be a national palliative care strategy in Canada to prepare for our aging population. People who need palliative care are primarily elderly, at end of life. People do not have to be old to die, though. Palliative care provides those basic, dignified needs of people at the end of their lives, whether they are young or old.

The second issue was that we needed to provide conscience protection for physicians and health care institutions.

I am thrilled the member for Sarnia—Lambton received a low number in the private members' business draw and was able to have this bill presented. I am also thrilled this basically has been unanimously supported in the House and will very soon go to the Senate, with some very constructive changes.

This is needed in Canada. Right now there are more seniors in Canada than there are youth. One in six Canadians is a senior. In 12 short years, and I have been here 13 years, one in four Canadians will be a senior. Right now, 70% of people who need palliative care do not have access to it; 30% do.

As a civilized democracy, a western democracy, we need to provide for the basic needs of dignity. In testimony we heard different terms. We heard “medical aid in dying”, which is not assisted suicide. It is helping somebody die by reducing the pain and making them comfortable. That can be through visitation, drugs, palliative sedation, or medical apparatus. There is a number of ways.

I was shocked that our medical professionals received very little training in palliative care or end-of-life care. There is a very large interest in taking care of babies, in pediatrics, but for geriatrics, not so much. Babies are very cute. We desperately need to train Canadians in geriatrics.

With the massive change in our demographics in Canada, the aging population, where one in four will be a senior, it is not possible to build enough care facilities. Therefore, we need to train people so we can provide that home care.

Palliative care includes all of that, medical care and required infrastructure. We need to create this national seniors strategy. Again, I thank every member in the House who supports Bill C-277.

Then we need the investments in the infrastructure and the training to see this happen. The aging population is coming. It will be here in 12 years. We are not ready for it. I encourage the government and I thank it for supporting the member for Sarnia—Lambton and for its commitment to this bill. We all look forward to the investments in the next budget. Next spring when the government introduces the budget, there have to be those investments.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, it has been heartwarming to see the way members of Parliament have worked together, from the beginning when the all parliamentary committee first studied palliative care, to the work of the Special Committee on Assisted Dying, to the discussions and the many heartfelt testimonies in the House from all parties as we studied this, to the amendments at committee and the collaborative way people worked together to bring improvements to the bill, to the Minister of Health who pledged $11 billion for home care, palliative care, and mental health care in the 2017 budget. This is how Parliament ought to be, addressing needs of Canadians and doing it in a way whereby we work together and come up with a better solution.

A growing number of individuals of all ages in Canada suffer from chronic pain or deadly diseases. Palliative care services can replace a wide ranges of services, such as short-term care, home care, crisis care, and psychological or spiritual assistance services.

Canadians need palliative care. It is hard to know how much palliative care is really available because the data is not that good. We have heard discussion tonight about the need to do more in collecting data on this situation. At least 70% of Canadians have no access to palliative care. We do not have enough palliative care physicians. Certainly from a cost perspective, palliative care done in different ways, by home care, by paramedics, can reduce the cost from $1,100 a day in a hospital down to $200 for hospice or $100 a day or less a day by paramedics. There is an opportunity to get more with our health dollars.

When the bill went to committee, the members were very happy about the language around the defining of service. We modified some language to clarify the federal and provincial jurisdictions. We had discussion around the collection of the research data and made a slight adjustment there. We had some great additions to restore the secretariat for palliative care to ensure that action was driven as we move forward into the future. I was very happy with the amendments that were brought because they made the bill stronger. I think this measure will be supported in the Senate.

Everyone has shared a personal story and throughout all the times I have been here, I have never shared any stories.

First, I thank the member for Langley—Aldergrove for being my seatmate when he was on the Special Committee of Assisted Dying and for giving me a book called It's Not That Simple, which talks about palliative care. It was made me interested in bringing this bill forward.

Within my riding of Sarnia—Lambton, we have a hospice called St. Joseph's. My father-in-law died of cancer, and he was in hospice. As I watched him wilt away like a sparrow, at least he was surrounded by a caring environment. He was pain free. He was surrounded by his family. I began to appreciate the services. We have 20 palliative care beds, a great hospice, and an integrated home care system. To find out that most Canadians did not have that was just a shock to me.

I am happy to see the bill move forward. This is the right direction.

I want to thank the many organizations that supported the bill throughout its journey. I want to read them because there are so many. It is just amazing. These organization include 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; many member hospices like Bruyère Continuing Care, St. Joseph's Hospice, West Island Palliative Care Residence; the Heart and Stroke Association; the Kidney Foundation; the ALS Society of Canada; the Canadian Association of Occupational Therapists; more than 50 organization members of the Coalition for Quality Care and the Interfaith Groups, including the Centre for Israel and Jewish Affairs, the Canadian Conference of Catholic Bishops, the Canadian Council of Imams, the Evangelical Fellowship of Canada, the Armenian Prelacy of Canada, the Canadian Conference of Orthodox Bishops, and the Ottawa Muslim Association Ottawa Mosque. I thank them all for their ongoing promotion and support of the bill.

It is these kinds of organizations across our country that will help us to integrate palliative care and leverage our best practices.

I want to also thank all my colleagues for their support and encouragement. I want to encourage everyone to vote yes to Bill C-277.

[The Assistant Deputy Speaker, Carol Hughes]

It being 6:30 p.m., the time provided for debate has expired.

The question is on the motion. Is it the pleasure of the House to adopt the motion?

[Some hon. members]

Agreed.

[The Assistant Deputy Speaker, Carol Hughes]

(Motion agreed to, bill read the third time and passed)