Framework on Palliative Care in Canada Act

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

Sponsor

Marilyn Gladu  Conservative

Introduced as a private member’s bill.

Status

This bill has received Royal Assent and is, or will soon become, law.

Summary

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.

Elsewhere

All sorts of information on this bill is available at LEGISinfo, provided by the Library of Parliament. You can also read the full text of the bill.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 30th, 2017 / 5:30 p.m.
See context

NDP

Don Davies NDP Vancouver Kingsway, BC

Mr. Speaker, I rise today to speak to Bill C-277, an act providing for the development of a framework on palliative care in Canada.

The legislation would require the Minister of Health to develop and implement a framework designed to give all Canadians access to palliative care provided through hospitals, home care, long-term care facilities, and residential hospices. The bill would also require the health minister to convene a conference within six months of the act coming into force, with provincial and territorial governments and palliative care providers, in order to develop a framework on palliative care in Canada. Finally, the bill would require the Minister of Health to table the framework in Parliament within a year and post the framework online within 10 days of tabling it.

New Democrats will be supporting the legislation because we believe that palliative care is a vital part of comprehensive health care provision, and we believe that every Canadian has a right to high-quality end-of-life care. New Democrats have a long history of strong advocacy for better palliative care services for Canadians. We are proud of the New Democrat motion adopted in the last Parliament with all-party support, which laid out a pan-Canadian strategy for palliative and end-of-life care. Launched October 31, 2013, my colleague the member for Timmins—James Bay's Motion No. 456 called for the establishment of a pan-Canadian palliative and end-of-life care strategy in conjunction with provinces and territories on a flexible and integrated model of palliative care. It passed with almost unanimous support on May 28, 2014.

At present, only 16% to 30% of Canadians have access to formalized palliative or end-of-life care services. Even fewer receive grief or bereavement services. With the subsequent legalization of physician-assisted dying, the provision of high-quality palliative care services has now become more important than ever, since it provides meaningful options for end-of-life decisions. It is well past time for the federal government to act.

Palliative care is the health discipline focused on improving the quality of life for people living with life-threatening illness. The World Health Organization defines it as follows:

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

provides relief from pain and other distressing symptoms;

affirms life and regards dying as a normal process;

intends neither to hasten or postpone death;

integrates the psychological and spiritual aspects of patient care;

offers a support system to help patients live as actively as possible until death;

offers a support system to help the family cope during the patients illness and in their own bereavement;

uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;

will enhance quality of life, and may also positively influence the course of illness;

is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

There is consensus among academics, health professionals, and the public that improvements in the palliative care system in Canada are desperately needed. Without clear national standards, individual jurisdictions are left to develop their own policies, programs, and approaches, resulting in inconsistent and inadequate access across the country. In Ontario, for instance, 40% of cancer patients do not receive a palliative assessment in their last year of life. In some regions of Atlantic and western Canada, data shows that less than half of people who die in a hospital receive palliative care.

The number of individuals actively caring for a friend or family member is expected to increase as Canada's population ages. On average, Canadians estimate that they would have to spend 54 hours per week to care for a dying loved one at home, and two-thirds say they could not devote the time needed for this care. Currently, family caregivers provide more than 80% of care needed by individuals with long-term conditions at home, in long-term care facilities, and in hospital. Replacing family caregivers with a paid workforce at current market rates and usual employee benefits has been estimated to cost about $25 billion.

Furthermore, according to a synthesis of the empirical literature, palliative family caregiving for older adults is gendered. When acting as caregivers, women experience a greater degree of mental and physical strain than their male counterparts. This is linked to the societal expectation that women should provide a greater degree of care at the end of life for family members.

Remarkably, there are many jurisdictions across the country where we do not even know how many Canadians receive quality palliative care. We lack consistent and ongoing data collection at a systemic level, which leaves us unable to effectively hold our health care systems accountable.

Indicators such as location of death, use of acute care before death, and referrals to formal palliative care show that there is significant room for improvement. Many Canadians who require palliative care receive it in acute and emergency care, if they receive it at all. Not only are acute care settings more costly than dedicated palliative care, but they are also not as well equipped to provide the most appropriate treatment and care for patients and their families.

It is vital that any national palliative care strategy take into account the geographic, regional, and cultural diversity of urban and rural Canada. It must also respect the cultural, spiritual, and familial needs of Canada's first nations, Inuit, and Métis people. According to Dr. Mary Lou Kelley, research chair in palliative care at Lakehead University, the federal health care dollars that would help indigenous people receive end-of-life care at home have not kept up with the increasing demand. Health care for first nations is the responsibility of the federal government, of course, and it does provide some home care services, but the system was never designed to provide complex health care to people with chronic or advanced terminal diseases.

Finally, I would be remiss if I failed to note that, although the bill is sponsored by a Conservative member, the previous government eliminated the federally funded national secretariat on palliative and end-of-life care when it first took office in 2006. If it had not been for this cut, we would have developed a palliative care framework a decade ago.

From 2001-06 the federal government funded the secretariat through Health Canada with an annual budget ranging from $1 million to $1.5 million, virtually nothing in terms of the federal budget. However, when the Conservative government disbanded the end-of-life care secretariat, it stopped working on a national palliative and end-of-life care strategy.

In 2011, the Conservative government made a one-time commitment of $3 million to fund the study and framework creation of community integrative models of hospice palliative care. This initiative was led by the Canadian Hospice Palliative Care Association, but according to Dr. Greg Marchildon, Ontario research chair in health policy and system design at the University of Toronto:

There is no national policy on palliative care in Canada. Instead, there are national guidelines developed by community-based palliative care organizations operating at arm's length from government.

Although Conservative support for palliative care had previously been absent, it is certainly better late than never. That is why New Democrats reached across the aisle at the health committee to successfully move an amendment to the bill requiring the federal government to evaluate the advisability of re-establishing Health Canada's secretariat on palliative and end-of-life care.

I will give credit where credit is due. The member for Sarnia—Lambton responded to our proposal thoughtfully, saying: “I'm a fan of doing that. As I said, I was not here during the Harper regime, so I can't fix the past. I can only improve the future.”

New Democrats, in keeping with that sentiment, will work together to improve the future. I will conclude my remarks by reiterating the NDP's support for this vital initiative and affirming that all Canadians deserve to live their final days in dignity and comfort. We look forward to contributing to the framework development process and sincerely hope that it will provide the strongest possible palliative care strategy for every Canadian from coast to coast to coast.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 30th, 2017 / 5:40 p.m.
See context

Conservative

Kelly McCauley Conservative Edmonton West, AB

Madam Speaker, I am proud to rise today in support of Bill C-277, which calls for the development of a framework to increase access to palliative care. I would like to personally thank the member for Sarnia—Lambton for introducing this private member's bill.

Years ago, while I was living in Victoria, I had the honour of serving as the president of the Greater Victoria Eldercare Foundation, Vancouver Island's largest seniors foundation, supporting six extended care hospitals. The Greater Victoria Eldercare Foundation, under my good friend executive director Lori McLeod, has developed leading community programs to assist seniors, including the annual Embrace Aging month, with initiative raising awareness about the wealth of resources and opportunities available year-round to help seniors and their families navigate the journey of aging.

I was pleased to hear recently that it has added additional palliative care facilities at its Glengarry facility. It was through my involvement with the Eldercare Foundation that I encountered first-hand the many issues that seniors and their families face now: the difficulty of obtaining proper care for seniors, proper facilities, and proper understanding of the unique situations and issues they face. I owe a lot to the many volunteers and staff whom I worked with at the Greater Victoria Eldercare Foundation, and I know they too would be supporting this excellent bill.

Alleviating the suffering of Canadians is a collective duty of the House, regardless of political agenda or party affiliation. Whether in hospitals or at home, Canadians should not have to go without the care they need simply because there is not sufficient support. Our society is capable of providing the best care for our citizens, and Bill C-277 provides a framework to utilize and implement these resources. This bill helps to promote good health while preserving the independence of Canadians in need of health support. As a Conservative, I am a proud supporter of this bill, which will invest in long-term and palliative care, which the Liberals have failed to do despite their many promises.

In 2015, the Supreme Court of Canada's decision in Carter v. Canada established that Canadians have a right to physician-assisted dying. We debated Bill C-14, and while I opposed the legislation, the House and Senate passed it and it received royal assent almost a year ago. One of the key aspects of the Carter decision, however, was its call for an advancement of palliative care as a means of increasing Canadians' access to compassionate health care. The Carter decision is intended to ensure that Canadians can make a legitimate choice regarding their own health care, and one of those options is to receive adequate palliative care, care that is focused on providing individuals who have a terminal illness with relief from pain, physical and mental stress, and the symptoms of their illness. It is intended to ensure that those who are at the end of their life can pass peacefully, with dignity and without pain.

The Carter decision enabled Canadians to pursue assisted dying, but it also established an obligation on the government to ensure all Canadians can access proper, adequate, and compassionate end-of-life care. Right now, we are not getting the job done. We are not in any imagination fulfilling our obligations as a society in caring for those in need of care. For example, a survey of pre-licensure pain curricula in the health science faculties of 10 Canadian universities shows many would-be doctors receive less training in pain management than their counterparts in veterinary medicine. I am sure my dog Hailey, who is no doubt at home on my couch right now as I speak, finds this reassuring, but as someone formerly involved in senior care, I find it quite distressing.

A survey of more than 1,100 doctors and nurses shows that those who treat fewer terminally ill patients, therefore knowing the least about symptom management, are most likely to be in favour of assisted suicide, while those with more experience in symptom management and end-of-life care tend to oppose it. Dr. Max Chochinov, a noted specialist on palliative care, explains that the will to live is directly inverse to the amount of pain, and that loss of dignity drives wanting to die and treatment of pain can improve sense of dignity.

We also have to remember the impact of terminal illness on a family: the emotional, physical, and financial struggle of caring for a loved one at the end of their life. Under the current regime, it is up to families to carry the overwhelming bulk of this burden. This system is not fair. People should not have to choose between paying bills and caring for their spouse, their parents, or their siblings.

We have heard horror stories time and time again from families who were completely ambushed by palliative and in-home care costs after their loved one got sick, and these instances are becoming more and more common. The health minister herself has acknowledged many times that Canada has a deficit in access to quality palliative care, yet despite her pledges to do more and provide more, she has neglected to take meaningful action to date. Canada's population as a whole is growing older, and seniors now outnumber children.

I said before in my speech to the RRIF financial security act—another bill that would have helped seniors, which the Liberals voted against—that we need to be ready to have the proper programs and mechanisms in place to adapt to our shifting demographics.

A recent Globe and Mail article states that, according to the 2016 census, we have seen “the largest increase in the share of seniors since the first census after Confederation”. Across Canada, the increase in the share of seniors since the 2011 census “was the largest observed since 1871—a clear sign that Canada’s population is aging at a faster pace”. That figure is projected to rise even more in the coming years. The proportion of those aged 65 and older climbed to 17% of Canada's population. This is not a new phenomenon obviously.

A September 2015 Statistics Canada report noted that, by 2024, 20% of our population will be over the age of 65, so we need action plans in place to address this shift, this massive wave that is going to be overtaking our health care systems. The provinces are going to be faced with an epidemic soon enough of people trying to access systems that are not capable of supporting the demand. Less than 30% of Canadians have access to this vital service, which allows them to choose to live as well as they can for as long as they can.

It is time for the government to fulfill its obligations to provide quality palliative care to all Canadians. This framework answers some of those calls, and it represents the needs of the aging population across Canada, including those in Edmonton West. The percentage of individuals in Edmonton aged 65 or older has risen to 14%, a significant figure representing thousands of individuals who will benefit from universal palliative care.

I know this bill will serve the aging population in my own riding, particularly those who find comfort in knowing that their family members and loved ones will receive the best care. No one should have to suffer through ailments alone, without the support of well-trained and compassionate health care practitioners.

Bill C-277 is required to define the services covered, to bring standard training requirements for the various levels of care providers, to come up with a plan and a mechanism to ensure consistent access for all Canadians, and to collect the data to ensure success. Good palliative care can cover a wide range of services, such as acute care, hospice care, home care, crisis care, and spiritual and psychological counselling. The creation and implementation of a palliative care framework will give Canadians access to high-quality palliative care through hospitals, home care, long-term care facilities, and residential hospices.

We need to ensure that our communities support the aging population with respect and dignity. As parliamentarians elected by our respective communities, reacting to this shift should be a priority and cannot be ignored. When I introduced my private member's bill last fall, which sought to help seniors who were being disproportionately targeted by an outdated tax measure, I heard from countless seniors across Canada who felt they were being left behind. While it is important to ensure the provinces are not pigeonholed by federal legislation, we need to acknowledge a legislative gap when we see one. Seniors need help, and no amount of discussion papers, working groups, or committee meetings will make this issue go away. We know what the issue is and we need action.

Bill C-277 is a step toward providing the much-needed support for seniors today and seniors to be. Palliative care is good, compassionate, and meaningful. Providing access to quality and affordable palliative care can help make painful decisions a little more manageable for those suffering from a terminal illness. It can also significantly help the families of those suffering, who carry the disproportionate financial and emotional burden of end-of-life care. The government needs to pass this legislation to begin the development of a framework on increasing access to palliative care.

When the Supreme Court's decision in Carter v. Canada was delivered, it included a significant and serious obligation on the government to ensure that Canadians could make a real decision on their end-of-life care. The ability to make that decision requires that the options are actually available, and today's unfortunate reality is that our palliative care system is inadequate.

As I mentioned, I would like to thank the member for Sarnia—Lambton for bringing this fantastic private member's bill forward. I am very pleased to hear my colleagues in the NDP speak so favourably toward this, and to hear that they will be supporting it. I am extremely proud that I and other members of the Conservative caucus will be supporting this very important bill.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 30th, 2017 / 5:50 p.m.
See context

Liberal

Sonia Sidhu Liberal Brampton South, ON

Madam Speaker, it is an honour to rise today to speak about Bill C-277, an act providing for the development of a framework on palliative care in Canada.

I first want to congratulate my colleague, the member for Sarnia—Lambton, for bringing this forward. I also want to congratulate my fellow members on the health committee for working so collaboratively on this bill at committee stage. I think our work and amendments improved this legislation to become something positive for all Canadians.

It is essential for us to be talking about palliative care. It is something I heard about a lot during my election campaign and continue to hear about from community members. Palliative care and access to end-of-life care are important issues for all Canadians.

Brampton South is a riding with a significant population of seniors, who brought this forward as an issue of dignity and quality of life. A strategy to address this need is an important step. I want to thank them for raising their voices and for championing this in my community.

As members know, palliative care is for all, regardless of age, who are approaching the end if life. It is for all people who desire a compassionate and comfortable place to receive care. In our conversation about medical assistance in dying, I raised the need for palliative care and home care to be involved in that discussion. That is why I am extremely proud that our government responded to all aspects of this issue in our relatively short time, so far, in government.

As members know, we will be investing $6 billion in home care through the provinces and territories; $2.3 billion will be going to fill needs in Ontario, which I hope will serve to fill the gaps that exist in our rapidly growing Peel region. Home care is about responding to Canadians' overwhelming desire to be at home, to receive care at home, and, sadly, if needed, to live out their end-of-life stage at home when possible. Palliative care is the other option that serves to make life more dignified for our most in-need people.

I would like to mention that palliative care workers and PSWs deserve our utmost respect for the difficult but important job they do for people in our communities.

I strongly support Bill C-277's goals to make a strategy and to incorporate work governments have been doing on this already. A strong evidence-based approach will deliver real results. That is the approach our government ran on and the one Canadians endorsed when they elected us.

Please know as I give my comments today that we recognize and respect that the provinces play the principal role in the delivery of health services, including palliative care. This bill, with the proposed amendments, understands that the federal role in health lies in coordinating and ensuring that there are the same services available for all. I am very pleased that the government will support this bill, with amendments.

The proposed amendments respect the intent of the bill but seek to align it with the scope of federal roles and responsibilities in relation to palliative care. They also seek to build on existing palliative care frameworks, strategies, and best practices being undertaken by provinces, territories, and stakeholder groups.

To ensure that Canadians have access to the best quality of palliative care, it is important that we do not reinvent the wheel. In many provinces, there are existing frameworks and policies. As such, it was important to me and my colleagues on the health committee to ensure that any new work on this would build on what exists already.

We also know that when it comes to caring for Canada's seniors in need of palliative care, the job falls not only to health care professionals but to other caregivers, including family members. As such, our committee made changes to the bill to ensure that all who provide care at this stage are supported and have their needs considered in the establishment of a framework for palliative care.

With our government's focus on evidence-based policy, it was also very important to ensure that any new work on this issue include the promotion of research and data collection so that we can ensure that the care provided to Canadians is based on the most relevant research, best practices, and up-to-date evidence in this area.

This is a very important part of the picture, as we all know very well that the incredible ongoing research in the Canadian health care field is innovative, leading to new opportunities for greater care. It is essential that this new knowledge be considered as we develop and maintain a framework for palliative care across Canada.

Our proposed amendments would facilitate federal support for improved palliative care in relation to three pillars, which are aligned with the objectives of the bill: training for health care providers; consistent data collection, research, and innovation in palliative care; and support for caregivers.

We continue to support pan-Canadian initiatives that enhance Canada's capacity to provide quality palliative and end-of-life care as well as a range of programs and services, such as family caregiver benefits and resources, that address the actions proposed in the bill.

Our government's investments in the provinces to in turn deliver health services are outpacing inflation, ensuring that they can deliver better health outcomes. I want to commend the Minister of Health on the recent health accord agreements.

I am also very proud to say that we are also working with first nations and Inuit stakeholders to identify options for building on current resources and services to provide increased access to palliative care.

It is crucial that any work we do regarding the health of Canadians reflects the different realities of the many communities across the country. Specifically, we know that the health care needs of first nations and Inuit communities deserve special attention to respect the traditions and existing frameworks that have been developed from community to community.

Overall, I cannot say enough how pleased I am that this important discussion is happening in this place. I do not doubt that this conversation will and must continue. The health committee, on day one, agreed that this was something we should look at, because it is an important issue for seniors and for us, too.

We have many important pieces of business before us at committee, but I imagine that a review of this strategy and of strategies stakeholders or provinces currently are using could be a full study in the future.

Palliative care and end-of-life options are the kind of hard but real topics that are our responsibility as leaders to address. These are the things that make us think of our loved ones and our own futures in personal ways. Regardless of our own views or choices, we are setting up a system that is fair, compassionate, and just. By taking a public health approach to issues like this, we are doing the responsible thing that serves as a framework for all Canadians.

I want to thank the parliamentarians in this House for supporting the bill and for all the contributions so far. It is something I have followed closely in the House. Today we continue to move this forward towards action.

Again, I congratulate the member for Sarnia—Lambton on Bill C-277 and her work to promote its aims. It is a noble quest that aligns with the priorities of this government to bring positive change to our health care system and with my own priorities to ensure that Canadians have access to the best possible health care services. I hope all members will join me in supporting the bill again at the next opportunity to vote for it.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 30th, 2017 / 6 p.m.
See context

Conservative

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.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 30th, 2017 / 6:05 p.m.
See context

Winnipeg North Manitoba

Liberal

Kevin Lamoureux LiberalParliamentary 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.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 30th, 2017 / 6:20 p.m.
See context

Conservative

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.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 30th, 2017 / 6:20 p.m.
See context

Conservative

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.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 9th, 2017 / 6:40 p.m.
See context

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

moved that the bill be read the third time and passed.

Mr. Speaker, I am so pleased to be standing in the House today at third reading of my private member's bill, Bill C-277, an act providing for the development of a framework on palliative care in Canada.

The need for palliative care is increasing in our country. What began as a seed with the all-party parliamentary committee on palliative and compassionate care that studied this issue in the 2011 session and brought forward a report, recommendations, and motion to the House, grew into this bill, which has been supported both here and at committee, and is now ready for final consideration in the House.

Canadians need palliative care services now more than ever. Less than 30% of Canadians have access to this vital service, which allows them to choose to live as well as they can for as long as they can.

Bill C-277 is the next action required to define the services to be covered, to bring standard training requirements for the various levels of care providers, to come with a plan and mechanism to ensure consistent access for all Canadians, and to collect the data to ensure success. Through the amendments at committee, it will also consider re-establishing the palliative care secretariat.

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.

A palliative care philosophy is needed to meet all sorts of needs through a process that is adapted and patient-centric. Increased demand for home and palliative care will split the cost of health care in four, compared to the cost of short-term care or palliative care in hospitals.

The creation and implementation of a palliative care framework would provide consistent access to high quality palliative care in hospitals, at home, in long-term care facilities, and in nursing homes.

The bill is timely, since the special committee that studied the Carter decision on medical assisted dying legislation said that without good quality palliative care there would be no true choice. We want Canadians to have a choice.

During discussion in committee, we heard testimony from some of the outstanding Canadians who pioneer in palliative care, people like Dr. David Henderson, a lead physician in palliative care, and Dr. Pereira, another pioneer in palliative care. We heard from national organizations of nurses, hospices, and other palliative care experts. As a result of their testimony, several amendments were brought.

The first amendment tasks the federal government with developing a palliative care framework though the provinces are responsible for implementing it. Of course the federal government will support the provinces in this, and I was pleased to see the $11-billion investment in palliative and mental health care in budget 2017.

The second amendment clarifies the wording of the provision dealing with the training of palliative care providers. Many individuals are active in this field, including health care providers, volunteers in a variety of settings, and family caregivers. The committee felt it was important to better define training for health care providers and other people involved, so it amended the wording of the provision accordingly.

The committee also requested that the provision amending the Canada Health Act to include palliative care as a protected service be removed.

From what the witnesses told us, there were clearly other mechanisms that the federal government was already considering, such as health accords, infrastructure spending reviews, and programs for palliative care and home care.

The focus of the bill was on developing a plan, and there are many ways to do that.

One of the amendments brought forward at committee was that the proposed framework designed to support improved access for Canadians to palliative care evaluate the advisability of re-establishing the Department of Health secretariat on palliative and end-of-life care. In June 2001, the secretariat on palliative and end-of-life care was established as the first step in Health Canada's work to co-ordinate a national strategy on palliative and end-of-life care.

Nearly a year later, the secretariat brought together over 150 national, provincial, and territorial specialists in the field. This included practitioners, researchers, and those making decisions in palliative and end-of-life care. This summit, the national action planning workshop on end-of-life care, resulted in the establishment of the main priorities or working groups deemed as essential for quality palliative and end-of-life care in Canada.

These five working groups led to the beginnings of the Canadian strategy on palliative and end-of-life care and focused on best practices and quality care, education for formal caregivers, public information and awareness, research, and surveillance. I am very interested to see what an entity similar to the Department of Health secretariat on palliative and end-of-life care could look like today.

The bill now outlines the advisability of re-establishing this secretariat, which could be discussed at length. However, I would like to elaborate on what such a secretariat or regulatory body might look like.

It would be known as the central entity for palliative care information, education, and accessibility in Canada. Setting a national standard, or a national framework, would create consistent care across the country through a variety of mechanisms. Virtual care, home care, palliative care, and hospice care are only a few of the current possibilities.

Working all of these types of different care into community networks would be beneficial to all Canadians and would facilitate the process of finding and transitioning into palliative care. At the heart of these operations would be our health care workers, our nurses, doctors, palliative care physicians, and all the many other caregivers that exist.

An amendment to improve the wording of the need to provide research and collect data on palliative care was approved, as well as an amendment to remove ongoing responsibility for measuring the performance of the framework, since the provinces would have metrics in this regard.

The committee felt that the wording of the bill was adequately clear to cover all Canadians and, as such, no further amendments were required. I want to thank the committee members for their diligent consideration of the bill.

I was able to tell the committee what I would like to see happen when the framework was implemented. In terms of covered services, I would like to see the covered services include pain control, crisis intervention, spiritual and emotional counselling, as well as all services provided in home care and hospice. In an overall patient-oriented palliative care approach, these things are brought forward when needed and do not necessarily apply to the circumstances of every patient.

I would like to see the government leveraging training on palliative care that is already available through organizations like Pallium Canada and many universities. I would like to see us encourage more palliative care specialists to work in Canada, since we only have 200 versus the current need of 600.

I have heard a lot of innovative ideas that have been implemented to accelerate getting palliative care in more remote parts of Canada. For example, there are places where they have trained paramedics and home care workers, and then they are connected to a virtual call centre with palliative care specialists who can guide the care providers. Training at this level really accelerates the actual care that can be provided in remote communities, which is currently a real challenge.

An excellent example of palliative care done right can be found right at home in my riding of Sarnia—Lambton. With an increasingly aging population, Sarnia—Lambton has done incredible work by creating and continuing to expand its senior care network in our communities. With 20 palliative care beds, five palliative care physicians, and our integrated network of home care and hospice care, I believe Sarnia—Lambton is ahead of the pack.

I am proud to say that St. Joseph's Hospice in my riding survives on fundraising currently of $1 million a year, so hopefully we can have the government provide support for these hospices, which provide such a great service. I would like to thank Dr. Glen Maddison who, along with his many colleagues at St. Joseph's Hospice, provided input on this bill.

I believe all Canadians should have access to consistent and quality care, such as is available in my riding. I would like to thank Sarnia—Lambton's many institutions and groups that support and deliver palliative care, such as the St. Joseph's Health Care Society, Bluewater Health Palliative Care Unit, the Erie St. Clair Community Care Access Centre, and of course, St. Joseph's Hospice. Unfortunately, these resources are not abundant everywhere, so I am doing everything in my power to create them in the rest of Canada.

I would also like to have the data we need to take improved action on palliative care over time. We know, for example, that palliative care in home care settings costs about $200 a day versus $1,200 a day for an acute care hospital bed, but we do not know how much the true cost of palliative care averages. Because of the numerous ways people receive palliative care, and the many who have no access, there is a clear lack of information about what the true demand is. Knowledge about which treatments are more effective or are more cost-efficient are also needed. Knowing how many hospices we would need to adequately address the demand is equally important. There are only 30 hospices in Canada versus 1,300 in the U.S., so there is definitely a need.

Using some of the infrastructure money that the government has announced, I would like to see it spent to create Canadian jobs and to build palliative care infrastructure. That would certainly be money well spent. The palliative care framework in Bill C-277 will contain the plan, and the government will then determine the pace of spending and where it will be focused.

There has been so much interest in this subject, and such great support from the many arenas, I hope that when I thank people I will not forget anyone.

I want to thank the many organizations that have supported this bill through its journey, such as 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, with many of their member hospices, like Bruyère continuing care, St. Joseph's Hospice in my own riding, and West Island Palliative Care Residence. I want to also thank the Heart and Stroke Foundation, the Kidney Foundation, the ALS Society, the Canadian Association of Occupational Therapists, the more than 50 organization members of the Quality End-of-Life Care Coalition, 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, the Ottawa Main Mosque and the Ottawa Muslim Association 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.

I also want to thank my colleagues on all sides of the House who have spoken passionately, and in support of this bill.

I want to thank the thousands of Canadians who have written letters to MPs and the Prime Minister, and who sent more than 84 petitions to this House asking for palliative care.

I want to thank the Minister of Health for her advocacy on this issue with the provinces, and for putting dollars into the budget to begin the journey to ensure that all Canadians have access to palliative care so they can choose to live as well as they can for as long as they can.

The time is right. This bill has been another fine example of how political parties can come together and work for the common good of Canadians, and it has been an amazing experience being part of it.

With that, I encourage each member of this House to support this bill. People in their ridings and people all across our nation desperately need access to good quality palliative care. This bill is another step in the right direction.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 9th, 2017 / 6:55 p.m.
See context

Winnipeg North Manitoba

Liberal

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

Mr. Speaker, palliative care is something that all members of Parliament are concerned about. We have a government that has allocated a considerable amount of resources, and the Minister of Health has raised the issue with her provincial counterparts. I recall the fantastic work that a very good, dear friend of mine, Sharon Carstairs, a former senator, did on this file.

I compliment the member on bringing the bill forward, and being open to the amendments. I would ask her to provide some thoughts on how it is this issue has brought many of us together, because we do recognize the importance of palliative care in Canada.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 9th, 2017 / 6:55 p.m.
See context

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Mr. Speaker, I would like to thank the parliamentary secretary to the government House leader for his question and for his support on this issue. As he has said, this is an issue that is timely because of the assisted dying legislation, but even more so, because of the aging population in Canada. We see the incredible need out there. It is daunting to think about remote communities and how we going to get access for the 70% of Canadians who currently have no service.

We are going to require some innovation. There are pockets of innovation that have already started to happen. The provinces are all starting to march along in their own ways. The government can have a role in bringing standardization to the whole thing. With that, there is an opportunity for the government to partner.

We have infrastructure dollars we want to spend. We know that we need hospices. We know that acute care is not the way to go, so I appreciate the Minister of Health putting money in the budget for home care, recognizing in budget 2017 home care and palliative care and some mental health funding, because as people go through these end of life issues, quite often there is an emotional and spiritual component and a mental health component to address.

I see that all parties recognize that people need this. It is something we need to do, and we need to begin that journey.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 9th, 2017 / 6:55 p.m.
See context

Conservative

Dianne Lynn Watts Conservative South Surrey—White Rock, BC

Mr. Speaker, I want to thank my colleague for the tremendous amount of work she has done to bring the bill forward. I think every member in the House is proud of the fact that we can come together, especially on a topic such as this.

I want to ask my colleague, in terms of the assisted dying legislation, how this plays an important role and what her thoughts are on that.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 9th, 2017 / 6:55 p.m.
See context

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Mr. Speaker, when it comes to the assisted dying legislation, the important thing to note is that the committee that studied the Carter decision said that without good palliative care, we do not have a real choice. For many Canadians who are in places where they have nothing, they are suffering horribly in pain, and they really do not have a choice.

We want people to have a choice. We have heard many examples and testimonies. I have heard stories that would make us cry, of people who went into palliative care and were able, in a pain-free way, to enjoy their last moments with their families, living much longer than many had anticipated and much better than many had anticipated.

Although Bill C-14 was more to address the Criminal Code with respect to assisted dying legislation, I think this bill brings the framework for palliative care and starts to build on the various aspects of that.

I appreciate the minister working with the provinces, because that will be key. We know that the provinces implement the work and the government funds the work, so there is an opportunity to partner with them to get a really great result for Canadians.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 9th, 2017 / 7 p.m.
See context

Louis-Hébert Québec

Liberal

Joël Lightbound LiberalParliamentary Secretary to the Minister of Health

Mr. Speaker, I am pleased to be here today to express support for Bill C-277, an act providing for the development of a framework on palliative care in Canada.

Our government believes that Bill C-277 provides us with a timely opportunity to take a leadership role on this issue. I would also like to recognize the efforts of the member for Sarnia—Lambton, who had the class and the elegance to send flowers to the minister with whom I feel fortunate to work. I would like to return the favour. I think she did an excellent job on this issue and has put forward a very thoughtful proposal. I sincerely congratulate her.

I also want to congratulate the members who served on the Standing Committee on Health and who studied this bill with a great deal of attention and care.

Our government understands that palliative care is a critically important part of our health care system, providing much needed support to patients and their families at one of the most difficult times of their lives. We also know that Canadians overwhelmingly support a palliative approach to care at the end of life.

Still, studies have reported that as few as 16% to 30% of Canadians have access to palliative care, depending on where they live in Canada.

There is no question that we must improve palliative and end of life care so that Canadians, irrespective of where they live, have access to timely, high-quality care at the end of their lives. If we are going to be successful in achieving this goal, however, it is paramount that the federal government collaborate with the provinces and territories and draw on the considerable expertise that key stakeholders, health care providers, and caregivers have to offer.

I would now like to take this opportunity to speak to some of the amendments made by the Standing Committee on Health, which I believe strengthen the bill.

The Standing Committee on Health received a number of briefs from key stakeholders on Bill C-277, including the Canadian Society of Palliative Care Physicians of Canada, the Canadian Cancer Society, the Canadian Nurses Association, and Pallium Canada. All of these organizations expressed strong support for the implementation of a federal framework on palliative care. However, they also indicated that a significant amount of work had already been done and should be leveraged in the development of any federal framework on palliative care.

For example, most provincial and territorial governments already have a palliative care strategy, plan or framework in place to support palliative care. Several of the briefs submitted to the committee also identified the Canadian Hospice Palliative Care Association’s “The Way Forward: Towards Community-Integrated Hospice Palliative Care in Canada” as a key resource that could be built upon.

Funded by Health Canada, “The Way Forward” Framework was developed through an extensive consultation process with health care providers, experts, key stakeholders and all levels of government. It provides guidance, best practices, and other resources to help communities and organizations adopt a palliative approach across all settings of care.

Organizations across Canada, including the Government of Alberta, the Canadian Home Care Association, the Canadian Nurses Association, the Canadian Medical Association, have used the framework to guide their efforts to implement an integrated palliative care approach.

I was pleased that the members of the Standing Committee on Health acknowledged this significant body of work and that it will be studied when developing any future framework.

A number of stakeholders also expressed their support for the priority areas identified in the framework, including palliative care education and training, support for care providers, and data collection and research. Each of these elements is widely understood to be essential in improving access to high-quality palliative care services by patients and their families.

Our government has been very clear in expressing its support on these issues. For example, the government has provided $3 million in funding to Pallium Canada to support training in palliative care to front-line health care providers. This initiative has developed a range of educational materials, trained trainers, and facilitated sessions to increase the palliative care capacity of health care providers.

We also recognize the critical role that unpaid caregivers play in the care of so many Canadians.

As announced in budget 2017, the introduction of the new Canada caregiver credit and a new EI caregiving benefit will provide additional support to Canadians caring for critically ill or injured family members.

Supporting the development of a solid evidence base has also been a clear priority for our government. Through the government's research funding arm, the Canadian Frailty Network centre of excellence is receiving $23.9 million in support over the next five years to facilitate evidence-based research, knowledge sharing, and clinical practices that improve health care outcomes for frail older Canadians, their families, and caregivers. It is my sincere hope that these foundational investments can be leveraged to guide future work in this area.

Our government is also committed to working co-operatively with provincial and territorial governments to improve the quality and availability of palliative care for Canadians.

While the federal government can provide leadership through the implementation of a framework to help support and unify efforts to make positive change, it is the provinces and territories that have primary responsibility for the delivery of health care services, including palliative care.

When first introduced in the House, Bill C-277 called on the Minister of Health to 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. The bill is significantly strengthened by the changes made at committee to indicate that the federal framework on palliative care developed through Bill C-277 would support improved access to these services by Canadians. While the federal government is well positioned to complement and bolster the important work under way across the country by provincial and territorial governments, this wording better reflects the constitutional realities of the Canadian health care system, as it is the provinces that deliver the services on a daily basis.

The amended bill being considered by the House today no longer requires an evaluation of “the advisability of amending the Canada Health Act to include palliative care services provided through home care, long-term care facilitates and residential hospices”.

While this would no doubt highlight the importance of palliative care within the health care system, I would agree with the briefs sent to the Standing Committee on Health by the Canadian Nursing Association and the Canadian Society of Palliative Care Physicians, expressing concern over potential amendments to the Canada Health Act as part of this bill.

Given the complexity of the Canada Health Act, there is a real risk that this measure would lead to lengthy delays in the implementation of the framework, when more immediate action is needed. That is definitely not our objective, nor that of the member for Sarnia—Lambton, I am sure.

These organizations also expressed concern that the review on the state of palliative care, as prescribed by section 4 of this bill, may not necessarily result in increased access to community and home-based palliative care services, services for which Canadians have expressed the greatest support.

With these considerations in mind, the removal of this point will focus attention to where it is most needed, the development of a framework which would support provinces, territories, and stakeholders in their front-line efforts to improve palliative care.

I would like to thank the House for the opportunity to reflect on some of the important changes that were made to Bill C-277, which I believe significantly strengthen the proposed framework.

I will conclude as I started by thanking the member for Sarnia—Lambton for putting forward such a well-considered proposal, and offer my support and the government's support for the amended bill currently before the House.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 9th, 2017 / 7:05 p.m.
See context

NDP

Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC

Mr. Speaker, I am pleased to rise in the House today to speak to Bill C-277, an act providing for the development of a framework on palliative care in Canada. I would like to thank the sponsor of the bill for her work and the members of the Standing Committee on Health for this new version.

The New Democrats have long supported and advocated for the idea of a Canadian palliative care strategy to provide end-of-life care to Canadians. With Canada's aging population taxing our health care system, the need for a coherent, coordinated, nationwide palliative and end-of-life care strategy is becoming more acute. This issue affects and will continue to affect us all directly or indirectly.

I was pleased to see these words in the new version of the bill:

2(1)(g) evaluates the advisability of re-establishing the Department of Health’s Secretariat on Palliative and End-of-Life Care.

I would remind members that we are in this situation because, when the Conservatives were in power, they decided to abolish the secretariat on palliative and end-of-life care and stop work on the palliative and end-of-life care strategy. We therefore missed an opportunity to make incredible advances for the well-being of patients, their families, and our society. Those decisions, combined with 10 years of inaction on this issue, have had a negative impact.

I hope that, with this bill, the Liberals will take this opportunity to restore the secretariat on palliative and end-of-life care and that it will be given adequate funding. I also hope that health care professionals will have the resources needed so that they can provide services across the country, because as we all know, there is a great and ever-increasing need.

I was able to gauge the extent of these needs when I had the opportunity to sit with my colleagues from the House and the other chamber on the Special Joint Committee on Physician-Assisted Dying. At the hearings, the vast majority of witnesses and experts told us how vitally important accessible and good quality palliative care is to Canadians. I was made aware of the fact that across the country only 16% of Canadians have access to quality palliative care. Thus, one in ten Canadians have access to quality palliative care. One in ten is too little, far too little.

The NDP respects the fact that a good part of health services are provided by the provinces. However, the federal government has a fundamental role to play when working with them. For that reason, we have been asking for a long time for a national palliative care strategy that respects provincial and territorial jurisdiction, but that seeks to find way to provide adequate palliative care services for everyone.

At the Special Joint Committee on Physician-Assisted Dying, we made informed and necessary recommendations on palliative care that called for reestablishing the secretariat on palliative care and funding, creating a properly funded national palliative and end-of-life care strategy, and support for family caregivers and better compassionate care benefits.

These recommendations have to be considered. They respond to the concerns of Canadians. As everyone probably knows, National Palliative Care Week is from May 7 to 13. It is happening right now.

I want to take this opportunity to thank all those who work with our constituents day after day. I am talking about health professionals and volunteers who devote their time to this. Their commitment is essential and I thank them from the bottom of my heart. I want to take this opportunity to specifically thank the health professionals, agencies, and organizations, and the many volunteers in the riding of Saint-Hyacinthe—Bagot who work directly or indirectly with the patients. The role these people play in providing high quality palliative care cannot be measured. They provide patients and their families the support they so desperately need during one of the most difficult times in their lives. The palliative care that they provide whether at home, a palliative care centre, or a hospital, is indispensable.

In my riding, Saint-Hyacinthe—Bagot, countless organizations do exceptional work.

These organizations offer palliative and respite care. Others raise funds to ensure that those who need quality palliative care can get it. One of these is the Hôtel-Dieu-de-Saint-Hyacinthe. The centre's palliative care team has been providing palliative care for 30 years. Hundreds of people go to the nursing home to live out their last days. It is around 500. The hospital has hundreds of beds, but only 12 palliative care beds.

In Acton Vale, the Centre d'hébergement de la MRC-d'Acton has just one palliative care bed. All of the people who work with patients and their families, on user committees and elsewhere, are doing exceptional work, and I am deeply grateful to them.

In support of Hôtel-Dieu residents, the Fondation Aline-Letendre will be holding a spaghetti supper and “Rock à la Sylvain Lussier” party on Saturday, May 13, at 7 p.m. in the Centre communautaire Douville in memory of Lucie-Anna Gaucher and Jeanne Palardy, who both received palliative care at the Hôtel-Dieu-de-Saint-Hyacinthe.

This Saint-Hyacinthe organization does crucial work in our community. I want to recognize the incredible work of its executive director, Christine Poirier, its volunteers, and its board members. Since it was created over 20 years ago, Fondation Aline-Letendre has given over $7 million to the Hôtel-Dieu-de-Saint-Hyacinthe. I am also thinking of the staff and volunteers at Les Amis du crépuscule, a community organization that provides assistance to people receiving palliative care and later to their grieving families. We also have the Maison Marie-Luce-Labossière, which provides support and assistance, as well as accommodations, in a safe, peaceful environment to people suffering from “preterminal” cancer, among others. The Maison Marie-Luce-Labossière also has spaces for short-term stays in order to allow caregivers a period of respite during the summer months.

Like me, the members of these organizations believe that a national palliative care strategy would have a positive impact on patients and their families, and that it is high time Canada developed such a framework for palliative care.

The growing demand for palliative and end-of-life care poses a major challenge for our society. The bill before us today encourages us to think about existing frameworks, strategies, and best practices in palliative care. In that regard, I would like to acknowledge the exceptional work that Quebec has been doing for the past several years to deal with this reality and provide appropriate services to Quebeckers. Quebec created a palliative and end-of-life care development plan in 2015, which builds on other existing measures, such as the end-of-life palliative care policy. Quebec is a leader in this area and we should learn from its example. There is also another inspiring initiative in this regard, and that is Motion No. 456, which was moved by my NDP colleague on October 31, 2013. The motion sought to create a pan-Canadian strategy on palliative and end-of-life care in co-operation with the provinces and territories.

New Democrats have been working with many stakeholders and organizations for a long time in order to develop and implement a palliative care strategy. We are proud that the member revisited the NPD's motion on palliative care, which was adopted in 2014. The motion was adopted in the House three years ago, but no real progress has been made on this vitally important issue since then.

That is why it is high time that we move forward without delay. The federal government must demonstrate leadership and take immediate action to establish a palliative care framework that will give all Canadians better access to quality palliative care.

I would like to once again thank the sponsor of this bill, which I urge all of my colleagues to support. We should be in unanimous agreement in the House on this subject.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 9th, 2017 / 7:15 p.m.
See context

Conservative

John Barlow Conservative Foothills, AB

Mr. Speaker, it truly is an honour to rise in the House today to speak to an issue about which I am very passionate. I wanted to have the opportunity to speak to this important legislation, brought forward by my colleague the member for Sarnia—Lambton, who is seeking to develop a framework for palliative care in Canada. This is an extremely important issue.

I enjoyed listening to the speeches from my colleagues, but I would like to start my speech off on a different tangent. I would like to look back to a very crisp winter day in 2012. In my previous career, I was the editor of a local community newspaper. I distinctly remember getting a phone call one afternoon asking if I would be willing to come down to the Foothills Country Hospice to cover an interesting story that was unfolding. It was a story about a man, Greg Garvan. He was in the Foothills Country Hospice, unfortunately, with a rare form of cancer. Knowing he was in his final days, he was really hoping to have one thing before his life ended. He was hoping to have one last visit with two of his favourite companions. Mr. Garvan was a horseman. He enjoyed the country living in rural southern Alberta, and certainly as any rancher and cowboy would know, he wanted to spend some time with his friends. His two friends were his two horses, Kiwi and Russell. The Foothills Country Hospice staff on that very cold winter's day wrapped Greg up in a blanket, rolled his bed out into the parking lot of the hospice, and there were his two horses, Russell and Kiwi.

It was very difficult, I must admit, to take photos that day and talk to the staff without having a tear in my eye. There are certainly not too many other staff or institutions that would have taken that kind of effort and passion and shown how much their patients and patients' families meant to them, to ensure they were able to make the dying wish of one of their friends come true. We have photos of Russell and Kiwi snuggling right up to Greg, wrapped in his blanket in his bed, in the parking lot of the Foothills Country Hospice.

To cap off the day, Greg's mother, who is from New Zealand, was staying in Okotoks. This was in early December. The staff at the hospice held an early Christmas dinner for Greg and his family, at the hospice. I am sure that was a memorable day in what was a difficult time for his family. It certainly was not one they will soon forget.

Those of us who do not have the fortune of having a hospice in our communities certainly would not have the opportunity to understand the wonderful things that hospice staff can do. I am very honoured that we have the Foothills Country Hospice in our community.

That really highlights the debate today. When we have an opportunity to have a facility like a hospice, with the ability and the things it is able to do for its community and its patients, I find it unfortunate that not everyone in Canada has the opportunity to experience that as an end-of-life option. The stats I have seen show less than 30% actually have access to a hospice facility. That is truly unfortunate.

Some of my colleagues have talked about how this really came to a head, and it is how I became more interested in the hospice facility and its lack of access for other Canadians. This was a very prominent issue during the debates on doctor-assisted dying. It was a very difficult issue for my constituents. I held four town hall meetings throughout my riding in Foothills and southwest Alberta. I had hundreds of people attend the town halls. I also sent out a survey to my constituents asking them how they felt about the doctor-assisted dying legislation. I had 4,000 responses to that survey, which was a very high response rate, along with the carbon tax.

My constituents were very torn on how they felt about doctor-assisted dying. It was a very difficult issue. Some were adamantly opposed. Some were adamantly in favour. The one theme that went through all my town halls and through those surveys was the importance of offering palliative care as part of that legislation.

If the government was to provide doctor-assisted dying, my constituents wanted to ensure there were resources in place and that a framework for palliative care would also be a part of that legislation.

It was very clear that my constituents wanted some options. One of those options, if we were truly going to have doctor-assisted dying, was that Canadians had to understand that they had another option, and that option was end-of-life care through hospice.

What has made this so profound and so loud and clear in my constituency is that we have the Foothills Country Hospice. Many other constituents and many other Canadians do not have that.

We are certainly blessed in my constituency to have the hospice, but also to have the people who work so hard to make it a reality. It has been about 10 years since the hospice was opened, but it has been almost 20 years since my constituents worked hard to make this project come to fruition.

I really want to take the opportunity to thank a few people who were instrumental in ensuring this hospice became a reality in rural Alberta, people like Dr. Eric Wasylenko and his wife Louise, David and Leslie Bissett, Jean Quigley, Dr. Jim Hansen, Doug and Susan Ramsay, Beth Kish and Dawn Elliott, Mark Cox, and the Council of the Municipal District (MD) of Foothills in the town of Okotoks. These people worked extremely hard to make this project a reality.

The annual budget for the Foothills Country Hospice is about $2.8 million. The province has picked up a significant part of that budget, but the community is also being asked to raise close to $1 million or more each and every year to ensure the hospice is able to operate. One of the wonderful stories about the hospice is to see the community buy into it and each year come forward to raise that type of money. It also shows that this is not an easy task, when it comes to having a hospice in a community.

We cannot have these types of facilities and the wonderful people who work in them without support from all three levels of government. That is why this private member's bill is so important. We need to develop a framework to ensure we can have the resources there to offer hospice care to Canadians, but also to ensure we have the resources there to make it a reality. That is what we are missing.

I know on both sides of the floor, during the doctor-assisted dying debate, many of us wanted an amendment as part of that legislation to ensure there was funding available for hospice. I am encouraged to see support among all parties in the House to ensure this becomes a reality. It is one thing to talk about it, but we have to ensure we provide the resources and the commitment as a federal government. As we proceed with doctor-assisted dying, one of the most important parts of that is also to ensure we have a framework for hospice care and a commitment that it is funded.

I spent a lot of time talking about the Foothills Country Hospice in my riding. I thought it was important to put a personal face on this service. I know many of us talk about hospice care and that it is an important option for that end of life. I have been through it many times, I have toured, and talked to the nurses, the doctors, and the many wonderful volunteers and staff that take their time to work there. It is hard to explain a hospice unless people have had an opportunity to experience it. Unfortunately, that is not something many of us want to experience, but it is a life-changing option.

As parliamentarians, we have to get across the fact that this truly brings a new definition to end-of-life care, that there are ways to make those difficult times as comfortable as possible for people and their families. If we are truly to have doctor-assisted dying, we must also have that other option, palliative care.

I want to again thank my colleague from Sarnia—Lambton for all the work she has done, which has been yeoman's work, to make this a reality. I look forward to working with my colleagues on both sides of the floor to ensure this becomes a reality.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 9th, 2017 / 7:25 p.m.
See context

Liberal

Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC

Mr. Speaker, I am pleased to be here today to address Bill C-277, an act providing for the development of a framework on palliative care in Canada and to discuss our government's commitment to improving palliative and end of life care for all Canadians.

This bill comes at the right time in our national dialogue on palliative care, and I would like to recognize the efforts of the member for Sarnia—Lambton in moving this discussion forward.

I had the opportunity to review this legislation with my seniors council in Coquitlam—Port Coquitlam at our last meeting. I want to thank the members for their input and for helping me better understand just how important it is for this bill to proceed.

Our government knows that the quality and availability of palliative care is an issue of great importance to Canadians. A Harris/Decima survey found that more than 90% of Canadians believe that palliative care improves the quality of life for both patients and their family members. Studies have shown that patients who receive palliative care services are happier, more mobile, and, in some cases, live longer than patients who do not.

The recent legislation on medical assistance in dying has amplified the public conversation on options for care at the end of life. While medical assistance in dying is only one potential option at the end of life, experiences in other countries suggest that only a fraction will seek it.

It seems that many Canadians who could benefit from palliative care do not receive it. For example, Health Quality Ontario found that two in five Ontarians had not received palliative care services at the end of life in 2015.

Palliative care is a priority for our government, and I support the creation of a framework to guide our work. I was pleased to see the amendments made by the Standing Committee on Health so that the framework takes a more targeted and integrated approach and builds upon the important work already under way to improve palliative and end of life care in Canada.

There is a wide range of promising initiatives established in provinces and territories as well as in stakeholder organizations in the health care sector. These initiatives touch upon many of the elements put forth in this bill, including identifying training and education needs for health care providers and other caregivers, providing supports for care providers, facilitating access to care, and promoting research and data collection.

The federal government recognizes the advantages of and the growing need for palliative care and has funded a series of strategic initiatives in order to establish key fundamental approaches and to address key issues.

For example, the Canadian Partnership Against Cancer, an independent national cancer organization funded by the government, has convened a group of palliative care experts from across the country to create the palliative and end of life care initiative. The network includes representatives from every province and territory, officials from provincial ministries of health, representatives from both professional medical organizations and patient advocacy groups, and patient and family representatives.

Through this venue for national conversations, the palliative and end of life care initiative is working to improve coordinated support for patients and families through the education of health professionals, patients, and caregivers. The network is also increasing access to evidence-based, integrated, high-quality palliative care services that align with patient preferences.

Apart from the network, the Canadian Partnership Against Cancer has also funded a series of studies focused on the experience of palliative care from the patient and family perspective. This patient-centred approach focuses on the importance of early and ongoing assessments of the expressed wishes of the patient and family for symptom management and quality of life. The Canadian Partnership Against Cancer has been expanding the visibility of its work by distributing its findings widely so as to bring this evidence to the broader health care community. By emphasizing the centrality of the patient and family, the Canadian health care system can provide end-of-life care that is responsive to patient needs and provide an improved experience for patients and families going through the most trying moments of their lives.

The Canadian Foundation for Healthcare Improvement is another national organization funded by our government to help identify proven health system innovations and accelerate their spread across Canada. In recent years, one of its priorities has been to evaluate and disseminate data on best practices with respect to palliative care services. The Canadian Foundation for Healthcare Improvement's programming in palliative and end-of-life care is well under way and focuses on identifying and validating high-impact innovations and practices ready to be spread and scaled up across the country. For example, in February it launched a pan-Canadian call for innovations to identify and validate high-impact palliative care models, practices, and tools. Projects identified as having the greatest potential impact will be featured at a forum of experts, decision-makers, and health administrators in June to discuss how these innovations can be scaled up and spread to other organizations and jurisdictions.

I would also like to highlight the important work being undertaken by Canadian researchers to understand the current status and potential of palliative care in Canada. Since 2011, the government has invested over $546 million with the Canadian Institutes of Health Research to support research on aging, including palliative care or related late-life issues. One area where the Canadian Institutes of Health Research is supporting a wide variety of research is through its team grants in late-life issues. In the past, these research projects have examined some of the most pressing issues on palliative care in Canada, including improving knowledge uptake across providers and institutions, appropriate protocols for transferring patients between different levels of care, and developing ways to measure the quality of patient experience.

Another example of CIHR research is the improving end-of-life care in first nations communities project. Led by Dr. Mary Lou Kelley from Lakehead University, this project was designed to improve the end-of-life care in four first nation communities through developing a culturally appropriate approach to palliative care. Providers in each of the communities chose a series of clinical, educational, or administrative interventions to build local capacity, with each activity being evaluated for its contribution to developing palliative care. The four communities created locally designed and controlled palliative care programs. This demonstrated the feasibility of providing local palliative care at home in first nation communities, the effectiveness of first nations community capacity, and the associated benefits of enabling among first nations people the choice to receive palliative care at home. Furthermore, the project produced a series of reports and resources for first nation communities and the government, with recommendations that will be critical for the improvement of palliative care in first nation communities and nationwide.

To build on this work, our government has now provided funding to work with Lakehead University to provide coaching and mentoring support to 24 first nation communities in Ontario who want to implement palliative care services within their community. The message is clear: Canadians want access to high-quality palliative care.

Based on these existing foundations and accomplishments, our government is poised to play an important role in helping Canadians receive the most appropriate, timely, and compassionate care at the end of their lives.

I am proud of the work our government has already supported in this area and the significant strides we have seen in the provinces and territories, as well as among stakeholders in the health care sector. I look forward to continuing to work toward improving access to quality palliative care services for all Canadians.

The member for Sarnia—Lambton should be commended for her work on this and for bringing this legislation forward. I also appreciate the work my seniors' council did to prepare me for this debate.

Framework on Palliative Care in Canada ActPrivate Members' Business

January 31st, 2017 / 6 p.m.
See context

NDP

Christine Moore NDP Abitibi—Témiscamingue, QC

Mr. Speaker, I did not think I would have the chance to complete this speech, so I am pleased to use the eight minutes I have left to do that.

In the first part of my speech, I had noted some things that the bill’s sponsor could come back to in committee. I had also suggested that she include the first nations governments in the consultation, because that is crucial. Often, the cultural approach to death is not really incorporated. Given the federal government’s duty to the first nations communities, it is essential that they be at the discussion table to express their needs.

In addition, there are enormous needs for palliative care in indigenous communities, because there are virtually no projects. Often, the communities are too small, so the feeling is that resources cannot be allocated specifically to palliative care. A number of first nations communities have no long-term care facility. Elders are therefore cared for by their province’s health care system.

When we go out and meet with the people who provide palliative care, we see that they are interested in developing projects. I have been to the Maison du Boulot Blanc in Amos, right next to the community of Pikogan. It sometimes takes in people from the Pikogan indigenous community who need its services. The people who work there are very happy to do that, but they say themselves that it is not the same, that the community is much more involved and there are a lot of people who come to support the dying person.

They do what they can in terms of needs, but if there were some openness to allocating federal funds for specific projects for the first nations, they would very definitely be open to having a room set up and decorated based on the person’s needs. That would reflect the desired approach, which is to accommodate clients who need palliative care.

This is something that will have to be discussed in committee. I urge my colleague to give immediate thought to people from indigenous communities who might be interested in talking about their situations and how they could be involved in delivering palliative care.

Although the administration of palliative care itself falls under provincial jurisdiction, I believe that the federal government has a role to play in bringing all the stakeholders together to discuss best practices. It is not about taking a paternalistic approach and bringing everyone together to tell them to look at the best practices happening elsewhere. It is about creating room for dialogue, where everyone can share their successes and failures in order to move palliative care forward.

We often forget certain particularities associated with palliative care. Pediatric palliative care is extremely difficult. How do we support a child who is dying of cancer or some genetic disease? We have a lot to learn by sharing ideas on this.

For instance, it is important to ensure that children who need palliative care are not forced to choose between being close to home or in a pediatric care centre. They are often hospitalized for long periods and find themselves far from home. Parents sometimes decide to bring their child home when it is time for palliative care to begin. When we talk about a special client group, it is often those in remote areas who have a hard time getting the care they need.

It would be helpful, then, to be able to talk about our practices in order to overcome these challenges. If the various ministries, provinces, and agencies involved could share tools with the rest of the country, we would all be better off.

Other patients are often neglected. For example, how does one help a person with a fairly serious intellectual deficiency prepare for death?

I have had to do it over the course of my career and it is not easy. Caregivers do not always have all the tools they need. They are used to working in a context where the person understands death and what is happening to him or her. However, it is often more difficult to help someone outside that context. I therefore think it is important for caregivers to have that skill.

When it comes to palliative care, for example, some deaths will affect caregivers more than others. That is why it is also important to talk about the distress they experience. Regardless of where the caregiver works, some cases will cause a lot of pain and sorrow. It is also important to be able to talk about that aspect of palliative care so that caregivers do not carry that pain and sorrow with them throughout their careers and can resist breaking down at some point.

Take, for example, soldiers who are deployed overseas and who have to be there for someone who is dying because there is no other choice. Sometimes these experiences are traumatizing and become difficult to live with after many years in the field.

In my opinion, it would be worthwhile adding this other element to the bill on palliative care, that is, monitoring the distress of caregivers, because we are hearing more and more about this issue.

Working with death every day is difficult. I believe it would be beneficial to monitor the distress of caregivers, especially those working in palliative care centres and paediatric and neonatal departments, who do their best to save infants, but are sometimes confronted by the reality that there is no other option but to let them go. These life situations can be difficult, and it would be advisable to monitor this aspect of public health.

I would like to thank my colleague and the House once again for letting me finish my speech. I look forward to my colleagues' comments.

Framework on Palliative Care in Canada ActPrivate Members' Business

January 31st, 2017 / 6:10 p.m.
See context

Conservative

Bernard Généreux Conservative Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

Mr. Speaker, I am pleased to rise in the House today to support my colleague, the member for Sarnia—Lambton, and her Bill C-277, an act providing for the development of a framework on palliative care in Canada.

Before continuing, I must first congratulate my colleague for her hard work since she was elected in 2015, and for earning the title of most collegial MP. She was awarded that title by her colleagues in the House, from all parties, when the prize was given by Maclean's and L'Actualité last fall. It speaks to the unstinting work done by my colleague, particularly on her present bill.

We are therefore very happy to have an engineer in our Conservative caucus as opposition science critic. That is why I am happy to speak today in support of her Bill C-277, a bill that has attracted attention from key health care stakeholders in my riding, Montmagny—L'Islet—Kamouraska—Rivière-du-Loup.

Like a number of rural ridings in Canada, we find that we have an aging population, and we can already anticipate that the demand for palliative care will rise considerably over the coming years. It has already started. It is therefore important to talk about it and give ourselves time to be well prepared.

Following a Supreme Court decision in Carter, last year, this Parliament passed Bill C-14, which provided a legislative framework for physician-assisted dying. Although the bill was well received by some people who wanted to avail themselves of this right, others had some concerns, because they wanted to make sure that this was not the only option available. In my riding, just like elsewhere in Canada, this is a real question: will we provide only a bill like that, or will we provide other types of care? The other types of care are much needed.

As my colleague from Sarnia—Lambton noted, in the final report of the external committee on options for a legislative response to Carter v. Canada, the Supreme Court stated that a request for physician-assisted death cannot be truly voluntary if the proper palliative care is not available to alleviate the suffering of patients.

This is where we are today. The bill proposed by my colleague seeks to improve the options available to Canadians at the end of their lives. It truly seeks to encourage consultations and dialogue with the provinces to develop a national framework so that palliative care is a real option. In fact, the plan highlights the importance of having access to palliative care of higher quality than what is currently available.

It is important that our seniors and other people with terminal illnesses are protected with healthy, safe, and comfortable options in the last stages of their lives if they do not wish to avail themselves of medical assistance in dying. This is an extremely important point. People must have access to high-quality care to be able to live as long as possible in palliative care facilities. This will prevent many people from even thinking about requesting that their lives be terminated. The dignity of people depends on it.

I would like to highlight the incredible work done in my riding by the Maison Desjardins de soins palliatifs in Rivière-du-Loup, which has provided an enormous amount of care since it opened in 2009. I should also mention the mission of the Fondation Hélène-Caron, which will soon be serving the region of Montmagny and l'Islet through the Maison d'Hélène. Passing Bill C-277 will send a message to organizations like those, all across Canada, that their work is recognized and greatly appreciated.

Last month, Dr. Louise La Fontaine, vice-president of the Société québécoise des médecins en soins palliatifs and a resident of Notre-Dame-du-Portage in my riding, wrote to me to say that Canadians across the country have joined together to draw attention to the importance of palliative care.

She recommends that a national policy be developed in order to considerably improve the quality and consistency of palliative care and access to it. She recommends examining and assessing new models of integrated care, broadening accreditation standards throughout the entire health network, and focusing on areas such as symptom management and advance care planning. Practitioners must also be trained so that they can work in accordance with the various models for integrating palliative care into the management of severe chronic illness.

That is convenient because many of the things she mentioned would be part of the legislative framework if my colleague's Bill C-277 passes.

By asking the Minister of Health to consult with her provincial counterparts, we can ensure that every region of Canada is included in the discussion and that best practices and innovative ideas in the palliative care field are shared. I want to emphasize that because it is an extremely important aspect of the bill. My colleague who just spoke mentioned first nations. Canadian regions differ from one another, of course. One feature of this bill is that it takes all those differences into account and creates a framework for sharing the good practices that some regions are using and looking at which ones would work elsewhere.

I encourage all of my parliamentary colleagues to join me in supporting Bill C-277 so that we can help people across our great nation. If passed, this legislative framework will meet their medical needs and give us a plan that reflects the looming new demographic reality.

I will close by saying that the Lower St. Lawrence region, where my hometown of La Pocatière is located, is the oldest in Canada. What my colleague wants to put in place to facilitate the aging of the population affects us in particular. The bill proposes to provide quality care and enable people to make a fully informed and conscious decision, and to live out their days in an environment where their dignity will be respected.

My brother-in-law died last year after having cancer for seven years. He was treated at a hospice in the Eastern Townships. I had the opportunity to visit him twice. My sister stayed with him for three months.

The Eastern Townships, where Magog and Sherbrooke are located, is well developed. The care offered in the region is already excellent. The experience that these people have developed over the years can most certainly be shared with Canada's other regions.

From what I could see, the quality of care that my brother-in-law received was incredible. I think it is important to mention that.

My colleague came to my riding last week. Our plan was to have her come to my riding to visit palliative care homes, but unfortunately, the weather did not co-operate. I want to thank her for making the effort to meet with my constituents, who have spent a great deal of energy and time fundraising. Palliative care homes are often autonomous thanks to the donations they receive. Donations keep these homes open and operating, as is the case in Rivière-du-Loup.

In Montmagny, Hélène Caron, who is in charge of the project, has cancer. She gives a lot of her time to ensuring that this home exists. It is not a self-serving gesture. She devotes her time to the people and the good of her community.

The bill is unifying. I think that all parties should support it and see it through. Then we could have a national framework for all palliative care homes and the necessary funding to ensure that they are operational.

Framework on Palliative Care in Canada ActPrivate Members' Business

January 31st, 2017 / 6:20 p.m.
See context

Liberal

Francis Scarpaleggia Liberal Lac-Saint-Louis, QC

Mr. Speaker, a few years ago, members from all parties in the House, including myself, established a committee on palliative and compassionate care. The mandate of the committee was to study the nature and scope of palliative care in Canada. I would like to congratulate the member for Sarnia—Lambton for following up on the committee's work with this important initiative.

My inspiration for joining the all-party parliamentary committee on palliative care, which was an ad hoc committee, was Teresa Dellar, a friend and Montreal social worker who founded the West Island Palliative Care Residence in my riding of Lac-Saint-Louis in Montreal's West Island

The residence has 23 beds making it the largest palliative care facility in Canada. It is a model for palliative and end-of-life care across Canada and throughout the world.

I had the joy and honour of being present at Rideau Hall this past November 25 with Teresa's husband, Gavin Fernandes, and sons Jonathon and Nicholas, when Teresa was awarded the Meritorious Service Cross by the Governor General for her vision and pioneering work in palliative care—and I would underscore that the member for Sarnia—Lambton happened to be there as well that day.

Some amendments will be necessary to make the bill better fit the constitutional and practical realities of health care in Canada.

For example, clause 2(1) calls on the Minister of Health to:

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,

(a) defines what palliative care is;

Unfortunately, it is not within federal jurisdiction to give, or require provinces and territories to give, access to palliative care.

That said, the federal government is well placed to support the efforts of the provinces and territories and stakeholder organizations, by focusing on aligning and extending federal levers in relation to health care system improvements.

We have already seen the government move in this direction during negotiations over a new health care accord, when it offered $5 billion over 10 years to the provinces for home care, a commitment that Marie-France Juneau, executive director of NOVA West Island, formerly the Victorian Order of Nurses, no doubt welcomed.

NOVA West Island offers indispensable services in a home setting to Montreal West Islanders dealing with cancer and other debilitating diseases like ALS.

Federal funding would benefit NOVA and its patients and leverage the efforts of its volunteers. In 2015–16 alone, 16,532 volunteer hours were donated by 232 active volunteers lending a hand with respect to a number of NOVA's services.

Clause 4(1) of the bill also requires amendment. Currently, it requires that the Minister of Health undertake a review and table a report on the effectiveness of the stipulated palliative care framework every five years. However, this would require the minister to report on progress in an area where the government has few levers to directly make change.

Instead, therefore, it would be more advisable to have the government simply report on the state of palliative care in Canada after five years, in this way aligning the bill with the law on medical aid in dying, which requires a parliamentary review on the state of palliative care in Canada within five years of its coming into force.

The federal government is also not in a position to dictate to the provinces what specifically constitutes medically necessary services that must be provided to be eligible for federal funding under the Canada Health Act.

It is further worth noting that there is, in fact, no positive right to publicly funded health care in Canada. This was affirmed in the 2005 Chaoulli decision, where the Supreme Court said, “The Charter does not confer a freestanding constitutional right to health care”, even though medicare is rightly considered a de facto right by Canadians—an entrenched, morally rooted societal norm, I would argue.

The federal government has never waded into defining what actually constitutes a medically necessary service. Nonetheless, I believe Canadians will come to expect palliative care as something that should morally and ethically be broadly made available to them at end of life—in other words, a de facto right.

The question is how this right will come to be realized. Some believe it will materialize through the courts. There are those who argue that under section 7 of the charter, the section that affirms the right to life, liberty, and security of the person, individuals must be afforded autonomous choice at the end of life, the basic principle at the core of the medical aid in dying legislation. However, if the degree of pain control provided by palliative care is not available, an individual's choice has in fact been limited.

In terms of section 15, the charter's equality provision, others make the argument that current provincial palliative care programs, although not technically viewed as medically necessary since the aim is not to cure but to care, de facto discriminate according to disability because they are generally aimed at those dying from cancer. It is interesting to note in this regard that the West Island Palliative Care Residence, once again a leader, caters not only to cancer patients but also to those with other terminal illnesses. A 2014 Globe and Mail article highlighting the residence stated:

At the outset, 98 per cent of palliative-care patients had terminal cancer...Increasingly, however, the hospice is seeing more patients with end-stage cardiovascular and renal disease, and with conditions such as ALS and multiple sclerosis

Also, palliative care is generally needed by those who are older. Therefore, some argue that the absence of broad access to palliative care amounts to a form of age discrimination.

I would like to take a moment to discuss the West Island Palliative Care Residence's vision for expanding palliative care in Canada. I believe it dovetails with the general framework and intent of Bill C-277. In particular, I would like to propose that the government partner with the residence, given its reputation as a national leading edge centre of excellence in palliative care, in advancing the palliative care agenda in Canada.

The residence draws on a community, namely Montreal's West Island, which harbours a critical mass of resources, including the leadership talents of medical practitioners connected to the McGill University and Université de Montréal medical centres. The residence has an important role to play in education and training and in the transfer of practice-based research and knowledge to the broader Canadian community. It intends to play this role by creating a newly formed division called the Montreal institute for palliative care. It is my hope that the minister will seize the opportunity to partner with the institute in fulfilling the government's expressed commitment to palliative care.

It is often said that the measure of a society's degree of enlightenment and civilization is found in how it treats its minorities and the extent to which it internalizes the principle of the equality of all its citizens, in the manner in which it accepts and integrates those with disabilities, physical and intellectual, and in how compassionately it embraces those struggling with mental illness. However, I would add to this list how it supports and comforts its citizens at the most vulnerable moment of their life; that is, at the end of life itself.

I recently read some interesting words of our Governor General, His Excellency, the Right Hon. David Johnston, which I am paraphrasing now. He said that the idea of Canada was worthy of expression and refinement. If the Canadian idea is embodied in, among other things, our national publicly funded health care system, then to make palliative care a more prominent part of that system is to further refine the idea of medicare and of what it means to be Canadian.

Let Canada show the world once again, like we have so many other times before, what it means to be a profoundly civilized nation, a nation that gathers its collective resources to enhance the dignity of the individual at the very moment when dignity itself is everything.

Framework on Palliative Care in Canada ActPrivate Members' Business

January 31st, 2017 / 6:25 p.m.
See context

NDP

Cheryl Hardcastle NDP Windsor—Tecumseh, ON

Mr. Speaker, anyone who has watched a loved one suffer through the ordeal of a terminal illness understands the profound importance of palliative and hospice care on behalf of the patient and for the families and loved ones.

I join my caucus in stressing, over the course of this debate, the fundamental right we also stressed in debate on Bill C-14. The New Democrats believe that every Canadian has a right to high quality end-of-life care.

According to the government's own mortality projections, the mortality rate will increase by 33% by 2020, making the need for palliative care as a thoughtfully laid out national strategy an increasingly urgent one, even more imperative within the context of medical-assisted dying.

Current, 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 plan. 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. That is why the New Democrats believe 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.

I am happy today to speak in support of the bill.

The New Democrats were surprised to find this year's federal budget contained zero federal funds earmarked for palliative care, especially after we fought to incorporate palliative care into the Liberal majority joint committee report on physician assisted dying.

Earlier this year, New Democrat Charlie Angus tabled Motion No. 46, which would accomplish much of what this bill would.

Framework on Palliative Care in Canada ActPrivate Members' Business

January 31st, 2017 / 6:30 p.m.
See context

NDP

Cheryl Hardcastle NDP Windsor—Tecumseh, ON

I am sorry, Mr. Speaker. It was a slip of the tongue.

Among other things, the motion called for the government to work with the provinces and territories on a flexible integrated model of palliative care by establishing a universal right to palliative care and by implementing a pan-Canadian palliative and end-of-life care strategy that would be tied to dedicated funding.

As I said, we expected this funding to be in the government's first budget but it was not. Here we are in the House debating a private member's bill from a member of the Conservative caucus, which indicates to me that we are at a momentous point in time. There is broad agreement across party lines on this issue and so it is time to face our responsibility to governance that makes progress on human rights and end-of-life care. That we are ready to be progressive on palliative care is momentous and I applaud my hon. colleague for utilizing her private member's bill for this noble initiative.

I was disconcerted when the previous Conservative government eliminated the federally funded national secretariat on palliative end-of-life care. Had it left the support funding intact, maybe we would not be discussing this matter today but would have a resolution and the member for Sarnia—Lambton would not have had to table this bill. I am sure she has other noble causes she could turn her attention to.

As for the current government, the Liberals have had ample opportunity to enshrine quality palliative care as a right for all Canadians, no matter where they live. They could have developed a national strategy that would have eased the burden on both the dying and their families on one end and health care providers on the other, but it was not a priority. I am still flabbergasted when I think of the callousness demonstrated as debate on Bill C-14 was introduced with absolutely no indication that anyone in the government understood the responsibility to secure end-of-life care standards for human beings.

The most significant reason I asked to speak to the bill today was I wanted to lament the unnecessary suffering in the reality of our systemic inadequacies. A national strategy would address these sufferings. I want to hear in person the government's rationale for choosing not to act on this issue.

The New Democrats were surprised to find that the 2016 federal budget contained zero federal funds earmarked for palliative care, especially after we fought for the joint committee on physician-assisted dying to incorporate palliative care.

Given the lack of health care spending in the federal budget, it is no surprise that palliative care was missing. Hopefully by now all of us understand this, that home care is very relevant to this issue. The fact that the Liberal promise of $3 billion for home care turned out to be fiction is also very disconcerting as we take stock of our health care system, its mandate and purpose and know that to move forward we have to include palliative care options that patients and their families deserve to expect.

The Canadian Cancer Society has stated that improvements to the palliative care system in Canada are desperately needed. Without clear national standards and accountabilities, individual jurisdictions are left to develop their own policies, programs, and guidelines, resulting in inconsistent or inadequate access across the country.

In Ontario, for instance, 40% of cancer patients do not receive a palliative assessment in their last year of life. In some regions of Atlantic and Western Canada, administrative data showed that less than half of people who died in a hospital received palliative care. Remarkably, there are many jurisdictions in the country where we do not even know how many Canadians receive quality palliative care. We lack consistent and ongoing data collection at a systematic level, which leaves us unable to more effectively hold our health care systems accountable to make positive changes.

Also, it is not just an issue of data collection. It is vital that any national palliative care strategy takes into account the geographic, regional, and cultural diversity of urban and rural Canada. It must respect our diverse cultural, spiritual, and familial needs, including Canada's first nations, Inuit, and Métis people.

According to Dr. Mary Lou Kelley, research chair in palliative care at Lakehead University in Thunder Bay, the federal health care dollars that would help indigenous people receive end-of-life care at home have not kept up with the increasing demand. Health care for first nations is the responsibility of the federal government, and it does provide some home care services, but the system was never designed to provide complex health care to people with chronic or advanced terminal diseases.

Members might imagine my disappointment that the words “indigenous”, “first nations”, “Inuit”, or “Métis” do not appear anywhere in the text of Bill C-227. However, that is not a deal breaker because it is something that can be addressed meaningfully as we move forward on a national strategy.

New Democrats believe strongly that any legislation that deals with the matter of palliative care must take into account the geographical, regional, and cultural diversity of our urban and rural Canada, and Canada's first nations, Inuit, and Métis people.

As our population ages, palliative care will become an ever-increasing function of the health care system. The federal government needs to support health care workers with the training and resources necessary to deliver it all across Canada. All Canadians deserve to live their final days in dignity and comfort. That is why there is an urgent need to address the significant disparities that remain across Canada with respect to end-of-life care, quality of care, and out-of-pocket costs.

For years now, New Democrats have worked to improve palliative care services for patients and their families. As the party that founded public health care in Canada—

Framework on Palliative Care in Canada ActPrivate Members' Business

January 31st, 2017 / 6:40 p.m.
See context

Conservative

Colin Carrie Conservative Oshawa, ON

Mr. Speaker, I am grateful for the opportunity to rise today in the House to support my colleague's hard work on Bill C-277, an act providing for the development of a framework on palliative care in Canada. We are in a time where Canada is seeing an aging population, and it is our role as parliamentarians to help prepare our economy and our health care system for the coming decades.

First, it is important to understand what exactly palliative care is. For someone who has a life-threatening condition or a serious illness, palliative care is used to help improve the overall quality of life, reduce and/or relieve any physical and psychological symptoms, help individuals have a more peaceful and dignified death, and provide support to families and friends while an individual is dying and afterwards.

Palliative care can be provided in a variety of settings. It is really dependent on the options and availabilities within a community. Palliative care is provided at hospitals, individuals' homes, long-term facilities, and hospices.

The bill ensures that all Canadians have a real choice in regard to their end-of-life plans, something that is extremely important now that physician-assisted dying is legal. The Supreme Court itself stated that a request for physician-assisted death cannot be truly voluntary if the option of proper palliative care is not available to alleviate a person's suffering.

As I've said in previous speeches, assisted suicide should only be made available on the rarest of occasions. Canadians expect and deserve a choice between quality palliative care and assisted death. The government has already committed to one of those, and it is now time for it to commit to the importance of high-quality palliative care in Canada.

We know that all parties are in favour of palliative care for Canadians, but we must ensure that all parties agree that the bill is in fact needed in Canada.

I will not lie, I do have some concerns about the current government's agenda when it comes to palliative care. The Liberals started off with promising all Canadians an immediate $3-billion injection for home care, including palliative care, but now the Liberals have changed course. The Liberals are using the urgency of palliative care in communities as a bargaining tool, and that, in my opinion, is absolutely offensive. The 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 have not yet agreed to the Liberals' terms have received absolutely nothing.

Again we see a lot of talk on home care specifically. I am not saying that home care should not be incorporated in the promised new funding, but to completely eliminate palliative care from the promised funding would be irresponsible.

The government must assure Canadians that there will in fact be some designation of money to palliative care. As I already said, the need for palliative care services is increasing. Currently, only 30% of Canadians have access to good quality palliative care and this is problematic. We must ensure that the government properly allocates some of the promised investment into palliative care, and ensure that this bill be supported by everyone.

Bill C-277 will ensure that action is taken to define services that would be covered. It would introduce a standard training requirement for various levels of care providers, and it would help to collect the necessary data to ensure palliative care is successful in Canada.

There is no reason for any party to oppose such a well-thought-out bill that has the support of so many stakeholders across the country including 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, the Heart and Stroke Foundation, the Kidney Foundation, the ALS Society, the Canadian Association of Occupational Therapists, and the more than 50 organization members of the quality care coalition.

It is by working hard with organizations and bringing awareness to the need for palliative care that we can make a difference and ensure that individuals at the end of their lives are under the best possible care. This allows families to feel comforted and individuals to die with dignity.

In my riding of Oshawa, there is a wonderful individual by the name of Dr. Gillian Gilchrist. Dr. Gilchrist worked at the Oshawa General Hospital as the medical director of the palliative care team. She was the driving force behind the first palliative care unit at Oshawa General Hospital in 1981, and is considered a pioneer in providing palliative care within our community and raising awareness of the need for end-of-life care.

Dr. Gilchrist, along with her team, were on call 24-7, over all of Durham region.

Today, Lakeridge Health, which the Oshawa General Hospital has become a part of, and Queen's University, have partnered to create the first academic chair in palliative care. This chair will be named after Dr. Gillian Gilchrist. The idea is to ensure that we continue to focus on important areas within palliative care and be able to improve how future patients receive the best end-of-life care possible. According to Dr. Gilchrist, there is a lot that proper palliative care can do for an individual who is at the end of his or her life. lt provides patients and loved ones with the necessary support through a difficult time, not just physical support but emotional support as well.

Proper palliative care cannot be done without a team or proper training. This is why we must support this bill to ensure that the proper resources are there for Canadians when we need them. Experts themselves have said that if given the choice of good palliative care or to end one's own life, 95% of patients would choose to live.

As Dr. Richard Reznick, dean of the Faculty of Health Sciences at Queen's University, said, “We have no desire to treat tomorrow's patients the way we're treating today's. We [must] treat them better.”

In conclusion, we must treat those people better. Many of the people requiring palliative care are seniors or veterans. Seniors built our communities, developed our businesses, and supported our economy. Seniors built this great country, fought in our wars, raised their kids, and ultimately created this prosperous country that we are all so fortunate to live in. It is our responsibility to ensure that the most vulnerable are taken care of. When these individuals, who have done so much for us, need the most support, it is Canada's turn to support them. It is our job to make them comfortable. This is why I will support this important bill. I encourage all members of the House to do the same. I want to thank my colleague for all of the good work she has done bringing this issue forward.

Framework on Palliative Care in Canada ActPrivate Members' Business

January 31st, 2017 / 6:45 p.m.
See context

Liberal

Lloyd Longfield Liberal Guelph, ON

Mr. Speaker, I thank the hon. member for Sarnia—Lambton for bringing this bill forward, for her leadership on palliative care in Canada, and for making sure that the conversation does not die between parliamentary sittings. I would also like to thank Hospice Wellington for helping me with its insights and input on what I am talking about tonight, and I thank the hospice centres across the country for the amazing work they do for some of our most vulnerable citizens.

This private member's bill aims to establish a national framework for hospice palliative care. My predecessor, Frank Valeriote, co-chaired an all-party parliamentary committee on palliative and compassionate care, along with the members from Kitchener—Conestoga and the former MP from Windsor—Tecumseh. Together the committee took the lead in crafting a report called “Not to be Forgotten”, which forms the foundation of Bill C-277.

The hard work demonstrated by this committee cannot be overstated. After a year of travelling, town halls, and consultations, the committee drafted a report that addressed at length the issues facing vulnerable Canadians, such as elder abuse, pain management, and family caregiver support. In speaking to Frank Valeriote about this bill coming back to Parliament, he said that it was one of the best experiences he had while he worked in this place.

This report establishes a clear and comprehensive guideline for the government to establish a national framework that will reinforce the fact that every Canadian life matters. This bill rejects the notion that Canadians who choose hospice palliative care are a burden on their families and on society. In fact, this bill acknowledges that palliative care offers patients time to live with dignity and to share precious time with loved ones.

Canadians deserve the freedom to make this fundamental decision about life and death without fear that their personal choices will be obstructed by politics or government. With 70% of Canadians left without access to adequate palliative care, we have a responsibility to act in the interest of patients and their families. This is why our government supports both access to palliative care and to medical assistance in dying.

End-of-life issues are as diverse as Canadians themselves, meaning that it is our responsibility as a government to provide as many options as possible for Canadians so that they can take these deeply personal choices and make them their own. This means that we must work with the provinces and territories to develop a flexible, integrated model of palliative health care delivery that takes into account Canada's geographic, regional, and cultural diversity, along with a funding strategy for implementation.

As was mentioned earlier, we have to work out how we work with provinces and territories on how we can deliver these services together. This system must be responsive to the needs of patients and create an environment that creates comfort and reassurance.

As discussed in the report, a hierarchy of care environments is an excellent example of how palliative care can adapt to the needs of patients and their caregivers. These environments offer a range of choices, from one to eight.

It is not the quality of care that determines why level 1 is better than level 3. For many people, level 1 or 2 is the best location, since it keeps them at home, where they can receive good physical, emotional, and spiritual support as well as informational care.

Level 7 is a more traditional hospital environment with more involved and expert care, which comes at the expense of a familiar environment for the patient. Patients have described being removed from their preferred surroundings as in itself a kind of dying, because removing what is valued increases the expectation that they will die sooner rather than later.

This system provides an appropriate space for terminally ill patients so that they can have access to the support they need and the dignity they deserve while retaining as much of their home environment as possible.

It is crucial that this palliative care framework provide for the medical, emotional, practical, and spiritual needs of patients. These are the four pillars of hospice palliative care.

Canada has played a proud role in developing modern hospice palliative care. Even the word “palliative” is a Canadian invention, developed in Montreal in the 1970s. Now we must take the final steps needed to make hospice palliative care available to all Canadians.

Many here in this House have heard me speak at length about the importance of innovation, and here too it has a role to play. Innovation can do more than grow our economy. It can also revolutionize how we protect and care for the most vulnerable in our society, including first nations and people who have difficulty getting to care.

A perfect example is the virtual hospice, an online exchange where ordinary people communicate with palliative care professionals to improve care. The virtual hospice uses readily available technologies to help Canadians living in remote areas access the medical professionals they need while remaining in the comfort and security of their own homes and their own communities.

Dr. Valerie Schulz, of the Schulich School of Medicine and Dentistry 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. Each student undergoes 30 hours of training and is mentored by an experienced hospice volunteer. 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. Thankfully, this practice has taken root with great success in hospices across Ontario. It develops the relationships that future doctors will have with their patients facing similar challenges.

Students relate to the hospice clients as persons, learning how they feel about and react to the prospect of dying. Friendships are formed and lessons are learned, which will be of lifelong value to the future doctors. The clients also are transformed, touched that a future doctor cares enough to spend time with them in a companion role. This program is worth emulation and broader application.

In my riding of Guelph, Hospice Wellington has been in existence for over 30 years. Their residential program is noted for being one of the best performing, if not the best, in the province. It serves over 300 individuals and their families. It is my hope that this bill will allow terminally ill patients to receive this kind of care from coast to coast to coast.

I am proud of the work the government and this Parliament have initiated with respect to end-of-life issues. Bill C-277 will provide Canadian patients with a comprehensive system of palliative care as a first option before they consider other options, such as medical assistance in dying.

Additionally, this approach emphasizes the importance of living with dignity before dying with dignity. By creating a national framework for end-of-life treatment, Canada will plug the gap in its medicare program, ensuring that all Canadians, from the very beginning until the very end, have access to the compassionate care they are entitled to under our Charter of Rights and Freedoms.

I thank the member for Sarnia—Lambton for bringing this forward for us. I will be supporting this bill as it comes forward with amendments.

Framework on Palliative Care in Canada ActPrivate Members' Business

January 31st, 2017 / 6:55 p.m.
See context

NDP

Ruth Ellen Brosseau NDP Berthier—Maskinongé, QC

Mr. Speaker, it is an honour to rise to speak even though I have only two minutes.

Obviously, I intend to vote in favour of Bill C-277. I want to congratulate and thank the member for Sarnia—Lambton for her bill, which seeks to develop a framework on palliative care in Canada.

This bill is very important and all Canadians have been waiting for it for a long time. Many Canadians are suffering because of the lack of clear national standards. There is also a lack of funding for palliative care.

In 2014, my colleague from Timmins—James Bay moved a very important motion calling for the creation of a pan-Canadian strategy for palliative and end-of-life care.

The population in my riding is aging. Approximately 17,800 people are over the age of 65, so people have been waiting for this bill for a long time. However, now we need to walk the talk and take meaningful action. We need to develop a national framework and ensure that there is funding for it. We must be proactive. I consulted my constituents and I know that family caregivers do extraordinary work. I recently lost my grandfather and I was able to see the excellent work that is being done in the area of palliative care, but again we need to support family caregivers.

I want to once again congratulate the member for Sarnia—Lambton. We are really proud of her. We are also pleased to see that the Conservative Party has woken up and seen the importance of providing palliative and end-of-life care in Canada. Congratulations and thank you.

Framework on Palliative Care in Canada ActPrivate Members' Business

January 31st, 2017 / 6:55 p.m.
See context

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Mr. Speaker, Canadians need palliative care services now more than ever. Fewer than 30% of Canadians have access to this vital service that allows them to choose to live as well as they can for as long as they can. Bill C-277 is the next action required to define the services to be covered, to bring standard training requirements to the various levels of care providers, to come with a plan and mechanism to ensure consistent access for all Canadians, and to collect the data to ensure 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, as we have heard, 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 wide variety of needs through an adapted and patient-centred process.

Use of more home care and hospice care will bring a fourfold reduction in health care costs compared to acute and palliative hospital care. 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, and residential hospices.

The bill is timely, as we have heard, since the special committee that studied the Carter decision on medically assisted dying said that without good quality palliative care, there really is no true choice, and we want Canadians to have a choice.

I want to thank many organizations. We heard them mentioned before. They are 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 of the member hospices, Heart & Stroke, the Kidney Foundation, the ALS Society, the Canadian Association of Occupational Therapists, more than 50 organization members of the Coalition for Quality Care, and many faith organizations, including the Canadian Conference of Catholic Bishops.

There are so many Canadians who have said that they support this bill, and 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 for Canadians.

I want to thank everyone for their support and for continuing to bring awareness to this. I thank the all-party committee that studied this subject and assisted me in bringing forward this bill with these recommendations. I want to thank colleagues on all sides of the House, who have spoken passionately and in support of this bill, and the thousands of Canadians who have written letters to MPs and the Prime Minister and sent 84 petitions to the House asking for palliative care.

Some hon. members have indicated that they are prepared to support referring this bill to committee for amendment. I have heard the members' input on getting the balance right between what is under provincial jurisdiction and what is under federal jurisdiction.

I know that areas such as education are under provincial jurisdiction. However, with the provinces beginning to roll out services in fragmented ways, the federal government has an opportunity to provide the leadership needed to leverage best practices and to fill the possible gaps, because the work does not end with one plan.

We must develop the infrastructure we need in order to provide palliative care beds and hospice care. With our aging demographic, we are going to have to increase the number of home support workers, personal caregivers, registered psychiatric nurses, palliative care specialists, and those providing support services. The promise that the government made in its 2016 budget to allocate $3 billion for this is a good start.

I am happy to see this bill go to committee, with the hope that we will find a way to accelerate the process of making this framework a reality. As we begin the new year, we have a chance, as parliamentarians, to come together in a co-operative spirit to do the right thing for Canadians without partisanship.

I urge my colleagues on all sides of the House to support this bill going forward to committee. Give Canadians the palliative care they so desperately need. Let compassion make members' choices, and support Bill C-277.

Framework on Palliative Care in Canada ActPrivate Members' Business

November 23rd, 2016 / 5:30 p.m.
See context

Conservative

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.
See context

London West Ontario

Liberal

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.
See context

Conservative

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.
See context

NDP

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.
See context

Conservative

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.
See context

Conservative

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.
See context

Conservative

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.
See context

Brampton West Ontario

Liberal

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.
See context

NDP

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.
See context

Conservative

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.
See context

Winnipeg North Manitoba

Liberal

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.
See context

NDP

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 ActRoutine Proceedings

May 30th, 2016 / 3:10 p.m.
See context

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

moved for leave to introduce Bill C-277, An Act providing for the development of a framework on palliative care in Canada.

Mr. Speaker, it is my pleasure to bring forward my private member's bill on palliative care. In the previous session of Parliament, a parliamentary committee of all parties looked at the issue and came forward with recommendations. The bill is the result of that. It is a timely bill, especially in light of the Bill C-14 legislation. The committee that considered the Carter report stated that the request for physician-assisted death could not be truly voluntary if the option of proper palliative care was not available to alleviate a person's suffering.

My bill provides a framework to implement consistent access for palliative care for all Canadians. I hope all parliamentarians on all sides of the House will support it.

(Motions deemed adopted, bill read the first time and printed)