Bill C-277 (Historical)

Framework on Palliative Care in Canada Act

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

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

[Sharon Baxter, Executive Director, Canadian Hospice Palliative Care Association]

First, let me thank you for allowing us to present this morning. I want to extend especial thanks MP Marilyn Gladu for putting the motion forward. We're thrilled to be able to present today.

The Canadian Hospice Palliative Care Association is the national association that provides leadership in hospice palliative care in the pursuit of excellence regarding the care of persons approaching death so that the burdens of suffering, loneliness, and grief are lessened. Hospice palliative care is aimed at the relief of suffering and improving the quality of life of persons who are living with, or dying from, an advanced illness or who are bereaved.

I noticed in the motion that there was a question about definitions. There are a number of definitions. If you refer to the brief we've submitted, on the last page we provide definitions for “hospice palliative care”, “palliative approach to care”, and “advance care planning”. These terms tend to get intertwined in people's thinking. Hopefully, that will be helpful for you.

We are pleased that there is a desire to develop and implement a framework designed to guarantee that all Canadians have access to high-quality palliative care. The provision of specialist hospice palliative care in acute care hospitals and residential hospices and the palliative approach to care provided in the community—including home care, long-term care, and other settings—have not received the attention, funding, and support that's needed in light of our aging population. It's going to become a critical issue.

Now, if I may, I'd like to take a little time to highlight some of the existing resources and documentation that could help you in developing and implementing a palliative care framework. To be clear, we are not starting from scratch. We have a lot of information and there have been a lot of reports.

CHPCA, my association, serves as the secretariat for the Quality End-of-Life Care Coalition of Canada. It was formed in 2000, so we've been around for 17 years. I'd like to give a quick shout out to a few of the coalition members who are in the room today. The Canadian Nurses Association, Pallium Canada, the Canadian Cancer Society, and the Canadian Society of Palliative Care Physicians are all in the room today. There are 39 national associations, including all the professional associations and disease-specific groups, and they've been working together for 17 years to try to highlight the issue of hospice palliative care.

At the end of our brief, we've also listed the coalition members just for your information, because, obviously, we don't want to take up the time today.

The Quality End-of-Life Care Coalition produced a guiding document called, “Blueprint for Action 2010 to 2020”, and it identified four priority areas of focus. They have stood the test of time through the last decade. The first one is ensuring all Canadians have access to high-quality hospice, palliative, and end-of-life care. The second is providing more support for family caregivers, including bereavement support through the federal compassionate care benefit and other opportunities. We actually have about six or seven different ideas. The third is improving the quality and consistency of hospice palliative care in Canada, including research, training, and education. The fourth is encouraging Canadians to discuss their wishes for their care in the future, including at end-of-life. We've often referred to this as advance care planning. It's called different things, depending on where you are in Canada. It's so Canadian that in different jurisdictions they call it different things.

Between 2012 and 2015, the Government of Canada provided CHPCA and the Quality End-of-Life Care Coalition funding for a three-year initiative called, “The Way Forward: An Integrated Palliative Approach to Care”. This culminated in the development of a national framework and the dissemination of practical resources and tools to help governments, policy-makers, regional planners, health service organizations, and health care providers on the ground to adopt a palliative approach to care. Indeed, five provinces are using it as a foundational piece of work in trying to push out an integrated model.

“The Way Forward” was intended to be a catalyst for action by raising the awareness and understanding of a palliative approach to care. The initiative also defined “hospice palliative care”, a “palliative approach to care”, and “advance care planning”. I refer you to the lexicon of terms. At the end of our brief, we've put some links to some of these documents and in “The Way Forward” we have a lexicon of terms. Hopefully, that will help you with your deliberations.

Traditionally, the last days or weeks of life are the most common time for referrals to hospice palliative care programs and services, if at all, and these are often reserved for individuals designated as “dying”. Those tend to be the patient who is dying with an end-of-life experience that needs specialist care—cancer patients, or those with HIV or AIDS or some of those diseases—but not necessarily those patients who are not designated as dying, like the dementia patient. Indeed, about 65% of Canadians die of diseases that do not necessarily need specialist palliative care, but do need a palliative approach to care. There is this nuance between the two.

The overarching goal of the initiative was to ensure more Canadians can live well until dying by enhancing their quality of life through the course of illness and through the process of aging, and not just in the last days or weeks of life.

In December 2016, just two months ago, CHPCA undertook an environmental scan of all the provinces and territories, as well as the QELCCC members, to determine where they stood in the implementation of a palliative approach to care. Given that health is a provincial and territorial responsibility, it is absolutely imperative to understand where their priorities lie to best determine how we proceed federally. The surveys provided important information that will drive the adoption of a palliative approach to care. Remember that the initial project was only $3 million and was a catalyst project, so it was just the start of the conversation.

The two surveys offered the following highlights. I'll name a few of them.

While public awareness is one driver of adoption of a palliative approach to care, we need to do more to enhance the understanding of a palliative approach to care and advance care planning with the public and health care providers. I think the issue of public awareness is an interesting piece of work that we really need to do. Most Canadians are confused about what hospice palliative care is, what a palliative approach is, what “do not resuscitate” means, what sedation is, and what your rights are among hydration, nutrition, and treatment. It's all blurry in the minds of Canadians, and we really need to do a much better job of giving them that information.

Next, a national education curriculum and ongoing continuing professional development through enhanced skills and training are needed for all health care providers across all settings of care. As well, conversations about the palliative approach need to be better integrated into usual medical care. This would help to make a palliative approach part of ongoing treatment and not necessarily a separate specialized or referral-based program, so that it becomes part of the care that anybody will receive when they're coming to the end of their life.

Also, ongoing advocacy efforts for a palliative approach to care must continue, particularly in light of the introduction of medical assistance in dying, which has created a need to clarify what hospice palliative care is all about, where it is available, and what more needs to be done to ensure that it is accessible to all Canadians. We've often said that it would be a shame if a Canadian chose MAID when they could have benefited from hospice palliative care, so we need to be able to make sure that they're given that opportunity. In addition, current care pathways need to include a palliative approach, and tools and materials for health care systems and professionals must enable adoption.

Last, we must ensure resources are available and dedicated to hospice palliative care and flexible to meet population health needs, including those Canadians who are members of the indigenous culture or vulnerable groups.

This final report was given to Health Canada just on Tuesday. There are several other great reports, studies, environmental scans, and evidence, such as the recent consensus statement and lay panel recommendations coming out of a November 2016 three-day Palliative Care Matters consensus conference that was held here in Ottawa. You can see that a lot of this is very recent. All the findings are consistent with the “Blueprint for Action” and many of the other reports. They include calls for a national care strategy; a national secretariat, including a national centre for research; a national public awareness campaign regarding the palliative approach to care and advance care planning, for the public and for health care providers; education and training for health care professionals; and caregiver support. As you can see, there is a great consensus among all these studies.

I notice that Bill C-277 references all Canadians. It is imperative that policy-makers remember that not all Canadians have equal access to health care—especially hospice palliative care—in this country. Vulnerable populations, including those who are indigenous, disabled, homeless or vulnerably housed, impoverished, or incarcerated are often forgotten. Innovative models for delivering hospice palliative care are required to meet these populations' unique needs and to address the barriers they face when accessing services.

Barriers to accessing high-quality palliative care include non-malignant diagnoses, geography—we do a much worse job providing services to rural Canada—poverty, lack of supports, comorbidities, mental health, and substance abuse all play into how these people do not receive the care they need at the end of their lives. When you say “all Canadians”, we really need to think about all Canadians.

Another group who are often not considered are children. A recent study from SickKids in Toronto that was finished in 2012 cited that overall only 18.6% of deceased children who might have benefited from palliative care received the care based on their diagnosis, and 25.2% had their care only eight days before they died. We can do much better. Pediatric palliative care has developed as an integrated model of care and can successfully be adapted in the adult population. We can learn from their experience.

In summary, we really don't need to study the situation any further. The studies and reports have all been done. The ample evidence clearly points to one course of action, which is to support and fund the agreed-upon priorities to make hospice palliative care accessible to all Canadians. Governments, health care associations, and organizations have all been partners in this, but corporate Canada has a role to play. The Canadian Hospice Palliative Care Association, my association, has a champion's council that is made up of leaders of industry and commerce. They've just launched a program called Canadian compassionate companies that highlights companies and organizations that accommodate—

[The Chair, Liberal, Bill Casey]

I call the meeting to order.

Thanks very much, everybody, for being here. We're going to continue our study on Bill C-277, an act providing for the development of a framework on palliative care in Canada. I think we're all very interested in this and all very supportive. We welcome the testimony of our witnesses today. We look forward to your presentations.

On the first panel, from the Canadian Hospice Palliative Care Association, we have Sharon Baxter, executive director, accompanied by the Josette Roussel, senior nurse adviser to the Canadian Nurses Association.

If you could keep it tighter, it will give us more time for questions. Thanks very much.

Ms. Baxter.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Under BillC-277, who would be responsible for funding the additional resources required to give Canadians access to palliative care?

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

That's what I was coming at—how much it's going to cost us for the infrastructure. In the end, will we be saving money by instituting a palliative care framework?

Paragraph 2(1)(f) of Bill C-277 requires that the proposed palliative care framework include an evaluation of the advisability of amending the Canada Health Act to include palliative care services provided through home care, long-term care facilities, and residential hospices. Has this possibility been raised with the provinces? If so, did they raise any concerns with respect to amending the Canada Health Act in this manner?

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

That's excellent.

Thank you and good morning.

I thank the committee for the opportunity to appear today and for the unanimous support the bill received at second reading.

I think this bill is timely. Our population is aging and only 30% of Canadians currently have access to any type of palliative care service. The special committee that studied the Carter decision on assisted dying stated that without quality palliative care, a true choice was not possible.

I was surprised to find out that not every location in Canada has the benefits of the integrated palliative care that is offered in my home riding of Sarnia—Lambton, where we have more than five palliative care specialists, palliative beds in hospital and in hospice, and an excellent network of home care, counselling, and crisis response services.

I began to ask about this. I found that an all-parliamentary committee in the 2011 session had studied palliative care and brought forward a report with recommendations. Although a motion was made, not much further action occurred.

With an aging population, the implementation of Bill C-14, and the desire to innovate and to get more out of the health care dollars that we invest in our system, we can see that the time is right for this bill,

Bill C-277 proposes a framework for palliative care in Canada, including a definition of the services to be covered, a definition of the training required at the different levels of service provision, care for those giving palliative care services, collection of appropriate data, and the development of a plan to get consistent access to palliative care for all Canadians.

During debate, amendments were suggested to add first nations to those covered by this framework and to ensure that the language of the bill reflects the proper balance of provincial and federal jurisdictions. I'm very happy to work with the committee should they choose to adopt these or any other changes.

My theme today will be to explain the sections of the bill and recommend to the committee how I see the framework proceeding.

I'll start with services to be covered.

Palliative care can begin more than a year before end-of-life care, and end-of-life care is defined as the last two weeks of life. Pain control, including the cost of the drugs, along with spiritual and emotional counselling, home care, hospice care, and home crisis intervention are the basic services that I would like to see covered. Today some of these are covered in part, and only in some provinces. Others are not covered at all. It's important to note that the costs associated with palliative care in hospital can be $1,200 a day, versus $400 a day in hospice and $200 a day, on average, in home care.

As compared to intensive care, palliative care in a hospital could save our health system between $7,000 and $8,000 per patient. Recent data suggests that, in Ontario, transferring just 10% of end-of-life patients from intensive care to home care could yield $9 million in savings annually. That is a better use of health care dollars in order to get better results for Canadians.

The second part is with regard to training. Different levels of training are required for the various types of care providers. There is currently a shortage of palliative care specialists in Canada. We have 200, versus a need for at least 600.

General practitioners receive two months of palliative care training as part of their medical degree. Registered nurses may not receive any palliative care training at all, but they should take training as offered today by organizations like Pallium Canada or equivalent.

Home care providers and personal support workers, when trained, would provide a cost-savings delivery model that would be effective, especially in remote regions where innovative solutions to delivering service will be needed. More registered nurses, RPNs, and personal support workers will be needed with our aging demographic. As the provinces are introducing training, it would be wise to set a standard terminology, set the training requirements, and have interprovincial recognition of those standards.

We also need measures to support those who are giving palliative care services. As you can appreciate, watching people die and seeing the emotional and physical agony they are in can bring symptoms similar to PTSD, and there is some need to provide support in the care system for those people, as well as for care providers who may be needing respite and rest. It's important to consider them.

Moreover, the lack of data on the need for palliative care, the total average cost, and the breakdown of services should be addressed by collecting data in order to standardize and monitor the provision of palliative care services.

I encourage you to consult the Minister of Health, who already has some ideas on what she would like to see in this regard.

With respect to research data, there's not really even a baseline of how many people are in need of palliative care or how much palliative care can be expected to cost per person. These are the kinds of numbers we would like to benchmark and monitor.

We also need a plan to develop consistent access for all Canadians. This is one of the most important parts of this framework.

The plan should have several pillars. We've already talked about the trained resources that will be needed. Second, infrastructure will be needed to achieve consistent access for all. There's an opportunity for the government to put money into building hospices and palliative care centres. Canada has about 30 hospices compared to the United States, which has 1,300. Building this infrastructure will create jobs and will address a need.

Finally, in order to service rural and remote communities in Canada, use of innovative ideas will be needed. One such idea is the virtual palliative care centre in Winnipeg, where home care nurses or doctors can call in on a 24-7 basis and get access to palliative care specialists who can guide remote treatment. Web and Skype consults will rely on the government's current infrastructure plan to address Internet in the rural and remote north. Training paramedics, nurses, and home care workers in palliative care and combining this with the fly-in crisis response teams has been shown to work effectively in other parts of Canada, and doing so should be levered as part of the overall plan.

Choosing the mechanism to implement this framework is also important. There are various options. One of them is to add palliative care to the services covered by the Canada Health Act. Another option would be to include palliative care in the new health accord. A final possibility would be to create a government palliative care program to fund the infrastructure, establish training standards, and work with the provinces to implement best practices.

I think any one of these options could work. There are probably other mechanisms I have not thought of, but it is up to the government to provide direction on implementation through the budget.

The $3 billion that is currently promised in the 2016 budget is a good start and I hope to see more in the 2017 budget.

The government should leverage the many national organizations that have supported this bill, each of which has solutions to help deliver the services. These organizations 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, and many other member hospices, such as Bruyère Continuing Care, St. Joseph's Hospice, West Island Palliative Care Residence, the Heart and Stroke Foundation, the Kidney Foundation, the ALS Society, and the Canadian Association of Occupational Therapists, as well as the more than 50 member organizations of the Quality End-of-Life Care Coalition of Canada and the many faith organizations across the country, including the Canadian Conference of Catholic Bishops.

In addition, coming up with a standard definition of services to be covered and of the training requirements will be a priority, as provinces are already progressing in their offerings in different ways. Now is the time to act to address this important issue so that Canadians can choose to live as well as they can for as long as they can.

I appreciate your time. I'd be happy to answer any of your questions, and I look forward to our discussion.

Thank you.

Seniors

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Mr. Speaker, I am going to change the way I was going to give my speech, because there were certain things that I was going to talk about last.

The first thing I want to respond to is the previous member's comments. Because it is on the record that the Conservative Party put forward a motion, members had better know what we are talking about when we say things such as that the Conservatives put through a counter motion. What actually happened, and I know the chair of the Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities is aware of it as well, is that on March 22, 2016, there was a motion. If we are going to say that we are playing politics, let us make sure we have our facts straight.

On March 22, 2016, the member for Langley—Aldergrove brought forward a motion in the HUMA committee. Being honest about this, because it is important that we have these discussions, I looked at the motion and saw a great deal of provincial jurisdiction. As a federal member of Parliament, it is very difficult for me to look at a motion and see that a study is going to be 80% provincial. Therefore, I played around with that motion in committee on February 14 and reintroduced it.

Let us be fair and put on the record that Conservatives were not playing politics with this and that our motion was introduced nine months previous to this motion. I want to clarify that. If we are going to talk about playing politics, let us be real. This was not a political move because seniors are very important to the Conservative Party. My riding of Elgin—Middlesex—London at one time had one of the largest populations of seniors in Ontario. I recognize how important they are and that it is a growing demographic.

I am going to talk about the importance of seniors. I believe that I bring a lot of experience to the House in dealing with everyday seniors, whether it is filling out old age security applications, dealing with the GIS, or doing voluntary tax returns for 10 years. There are a lot of things we can do as federal legislators to help seniors, important things like income splitting. That has had a great and positive impact for seniors.

Another great example of what the Conservative government improved on was the age for OAS. From my experience in doing tax returns, usually $12,000 is the basic income, and from there it is added on. That age amount allowed seniors, many times, to go from about $12,000 to almost $18,000. The first $18,000 was not taxed. I am going to remind people that the guaranteed income supplement is not a taxable amount, so that is not part of the old age security and CPP that is taxed.

We need to look at what federal legislatures can do. When it comes to seniors, we can make sure there are proper tax credits. I appreciate the tax credits that seniors currently have and can only ask that we continue to do more of that, that we continue to look at what more we can do for seniors in that respect. Another thing is making sure that there are the right vehicles to allow seniors to save.

We all know that in the 2015 election, there was so much talk about old age security. There were some misnomers and then there were some truths. One of the truths is that my oldest sister Linda was born in 1962. She will be happy that I said that. The fact is that her age group was going to be the first to be affected by the increase in retirement age from 65 to 67. We are not talking about the seniors of today; we are talking about the seniors of tomorrow. I felt that we were allowing seniors to prepare for their future. We put in vehicles like the tax-free savings account that would allow people to prepare.

My sister is going to be 54 on May 12 and will be retiring in 11 years. Age 65 is when she was going to receive her old age security. It was changed in 2012 or so, to age 67, and the change was going to give her almost 15 years to prepare for her retirement. The Liberals changed that back to age 65.

The finance council has been established, and the Minister of Families, Children and Social Development will not be taking the advice of this council to increase the age from 65 to 67, although we see that 23 out of the 32 OECD countries are doing so. They are doing so because they recognize that there is an aging demographic and people are living longer.

When old age security was brought forward it was not in a time when people were living 10 and 12 years longer, as they are doing now.

We also have to recognize that we have many other great benefits, our health care, and every day we turn a page we find new scientific adventures and there is better health care. As my friend sitting beside me today said, there are great initiatives like Bill C-277, our framework for palliative care policies. We are putting forward strategies that can work, and we need to do those things.

I have to say that I would have preferred that the member for Nickelback had not put in section B—

[The Chair, Liberal, Bill Casey]

Okay. We have a little committee business. I want to point out there are extended hours on Thursday so people should be prepared for that. Whether we sit through question period or not is up to the committee at the time. We'll have to decide if we are still going. I don't know what's going to happen on Thursday. We'll see how it goes. We have to have all our questions answered by five o'clock and then deal with it after that. We could sit through question period, just so you're aware of that.

We need all of the suggested witnesses for M-47 by five o'clock on Thursday. When we have our steering committee meeting on the 16th, we'll decide whether Mr. Viersen can attend or not. I think he can, but we have to clarify the rules. We're going to talk about M-47 and Bill C-277 at that time, and how we're going to handle it.

We'll have to figure out how many meetings we're going to have on the M-47 motion, as well. The witnesses are talking about six, seven, or eight meetings. I don't know if we can do that or not, but we'll talk about that at that time.

That's really everything I have on my list. Is there any other committee business?

Mr. Webber.

Framework on Palliative Care in Canada Act

[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.

[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.

[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.

[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.

[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.

[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.

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

An Act respecting the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercury

[The Assistant Deputy Speaker, Liberal, Anthony Rota]

Pursuant to Standing Order 30(7), the House will now proceed to the consideration of Bill C-277 under private members' business.