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.

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

Thank you, Chairs, and thank you to all our witnesses.

I want to talk about palliative care. As a result of the special committee that studied the Carter decision and their recommendation that in the absence of good quality palliative care, you actually don't have a choice, I brought forward Bill C-277 to create a palliative care framework, which I am very proud of.

The government pledged $6 billion over 10 years in the 2018 budget for palliative care. Sadly, what's happened is that they've spent only $200,000 of that, and it was bucketed together with MAID, which was never the intent. The World Health Organization has been clear that palliative care does not hasten death; that's a totally different thing from MAID.

My first question is easy and for each of you. We know that the framework was also looking at addressing the 60,000 missing resources in terms of palliative care doctors, nurses and other providers. Would you agree that the government should meet its commitment of $6 billion over 10 years for palliative care and address the gap of missing resources?

Dr. Buchman, I'll start with you.

[Dr. Leonie Herx]

Certainly there is renewed attention, as you said, on the importance of palliative care, and it was indeed positioned, by both the Supreme Court and in the Bill C-14 legislation, as something that could alleviate suffering that might lead to a request for hastened death. We were so fortunate to have supported, through the Canadian Society of Palliative Care Physicians, Bill C-277, which created the national framework for palliative care. What that really allowed us to do was to put together all the good work that's been done across the country, informed by international standards, to solidify what we need to achieve in Canada to make palliative care a reality.

Unfortunately, we haven't really done anything further than to put a framework on paper. What we need is the money and the infrastructure to get the boots on the ground. We now have clearly defined national competencies for all professionals who provide a palliative approach to care for their patients and for the specialist training that is needed, but they are not embedded into curricula across the country. We do not have quality standards to evaluate what palliative care is happening across the country. That goes back to the Health Canada data. We just don't know what's happening and who's providing the care, although now we have these credentialing programs.

We need a national system that's linked to Accreditation Canada's standards and that's administered so that provinces collect data on outcomes for patients that is patient-reported. We also need the quality standards to make sure that provinces are accountable for improving both the quality of palliative care and the access to it. Achieving that will take a sustained investment of resources over time to get those trainings embedded, to get the standards up and to hold the provinces accountable through accreditation standards. That's absolutely needed, and we haven't seen any of that. There was no money in the last federal budget, and that needs to change. At least 95% of Canadians don't want to die via an assisted death, so let's put some money into supporting the needs of all those people who don't want MAID.

Criminal Code

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

Madam Speaker, I am happy to have the opportunity to rise today to speak to Bill C-7. It is a very serious matter. As the member for Fundy Royal just mentioned, it is a matter of life and death. I was part of the debate on the original bill, Bill C-14, and I am familiar with a number of the issues with that bill.

It is very disturbing to me. I understand with the Quebec court decision the government had to make a response of some sort, but the previous bill required them to do a fulsome parliamentary review, which was supposed to take effect this past summer. The government refused to let Parliament sit this summer and do the kind of fulsome work that needed to be done.

It is actually quite irresponsible that when the government introduced Bill C-7, instead of just addressing what was time sensitive in responding to the Quebec decision, it went further and took actions without doing that fulsome review of how things have been going with Bill C-14 in the last number of years.

For those watching at home who are not familiar with Bill C-7, the bill would repeal the provision that requires a person's death to be reasonably foreseeable. In addition to that, it would specify that people whose sole underlying condition is mental illness are not eligible for medical assistance in dying. It would create two sets of safeguards that have to be respected before medical assistance in dying can be provided to a person, and it would permit medical assistance in dying to be provided to a person who has been found eligible to receive it and whose death is reasonably foreseeable but who has lost the capacity to consent before the medical assistance in dying is provided. That is sort of an advance consent, and we will talk a bit more about that.

Bill C-14 was not without some issues that were not addressed in the previous legislation and will probably be considered in the fulsome review. There was a question about whether minors should be able to receive medical assistance in dying. There was significant discussion about advance consent. A lot of Canadians were demanding it, and I will talk a bit about some of the considerations that may have kept the government from moving ahead at that time. There was discussion of those who are not mentally competent to give consent. There have been a number of speeches today mentioning people with dementia, for example. That is another area where there was work done by the Council of Canadian Academies, the CCA. It did fulsome reports on a number of these things, and I will talk a bit about what was found.

There was discussion today about the protection of conscience rights, and I do not agree necessarily with the Parliamentary Secretary to the Minister of Justice. I see the charter provisions that were put into Bill C-14, but forcing somebody to refer, when they do not want to have anything to do with the process at all, is actually violating their rights. I am not a fan of violating one person's rights to give another person their rights. That is not good, so we need to have more discussion about that.

In its report, the special committee that studied the Carter decision said that, without good-quality palliative care, people really cannot make a true decision. They really do not have a choice. Obviously I have been an advocate for palliative care. My private member's bill, Bill C-277, on palliative care, was unanimously passed in the House and in the Senate. The government did a good job of putting the framework in place to get consistent access for all Canadians to palliative care.

The problem is that, once the framework was in, the government has since really not pushed ahead. There are 70% of Canadians who have no access to good-quality palliative care. Especially in the time of COVID, where people are dying, it is becoming even more important. The government needs to take action to up its game on palliative care to make it more available to Canadians.

There is an opportunity and a responsibility for the government to show leadership in how palliative care is being implemented in Canada. Right now, for example, British Columbia is violating the World Health Organization's requirements for where MAID should be performed. It has specifically said that palliative care is a different thing from medical assistance in dying and that they should not be performed at the same location because of a tendency by people wanting palliative care to be afraid that they will accidentally receive medical assistance in dying against their wishes. There is an opportunity for the government to revisit that and I am hopeful that it will.

With respect to the Council of Canadian Academies, many issues were studied. On the advance directives and advance consent issue, we see in this legislation that the government is allowing people who believe their conditions are going to decline and are eligible to receive medical assistance in dying to have a 90-day advance consent. It is not clear to me in the legislation when the 90 days start. Is it when patients first have discussions with their physicians? When does the clock start? That is a clarification that is needed in the legislation.

When the council looked at advance directives, it said there were a few difficulties. The first one was how to prove people have informed consent, what the criteria are and what the definition is of that. Therefore, that would have to be addressed. Who decides what is intolerable suffering, especially if the person has lost capacity? That is another question that needs to be and should be considered in this fulsome review that is required and that I would have preferred to have had before this bill came forward.

As a point of information, Belgium and Luxembourg only allow an advance directive when a person is permanently unconscious. That is the only way they will allow a person to have an advance directive in place: If they become permanently unconscious, they will receive medical assistance in dying.

On the issue of minors, “mature minors” would have to be defined. In Quebec, that is defined as people aged 14 to 17. However, we have to make sure they have the capacity to make medical decisions and confirm they understand that it is voluntary and they are not under duress. There are not many jurisdictions that have extended this to mature minors. The Netherlands does allow people aged 12 to 16, with parental permission, to have medical assistance in dying, and those aged 16 to 18 with parental consultation. Belgium allows it if the person is terminal, but pediatric palliative care has to be provided as an option. Therefore, there needs to be further discussion on that one.

Then there are those who suffer from mental illness. I was very pleased to see that it is clear in this legislation that they would not be eligible. It was very controversial. The council that studied it could not agree. There was discussion about the capability for informed consent and the fact that people with depression could have good and bad days and may change their minds, which again points to the need for some kind of cooling-off period. The Netherlands allows this but for dementia only, and there is still a lot of controversy about that.

The safeguards that were in the bill originally seem to have been removed. I am not a fan of doing that because I would say that if we remove the conditions that have to be met in order to get something, more people will take advantage of it. I am concerned with a broader creep on this, but I am sure there will be fulsome discussion about this at committee.

In Canada, everyone has the freedom to express themselves, to believe what they want and to choose what they want, and we should treat everyone's individual choices with respect.

[Sharon Harper]

We are planning a series of indicators to address the action plan and how it's being implemented. We expect those to be available in fall 2020. There is also a parliamentary review that will require a report on palliative care in June 2020. Also Bill C-277 requires the minister to provide a follow-up report on palliative care in December 2023.

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Mr. Speaker, I am happy to stand today to add my voice to this debate. I think it is a particularly important debate. It is an important subject, and I think there are a lot of issues that need to be discussed.

I am going to confine my comments to issues I have with the bill, things I am concerned about, and my genuine belief that the government will take a very collaborative approach to this legislation. If we take a collaborative approach to this legislation, Canadians will have trust and faith that we developed legislation to actually address their needs and protect their concerns.

Speaking of concerns, I have a number of them. I will start off by talking about what I consider to be a significant lack of consultation.

This legislation will come up for review in June. It is the five-year mandated review of the legislation. My understanding is that the government has applied for a four-month extension with respect to the implementation of this legislation, which the Quebec court struck down.

If we have this four-month extension and have the mandated review of the legislation scheduled in June, what is the rush? Why have we rushed to introduce legislation prior to that mandatory review, which would, of course, be extensive and broad and far more in depth than any consultation that has been done with respect to the current legislation? My understanding is that there was only about two weeks of public consultation for this legislation. In my opinion, that is woefully deficient given the gravity of the topic we are discussing today.

This is my first real concern. What is the hurry? What is the rush? The court has given us more time to do this, and I believe we should be taking the time to go through the mandatory review and consult with Canadians, and then decide on the path forward. That is my number one concern.

I want to mention that I will be sharing my time with the member for Langley—Aldergrove. My thanks to the page for bringing that to my attention. She is doing an excellent job.

The next thing I want to talk about is palliative care. The minister has made comments in the House today espousing the great investments that are being made by the government in health care, but has not really talked about any specific investments with respect to palliative care. I think that is a critical thing to look at when we discuss this legislation. I want to remind the minister that Bill C-277, an act providing for the development of a framework on palliative care in Canada, was passed in the previous Parliament in 2017, and clearly states in the preamble:

Whereas the Final Report 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;

This was passed by Parliament, so if we are looking to expand the scope of medically assisted death without also expanding the availability of palliative care, we are doing an incredible disservice to Canadians, because the availability of palliative care in this country is poor at best. I am going to speak about this personally just for a moment.

Both of my parents suffered from terminal cancer. My mother was not able to get into a palliative care facility because there was no palliative care facility available for her, so she passed away in the hospital. My father was also not able to get into palliative care, but fortunately his illness was longer than my mother's, or unfortunately, depending on how one looks at it, and we were able to get private home care that eased his suffering and made sure he was being taken care of. However, there was no way that he was going to be able to get into palliative care within the scope of his illness.

This is affecting Canadians from coast to coast to coast, and the minister has rushed to introduce this bill. Why would the minister not have introduced corollary legislation, or legislation in tandem, or announced increases in funding for palliative care?

In my riding of Dufferin—Caledon, there is a fantastic hospice for palliative care. It is called Bethell Hospice. It only has approximately 15 beds. That is the palliative care option in my riding. For approximately 200,000 people, there are 15 palliative care beds.

Members can imagine that there is a significant number of people who are not able to get into palliative care. Therefore, the option of medically assisted death becomes far more attractive for someone who is not able to enter into a palliative care facility.

I will repeat that it is clearly a violation of legislation that was passed by the House. When people do not have the option for proper palliative care, their consent for a medically assisted death is significantly in question. I am extraordinarily concerned by the lack of any plan by the government to deal with investments in palliative care.

The minister has suggested that there are significant safeguards in place for people who suffer from any type of mental illness. However, I am not sure what those safeguards are. She suggested that just having that condition would exclude someone from obtaining a medically assisted death. What is the definition of that? How are we proving that is the only issue?

There is no requirement for individuals to go to a psychiatrist in order to assess that they are not suffering from a severe bout of depression. In my own life, I have gone through extraordinary stages and phases of depression during which I actually did not want to live anymore. I was not seeing a psychiatrist at the time. Would I have then been able to avail myself of these services while I was in a period of particular darkness? We know that mental health is an issue that is rampant throughout this country.

Again, I will go back to my first point, which is: Why are we rushing to do this? Why are we not taking the time to go through the five-year review? We need to take the time to find ways to make sure we are safeguarding all Canadians in providing them the option of medically assisted death, if they want it, but also ensuring that people who are choosing this, maybe because of a lack of palliative care, or maybe because of underlying mental health issues, are going to be protected.

These are some of the major concerns I have with respect to this piece of legislation.

Going back to the consultation, two weeks for online submissions with respect to concerns by Canadians is not anywhere near a sufficient amount of consultation. My understanding is that it was mostly online submissions. This is not a way to get the pulse of Canadians with respect to a very significant issue that is going on in this country. I will continue to ask why there was not a longer or broader consultation.

I know this matter will be studied at committee, but having been a member of Parliament now for going on five and a half years, I understand the extreme limitations at committee. We will often have a panel of six witnesses. Those six witnesses will each get their 10-minute statement, and then members of Parliament might get a six-minute intervention to try and raise an issue.

If one is going to suggest that a committee study will be far broader in scope, or somewhat more encompassing than the mandatory statutory five-year review, I will respectfully disagree with that submission.

Committees absolutely do great work, but they also suffer from an extreme pressure of legislation and time. To suggest that one or two weeks or three meetings at committee is sufficient time to analyze, debate and discuss this legislation, I do not think that is the correct answer. We should be putting this legislation off until we have the mandatory five-year review in June, which would allow us to have a far more expansive discussion with respect to all of the issues that are being discussed in the legislation.

These are my comments and concerns with respect to the legislation. I certainly hope the government will listen to these concerns, act collaboratively and co-operatively, and not try to drive this legislation through without listening to legitimate concerns that are being raised by members of the opposition.

National Physicians' Day Act

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

Mr. Speaker, I am pleased to rise in the House to speak to Bill S-248, an act respecting national physicians’ day.

This bill designates May 1 as national physicians' day. It seeks to recognize the importance of the 125,000 resident and student physicians across the country.

In coming to my decision to support this bill, I considered the following points.

Members who have been here for four years have seen a number of days, weeks and months of various sorts to recognize great things across the country, but what could be more important to recognize than our doctors? Doctors save our lives. Every one of us is going to need a doctor at some point in our life, and usually all the way throughout, from the time we are born to the time we go into palliative care and pass on from this life. It is definitely worthy to have a day to talk about doctors and all the things they do.

From the time people decide to go into medicine, it is an incredibly long journey. We know it is difficult to get into med schools, and once they are there, they study for extremely long hours. It is a very competitive field. Once they have finished their studies, they have to do their residency. This involves extremely long hours of work, very interesting work, when they get real experiences. My nephew is a doctor. He did undergraduate work in Michigan, but got his medical training in St. Martin, which sounds like a wonderful place to get medical training. He did his residency in the U.S., so he had the opportunity to work in Detroit and Long Island. One can imagine the excellent training he got in the emergency departments there. He and so many other doctors go through all of that, and at the end of their studies and just beginning their careers, many of them have racked up between $200,000 and $300,000 worth of debt in student loans.

It is really quite a commitment to embark on becoming a doctor in the first place, and one of the problems in Canada is graduating enough doctors. There is a certain number of spots for residents. When I became the shadow minister of health, I became aware that there was an issue with the matching of residents to positions and, in fact, some of them were unable to get a position. We can imagine, after all the training doctors have gone through, how devastating that would be not to be able to pursue their life's dream. I was able to work with the health minister to address that gap.

That being said, there is a huge doctor shortage right across the country. I have been able to go from coast to coast to coast to see the state of the nation in terms of doctor shortages, and I can say there are some very dire situations. Cape Breton is missing 52 emergency room physicians and a vascular surgeon. Individuals who cut an artery there would lose a limb or die because they cannot get to Halifax in time. In Ottawa, the wait time for a family physician is six years. In B.C., there is a huge shortage of doctors. There is an incentive system there that has resulted in having more emergency room doctors than family doctors. Rural and remote spots across the country are in dire need of doctors.

I have a list of the types of doctors missing in my own riding of Sarnia—Lambton. We're missing 10 family doctors, two geriatricians, one rheumatologist, three psychiatrists, one rural emergency physician and two other ER physicians, one plastic surgeon, two anaesthetists and an otolaryngologist, though I am not sure what that is.

The government should definitely be taking a leadership role. We recognize that, while health care is executed by the provinces, the federal government has a responsibility to address this gap. We have an aging population. One in six seniors right now will become one in four seniors in six to 10 years, so we are going to need even more doctors. We are short 600 palliative care physicians and innumerable doctors for seniors.

It is time to work alongside the provinces and territories to figure out how to address what is really a disastrous shortage. Without a doctor, how is someone going to stay healthy or deal with chronic disease?

It is worthwhile having a day to celebrate doctors, but it is a bit hypocritical for the Liberal government to be bringing this forward. It was a Senate bill originally brought forward by Senator Eggleton, but the Liberals have brought it forward. As a government, Liberals have not been kind to doctors. Remember, it was the Liberal government, under the finance minister, that called doctors tax cheats. It did not recognize that when doctors have their corporations and run their medical practices, they need to accumulate passive income to buy the equipment they need to run their practices. The government wants to tax them at a 73% rate. Again, the Liberals have not treated doctors well.

If we look at the medical assistance in dying legislation that was brought forward, it was the Liberal government that did not protect the rights of conscience of doctors in this country, even though it was brought to its attention. Most recently, the Ontario court has not allowed for doctors to have freedom of conscience with respect to assisted suicide in Ontario. That has never happened anywhere else in the country, in the world, and it was the Liberal government that began that path.

When doctors are becoming doctors, it is a very long and arduous process. However, once they become doctors, they face very strenuous working conditions with very long hours. They may be working 80-hour weeks, depending on whether they have someone helping them out in their practice. As well, the Standing Committee on Health is doing a study right now about the violence that health care workers experience. I was astounded to learn that more than 60% of health care workers, including doctors, are experiencing violence from patients, frustrated family members and people who suffer from mental health and addiction issues or dementia. There is a real and serious problem that we need to address on behalf of doctors.

Many people know that I am a passionate advocate for palliative care. While we are talking about having a national doctors' day, I send thanks to the doctors at the palliative care at St. Joseph's Hospice in Sarnia—Lambton. I thank them for everything they do. I also thank the palliative care physicians across the country and those who work in that area. With the aging population we have, we need to do more to make sure that Canadians can choose to live as well as they can and for as long as they can. There are 70% of Canadians who do not have access to palliative care today.

The palliative care framework brought in under my bill, Bill C-277, has certainly helped to advance the cause. I have worked with the health minister and the parliamentary secretary, who I see is here today, to try to make sure we have training for health care workers in palliative care and the infrastructure we need in terms of hospices and broadband Internet to access virtual palliative care. As well, we need to take the innovative ideas put in place across the country, with the paramedics, for example, learning palliative care and taking that to rural and remote places, and that we take all of those ideas and make sure we build our palliative care capacity in the country.

In summary, there is more to be done. There is more to be done to support doctors, and not just their rights of conscience or the tax laws that allow them to operate here. We have to also listen to the doctors when they provide advice. The Canadian Medical Association provided a lot of input on the cannabis regulation, and it was largely ignored. While having a day for doctors to celebrate is great, there is a lot more that we could and should do to celebrate how important doctors are to each one of us. They save our lives and help us throughout our lives. I am certainly happy to stand here today with Bill S-248 and say that I will support this bill. Happy national doctors' day.

Member for Langley—Aldergrove

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

Mr. Speaker, it is my birthday.

[Members sang Happy Birthday]

Mr. Speaker, I was in the hospital recently for 15 days, and I had zero interest in politics since I was in the hospital and possibly facing the end of my life. In just a few minutes here in Parliament, I am interested in politics again.

I am not running again; I announced that. However, I wanted to make a farewell speech. It is tradition in this House to be able to say goodbye and thank members of this House. I have surgery for colon cancer coming up on May 22, and my only opportunity to say goodbye was this week. I am here to give the House an update and thank members.

I was an election observer with a colleague, and I had to come back early because I was turning yellow. I was very jaundiced. I came back, went to the hospital after a few days, and doctors found that I had a pancreatic tumour. They then found that I had colon cancer and then that the pancreatic cancer, which is the same as what Steve Jobs had, had spread to my lungs. The prognosis from the doctors is not great. However, I have a strong faith in God; and the God who created me can heal me.

I want to share a little about my life. Throughout my life, there have been some wonderful little God moments, nuggets and interventions of guidance. People ask me why I became involved with politics in the first place, and it started with a dream back in 1990. I had a dream that there was an upcoming municipal election and that I was elected. This was out of the blue; I had no interest in it.

Later that day, somebody came up to me and said that they had a dream about me. “Oh, really?” I asked. “What did you dream?” The person dreamed that I ran in the election and was elected. When those little nuggets happen, one has to listen. So often we get busy and do not. I put my name on the ballot, and surprise, I was elected. That was in 1990.

I served on Abbotsford council with the wonderful, intelligent, good-looking member for Abbotsford. I served there for 14 years, and what an honour it was.

Then there was another God moment. I was with my beautiful wife, Diane, and we were going out for our anniversary. I said to her that one day before I retired I would love to get into managing or owning an auto body shop. I had just sold a business and everything, and she told me not to start a new business. I told her that I was just thinking out loud, because I loved cars and would like to do that. That happened on Saturday. On Monday morning, the phone rang and this fellow said that he was Gary down at the so-and-so avenue body shop. He said that he was looking to retire and asked if I would be interested in managing his auto body shop.

From that I then went to ICBC, and then brought money into Langley and started fixing up things. I became known, and the next thing I knew, I was running for federal politics. Again, there are these little voices, these little nuggets in our lives where we need to listen and follow God's leading. That is why I am here. I am just an average guy who has had an incredible honour serving with members and serving our community.

I want to thank God. I want to thank my family.

Diane and I were married in 1972, almost 47 years ago. She is my best friend. We have five kids and 10 grandkids. We are so blessed.

My passion has always been the environment, justice, family, seniors, children's issues and respecting life right from beginning to end.

Diane and I met at Trinity Western University, and on the weekends, as I did not have a lot of money as a student, I would take her on a date to a seniors place, where we would play the guitar and sing. We just loved dealing with seniors. We did not have to be great singers for the seniors to like us.

We are so blessed with our kids and grandkids: Jon and Jen with Carrington and Rich; Ryan; Eric and Carolyn with Christian, Jonah, Jeremiah and Jakob; Nathan; and Kristen with Russel, Mya, Mark and Will.

I have always been involved with sports over the years, and I know the importance of teamwork. We cannot get anything accomplished as a lone wolf; we have to be part of a team. I understand the importance of this in politics as well, and I have this incredible team that I get to work with, my staff. I could not have accomplished anything without them. They are Annette, Kim, Jane, Liat, Monique, Megan and Rebeca.

As members all know, the best part of the job is being able to help people, and it has been such a blessing. We love our community, and it has been an incredible honour.

When I announced that I was not going to be running again, I felt that God was creating a new chapter of my life. I was preparing to be a chaplain giving pastoral care to seniors. I was doing this studying and reading, and lo and behold, I got sick. I was reading all these case studies about whether to operate or whether to give palliative care and I was honoured by our leader to be given the responsibility for palliative care. Then I found myself in the hospital, a surprise, and experiencing what it is like to face end of life. With all that reading and preparation, maybe it was not for me to administer to others but to prepare myself for this trial. I want to thank everyone so much.

When someone is first given the diagnosis that there are some serious problems, doctors are dealing with the physical person, but there is more than just the physical to us. There are the spiritual and the emotional sides, the psychosocial, but that was left unadministered to. While the doctors were looking at my physical condition, that was being ignored. This is tremendously important. Doctors give a diagnosis and look at how they are going to fix a patient, at what kind of operation is needed or what chemo, but what about the person? What about the family and the distress? We need to encourage our medical system to make sure that they are providing a ministry for the rest of the person.

I was at the Vancouver General Hospital, which is an incredible hospital with incredible physicians and surgeons, but that need was left unmet.

I asked for palliative care. I was there for 15 days. Of the thousands of doctors, there are two palliative care physicians at VGH, and I never saw them. They came once while I was recovering and groggy and sleepy, so that need was unmet, unfortunately.

I have experienced first-hand the difficulty of accessing palliative care. We know from statistics that it is not available to 70% to 84% of Canadians, a tragic number. Our system is not designed to meet that need. We are trying to fix the body, but in some cases it is better not to do the heroic thing, not to remove the organs or use chemo and that sort of thing. Science has shown us that people can live longer and have a better quality of life, in some cases, if they are given palliative care, but those options were not provided to me. Why is that?

The system is broken and needs to be fixed. We passed Bill C-277. This Parliament is coming to an end, but I hope that the next Parliament will make a commitment to fix that and provide leadership in Canada, maybe through a university chair or something, so we can fix this situation. People are left in despair, emotions are raw and family support is not there, but they are not given the opportunity for palliative care. What is the only remaining option? If it is not surgery, it is maybe that they should consider MAID, medical assistance in dying. I was on the legislative committee when we discussed that proposal and passed it. We had to, because of the Carter decision.

We have a situation in Canada of basic needs not being met, and out of desperation people are saying that the easiest way is to end their life through an injection. They are saying that would be the humane thing to do, but we cannot force people into that kind of a choice. We have to provide palliative care.

It has been such an incredible honour to work in this House. I was first elected federally in 2004, and 15 years went by just like that. It has been such an honour.

None of us are here by accident. I believe that strongly. I have a strong faith in God. If we are not here by accident, then what is the responsibility for each of us that goes along with that?

To whomsoever much has been given, from him much will be required.

Therefore, we have a responsibility to do what is right, to be truthful, to be people of integrity in making Canada better and working with one another when it is appropriate to do so.

I have not always done things right. I have a very mischievous nature, as chairs of different committees can attest, so I would like to apologize for some of the problems I created.

Death does come to each of us, and to some very early. We just said goodbye to a very dear friend. He had an aneurysm and he was gone. God has given me some time. I may be around for a long time or I may be around for a short time. We do not know.

This is the most important part: It is that I want to encourage each of you to love one another, to encourage each other, because God loves us. Pray for another. Pray about what is really important. Help one another. Seek God's will for you each day. Do what is right. Be honest.

We read in Galatians:

But the fruit of the Spirit is love, joy, peace, forbearance, kindness, goodness, faithfulness, gentleness and self-control. Against such things there is no law.

It is all legal. It is all good.

Life is precious. Life is sacred. I have been reminded very freshly of how valuable and precious life is, from beginning to end.

God bless you. I love you all. I will look forward to being able to serve. Until October, it will likely be out of my constituency office, but to God be the glory.

[Michael Villeneuve, Chief Executive Officer, Canadian Nurses Association]

Thank you, Mr. Chair and members.

My name is Mike Villeneuve, CEO of the Canadian Nurses Association. I've been an RN for the past 35 years, and I worked for 40 years in the health care system in a couple of other roles.

I would like to thank the Standing Committee on Finance for the opportunity to present recommendations from CNA, which is the national and global professional voice of registered nursing, representing over 139,000 registered nurses and nurse practitioners across Canada.

Our submission highlights four recommendations, but I'd like to focus on two of them today.

Our first recommendation calls for the creation of a health care innovation agency for Canada. CNA believes that the federal government has an opportunity to build on what provincial and territorial counterparts have already achieved by facilitating new opportunities for health care innovations across Canada. We see the spark. There are some successful innovations right across the country, but there is no mechanism to help spread them and scale them up. A new federal agency would target funding on innovative health projects to ensure that they are adopted more widely for everyone in Canada, including indigenous peoples, wherever they live.

The new agency, for example, could lead efforts to evolve medicare to help overcome the sometimes fragmented nature of our health care system. To drive the notion of the right care provided by the right provider at the right time in the right place and delivered at costs we all can bear, we need innovations that will accelerate the de-hospitalization of health systems, not unlike what you just heard from the Canadian Medical Association president. Nurses work at all points in health systems, and we recommend that nurses have a strong leadership role in any such new agency. There are nearly 428,000 regulated nurses across Canada, and we're well poised to dig in and help.

The second recommendation I'd like to highlight today and encourage the committee to support is the third one in our submission, which is about improving access to palliative care and support for people in Canada who are acting as caregivers.

I am pleased to inform the committee that CNA is a member of the Quality End-of-life Care Coalition of Canada, and I serve as co-chair of a committee of the national network along with 38 other national organizations whose vision is that all Canadians have the right to quality end-of-life care that allows them to die with dignity, free of pain, surrounded by loved ones and in the setting of their choice. Most Canadians tell us that they want that care, and we know they could benefit from it. Better palliation drives down costs. Most Canadians never receive that care.

The challenges we face in palliative care are compounded by our country's aging demographics. As I always remind people, we are set to become one of 13 super-aging nations by 2020, just 18 months from now. Nearly one in four Canadians will be over 65 by 2031.

We recommend that the Framework on Palliative Care in Canada Act, which was passed into law in December 2017, must include targeted federal investments for both new and existing federal programs to improve standardization of delivery of palliative care for people across Canada. We were happy to support Bill C-277, tabled by the shadow minister of health. We acted strongly to help that move along.

New federal funding that is predictable and sustained would help to address the gaps that currently exist in palliative care across Canada. We are pleased that the framework recognizes the palliative care training and education needs of health care providers as well as other caregivers, and we urge the committee to support our recommendation to provide funding for early career access to palliative care training and education to nurses and all other health care providers.

Research tells us that our country does not have adequate palliative care training for health care providers. One way to address the gap is to include education and training in core curricula for students, but we also need to create structures to provide that education soon after licensure. We are also calling on the federal government to provide increased financial support for the country's 8.1 million caregivers by making refundable the former family caregiver amount tax credit, which is now under the new Canada caregiver credit, and extending the compassionate care benefits to include a two-week period of bereavement.

In its current form, the tax credit is not paid to recipients as a direct cash benefit. We support the drive to move care out of hospitals, but we have also pushed significant costs on ordinary people. Many caregivers face high out-of-pocket expenses for specialized medical aids, medications, transportation, hiring staff, lost wages and so on. A refundable tax credit could help ensure that all eligible households receive something in return for those expenditures of time and money.

Regarding the CCB, CNA believes that adding a two-week period for time for bereavement would allow flexibility for caregivers, many of whom are employed, after a patient's death. Such a measure also allows for a more reflective and humane palliative care process.

Currently, support that's provided for successful applicants only covers the caregiving period for up to 26 weeks and not bereavement. Adding that two-week bereavement period would surely provide caregivers with some important financial support after such a profound loss.

Thank you for hearing our ideas, and I look forward to our conversation.

Palliative Care

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

Mr. Speaker, it is an honour to present two petitions.

The first petition asks Parliament to establish a national palliative care strategy. It highlights that in the last Parliament, a motion was unanimously passed calling for the government to create a national palliative care strategy, and that in this, the 42nd Parliament, Bill C-277 passed unanimously, saying that it is impossible for a person to give informed consent on assisted suicide and euthanasia if palliative care is not available. The petitioners are calling on Parliament to establish a national palliative care strategy.

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

Once again, Ms. Gladu, we were very pleased, as the government, to be able to support your bill, Bill C-277, and we're very keen to move forward on its implementation and the work that needs to be done in that area.

We certainly recognize that all Canadians want to stay home as long as they can, but to do so, we certainly need to make sure they have the quality care and necessary care they need to live the rest of their days in comfort. Those support services are absolutely critical. We are very pleased, as I've indicated, to support Bill C-277 and to work on the development of a framework that promotes palliative care.

I was also very pleased that we were able to make some announcements this year, and I believe you were with me for the funding announcement of $6 million for Pallium Canada. Those monies were put in place to expand existing services, called the learning essential approaches to palliative care program. That money will go specifically to front-line service providers, like ambulance attendants or EMTs, to provide them with the training they need so that when they go to homes, especially in rural areas where they can provide direct services to people at home, they will be able to provide people with the additional quality services they need so they won't have to go to community centres or hospitals to receive those services. We're certainly moving forward in that direction and making sure that investments are made in that area.

I was also pleased that we've invested $184.6 million over the next five years to improve home palliative care for indigenous communities. We recognize that an awful lot of work needs to be done in that area, and we certainly recognize that those investments will help moving forward.

Finally, we recognize as well that research is key in this area, so we're investing over $2.8 million over the next four years to support two research teams, which I'm sure you're probably well aware of. We certainly want to generate high-quality research and evidence to inform professionals in health care with respect to best policies as we move forward in end-of-life care and the policies that we need to put in place.

Finally, Mr. Chair, with respect to the investments that we've made in home care in budget 2017, $6 billion has been put aside, and I'm in the process right now of completing bilateral agreements with provinces and territories. In the ones that I have seen thus far, palliative care services are absolutely mentioned in those, as well. They may not be a line item in the budget, but we certainly know that provinces and territories, especially with our aging population, and people who want to make sure they expand palliative care services see it as a priority.

Budget Implementation Act, 2018, No. 1

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

Mr. Speaker, it is a pleasure to be here to speak to this budget implementation bill. My speech today will be called “promises, priorities and plans”. When we put a budget together, we should consider the amount of money we will need to keep all the promises we have made. Of course, there is not an endless amount of money in the world so there is a need to prioritize those promises we have made to ensure we hit the important ones and put those first.

Then it is important to have plans. We all know that without plans, we may spend a lot of money and not really accomplish anything, which we have seen an incredible amount of from the Liberal government.

With respect to promises, one of the early promises made by the government, which we hear repeatedly, was that it would run very small deficits, a small deficit of $10 billion in the first year, coming to balance in the fourth year. However, we have seen double that deficit in the first year, double the deficit in the second year, and triple that deficit in this budget. There is no end in sight with respect to balancing the budget. It is certainly not going to be in the fourth year of the mandate. Now it looks like it may not be until 2045. This is promise was broken into about 1.5 trillion pieces.

The other thing is that a lot of promises were made that were extremely important to rural communities across Canada. The first one was the restoration of home mail delivery, which for people who are living in very rural places, especially those who are elderly, is a very important service.

Even more important than that was the promise about infrastructure money. Members can remember that we were going to spend infrastructure money to create jobs and get the economy going, and that money was going to be spent on roads and bridges in municipalities. This is a critical thing in ridings like Sarnia—Lambton, where we have a lot of roads and bridges that need to be fixed, and the municipality certainly does not have the money to fix them. I was disappointed with the last budget when the government took $15 billion from those municipalities and put it into the infrastructure bank. Of course we have seen nothing come out of that whole situation.

Then there was the Asian Infrastructure Bank to which the government gave another half a billion of taxpayer dollars to build roads and bridges in Asia, which is not helping the rural community at all. Thus was another broken promise.

One of the most disturbing promises broken by the government was that of openness, transparency, and a higher ethical standard. Every time we ask questions about what is in this budget, such as the carbon tax that is outlined heavily in the budget, the government refuses to say how much it will cost the average Canadian taxpayer. The average Canadian taxpayer wants to know. If it is not a bad number, then why is it afraid to say it? Obviously, if it does not want to tell Canadians, it is because it is bad news.

Beyond not telling them how much it will cost, it will not even tell us what it will accomplish. The environment minister has been asked multiple times at committee, and here in the House, what kind of a greenhouse gas reduction she expects from this, and she has no answer. There is a huge amount of money being spent in the budget in this area. There is a huge amount of tax that will be paid by Canadians, yet there is no openness and transparency from the government with respect to those issues.

The government promised not to use omnibus bills, and here we are again with this huge budget bill. So many things have been snuck into this bill that if we did not really read all the pages, we might not be aware of them. My colleagues to the left have already talked about the medicinal marijuana issue and the taxes associated with that. However, more so, there is language in the budget bill that suggests that if people had a drug information number, they would be exempt. The fact remains that there is no drug exemption number for any medicinal marijuana because of the variability of all the components. Therefore, that is just another misrepresentation in the budget bill.

With respect to the taxes on cigarettes' portion of the bill, there is an escalating tax that continues to go up in perpetuity, without any parliamentary vote and without Canadians being able to talk about that. This is the same kind of deceptive tax that was put on beer and wine. It is fine for the government to put a sin tax on something when it wants to, but when it wants to hide a tax in there that continues to go up and generates revenue for the government, and it sneaks it onto page 324, Canadians may never get to that.

Therefore, there is no openness and no transparency in omnibus bills.

As members know, I am a passionate advocate for palliative care, so I was very excited when the government said it would spend $3 billion on home and palliative care in the 2016 budget. Then the government updated the 2017 budget and said that it would spend $6 billion over 10 years. It was a little more paced out, but at least it was something. I was really disappointed to see the word “palliative” removed from the 2018 budget. It was taken out altogether, even though the government supported my private member's bill, Bill C-277, on consistent access for palliative care for all Canadians. Surely, if we want there to be consistent access, we know we will have to plan something to back up that promise and put money in the budget. I was very disappointed there was nothing in the budget on that.

I will go to priorities.

One would think that in a country with one person out of six being a senior, maybe seniors would be a priority, but no. The Liberal government took position of minister for seniors away, and there is relatively nothing in budget 2018 that will help seniors, many of whom really struggle to afford to live and pay for many of the things they need, such as cataract surgery, perhaps hearing aids or dentures. I certainly heard this when I went door to door. A priority has been missed.

Then there is the agriculture sector. Agriculture is hugely important in Canada. Everyone can agree that we need to eat. This is one of our largest industries. What is the government doing? First, it is loading all kinds of bureaucracy on the Canadian agriculture industry that does not apply to other people. It has taken away pesticides without any replacement. Those very pesticides are used by countries that then import their food to Canada, putting us at a competitive disadvantage. Most recently, it decided it would not allow the sale of premixed feed that contains antibiotic. This product has been sold safely for quite a number of years. Again, it is a burden on our industry that is not on other industries outside of the country that ship products into Canada.

There is very little support for research in agriculture, very little support for the industry overall, and total betrayal when it comes to the agreement that was made with respect to the TPP, that farmers would be compensated for the quota they had to give up. That is gone. They still have to give up the quota, but they do not get the compensation. It is another broken promise for the agriculture industry.

Regarding health care, the government's priorities are really screwed up. The government putting $80 million in a budget to get people to stop smoking tobacco is a wonderful thing. However, to then put $800 million in the budget to get people to start smoking marijuana just does not seem like the right message from a health point of view, especially when we consider the danger to children.

Then there is the $7-billion slush fund. I am not sure what kind of priority that is backing up in an election year, but I can only guess. That is a disappointment as well.

Then there are plans. We do not see any plans. We have talked about how there is no climate change plan and no answers on the carbon tax. What about NAFTA? The Liberals have known for over a year that tariffs could be put on the steel industry. There is no plan and no money in the budget to address that whatsoever.

What about this $4.5-billion pipeline? Members can hear that my voice is a bit hoarse from having a $4.5-billion pipeline that is 65 years old being shoved down my throat. Where was the plan for that in the budget? It is missing.

Overall, when we look at this budget, we can see that when it comes to promises, priorities, and plans, the Liberals have broken their promises, their priorities are definitely screwed up, and they have no plan to achieve anything. That is a super disappointment.

Health

[Ginette Petitpas Taylor, Liberal, Minister of Health]

Mr. Speaker, we recognize that Canadians want to stay independent as long as possible and if they need services, they want to receive them within their home. In addition to the Canada health transfer payments, we have invested more than $6 billion to provinces and territories to ensure that better home care and palliative care services are in place. We recently announced $6 million to Pallium Canada to increase capacity to deliver palliative care to communities.

I look forward to working with provinces and territories as we move forward in the implementation of Bill C-277. We certainly want to make sure that the provisions of the bill are put in place.

Palliative Care

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

Mr. Speaker, I am honoured to present two petitions today.

The first petition relates to a national palliative care strategy. It highlights that 70% of Canadians who need end-of-life palliative care do not have access to it. The petition also points out that it was this Parliament's decision, passed unanimously, to create a national palliative care strategy in support of Bill C-277.

The petitioners call on every member in Parliament to support palliative care and respect the international definition of palliative care by the World Health Organization that palliative care neither postpones nor hastens death.

Financial Statement of Minister of Finance

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

Madam Speaker, to get 10 minutes to talk about budget 2018, when I first got elected, I would have thought was a long time, but now it just does not seem to be that much time.

This budget was not well received by most Canadians. I am going to talk about health care, infrastructure, and some of the spending. I was always told that when one is bringing a critical message it is good to make a sandwich and say something nice at the beginning and something nice at the end. Therefore, I am going to say something nice at the beginning and something nice at the end.

The thing I will say at the beginning is that I was pleased to see that the response for science to the Naylor report was a good one. As the former science critic for our party, that was something I was looking for. I do not have anything bad to say about that, but now I will turn to the other issues.

The first topic of discussion of course has to do with palliative care. I was surprised that the word “palliative” does not appear once in this budget. After seeing the word “palliative" in budget 2017, and considering the unanimous support of the House of Commons and the Senate for my bill, Bill C-277, regarding palliative care, I was surprised that the word was not mentioned in this budget.

In 2017, the federal government proposed investing $6 billion over 10 years for home and palliative care, as well as $5 billion over 10 years to support mental health initiatives. These investments included improving home care services in Canada, as well as palliative care. In other words, there was $11 billion for mental heath, home care, and palliative care. However, budget 2018 announced different investments, specifically $11 billion over 10 years for provincial and territorial governments to support home care and mental health, but not palliative care. There is no mention of palliative care.

Palliative care is a necessary but extremely underfunded service in our country. By leaving palliative care out of the budget, the government is ignoring the needs of many desperate Canadians who need financial support not only to improve their living conditions, but also to help ease the burden on our health care system.

The second issue has to do with mental health, dementia, and PTSD. As with palliative care, budget 2018 fails to make investments in mental health care. As I mentioned earlier, only $11 billion was earmarked for mental heath, including home care. That is not enough. Canada is still in crisis, and we must do everything we can for all those in need.

To make matters worse, the federal government is investing only $20 million over five years and only $4 million a year after that for Canadians with dementia. Over 400 million Canadians have dementia, including Alzheimer's, and this disease disproportionately affects elderly women. That amount is simply not enough. Given our aging population, we need to prepare and invest in quality programs.

I would like to thank my colleague on this side of the House for all of the work he has done regarding injuries and post-traumatic stress. I believe that it is thanks to him and his efforts that investments were made in this area. However, the government is proposing to invest only $10 million over five years to create a pilot project. Research and pilot projects are important, but so are services for all those who are living with PTSD. I believe that this is a step in the right direction but that the government needs to do a lot more.

Another point worth noting is the $20-million investment, and $6 million a year going forward, to improve mental health supports for offenders in federal correctional facilities. Those funds are intended specifically to enhance supports for women inmates in those institutions.

Despite those small investments, the government is also proposing to provide $10 million over five years for the Mental Health Commission of Canada to assess the effects of cannabis use on Canadians' mental health.

The Liberal government is doing everything it can to control and limit cigarette use, yet it wants to legalize marijuana as soon as possible, despite knowing the mental damage it can cause to users. This $10-million investment proves that the government recognizes the dangers associated with cannabis, yet it is going ahead with full legalization anyway.

What really struck me in this budget is where the government put the priorities in terms of health. There is $80 million in the budget to get people to stop smoking, but there is $800 million in the budget to get people to start smoking marijuana. That seems like the wrong priority. At the same time, while people are dying across the country in the opioid crisis, there is $40 million a year being put toward that crisis. Again, in comparison to the legalization of marijuana, it just does not seem to be the right priority at all.

I talked about my disappointment that palliative care was not even mentioned in this budget. I had approached the minister with a plan for once the framework was put together to build palliative care infrastructure across Canada. When we talk about the infrastructure spending that was promised by the government at the beginning, that was the whole reason for going into deficit. However, it does not seem that the money is flowing to the municipalities. What could be a better example than my riding?

Most members know that on January 11, the Canadian Coast Guard decided not to close the channel, which it normally does when ice floes are heavy, and the resulting push from the icebreakers crushed the Sombra ferry causeway. That border has been shut since January. The Minister of Public Safety is in charge of the CBSA, which makes $3.3 million in duties from that crossing every year. I approached the minister to get the repair money to put that back together. At first there was no response, but then a denial. I approached the Minister of Transport, who has the responsibility for the trade corridor funding. Again, there was a refusal. I approached the infrastructure minister, who seems to be looking for somewhere to spend $186 billion. I only need $2.5 million. Certainly, he could spend it on the restoration of the Sombra ferry crossing, but again, that was refused.

Combat engineers in my riding said that if the Minister of National Defence decides that it is in the national interest, he could send them to repair the bridge. They had done that in Laval and Guelph, and they could do it elsewhere. Again, there was a great opportunity, but the Minister of National Defence turned me down. I have escalated this to the Prime Minister's Office, but nothing has been done. When the government states that it wants to spend money on infrastructure and the municipalities, it falls on deaf ears for me and my constituents, who feel that there is no infrastructure money for the Sombra ferry restoration in Sarnia—Lambton.

That said, at the beginning of my speech I gave some commentary about the things I thought were missing in the budget, and said that I would say something nice at the end. I have a couple of nice things to say.

I was glad to see a reference to the thalidomide issue. We know there are people who did not qualify for their thalidomide claims because they could not produce the paperwork. I have brought this to the attention of the Minister of Health, and I am pleased to see that this has been put into the budget. No dollars were associated with it, but I am trusting that money will be parcelled out to those people who deserve compensation.

Other than that, the only other happy news is that most of the spending has been pushed out into the years after the Liberal government will have been defeated.

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

Mr. Speaker, I appreciate your leadership. I will be sharing my time with the incredible member for Milton.

It is a real honour to make comments today regarding the 2018 budget.

Canadians are looking to the budget with great hope that the government will be responsible in its spending, that its focus and priorities will be balanced and prudent, and that it will be careful with their tax dollars. The budget is about what we do with the resources, the taxes that are collected by the government from Canadians. Are taxes going to go up or down? Will things become more expensive and less affordable?

This is a political place where we have very interesting debates at times. However, it is important that we listen to some of the experts. One of those experts is the Parliamentary Budget Officer. It is important that we rely on the unbiased professional critique of this budget.

We have seen huge announcements in this budget. This is the third budget that the Liberal government has introduced. It has one more budget to bring in, in another year. Is the government doing a good or bad job? Is it responsible or irresponsible? We have seen hundreds of billions of dollars in announcements that have been made over the last almost three years, and the Parliamentary Budget Officer has provided an important critique.

After the budget was presented, it was recently reported that budget 2018 provides an incomplete account of the changes that the government has made to its $186.7 billion infrastructure spending plan. The PBO requested the plan, but it does not exist. Roughly one-quarter of the funding allocated for infrastructure from 2016-17 to 2018-19 was not spent and will lapse. The money was announced but was not spent. The mystery for Canadians is how these announcements can be made, how we can have a growing deficit, a growing debt in Canada, yet the money is not being spent. Where is this money going?

The Fraser Institute provided an analysis on this budget. It stated:

In the midst of serious concerns over Canada’s economic prospects, and challenges emerging from the United States, [the] Finance Minister[’s]...2018 federal budget does nothing to address these problems. In some respects, the budget makes matters worse by continuing the government’s self-destructive policies of chronic deficit-financed spending and new taxes on entrepreneurs.

It does not sound good.

Andrew Coyne stated:

Once upon a time the federal budget was about the budget of the federal government. It was an annual opportunity for Parliament and the public to examine the federal government’s program of expenses and revenues for the coming fiscal year.... All that is now in the past.

It sounds like what the Prime Minister said at the beginning, that budgets balance themselves. We all know they do not, and it is no mystery why we have this growing problem.

John Ivison of the National Post wrote, “as the Liberals have proven over the past two years, policies are adopted to get elected, not necessarily to be implemented.” We continue to hear announcements of hundreds of billions of dollars with no action taken.

I am particularly concerned that there is almost no mention of seniors in the budget. I am the critic for palliative care and income security for seniors. I listened intently to my colleague on the other side when he spoke about seniors. In budget 2018, there is no mention of seniors. He spoke about the national housing plan. That is reliant on the provinces buying into that plan, but the provinces have not bought into it. Again there are a lot of big announcements and confetti in the air, but no substance in those announcements. Just as we heard from the Parliamentary Budget Officer regarding the billions of dollars for a national infrastructure plan, that is fizzling. The Liberals are not getting it done.

As for seniors, the mystery is why there is no priority for seniors. We have heard announcements about how important seniors are to the government, but in the budget document, they are missing. There is no mention of seniors and the importance of seniors, except for one time. There is no minister advocating in cabinet for seniors. In the shadow cabinet on this side, in the official opposition, we have two members of Parliament appointed to deal with the issues of seniors. Why is that? It is because we have a growing aging population, and it is very important that we take care of our Canadian seniors. At least it is on this side of the House. Therefore, we encourage the government, as do stakeholders across Canada, to appoint a minister for seniors so that there is a strong voice at the cabinet table. Because that voice is missing, seniors continue to be ignored.

There were dollars in the previous two budgets for palliative care. Palliative care is end-of-life care that Canadians need. Seventy per cent of Canadians who need palliative care do not have access to it. That is why, with the passage of Bill C-277, this Parliament unanimously supported providing palliative care, but we have to have the dollars appointed to it in the budget, and they are missing. The dollars used to be there. They are gone. Hopefully the government will consider an amendment to its budget to include those dollars again for palliative care, because we will continue on a trajectory where we have Canadians not having the palliative care that is needed.

The healthy seniors pilot project was announced for New Brunswick on page 173. I would suggest another amendment to include the west. Where are most Canadian seniors going to retire to spend the last years of their lives? It is on the west coast in the Vancouver and Victoria areas. The west coast is where the climate is much more favourable. Accessibility is better year-round. Flowers actually are growing right now in that area, and people have already started to cut their lawns. Spring is coming to this cold, white area, but that is where seniors like to retire. Why was the west not included in a pilot project? It is because this is the government's riding. It is a partisan appointment, and dollars were appointed based on politics, not on the needs of seniors.

The other issue is the Canada summer jobs program, mentioned on pages 56 and 250. We had a very sad vote here in the House yesterday. Each of us, as members of Parliament, have received our list of applicants. I am going to be digesting that and going over it carefully, but it has really changed. It is not on par with previous Canada summer jobs programs. I looked very carefully, and it is primarily for commercial applications. The not-for-profit organizations have provided job experience and are very important to bless our communities. It is all gone, it appears.

I am concerned that this has affected my opportunity to carry out my responsibility as a member of Parliament. Every year for the last 14 years, I have gone over that list. Because of the government's discrimination against Canadians, because of its bias, it has introduced the new values test. Quality job experiences for our youth have been lost. It is not fair. It is not equitable. There are going to be fewer job opportunities because of what the government has done. It is not on par with previous years. Hopefully the government will consider an amendment to that too.

Palliative Care

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

Mr. Speaker, I am honoured to present three petitions to the House today, the first being on palliative care.

The petitioners acknowledge that 70% of Canadian residents that need end-of-life palliative care do not have access to it. They are calling on Parliament to support Bill C-277 to ensure that every Canadian that needs palliative care has access to it, and that palliative and hospice care do not hasten nor postpone death.

Health

[Ginette Petitpas Taylor, Liberal, Minister of Health]

Mr. Speaker, I would like to thank my friend and colleague the member for Cumberland—Colchester for his hard work on this matter.

As my colleague highlighted, in addition to Canada's health transfer, our government is providing $6 billion to provinces and territories to support better home care and palliative care services. We were also pleased to support Bill C-277.

Earlier today, I was very pleased to announce an additional $6 million in funding to Pallium Canada to train additional health care providers so that they can provide services to Canadians when at home. Bilateral agreements are in the process of being signed, with already two being done and many more to come in the very near future.

[Ginette Petitpas Taylor, Liberal, Minister of Health]

Mr. Speaker, we know that the majority of Canadians want to stay independent and receive the care they need within their homes. Quality in palliative care is critical to making this happen.

In addition to the Canada health transfer, our government is providing $6 billion in federal funding directly to provinces and territories to better support home care, including palliative care. Our government was pleased to support Bill C-277, and looks forward to working collaboratively with provinces, territories, and stakeholders as we move forward. Also, I am in the final stages of completing some bilateral agreements with several of the provinces and we look forward to working again with them.

[The Speaker, Liberal, Geoff Regan]

I have the honour to inform the House that when the House did attend Her Excellency the Governor General in the Senate chamber, Her Excellency was pleased to give, in Her Majesty's name, the royal assent to the following bills:

Bill C-305, An Act to amend the Criminal Code (mischief)—Chapter 23.

Bill S-211, An Act respecting National Sickle Cell Awareness Day—Chapter 24.

Bill S-3, An Act to amend the Indian Act in response to the Superior Court of Quebec decision in Descheneaux c. Canada (Procureur général)—Chapter 25.

Bill C-60, An Act to correct certain anomalies, inconsistencies and errors and to deal with other matters of a non-controversial and uncomplicated nature in the Statutes of Canada and to repeal certain Acts and provisions that have expired, lapsed or otherwise ceased to have effect—Chapter 26.

Bill C-23, An Act respecting the preclearance of persons and goods in Canada and the United States—Chapter 27.

Bill C-277, An Act providing for the development of a framework on palliative care in Canada—Chapter 28.

Bill C-67, An Act for granting to Her Majesty certain sums of money for the federal public administration for the fiscal year ending March 31, 2018—Chapter 29.

Bill S-236, An Act to recognize Charlottetown as the birthplace of Confederation—Chapter 30.

Bill C-36, An Act to amend the Statistics Act—Chapter 31.

[Melissa De Boer]

Social inclusion and quality of life for Canadian seniors also extends to dying well. Nurses advocate for dying well as an extension of living well. It is estimated that 90% of Canadians will require care and support at the end of life, yet currently less than a third of Canadians are estimated to have access to high-quality palliative care services. Palliative care must extend beyond care for those who are dying from cancer to also support those who are dying from chronic conditions.

Professor Sheryl Reimer-Kirkham is involved with a University of Victoria research team led by Dr. Kelli Stajduhar on end of life care for persons who are under-housed. This research is showing how dying happens in the cracks between our health and social services, and that end of life care is often provided by volunteers and shelter staff who know little about how to care for the dying. Other times, vulnerable seniors are dying alone on the streets.

Bill C-277, a framework on palliative care in Canada, is a chance to address this. We need a coordinated approach to palliative care, coordinated across sectors, jurisdictions, and levels of government. Linking a national seniors strategy with a national home care plan and a pan-Canadian palliative care strategy will ensure that a shared-care model is coordinated, comprehensive, and effectively administered across governmental sectors.

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

I apologize, Madam Speaker. That was my error.

The article states that:

The man advising [the Prime Minister] on building a new infrastructure financing agency was told the body could take on a “significant” amount of risk to help projects come to fruition.

The agency would “help bear a significant portion of the risk” in a project if the government took on an equity stake to make a project more attractive to private investors, says a confidential briefing package prepared for special adviser Jim Leech.

The Feb. 20 briefing document says the bank could take on debt that allows other debtors to be paid first in order to provide a “loss buffer” to the private sector, or invest on an equal footing “at concessionary terms.”

That latter reference could mean giving a private partner exclusive rights to use and receive revenue from a piece of infrastructure, like a rail line—such as the arrangement between the U.K., France and the private companies involved in the Channel Tunnel.

With reference to the infrastructure bank, we have asked time and time again in the House of Commons if there will be risk to the government and to the private sector. All the opposition side, whether the official opposition or members of the NDP, has heard is that the only person on the hook for this will be the taxpayer. The only way we were going to get this type of information was through an access to information request, and it was requested by the Canadian Press. The government has backgrounders on information and it is not willing to share because it is against its mandate and agenda. We see that with the carbon tax and the infrastructure bank. We are asking for some transparency on behalf of taxpayers. Somebody needs to be the voice of the taxpayers.

By no means am I an economist. I like to look at things as simply as possible. I am looking at information from the Fraser Institute, which noted that in 2016-17 the combined debt of the federal and provincial governments will be $1.4 trillion. I know we have talked a lot about this. People have said that deficits do not matter. We have heard that over and over again. However, when the government continues to spend greater than the revenues received, it will matter. It will have an impact on those things that are vital and important to Canadians, our top priorities.

If we know we are spending billions of dollars, a lot of which is money that we have borrowed, imagine when we have to start paying interest on that, money that could benefit Canadian society. I believe the cost would be over $37,000 per person if we were to divide the debt among everybody. That is more than the cost of my new car. That means everybody would be able to buy a brand new car as of today. I want to put that into perspective, because most families are buying a used car or cannot afford a car at all.

The government is spending all of this money. If we are looking at $62.8 billion just in interest in 2015-16, let us put that into what really matters. The member who sits beside me could buy the Toronto Maple Leafs 62 times over. Everybody knows how wealthy the Toronto Maple Leafs team is. Our debt is 62 times the worth of the Toronto Maple Leafs. We could buy 315 F-35 fighter jets. Would that not be wonderful for our troops? Instead, we have to worry about a debt that will continue on.

I look at the effects this will have on our generations. We talk about the debt, but we really do not understand the effects of that debt. What will that mean to the future of our health care system or our our educational system? How will that affect the environment, something so important to the government? How will that affect the government if we spend all of the money today? Later on we will be unable to afford anything. It concerns me because as we move forward with the great plans of the government, all we see is debt. We have already discussed that the debt we are accumulating is all on borrowed money. Who is going to pay this debt back? Debt and deficit do not seem to be key words for the government, but for most families it is.

As the critic for family, children, and social development, what would happen if we budgeted that way in our own homes? We would lose our cars, houses, and everything we ever owned. We cannot max it out time and time again. This is what the government is doing.

A lot of times when we have this conversation, the government of the day will reflect back to the spending of the previous government when we went through a global economic downturn. There was one in 2008, 2009, and 2010. We were the first country to recover, and we did so very well. I would like to thank the late Minister Flaherty for doing such a phenomenal job in the work that was done in Canada. Out of that spending, there were new arenas, new roads, new facilities for our communities, and a lot of growth in the economy as we went forward.

Now we are spending for the sake of spending and it does not make sense. We are not in a global recession when we need to go up against huge debt. I do not know why the government is putting our future in debt time and time again. The next generation will pay for this. When we look at medical care, such as palliative care, as Bill C-277 put through, why are we not investing in things that are really important to Canadians? Why are we not investing in long-term plans? We are spending so much money. I could talk about the $130,000 spent by the Prime Minister to travel abroad. Something as simple as that reflects respect for Canadian taxpayer dollars, and we do not see that.

I will bring this back in layman's terms. A lot of times when we talk to Canadians, we often talk about such big numbers, and they cannot grasp it. We are talking about miles and miles of money. If we laid it down, how much would it look like? A lot of times Canadians cannot put it into perspective because it is so grandiose. We want to do a lot of things in Canada and I am really fearful of where this ongoing debt and bad plans, such as the infrastructure bank and all of the other things that are planned, are going to put our country. It is going to put our grandchildren far behind the eight ball. What is going to happen to their education and health care? These are so important that we have to step back and ask ourselves how we can do it better. We are spending and spending and there is no plan to get back to a balanced budget.

Again and again, the opposition side has asked the government for its plan to get back to a balanced budget. Unfortunately, I do not think any member on the government side has actually said there is a plan. All we are hearing is 2035, 2055, or whenever it may be, but it will not be in two or three years, as it should be. When the government was elected, you said there would be a $10 billion deficit and I am not sure why you, time and time again—

Framework on Palliative Care in Canada Act

[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.

[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.

[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.

[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.

[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.

The House resumed 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 third time and passed.

[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.

The House resumed from May 9 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 third time and passed.

[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.

[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.

[Joël Lightbound, Liberal, Parliamentary 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.

[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.

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

moved that C-277, An Act providing for the development of a framework on palliative care in Canada, as amended, be concurred in.

The House proceeded to the consideration of Bill C-277, An Act providing for the development of a framework on palliative care in Canada, as reported (with amendments) from the committee.

Hospice Palliative Care

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

Mr. Speaker, I am honoured to stand today in support of National Hospice Palliative Care Week 2017.

Hospice palliative care is about living well right to the end. Seventy per cent of Canadians have no access to such services, but we have the power to change that. My private member's bill on palliative care comes back to the House tonight for third reading. This bill has been supported by all parties in the House and I hope to have members' support again this evening.

Bill C-277 would create a framework that would define the services to be covered, the training needed for different levels of care provision, the data and research needed, support for caregivers, as well as a comprehensive plan to get access for all Canadians to palliative care so that each of us can choose to live as well as we can for as long as we can.

[The Chair, Liberal, Bill Casey]

I call the meeting to order. This is our first meeting on M-47.

I also want to say that we tabled Bill C-277 this morning, and that went smoothly. Congratulations. That's the eighth report of our committee.

We are starting M-47 today, and we have a bit of a change in our witness list from the schedule. One witness is not able to be here, for personal reasons. I understand we are also having technical difficulties with Pennsylvania.

In any case, we're going to start. We have Professor Jacqueline Gahagan, interim director and assistant dean in the Faculty of Health Professions at Dalhousie University. Welcome. We also have Kathleen Hare, doctoral student in the department of language and literacy education at the University of British Columbia. We have both ends of the country represented here, and we are very pleased to have you.

Eventually, we are hoping to have Dr. Mary Anne Layden, director of the sexual trauma and pychopathology program in the department of psychiatry at the University of Pennsylvania, but we have not successfully made the hookup yet.

I want to welcome you to our committee. Each of you has a 10-minute opening statement.

I understand that Ms. Hare is going to start.

Health

[Bill Casey, Liberal, Cumberland—Colchester, NS]

Mr. Speaker, I have the honour to present, in both official languages, the eighth report of the Standing Committee on Health in relation to Bill C-277, An Act providing for the development of a framework on palliative care in Canada. The committee has studied the bill and has decided to report the bill back to the House, with amendments.

I want to thank the MP for Sarnia—Lambton for her good work on this. This bill had all-party support. It is timely and very much appreciated by all. Certainly, I am very pleased and proud to present the report.

[Sonia Sidhu, Liberal, Brampton South, ON]

Good morning, Mr. Chair.

I want to amend Bill C-277 in clause 2 by replacing lines 21 and 22 on page 1 with the following:

care providers, develop a framework designed to support improved access for Canadians to palliative care—pro-

[The Chair, Liberal, Bill Casey]

I call this meeting to order.

We're here to do clause-by-clause on Bill C-277, a very controversial and difficult bill that everybody's had a lot of trouble with.

At any rate, we're going to do clause-by-clause on this and we have some proposed amendments.

Pursuant to Standing Order 75(1), we will postpone consideration of the preamble and the short title and go right to clause 2.

(On clause 2)

We have a Liberal amendment proposed by Ms. Sidhu.

Ms. Sidhu.

[The Chair, Liberal, Bill Casey]

We'll discuss that, but thank you very much.

Now we have a little committee business we have to do, as quickly as we can. We have all-party agreement, I think, on changing the schedule. The next meeting is going to be clause-by-clause. That's settled. The meeting after that will be on M-47, on March 23.

Would somebody move the adoption of the budget for Bill C-277, to help pay our witnesses?

That's moved by Dr. Carrie.

(Motion agreed to)

Thanks for that.

Just before we leave, one last thing. We need to adopt the work plan for M-47. Everybody has a copy of it. Do I have a motion to adopt the work plan for M-47?

Thank you, Mr. Viersen.

(Motion agreed to)

That's it. The meeting is adjourned.

[Dr. J. David Henderson]

We need the leadership and somebody holding the rudder of the ship, so with Bill C-277, it's having a secretariat, starting to form a work group. We can have that oversight to start to put in the standards, to make sure the indicators and so on are in place so that we can gather the proper data so that we can see where the real gaps are, and then really start to fill those.

We have a lot of recommendations on how the gaps can be filled, but we need that oversight and the authority to start saying, “Okay, this has to happen.” There has to be an investment of some monies, and I know there have been promises of monies going towards home care.

I was in Nova Scotia when the last health report came around and there was the basket of services. Within that, there was supposed to be a fair bit of money for palliative care issues within the provinces. I know in Atlantic Canada it was years before we saw anything happen. We did eventually, in Nova Scotia, start to see some improvements in the amount that home care patients with palliative care needs could have. It was just two years ago that we actually had medications, what we call palliative care medication entitlement, in place, so it was that long after to get anything happening.

Those are very basic things. We haven't had any increase in staffing for our programs since 2004 despite having a 400% increase in referrals. We need human resources. We need the specialty teams who can then start to work out, fan out, provide the education, the mentorship, the capacity building to raise the tide so that all the ships rise and we can all do this better.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Dr. Chasen, I had an opportunity to go to the Brampton Civic Hospital where you work. I also toured the geriatric ward. Can you share some of the challenges faced by a palliative care unit on the front line at Brampton Civic, which would provide a useful tool for making Bill C-277 and the future national palliative care plan?

[Dr. Martin Chasen, Medical Director of Palliative Care, Brampton Civic Hospital, William Osler Health System]

Good afternoon to all of you.

I am a clinician in the trenches, and I think that what I'm going to say to you will answer a lot of those questions, because I'm going to show you that it's all practically possible and it delivers good results.

I'll present myself. I am from South Africa. I came here in 2004, to McGill, initially. Then I went to Ottawa, and I'm now in Brampton. I am a qualified internal medicine specialist, as well as a medical oncologist, and I also have a degree in palliative medicine.

In South Africa, which has the reputation of having the most hospices in Africa, we indeed have a recognized university degree. I was in the first class that got it, in 2004. We do see that having it formally recognized changed a lot of government policy.

I'm going to reference two documents. The first is Bill C-277, which clearly says that in order for a patient to have a proper...and to really have a voluntary decision to participate in medically assisted dying, he must be given the choice of palliative care. I think that has motivated me a lot to develop what we've done.

I'm not sure if any of you know about the 2015 quality of death index. It's a report by The Economist's intelligence unit, and I think it is enough motivation to say that Canada is at number 11 on the list. This is not good enough. Before I got to Canada, I did read that the Honourable Irwin Cotler, in 2002, when he was justice minister, said that palliative care is a basic human right, and I think we should move forward on that one.

You may have heard many definitions of palliative care as an approach that looks at patients who have life-limiting disease and their families, and that is impeccable symptom management. It definitely involves the psychosocial, spiritual, physical, and every other domain of a human being. It's holistic care.

In the World Health Organization definition, there are little attachments that people don't know about, and I'm going to speak specifically about three of these attachments.

First, palliative care “affirms life and regards dying as a normal process”. It doesn't “hasten”, nor does it “postpone” death. It “offers a [full] support system to help patients live [as long as possible and] as actively as possible”, keeping people as comfortable as possible for as long as possible. It has a goal of enhancing quality of life, and once again, it is “applicable early in the course of illness”.

This is not just about end-of-life care. We now know from many clinical trials in patients.... The most topical one is in patients with metastatic lung cancer. The patients who were randomly assigned to receive palliative care and normal chemotherapy had less chemotherapy and lived longer.

This is the model that we put together, initially in Ottawa and now in Brampton. What it looks at is the four pillars. This is a model where we start with an in-patient palliative care service for those patients requiring specialist palliative care: terrible pain that's not controlled, extreme anxiety, or existential issues, so the patient needs to come into hospital to be treated in a palliative care unit.

We also have a consultative service in our hospital, where patients are referred to us from the different wards—orthopaedic, medical, geriatric, internal medicine—and I'll show you that. Patients are seen and treated in conjunction with the most responsible physician. We cannot see all the patients. There are more than enough patients, so our aim is to build capacity. I'm surprised that nobody is speaking about building capacity at such a great level, but we have an enormous obligation to build capacity.

Then, what we recently started is the ambulatory outpatient clinic; we have patients who are able to come to the clinic and are seen. We also—I'm going to show you some results of this—have a robust community service. We have patients being seen in their home by a physician, as well as a nurse. We work as a dyad.

Around the centre of these four pillars, we are embedded within education, because without education we will never be able to build capacity. In our specific area in the LHIN, we have made it a goal to have as many of the LEAP courses as we can to build capacity. I'm sure you've heard of that, learning essential approaches to palliative care, with the Pallium project.

Then, of course, we all need to know that research is important. Why is it important? Because research allows you to have that margin of error. It tells you you're not doing as well as what you want to do, that you need to research this to get better. It's a self-audit. Let's use our model, and it works.

Since I started this program in Brampton, these are the patients who have been referred to us as new patients, and you will notice that the majority, more than 765 patients have been referred to us from general internal medicine. Palliative care is not only about patients with cancer, and I will once again ask you to please not call them palliative care patients. They're patients with cancer, cardiac failure, renal failure, chronic obstructive airways disease. They're patients with a terminal disease.

We're getting patients from all spheres, and this brings in the question: how do we bring it in earlier? How do we start the earlier goals of care discussion? From the ER, we've had 104 patients referred directly to us. How do we start the discussion of advance care directives, not necessarily saying that a DNR doesn't mean any treatment? I like the term ANC, allowing natural causes, but, of course, explaining to a patient that it means that everything possible that can be done will be done to keep them as comfortable as possible for as long as possible.

Here are some little graphs that we can show you since we started the palliative care outpatient clinic at the Brampton Civic Hospital, as well as the Etobicoke General Hospital. We only got it going in April of last year, but you can see that we're having more and more patients referred to us on an outpatient basis. We have already admitted 60 patients into the ward directly from the community through the outpatient clinic. They have not gone to wait for a day or two in the ER, where you have 400 to 600 visits a day, where you have people coming from the long-term care facilities who can wait 30 hours there, where you have 300 patients from the long-term care facilities dying in the ER while waiting to see a doctor.

Seeing them in the community, putting them into the outpatient and then, if necessary, admitting the patients.... You will notice, of course, that the last month or two we've had a decrease in palliative care clinic visits, the reason being that we've had more home visits. We're taking the palliative care to the patients where they want it and wherever we can do it as is best, but it's a dyad. This is teamwork. This is about communication. This is not about the patient belonging to me, and that is where I appeal to you to try a funding model that is not fee for service.

If you have a funding model that's not fee for service, everybody can be obliged to do education, to do research, but when you have a fee-for-service model, it's about how many patients I can collect. That is the one recommendation I would say. We move the patients into the community, but of course, we change the funding structure of how people are paid.

The other program I'd like to speak to you about is the palliative rehabilitation program. This program was designed and implemented very successfully here in Ottawa at the Élisabeth Bruyère and the Ottawa Hospital. The goal of palliative rehabilitation is to enhance the physical, psychological, social, and professional well-being of the patient.

Answering the questions that were asked by Mr. Webber about whether we look at the spiritual aspect, each one of our patients gets a spiritual history. You can have a physical history: how is your pain, your nausea, your vomiting, your anxiety, your depression? But for your spiritual history, it's do you have faith? How important is it to you? Do you have a community that you work in? Do you have community support and how would you like me as your physician or your health care provider to provide a spiritual backup for you?

The palliative rehabilitation patients we're seeing here. I'm just going to show you. This was an eight-week program where we had the patient see the OT, the physio, the dietitian, the social worker, the nurse, and the doctor with the patient and the family at the centre of the team. These are values that are taken before the program and eight weeks later, and you can clearly see the statistical significance of the general activity of the patient that's improved, their mood, their working, their relationships with others, their walking, as well as an enjoyment of life. These are validated tests shown statistically significant.

I have to bring you one of these because this is the patient testimony, if we're talking about patient-reported outcomes and what it means to the patient and their family. They said, “I feel I have been remiss in not writing to you sooner. I cannot say enough about how positive I felt being involved with your team. The thing that impressed me most was your profound respect for me. I think that this was only surpassed by the admiration and respect you had for each other. This allowed me to open up and be more trusting. I knew that anything I shared of value and significance was relayed to other team members. My wife and I were no longer on our own.”

None of our patients want to feel helpless, hopeless, and abandoned. It's our job to take that away from a patient. “Simple things seem to take on a profound meaning 'you need to eat more', 'don't feel guilty about resting', 'you don't have to endure the pain, that's why we give you medication” are a few things that come to mind. As I write I realize that the most important thing is that we felt we were part of a team and that made all the difference.”

So how do I see the future? I see the future with public health, billboards at the side of the road saying, “This is palliative care. It is not physician-assisted suicide”. I also say to you palliative medicine specialty training needs to be brought to the fore. It's happening. It needs a push. The funding of hospital and community palliative care rehabilitation teams, which is not an expensive funding model, have been off course to push the leap as well as the Pallium educational sessions and research.

I thank you for your attention.

[Dr. J. David Henderson, President, Canadian Society of Palliative Care Physicians]

Thank you very much.

It's a pleasure to be here. This is such an important issue that we are thrilled to be here to help support this.

To quickly come to the point of the matter, our society certainly recommends the acceptance of Bill C-277. We've been supporting this concept for quite some time. We're thrilled to see this coming forward and to see the uniformity across all parties in understanding this need and the importance of this issue. We're happy that this is moving forward. We're here to help make sure it moves forward, and we'll do what we can to support it.

I know that you have already had several presentations and are getting the big gist of things, but I want to bring us back to a big picture and down to earth a little. Despite Dr. Oz and all the wonderful health care you get through Dr. Google, the world mortality rate unfortunately is still at 100%. We'll all die eventually, so this is really the only issue that is non-partisan. It's non-faith-based. It's women, it's men, and it's children. This is something that affects everyone.

We're all going to be dealing with this at some point, but dealing with this today is different than it was even 50 years ago. With the advent of some of the advances in health care, dying has changed. It has become more complicated and we need to be able to address that.

I think the aging demographics that we're facing have been discussed before. The graph I have here is a nice one to give a good visual of where we are and the urgency with which we need to move these things forward. If you look at where we are on the graph, you'll see a very large jump from 2011 to 2021 in the number of people who are going to be 65 and older. We know we're human beings. We know we have parts that wear out and break down, and we can't get replacement parts very readily, so things are going to happen. This is going to be the largest part of the population that ends up driving the demand for palliative care services. Again, as that baby boomer generation is hitting this age group, we can see very dramatic increases in the numbers, very significantly so.

I've actually put myself on the graph. I'm coming into this, too, so one could say that this is a very self-serving thing for me, because not only do I want to make sure that I can get the care I'm going to need down the road, but I've put in my son, who's now 15, at where he will be at 65, so that coming down the road for my children and my children's children we will have a strong foundation for the type of care they're going to need as well.

As I look around the room, I see a couple of grey hairs here and there, so you know what? If there's no other good reason, folks, this is for all of us sitting in the room, and also, some day, for some of the younger people sitting off to the side.

Where are some of our current gaps? I've broken it down very basically into professional and human resources. We've talked about that a bit, about just the sheer numbers of people with a bit more of that advanced training in palliative medicine, or the specialty training, and that builds into the skilled providers. Along with that aging demographic, it includes those of us working in palliative care. We have an aging demographic of skilled labour as well, and that too needs to be replaced as time goes on.

In the current gaps in terms of public issues, access now has been well documented as a big issue. There are pockets of places where access is pretty good but likely could be better. I know that in our neck of the woods—because on the east coast we do have some of that aging population—we're probably a little bit skewed on the curve. We have wait-lists now to access palliative care services, which is just atrocious, but that's the reality of the world right now.

As I said earlier, people are living longer with multiple comorbidities because we've been able to manage their renal failure and manage their heart failure. As well, they may have a couple of new arteries in their heart, so they're pumping longer. We've advanced some things, but at the end of the day we still have people with more chronic comorbidities that complicate things as they are getting older, and as these organs and parts still continue to wear out.

There's a higher complexity from the physical nature of it, but it's also a higher complexity because of our generation too. We have a lot of people who have been moving back and forth across the country for work opportunities the way our children do, so often there are not as many caregivers around family-wise to help provide the care in the home that we used to have years ago.

Again, with the aging demographic, we have higher numbers requiring care, and because people are living longer, often there are lower numbers of care providers. If someone is 91 and their spouse is 92 and a fair bit of physical care needs to happen, there are limitations, because of that age range, in what they can and cannot provide physically.

As far as informational gaps that we're facing go, again we still don't have national indicators for palliative care across the country. We don't have our national standards. There's no national reporting and there's no national oversight. That's one of the key things I think this bill can actually bring to the table and really needs to bring to the table. We need that large-scale look at how things are going in a unified way so we can start to look at how things are being done across the country and optimize best practices and make sure they get translated across the country so that we can all do better.

Some great work and some great projects have been done. Now is the time to be taking those and implementing those across the country. As I've said in the past, the time of pilot projects should be done. We need to be moving forward.

I'll just very briefly make one statement, and I think maybe Mr. Oliver made a comment on this earlier. Medically assisted dying is not a choice when there is no other choice. Unfortunately, that's the way it is in Canada right now because of the lack of access to palliative care services.

Bill C-277 would fulfill some of the recommendations that were brought forward in the Special Joint Committee on Physician-Assisted Dying. Specifically number 19 was to:

re-establish a Secretariat on Palliative and End-of-Life Care; and that Health Canada work with the provinces and territories and civil society to develop a flexible, integrated model of palliative care by implementing a pan-Canadian palliative and end-of-life strategy.

Number 18 was to:

ensure that culturally and spiritually appropriate end-of-life care services, including palliative care, are available to Indigenous [people].

This bill would also ensure that palliative care is provided to the people the federal government is responsible for providing health care to. The groups under federal jurisdiction include first nations people living on reserves, the Inuit, serving members of the Canadian forces, eligible veterans, inmates in federal penitentiaries, and some groups of refugee claimants. We need to ensure that we have national standards in this for that population as well.

The bill talks a little bit about the Canada Health Act. When we really start to look at the Canada Health Act, we see that it says that all Canadians should have universal complete access to care. Approval of Bill C-277 would ensure that Canada set the standards for access to quality palliative care for all ages including children, all geographies, and all diagnoses.

To ensure that Canadians have access to high-quality palliative care, we have developed a couple of documents recently that we sent to all the members previously and can certainly make available again. The web connection is present there for you. Basically we're stating clearly that we need to look at implementing the palliative approach to care as outlined in the national framework document “The Way Forward”, which you've heard about today and, I think, previously as well. That document is a good foundation for how things should be moving forward. We, along with many other palliative care organizations and other organizations throughout the country, have endorsed that.

Again, we don't need to start from scratch. One of our key messages is that we need to start to work on implementation as opposed to doing further development.

The second document, which we released just a couple of weeks ago, was looking at the cost-effectiveness of palliative care. Very briefly, some of the different studies looked at lowering costs of delivery by up to 30%. Even more importantly when you look at the delivery of this care, it will also help to free up scarce resources in acute care such as beds in intensive care units for patients who truly need them.

When palliative care can be involved early on, you start to have some of those discussions about goals of care and what the patients' wishes are and their understanding of their illness. They can realize that going into the ICU may not be what's really in their best interests. It's not going to fix things. If we can keep people out of the ICU, for whom there really isn't going to be true benefit, that will open up those beds for somebody else who truly can benefit from using up those very limited resources.

Again, we come back to that aging population. There's going to be a bigger demand on everything throughout health care. There are going to be more people who will need those intensive care beds, so we need to be really making sure we utilize our resources as efficiently as possible. At the same time, while we're offering the same type of care, we're improving quality of life and quality of care for patients with serious illnesses and for their families.

Health care costs have been escalating as a consequence of our failure to adapt to the changing demographics of Canadians and advances in chronic disease management, including cancer. Change is now long overdue. Continued failure to invest in palliative care will be a lost opportunity to achieve better efficiencies, improve outcomes, and reallocate budgets to other priorities. The status quo really neither meets Canadians' needs nor is financially sustainable.

What we're recommending certainly is the forward movement and acceptance of Bill C-277. We'd really like to see an established well-funded secretariat, and the formation of a small, nimble, high-level working group made up of key national organizations to start working with the secretariat on implementation.

Focus needs to be on administrative cost containment so that funds can see their way to the delivery of services. We've seen other projects go on and lots of money put into major infrastructure, which unfortunately hasn't translated into a lot of key things hitting...your rubber hitting the road. This is something where there's lots of good work happening across the country. We have shown in the palliative care world that we work well together. We've been doing things on a shoestring for years. This can be done efficiently. We want to see the monies get to providers out in the areas with increased resources so that we can actually make those differences that need to happen.

We need to bring in additional stakeholders, when and where required, to develop the efficiencies, gain the insights, and mobilize strategies. Having another 100-body committee to work on things is going to be very slow and tedious. Again, you see by that demographic curve, we're into it now. We don't have 10 or 15 years to be doing this. Our hospitals are already starting to be overloaded. I know in Nova Scotia they have overcrowding. They're having to develop new terms to label the levels of overcrowding we're having in some of our hospitals because of this aging demographic and the demands.

What is needed? Again, we need to start with what we know. We really need to be collecting standardized national data. That can happen as well through a national secretariat to help move that forward and make sure we're doing this: setting, monitoring, and enforcing national standards and indicators for palliative care in Canada; and making accreditation of health care services both in hospitals, long-term care homes, home care services, etc., all mandatory and contingent on palliative care services being provisioned to nationally accepted standards. We also need to—and my colleague here will be speaking to this, I think, a bit more—standardize and insist on integration of core competencies in the schools of health care professionals.

We had the opportunity to hear from the Canadian Nurses Association today. I know for medicine, for nursing, for social work, and for pharmacy in particular the core competencies are developed. The big challenge has been getting those integrated within the health care professional schools. That is something for which we may need some federal pressure to help make that happen. We've been advocating. We've been trying to get that to happen, but there's so much competition for that time within our professional schools that you have to look to take something out to add some more time in. But, at the end of the day, what we're doing is so fundamental it needs to be there.

[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.

Framework on Palliative Care in Canada Act

[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”.

[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.

[Kamal Khera, Liberal, Parliamentary 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.

[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.

Palliative Care

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

Mr. Speaker, it is my pleasure to present an e-petition with thousands of signatures from my riding of Sarnia—Lambton on the subject of palliative care.

The petitioners state that the 2011 report from the Parliamentary Committee on Palliative and Compassionate Care outlined the importance of quality palliative care.

In light of the fact that upwards of 70% of Canadians do not have access to quality palliative care, the petitioners call upon the Minister of Health to help ensure that all Canadians have access to quality palliative care by endorsing palliative care options such as those contained within Bill C-277, which incidentally is coming to second reading next week.

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

Mr. Speaker, it is my pleasure to present this petition that calls on the Minister of Health to help ensure that all Canadians have access to quality palliative care as an end of life choice by endorsing palliative care options, such as those contained within Bill C-277, an act providing for the development of a framework on palliative care in Canada.

[Dan Albas, Conservative, Central Okanagan—Similkameen—Nicola, BC]

Okay, that takes care of that concern.

Lastly, Bill C-277, have you heard about it? It's a national strategy for palliative care.

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

Mr. Speaker, I am delighted to update the House on Bill C-277, my private member's bill designed to create a framework for consistent access to palliative care for all Canadians.

Over the summer many groups stated their support for the bill, including the Canadian Medical Association, the Canadian Nurses Association, the Pallium foundation, the Canadian Society of Palliative Care Physicians, the Canadian Cancer Society, the Heart & Stroke Foundation, the Kidney Foundation, the Mental Health Commission of Canada, ARPA, and 38 hospices and related organizations across the country.

Canadians who have access to good palliative care choose to live as well as they can, for as long as they can. The need for these services is increasing. I urge members to do their part to help make this a reality by supporting my bill C-277.

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

Mr. Speaker, I am pleased to share with my fellow parliamentarians that since being introduced in the House of Commons on May 30, my private member's Bill C-277, An Act providing for the development of a framework on palliative care in Canada, has gained support across the nation.

The Canadian Nurses Association, the Canadian Society of Palliative Care Physicians, and care centres such as St. Joseph's Hospice in Sarnia and the West Island Palliative Care Residence in Montreal are among several prominent groups to endorse Bill C-277.

Given the non-partisan and important nature of the legislation in question, I once again call upon all members in the House to support Bill C-277 to ensure that we are doing our part to help all Canadians live as well as they can for as long as they can.

Budget Implementation Act, 2016, No. 1

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

Mr. Speaker, I will be sharing my time today with the member for Edmonton Riverbend.

It is said that if one wants to bring constructive criticism, one should make a sandwich; say something positive, then bring the criticism, then finish off with something else positive. That is what I will try to do today. I will make a budget 2016 sandwich.

As the science critic, I will begin by pointing out an extremely positive aspect of the budget. The Minister of Innovation, Science and Economic Development and I met earlier in the session and, together, we decided that it would be a good idea to develop a Canadian science strategy that both sides of the House could support. That is what we did.

As members can see in this budget, we kept the granting council, which supports quality applied research in co-operation with universities, industries, and governments. Increased funding was granted in order to enhance Canada's innovation skills.

Built upon the strong supports of our previous government, budget 2016 would now provide the granting council program for NSERC, CIHR, and SSHRC for research investment with an additional $141 million in annual resources.

I am also very pleased that our previous Conservative government's knowledge infrastructure fund has been retained as the post-secondary investment fund. Targeted investments aimed at our post-secondary institutions will promote Canadian research and discoveries for generations to come.

Similarly, we restored targeted basic research methods. As a result, Canada has made considerable gains in genomics and particle physics, several areas of medical research, and big data.

In other areas, at the global level, we are working on maintaining our international ventures. We also recognize that we need to support the commercialization of Canadian technologies to create more jobs in Canada. Therefore, $100 million was included in the budget to that end. That is very positive.

However, not everything in the budget is positive. The Liberal government has promised deficits nearing $30 billion this year, and more than $100 billion over the next four years. On top of this, the Liberal government seems to have no clear plan on how to pay it back or to balance its budgets in the future. This will cause Canadians to have a deficit of $10 billion annually just to pay back the interest on the money borrowed by the Liberal government. No family would put in place a budget that would put it into debt forever. It is just not wise.

I am also not pleased about the fact that tax cuts to the Canadian middle class will cost the country more than $1.7 billion every year. It was supposed to be cost neutral. Can the government not do basic math?

The same goes for small businesses. Budget 2016 would stop the previous government's lowering of taxes on small businesses. The Liberals promised to cut the tax rate to 9%, but they have broken this promise, which would now cost these same small businesses upward of $2 billion in extra taxes annually.

Next, we will look at infrastructure funding, which was supposed to keep the recession at bay while creating jobs. However, less money is available this year than was promised.

My riding of Sarnia—Lambton has a project for the creation of an oversized load corridor. In discussions with the Minister of Infrastructure and his team, I was assured there would be a fund for trade corridors that this project would fit very well into. For $12 million, this project would create up to 3,000 well-paying jobs in southern Ontario. However, no funding was made available in the budget and therefore no jobs were created for the project. In fact, overall in the budget, the government predicts it will only change the unemployment rate by 0.3% over four years. Seriously? This, for $113 billion?

I would now like to speak about the climate change direction in the budget.

The reality today is that Canada makes up less than 2% of the world's carbon footprint. We could totally eliminate our footprint in Canada, and it would have no fact and evidence based temperature result on the planet. Therefore, our approach should be to leverage our carbon emissions reduction technologies to the substantive contributors like China, the U.S., and India, which make up 40% of the footprint. This budget, with an attempt to layer on additional carbon tax, would drive jobs out of Canada to other regions, but would not help the planet. It would just move the carbon footprint somewhere else.

An example of this from my riding is a project currently being considered, worth billions of dollars and thousands of jobs. With two levels of carbon tax, this project is uncompetitive here and will go to the U.S. gulf coast. The carbon footprint is the same for the planet, but we lose thousands of jobs. This is what will happen across the fossil-fuel business without a better plan. While we lose job opportunities like this one, $2.65 billion is being spent in a foreign fund to benefit other nations like China and India, which are substantive contributors to the global carbon footprint and which are still building coal facilities. This is not an approach that would help the planet, help Canadians, or help Canada.

I am also concerned about how much money we give to other countries, in light of the fact that there are people in need in Canada.

At present, more than $5 billion of taxpayers' money is sent abroad for various programs. At the same time, we have homeless veterans and seniors who cannot make ends meet after having worked all their lives. Fort McMurray is still burning and hundreds of thousands of jobs have been lost.

We need to help Canadians and realize that we cannot be as generous as we once were given our current financial situation.

Let us move past these issues into another area of concern for the Canadian public: national security and defence. One of the most important jobs for any government is to protect its citizenry. Now more than ever we need more defence, not less defence. Cutting $3.7 billion from the defence budget is absolutely reckless, as I heard at the town hall meeting I held on this issue in my riding, where I consulted broadly with people. Much-needed ships for the navy as well as equipment for the air force have been put on hold with no explanation or expectation given for future timelines of availability. We need to ensure the men and women who protect our country are well-equipped, and we need to ensure our borders remain secure.

Now, I come to the final part of the budget 2016 sandwich.

Having just spoken about defence, I do appreciate any increase in benefits for veterans. There is much more to be done, and we need to ensure veterans are treated with the dignity and respect they deserve.

I also would like to speak about seniors. My riding has an aging demographic, so I am pleased to see an increase in the guaranteed income supplement. It may only be $18 a week, but seniors on a fixed income need all the help they can get. I still think we need to do more. I am glad that the income splitting for pensioners was retained, but I would like to have seen the tax-free savings account limit expanded. Many seniors use this to preserve their savings and increase their flexibility in retirement.

Finally, with an ever-growing number of individuals of all ages experiencing chronic and terminal conditions across Canada, and in light of the assisted-dying legislation, I was happy to hear the Minister of Health say that there were $3 billion in this budget for home and palliative care. That said, I could not find the actual words palliative care in the budget. However, I trust that since this has been repeated by the minister in the House on numerous occasions, and the Liberal Party recently made a resolution on palliative care, I believe there is support for this on all sides of the House.

That is why I have introduced my private member's bill, Bill C-277, on palliative care. Good palliative care covers a wide range of services such as acute hospital care, hospice care, home care, crisis care, and spiritual and psychological counselling. Those who have access to good palliative care choose to live as well as they can for as long as they can. Now is the time to get this in place for the 70% of Canadians who do not have access to this service. I am pleased with this commitment. It is a good start.

I am happy to see more summer jobs for youth as well.

To summarize the budget sandwich, thumbs up on science, thumbs down on fiscal responsibility; thumbs down on the approach to infrastructure, climate change and defence; and thumbs up for moving in the direction of good for seniors, veterans, palliative care, and youth.

Criminal Code

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, I will share my time with my colleague the member for Carlton Trail—Eagle Creek.

This is a very difficult time in my short political career, because it is a sensitive subject that should be free of partisanship. All opinions are right, and no one is wrong. We are all good Canadians of good conscience, and we are looking for the best solution on such a sensitive subject.

When it comes to this subject, we are not here to try to convince anyone; we are here to explain our point of view. According to the Supreme Court’s decision in the Carter case, it is not a matter of determining whether we are for or against medical assistance in dying, but of determining how we will apply it.

Here we are at the final reading of Bill C-14. At my leader’s invitation, I had the privilege of participating in the parliamentary committee that studied the matter and produced a main report and a dissenting report. My official opposition colleagues and I signed the dissenting report, while my Conservative colleagues in the Senate signed the main report. This shows that there was no partisanship in our approach.

In our dissenting report, we raised five major concerns. Most of them were noted by the government and are reflected in Bill C-14. We were against the medical assistance in dying bill applying to minors; the government listened to us. We were against the bill applying in the case of mental illness; the government listened to us. We wanted complete openness concerning conscience protections for physicians and institutions; the government listened to us in part. We also wanted a clear commitment from the government concerning palliative care; the government listened to us in part.

On another note, I salute my colleague from Sarnia—Lambton, who introduced Bill C-277 in the House almost exactly 24 hours ago. The aim of this private member’s bill is to force the government to make a firm commitment to provide the necessary palliative care to as many Canadians as possible. As we know, only one-third of Canadians have access to that type of care. With Bill C-277, we want that to be enforced.

Those are the elements of Bill C-14 that we consider positive or semi-positive. Now here are the things that are of great concern to us.

First, there is the famous definition of reasonably foreseeable death. For us, this makes absolutely no sense. “Reasonably foreseeable” means both everything and nothing. I am going to die some day. That is reasonably foreseeable, of course, but it means absolutely nothing. From sage experience, Quebec used the expression “end of life”. That is at least clearer.

There is also the matter of nurse practitioners, who have the same decision-making powers as physicians under the bill. I have tremendous respect for nurses, and I know what I am talking about, since they are often the first people, and sometimes the only people, who see us when we are in hospital. However, when it is a matter of life or death, and that is literally the issue here, I would prefer that physicians have the ultimate responsibility rather than the wonderful nurses.

The points I have just mentioned are based on Quebec’s experience. I know what I am talking about, because I was a member of the National Assembly of Quebec. We worked on and gave serious consideration to the issues surrounding medical assistance in dying for six years, whereas here in the House we had only a few months to do the same work.

Later, I will talk about an unfortunate statement we heard during question period.

Based on Quebec’s experience, we built our case for the dissenting report. The current bill includes some elements in full, others to some extent, and still others not at all. It is a fairly even balance of the positive and negative elements.

Then there remains the famous issue of constitutionality. Every bill that is put forward can be challenged. In fact, whatever bill was introduced, it would have been challenged by one group or another. For weeks, some people have been saying that it is constitutional, and others have been saying that it is not. Most of the people we heard from said that it did not make sense and that it did not comply with the Constitution or the Carter decision. However, this morning, in La Presse, if I remember correctly, three constitutional experts from three different universities, namely Laval University, the University of Montreal, and UQAM, said it was constitutional.

If we table a bill, we will hear a bunch of lawyers say that it is good and a bunch of lawyers say it is not good. This is the point, and we have to live with that. It is democracy. This is how it works in our judiciary system.

I say this with great respect for legal eagles. I know that there are some here, some prestigious ones in fact, and I salute them, including the member for Mont-Royal.

The charter issue is another interesting point. Some people say it complies with the charter, while others say it does not.

Let us try not to be too partisan. If we cannot rely on the Liberal government to draft a bill that complies with the charter, whom can we rely on? Do I need to remind anyone that it was the Liberal Party, under the leadership of the Right Hon. Pierre Elliott Trudeau, father of the current Prime Minister, who enshrined the Canadian Charter of Rights and Freedoms in the 1982 Constitution, signed some 300 feet from here by Her Majesty the Queen on April 17, 1982? We all remember that. The sky was overcast, and at the very moment the signing took place, there was a rumble of thunder. Just a brief history lesson.

Seriously, I am not the greatest fan of the charter, much less of the Liberal Party, especially not the Liberal Party, but good Lord, if we cannot rely on the Liberal government to draft a bill that complies with the charter, I wonder whom we can rely on.

The events are balanced. This bill has good points and bad points. Over the past 24 hours, three events occurred that are worth thinking about. First, yesterday we voted on 10 possible amendments and they were all defeated by the Liberal majority. I commend the government members who voted against their party's position for their courage, honour, and dignity. Well done.

However, I believe that two of those amendments, both of them introduced by the member for St. Albert—Edmonton, were essential.

The first amendment protected the most vulnerable members of our society by proposing that people undergo a psychiatric assessment before giving their consent. We think that is extremely important because protecting the most vulnerable members of our society is essential. Nevertheless, the government voted against that amendment.

The second amendment had to do with conscience protections for institutions. I speak on behalf on my friends from Quebec when I say that, in Quebec, institutions such as hospitals are secular. However, outside Quebec, some institutions are religious and act according to the dictates of their conscience. We need to protect their conscience rights, but this bill does not do that. We proposed that amendment, but the government voted against it. That is unfortunate. The government refused to accept amendments.

Moreover, this morning, Quebec's health and social services minister, Gaétan Barrette, made a statement. I know the guy. He is honest, hard-working, conscientious, and a man of integrity. He is also a medical specialist who was once an administrator and is now a minister. Speaking on behalf of the government of Quebec, he said:

I myself am disinclined, for governmental and professional reasons, to support C-14 because of its worst feature: reasonably foreseeable natural death. That makes no sense. It cannot be enforced. I would be very hesitant to get on board C-14 as it stands...

He added that the bill is very off-putting, that this is a bad clause, and that it is [too much] of a minefield for him.

The third element applies to the Prime Minister's statements in question period today. He said he is working with the provinces on this, but that has no basis in fact. Worse still, he said, “we drew a great deal of inspiration from the reflections of the Quebec National Assembly”.

I can tell you one thing. I sat in the National Assembly. I was there for the six years that this was being studied. What we have seen here in the past six months does not resemble in the least what took place in the National Assembly.

I will not revisit the unfortunate events that took place two weeks ago when there was to be a vote to restrict our right to speak. I will look at the overall process. Unfortunately, the government did not follow the example set by the National Assembly in terms of either substance or form.

Consequently, bearing in mind the positive and negative elements of the bill and the three events that have taken place over the course of the past 24 hours, that is, the vote against the amendments, which were all rejected, the statement by the Quebec minister of health and social services, and the misleading statement by the Prime Minister of Canada, I will be voting against this bill.

Palliative Care

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

Mr. Speaker, yesterday, I was pleased to introduce my private member's bill, C-277, an act providing for the development of a framework on palliative care in Canada.

Currently, only 30% of Canadians have access to good palliative care. Hospital care is four times as expensive as home care, and hospice care is not fully funded. The bill would help implement a framework for palliative care in Canada, including the definition of services included, required training, and most importantly, measures to ensure consistent access for palliative care across the country.

Previously, the all parliamentary committee brought recommendations that are now captured in the bill. The NDP and the Liberals have both endorsed the need for palliative care. Now is the time to come together as parliamentarians to ensure that Canadians can choose to live as well as they can for as long as they can.

Framework on Palliative Care in Canada Act

[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)