Health Committee on March 9th, 2017

[John Oliver, Liberal, Oakville, ON]

First of all, thank you very much for your presentations, excellent content.

To be clear about the committee, we're reviewing the bill. Many of your comments were very important and I think very insightful, but they're probably for the next phase. If the bill gets approved, then the minister would convene provinces and territories and palliative care providers such as you to talk about how to build the framework, and then how to move that framework forward across Canada. A lot of your comments and some of the questioning from the committee is really, I think, in that broader, second-stage context.

Our job is to review the bill and modify it or approve it. I guess that's my first question to you. You've both seen the bill. Were there any amendments, any changes, that you thought would be appropriate to it?

[Dr. J. David Henderson]

Yes, and we've submitted our document. We have really one change.

[John Oliver, Liberal, Oakville, ON]

But that was about data-gathering, wasn't it?

[Dr. J. David Henderson]

Actually, the one change was take out “develop” and move straight to implementation because so much has been—

[John Oliver, Liberal, Oakville, ON]

Sorry, what was your amendment again?

[Dr. J. David Henderson]

In our submission to this committee, the only recommended amendment would be to delete the words “develop and” from subclause 2(1) and just have “implement a framework designed”.

[John Oliver, Liberal, Oakville, ON]

The issue, just so you're aware, with that amendment is that there's federal and there's provincial and territorial, so implementation of a palliative care program is absolutely provincial-territorial responsibility. The role federally would be to work to make sure there's a framework put in place to have definitions around it, but implementation or operationalizing is territorial-provincial territory. I'll just provide you that feedback.

The preamble of the bill doesn't talk broadly about the benefits of palliative care and why we need it. Much of your presentations were around the significant shortfalls we have. It is more couched against this: since we now have physician-assisted dying, we need to have a full palliative care program around it. Personally, I would like to have seen a broader endorsement of palliative care, not because we have PAD or MAID, but because we need this regardless.

Did you read through the preamble? Did you have any thoughts on that?

[Dr. Martin Chasen]

I fully agree with you. It seems as if this is in reaction to the medical aid in dying when it actually should have been the primary care that should have been given to the patients, with palliative care, as Carter said, as a basic human right. That should have been the model presented, and then later....

However, it didn't happen that way, so we now move forward and say, yes, we need to present palliative care as a viable option, but understanding, of course, what palliative care is. That's why I think the public health help is very important in this. It's to make the populace aware of what palliative care is and that it doesn't mean just a one-way ticket.

[Dr. J. David Henderson]

Going back through the years, there was the former secretariat, and there was Sharon Carstairs who served. There was so much work done much prior to MAID that was outlining the need for palliative care.

The reality is that those of us working in palliative care knew for years that the only thing that was going to put palliative care on the minds and eyes and tongues of Canadians was euthanasia becoming an issue. That's really the only thing that has brought it to the public's attention to push this forward, which is I think why we are kind of tailing onto it. We don't want to see palliative care fall off again, which is a big concern we have had. Our concern is that as soon as the MAID propaganda dies off—no pun intended—palliative care will be shoved back in that box and back into the corner and won't be looked at again.

[John Oliver, Liberal, Oakville, ON]

That's an excellent perspective on this. Thank you.

Under paragraph 2(1)(d), the wording in the bill is “collects research and data on palliative care”. This is the role. This is the framework. You had some wording changes to that. Did you not say “collect standards”, or was that the people before you? Did you have a wording change on that?

[Dr. J. David Henderson]

We need to have the standards clearly defined. Even at Accreditation Canada right now, they're creating standards for looking at palliative care within facilities, and even within facilities, you must have a 10-bed-plus unit before they start to look at some of those standards. I received an email a couple of weeks ago saying that they are now looking at developing standards for the community part of the care as well, which is great. I've offered to help with that as well.

Again, we need the national standards to measure things by. A lot of the questions that come up are hard to answer because there aren't these national standards that need to be there. We've been working on it for years in terms of national indicators and deciding what the specific indicators are that we need to be measuring that are going to be beneficial to the patients and families, because they truly will carry that kind of information away, as opposed to indicators that are going to show, yes, you're worth your weight in salt kind of thing.

[John Oliver, Liberal, Oakville, ON]

It would be collecting research and data on palliative care, which is valid in and of itself, and then you would look for another clause to develop national care standards or national...?

[Dr. J. David Henderson]

That's right, national care standards.

[John Oliver, Liberal, Oakville, ON]

It would be national care standards and quality indicators—

[Dr. J. David Henderson]

Yes, exactly.

[John Oliver, Liberal, Oakville, ON]

—for improvement.

[Dr. Martin Chasen]

If I may say so, I don't know what they mean by “collecting research”. I would say that it's “encouraging research and collecting data” or “stimulating research”—

[John Oliver, Liberal, Oakville, ON]

Or promoting research—

[Dr. Martin Chasen]

Yes, promoting research.

[John Oliver, Liberal, Oakville, ON]

—and collecting data.

[Dr. Martin Chasen]

Yes.

[John Oliver, Liberal, Oakville, ON]

That's good. Thank you very much.

That's all I have, Mr. Chair.

[The Chair, Liberal, Bill Casey]

All right. That completes our session.

I want to point out to the members of the committee that Dr. Henderson was scheduled for Tuesday, and he spent Tuesday at the airport in Halifax. He called me just before the committee meeting and said that he was between cancelled flights and couldn't get here, so he spent that day for the committee but not at the committee.

Here you are again today, Doctor. I appreciate your commitment. I know that in the long term you've been devoted to palliative care. It won't fall off the table as long as Ms. Gladu is here, I can assure you of that.

[Dr. J. David Henderson]

Thank you.

[The Chair, Liberal, Bill Casey]

Dr. Chasen, it's interesting that you're from South Africa and one of our witnesses yesterday had roots in South Africa as well. I don't know what the South African influence is, but it's interesting.

We very much appreciate your contributions. They've been very helpful to us. I think we're making significant headway here.