Thank you for allowing me to address the Special Joint Committee on Medical Assistance in Dying.
As a physician specializing in home‑based palliative care, I would like to talk to you about the lack of home access, both for palliative care and for medical assistance in dying.
I am speaking to you this morning as an expert in home‑based palliative care who has been practising in Quebec for 35 years, and this home‑based care covers seniors' residences. In Quebec, clinicians have unfortunately so far failed to convince decision makers of the importance of giving people access to comprehensive palliative care at home. I am talking about multi-professional palliative care teams. These teams should include at least the basic duo of a nurse and a physician, who work as a team to provide 24‑hour care. In Quebec, we use the term “intensive team”.
These teams are experts in palliative care and have demonstrated their efficiency. Hospitalizations are reduced by 65%, and 64% of the deaths of patients under care are at home. These figures are good and comparable to those of the palliative care teams of the main English-Canadian and European authorities. Unfortunately, Quebec clinicians are still trying to get people to accept the average length of palliative medical care for end-of-life patients at home, which is eight months, not seven days, as set by Quebec authorities in 2019.
International evidence shows that home-based palliative nursing care is enhanced care. This is the expertise of clinical nurses with undergraduate degrees who are dedicated to this practice. These nurses are given additional training and time to care for these difficult cases and support patients' loved ones, who are very actively involved in home care. It's not a basic nursing practice, and it's not a hospital practice at all.
We also know that not all physicians have the training and experience they need to relieve patients' suffering in the last year of their lives. These patients are indeed complex and unstable. This is not a basic medical practice.
It has been shown in several recognized scientific publications that palliative care physicians provide better and faster relief to patients, at a lower cost to the health care system. Despite this, there is still a serious shortage of home-based palliative care physicians in Quebec. This is clearly a medical desert that affects 80% to 85% of all Quebeckers at the end of their lives.
Home care clinicians were hoping that comprehensive palliative care would finally be implemented in all care settings, including at home, along with medical assistance in dying, with the implementation in 2015 of Quebec's legislation on end-of-life care. In order to meet the criteria of this legislation, every effort must be made to relieve the patient before proceeding with medical assistance in dying, be it physical or psychological suffering. However, priority was given to medical assistance in dying, not palliative care, which is absurd, because both are in fact—and I emphasize both—complementary and essential.
I will now talk about the accepted metric for measuring access to home-based palliative care and the rate of death at home. Quebec's home death rate is the lowest in the western world. It stands at 12%, compared to an average of 30% elsewhere in Canada and Europe. We are experiencing this on a daily basis in our overwhelmed emergency rooms. The data show that at least 70% of Quebeckers want to be treated and die at home. In Quebec, our family doctors devote a very significant part of their working hours to the hospital.
During our first home visit, patients very often talk to us about medical assistance in dying because they are suffering. Many don't even know that their prognosis is less than 12 months, especially in cases of non-cancer diseases. They tell us of their exhaustion and despair at the persistent suffering they are facing, after repeated stays in crowded emergency rooms. When palliative care teams are present at home, the suffering is managed intensively until it is relieved, and few patients choose medical assistance in dying.
Theoretically, the Act respecting end-of-life care stipulates that palliative care, as well as medical assistance in dying, should be available to all Quebeckers who want it, in all care settings, including at home. However, that is not the case in Quebec. Inequity in access to palliative care at home and medical assistance in dying persists, with most other provinces prioritizing home care over hospital care.
In Quebec, in 2022, the place of our death is determined by our postal code. We can and must do better.
In order to do so, we will need to get out of a health care model that is hospital-based and accept the fact that here in the West, the end of a life is a long journey which requires expert medical care and enhanced nursing.
Thank you.