Evidence of meeting #19 for Medical Assistance in Dying in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patients.
A video is available from Parliament.
9:25 a.m.
Senator, Quebec (Rougemont), ISG
We also have something we wanted to clarify at some point with a witness.
How would you define “good palliative care”, or comprehensive palliative care as you call it in your document?
9:25 a.m.
Family Doctor, As an Individual
The World Health Organisation and the Canadian Hospice Palliative Care Association have defined “good palliative care”. All professions must be involved. There is the core team, the first step in the staircase, represented by the nurse and physician, who must be available in all care settings with 24-hour coverage. The core team should also be surrounded by other health care professionals, that is, nutritionists, social workers and the all-important home care workers, who provide all the hygiene care and help patients eat and get around. These are inter-professional teams.
That's what we call “good palliative care”.
9:25 a.m.
Liberal
The Joint Chair Liberal Marc Garneau
No, you had three minutes.
Senator Kutcher, you also have three minutes.
9:25 a.m.
Stanley Kutcher Senator, Nova Scotia, ISG
Thank you very much, Mr. Chair.
Thanks to all the witnesses. Just as an observation, gosh, three minutes goes fast.
Our family has had personal experience with excellent home-based palliative care. I agree that improving home-based palliative care is essential to providing more end-of-life choices. We've known for decades that health human resources across Canada are inadequate in all kinds of health care, including in palliative health care. This is not unique to palliative care.
Dr. Downar, we've also heard arguments that MAID funding is stealing resources that were originally directed for palliative care, or that funding for MAID is causing deficits in funding for palliative care, that funding is being specifically directed to MAID instead of palliative care. Can I have your thoughts on these concerns?
9:30 a.m.
Professor and Head, Division of Palliative Care, University of Ottawa, As an Individual
I have heard these claims too, but I don't think there's really any basis for them. I think in most cases in many parts of the country, palliative care funding is increasing, and increasing quite substantially. My own division in Ottawa has roughly doubled in size, including a large increase in salaried positions over the past few years. I think that has largely been the case in much of Ontario.
I know that it's not the case across the country, and I'm not claiming that it is, but definitely there has been a substantial increase, I think, in funding for staff and funding for beds, which unfortunately we're just generally missing staff for and can't always fill. That's super-important to state.
In terms of resources and our resources being stolen, I think it's also important to remember that if somebody is at end of life and is suffering, and they are getting resources, I find it hard to understand why people would say that it's an inappropriate use of palliative resources. I'd really regret if any member of the palliative care community would say that it's stealing resources. The resources belong to the patients. They are patient resources, not my resources and not anyone else's resources. They are for them. If they are nearing the end of life and suffering, and the resources go to them, good. The fact that they have chosen MAID shouldn't make them ineligible for resources.
9:30 a.m.
Senator, Nova Scotia, ISG
Dr. Dechêne, thank you so much for being here. Your sister is a great senator.
9:30 a.m.
Senator, Nova Scotia, ISG
Could you give us your comments on what Dr. Downar told us? What is your perspective on that?
9:30 a.m.
Family Doctor, As an Individual
I would not add a word more.
Thank you, Dr. Downar. I agree completely with you.
9:30 a.m.
Professor and Head, Division of Palliative Care, University of Ottawa, As an Individual
Is that why you get all the questions—because your sister is a senator?
9:30 a.m.
Voices
Oh, oh!
9:30 a.m.
Family Doctor, As an Individual
Well, she supervises me. I have to give short answers, so I'm trying to do so.
9:30 a.m.
Senator, Nova Scotia, ISG
Oh, dear.
We have seen chaos in nursing homes during the pandemic. Do you think we should recommend a pan-Canadian approach to improving care for our elderly? That would be for everyone who's elderly—not just at end of life, but for all elderly people in this country.
9:30 a.m.
Family Doctor, As an Individual
I'm going to answer in French because it's a delicate matter.
Health care is a provincial jurisdiction. In other words, health care decisions are to be made by the provinces .
In my opinion, Canadians should receive a minimum level of care from coast to coast. I'm talking about palliative care, but also geriatric care and in long-term care facilities.
9:30 a.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you very much.
I will now turn the floor over to Senator Dalphond for three minutes.
October 7th, 2022 / 9:30 a.m.
Pierre Dalphond Senator, Quebec (De Lorimier), PSG
Thank you, Mr. Chair.
My questions are for Dr. Downar and Dr. Dechêne.
We've talked about the fact that 98% of those who have had access to MAiD were receiving palliative care. We also spoke of the lack of resources related to access to palliative care.
Would you say that individuals who have access to palliative home care are less likely to choose MAiD than those who don't?
Quebec appears to have a lower rate than Ontario, but I'd like to hear about the Ontario experience first.
9:30 a.m.
Professor and Head, Division of Palliative Care, University of Ottawa, As an Individual
Thank you for your question.
We know that individuals who have received palliative home care and patients who receive MAiD are the same people. If a study were conducted with these groups, it would clearly demonstrate that these are the same people. So it's hard to say whether it's access to palliative home care that determines if people will seek out MAiD.
9:30 a.m.
Senator, Quebec (De Lorimier), PSG
Do we distinguish between individuals who are at home and those who are in the hospital due to a shortage of suitable hospice beds?
9:30 a.m.
Professor and Head, Division of Palliative Care, University of Ottawa, As an Individual
I'm not going to lie to you. We don't really have any data on the subject. However, we do know that the fact that people live in an urban or rural community has no incidence on the rate of MAiD requests. The rate doesn't change. A number of studies have shown that we have no reason to believe that access to palliative home care determines whether an individual will request MAiD.
It's important to understand that the reason people request MAiD is primarily because they are experiencing existential and other pain that we can't really treat effectively as hospice workers. That's why even those who are likely getting the best palliative care in the country are going to request MAiD anyway.
9:35 a.m.
Senator, Quebec (De Lorimier), PSG
Thank you.
I believe Dr. Dechêne wanted to add something.