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.
10:40 a.m.
Director, Champlain Regional MAID Network, Champlain Centre for Health Care Ethics, The Ottawa Hospital
I think that's a very difficult.... Are you talking about mental illness as a sole underlying medical condition?
10:40 a.m.
Director, Champlain Regional MAID Network, Champlain Centre for Health Care Ethics, The Ottawa Hospital
Yes, in preparation, we've had a lot of conversation about that.
Certainly I'd be lying if I said that there wasn't apprehension about how we're going to be able to effectively support some of these patients. I think it perhaps goes back to another comment, which is that we're talking a lot about palliative care, but patients also require timely, ongoing access to other services in terms of mental health supports, complex pain and other specialized care. I think we need to make sure that we recognize that not all of these patients are going to receive MAID. What, then, is the support for these patients to make sure that their care is good?
10:40 a.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Senator Dalphond.
We'll go to Senator Martin for three minutes.
10:40 a.m.
The Joint Chair Hon. Yonah Martin
My first question is for Dr. Pereira.
What is meant by specialist palliative care versus the palliative approach to care, as outlined in the “Framework on Palliative Care in Canada”? Why is that so important with respect to providing access to palliative care, and where does Canada stand on that?
10:40 a.m.
Professor and Director, Division of Palliative Care, Department of Family Medicine, McMaster University, As an Individual
If you look at jurisdictions that have done very well in exercising palliative care, they've developed specialist palliative care services and have also ensured that all health care professionals are getting basic training so that they can identify earlier the patients who would benefit from palliative care. They can start addressing the psychosocial, spiritual and physical distress those patients are experiencing, and as a result, patients then have a lot more access to palliative care.
There was an earlier assertion that there has been considerable funding going into palliative care across the country. That may be true in some jurisdictions, but not in all. In my region, for example, we don't have enough specialist funding for specialist palliative care physicians. I know of another hospital in Ontario that has been trying for years to get extra funding to build palliative care specialists.
We also struggle with funding to make sure that we train up health care professionals in practice, the very professionals who are going to be asked by patients “What choices do I have?” and “What are my options?” When they don't know what palliative care is, when they keep equating it to only the very end of life and when the patients and the public still think of palliative care only at the very end of life, we have a problem, and I think we do need to address that.
10:40 a.m.
The Joint Chair Hon. Yonah Martin
Speaking of training, I see how important it will be to have training, and really for all the people in the system if we're expanding MAID, because we'll need these professionals. To what extent has palliative care education been integrated into medical, nursing and social work training programs in Canada?
10:45 a.m.
Professor and Director, Division of Palliative Care, Department of Family Medicine, McMaster University, As an Individual
Mr. Chair, I think we've come a long way in the last two decades. I've been doing palliative care since 1995, and over the years I've worked really hard to try to get palliative care integrated into curricula. It's a real challenge, and Dr. Roy alluded to some of that challenge as well, but there are ways of doing it.
I think it's unacceptable that specialists in internal medicine, cardiology, nephrology and respirology don't get core palliative care training. How can they inform their patients with the options appropriately when they don't have that training?
I think it's still not adequate that only 30% of medical students across the country have clinical rotations. We're not even speaking about nursing schools, because in nursing schools there are still major gaps in the curricula. We need resources. We need funding. I've experienced many push-backs, largely around how we don't have the resources, we don't have the space and we don't have the time, but we do, actually, and we can be innovative. There are examples across the country of how that can happen.
Thank you.
10:45 a.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Senator Martin.
This brings our panel to an end.
Just before I finish, this is for you, Dr. Pereira. You probably heard the request from Senator Kutcher: Could you provide documentation that supports some of the points you raised during your opening remarks and in answering questions? Are you in a position to do that?
10:45 a.m.
Professor and Director, Division of Palliative Care, Department of Family Medicine, McMaster University, As an Individual
Yes, sir, I am. It would take a few days, because I have some family priorities I have to deal with.
10:45 a.m.
Liberal
The Joint Chair Liberal Marc Garneau
That's fine. Thank you for providing that additional information.
With that, thank you, Dr. Pereira.
Thank you, Dr. Roy.
Thank you, Mr. Kekewich, for appearing in front of the committee this morning. We very much appreciate it and are continuing our analysis of the theme of palliative care in the context of medical assistance in dying. Thank you very much for your appearances this morning.
With that, for the committee, our next meeting is Tuesday, the 18th. We won't be here next week, of course. We'll continue with the study of palliative care.
Thank you very much.
This meeting is adjourned.