Oh yes. It is—
Evidence of meeting #20 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 research.
A video is available from Parliament.
Evidence of meeting #20 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 research.
A video is available from Parliament.
7:05 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
Oh yes. It is—
7:05 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
So the palliative care you provided did not successfully relieve the existential suffering and anguish or the anxiety of the dying patient at the end of his life?
You offered him palliative care, but did you also offer him medical assistance in dying?
7:05 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
I'm not clear on your question. Are you asking me if I offered palliative sedation for existential suffering?
7:05 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
You told us about a patient in a state of anguish and anxiety who was delirious and in pain. Palliative care did not successfully relieve his pain and suffering, because palliative care can't relieve all types of pain and suffering. I imagine you agree with that.
When you offered him palliative sedation, did you also offer him medical assistance in dying?
7:05 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
First, I would say that delirium is a syndrome where a person is hallucinating and is often very confused and trying to climb out of bed and is maybe quite agitated. That is different from someone who has anxiety and existential distress, so what I'm—
7:05 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
How do you go about obtaining free and informed consent when the patient is in such bad shape?
Why do you consider that more acceptable than, say, an approach where one morning, as they are being accompanied on their journey toward death, a dying patient says they are ready to let go and decides to go ahead with medical assistance in dying?
How was what you were offering more morally acceptable than the alternative scenario, the one you didn't offer your patients?
7:10 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
I'm not saying it's morally acceptable. I certainly work very hard to deal with someone's existential concerns. You may recall that in my talk I mentioned how interconnected all these fears are and how palliative care has a lot to offer for people who are suffering and who have—
7:10 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
I understood what you said, but I'm asking you that question.
Conscientious objection and moral objection to medical assistance in dying happen all the time. So I wanted to hear your answer to that question.
7:10 p.m.
The Joint Chair Hon. Yonah Martin
Thank you. That's your time.
I'm going to move to Mr. MacGregor for five minutes.
7:10 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you very much, Madam Chair.
I would like to echo my colleagues and thank all of our witnesses for helping guide our committee through this study.
Dr. Gallagher, I would like to start with you. I take it from your comments that a patient-centric approach is very important to you in trying to understand what patients want.
We have had a number of witnesses here in previous meetings. I had Dr. Valorie Masuda from my own riding. She's a palliative care physician. We had a representative from TheraPsil who specializes in psilocybin and psilocybin therapy. We also had comments from Dr. José Pereira, who indicated a willingness to explore further research in this area.
You mentioned existential distress. There has been some promising research, notably from Johns Hopkins University, on how carefully administered doses of psilocybin, with the care and attention of someone who has expertise in this kind of therapy, have really allowed patients, particularly during end-of-life care, to gain a measure of acceptance in meeting their end.
I would like to hear from you with regard to your understanding of the state of research into that. Do you think our committee can make some recommendations to try to make sure that type of therapy is more widely available to patients in palliative care?
7:10 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
Yes. I definitely think there's a lot more work to be done on dealing with existential suffering. I think we're relatively early into a detailed understanding about existential research and how to offer therapeutic ways to mitigate this. I think there's good promise for this, and I would certainly support that.
I actually took a little part in the training of Dr. Masuda, and I know she is a great resource to her community.
I think we should explore this. However, I don't want you to go ahead and do that without mentioning all the other things that I mentioned about being able to measure the kind of quality of care we're giving to people and enacting standards, because that's the way we raise the bar across the country.
7:10 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Yes, and taking that in stride, but is recommending further federal funding and research into this area something you would support?
7:10 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
Yes, absolutely.
7:10 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Okay, perfect.
I will turn to the Canadian Cancer Society on the same theme. I know a lot of cancer patients end up in palliative care and some choose to access medical assistance in dying, as is their right.
On the same theme of what seems to be promising research into the use of psilocybin and psilocybin-assisted therapy, does the Canadian Cancer Society have any comments on that and on what recommendations our committee might be able to make in this specific area?
7:10 p.m.
Advocacy Manager, Hospice Palliative Care, Canadian Cancer Society
We are certainly exploring that. One of our research projects is associated with it, so we're going to try to get more information back to you on that.
We have certainly called for more access to funding for palliative care research specifically in this area. The Quality End-of-Life Care Coalition has an ask particularly around seed funding for research. This is a very difficult area in which to raise matching funds for research.
We will make sure to send that submission to you so you can understand more context around that and around the challenges of accessing funding for research on palliative care.
7:15 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you.
When it comes to palliative care, I don't know if we've spent a lot of time speaking about caregivers and the emotional and financial strain they can go through.
I will turn this to Dr. Gallagher. Do you have any comments about the supports that are currently available to caregivers and anything you would like to see us recommend in that area?
7:15 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
That's a great question. I would say, first of all, that people who are connected early to palliative care show a reduction in caregiver distress and show benefits even after a person has died. I also think, though, that we need some sort of financial benefits and help for caregivers because many patients and caregivers report out-of-pocket expenses when they have an illness. You never think about them until you actually have an illness and have to go back and forth to the hospital all the time.
I also think we could look at other things that aren't tax credits, because there are people who are poor enough that they never pay tax, and they don't benefit unless there are refundable tax credits. There are many more things we should do, because we cannot manage our health care system without caregivers. I would hate to think what it would be like without them.
7:15 p.m.
The Joint Chair Hon. Yonah Martin
Thank you, Mr. MacGregor.
I'll now it over to my co-chair for questions from the senators.
7:15 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Senator.
We will now go to the senators' questions.
Senator Mégie, you have the floor for three minutes.
7:15 p.m.
Marie-Françoise Mégie
Thank you, Mr. Chair.
My first question is for Dr. Gallagher or anyone else who would like to comment.
Some witnesses who appeared before us have said that there is very little access to palliative care across the country. One individual from Quebec told us that access largely depended on the patient's postal code.
What can the federal government do to help address the disparity in access to this type of care?
7:15 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
I think it would make an enormous difference if high-speed Internet and telehealth were accessible to all people. For instance, when I went to Haida Gwaii, I found out how poor the cell service there was. The nurses, in order to make a call, had to go to the beach to get cell service. They couldn't access any of the apps on their phones unless they were downloadable. That meant no house calls to a person at home. We have the technology to give palliative care much better accessibility, but I'm afraid it's going to cost money. I think there would be enormous benefits along with that.
The other thing is standards. I can't say enough about standards for palliative care. We are establishing the quality we expect every person to receive.
7:15 p.m.
Marie-Françoise Mégie
Thank you.
The next question is for the Dorothy Ley Hospice team.
When I worked in the medical field, I opened the Maison de soins palliatifs de Laval, whose mission was similar to that of the Dorothy Ley Hospice.
Is your organization funded by federal or provincial funds?
7:15 p.m.
Executive Director, The Dorothy Ley Hospice
In terms of our funding, 60% of our funding is from the provincial government and 40% must be fundraised, so that's about $1.5 million a year. That's a significant strain on us, and it's growing every year because operating costs are growing. When you talk about accessible, high-quality care, funding for hospices is certainly an issue that needs to be addressed.
In terms of caregivers—
7:20 p.m.
The Joint Chair Hon. Yonah Martin
Sorry for the interruption, but we're not getting the French interpretation.
If you can speak slower in your response, that will help with interpretation. Thank you.
Go ahead.