Hello. I hear you very well.
Madam Chair and honourable members of the committee, I have a written statement, which I prefer to read. It will be more comfortable. I will be addressing you in French.
My sincere thanks for inviting me to appear before the Special Joint Committee on Medical Assistance in Dying. This is a subject that is of particular interest to me. The objective of this testimony is to tell you about the challenges I see when it comes to access to the continuum of palliative care, including medical assistance in dying.
I have been a family physician in Quebec since 1993. My field of practice was very general in the beginning, but since 2009 I have worked mainly in geriatrics. I have had the opportunity to practise family medicine and geriatric medicine in virtually every setting, in all types of general medicine practices. I have also been a medical manager for several years.
Caring for patients who have irreversible and incurable diseases is an important part of my everyday work, and I have administered medical assistance in dying several times over the last few years, so I want to tell you about my experience.
The demographic changes we are experiencing, that become more apparent every day, mean that the need for palliative care and requests for medical assistance in dying are rising exponentially. Despite the efforts made to develop these kinds of care, there are still limits on access to them.
I observe that each person's experience can be very different, for a variety of reasons. Some examples come to mind.
First, there a person who is in hospital and needs palliative care and is waiting for a single room, to which they are entitled. In the health institution where they are, there are not enough single rooms, and the person dies in a two-person room or in a ward. Too many people are still dying in the less than optimal environment of our dilapidated institutions that offer poor accommodation for both the people being cared for and their families.
Second, people at the end of life are often waiting for a bed in the palliative care unit, but the number of beds is limited. Some people receive a bed only at the very end of the course of their disease. Often, they are unconscious when they are transferred there; sometimes, they die without a bed being found for them.
Third, a person suffering from a non-cancerous chronic disease who requires specific palliative care may have more trouble accessing that care, given the limited number of beds in palliative care units.
Fourth, a patient living alone at home who is waiting for palliative home care services to be arranged may have to attend at the emergency room. Given the rising number of seniors who are living alone, this problem may arise more often.
Fifth, one of the admission criteria for a bed in a palliative care unit is that the person have less than three months to live. Individuals with a serious loss of autonomy with more than three months to live are often directed to the CHSLDs, regardless of their age and diagnosis. A person then admitted to a CHSLD is not in the right place to get the best palliative care. As well, they are unfortunately occupying a bed that is ordinarily reserved for seniors with very different needs, including specific palliative care. As well, some of these people die in less than three months without receiving optimal palliative care, unfortunately.
Sixth, some people who request medical assistance in dying have their access limited to certain palliative care beds in institutions that do not offer this type of care. Some of these people die without having access to optimal palliative care.
Seventh, some patients admitted to a palliative care institution have to change institutions in order to receive medical assistance in dying, since it is not offered in the institution where they are at the time.
Eighth, there is the issue relating to respect for the wishes of people who become incapable.
I believe we have to examine the level of care and the quality of the care offered and the services to be developed for the continuum of palliative care, which includes medical assistance in dying. The present shortage that affects every interdisciplinary professional team also makes this examination necessary.
I would stress that we are very fortunate to live in a society that allows and encourages the expansion of the available palliative care. In my area of practice, the east end of Montreal Island, the demand for medical assistance in dying is rising steadily. I am sure that this is the case everywhere in Canada.
Every day, patients ask me about medical assistance in dying and palliative care. Being able to choose care that is appropriate for their needs gives them reassurance. However, they are still worried about their wishes being respected and about access to their choice. Certainly, we have to continue working on educating our professionals and raising their awareness.
You and I do not know in advance what care we are going to choose in an end-of-life situation, which is where we will all inevitably find ourselves. My wish for you all is that we be able to be accommodated and that our ultimate and deeply personal choice be respected, and that we have access to all the care we need when the time comes.
Personally—