I want to thank you for the opportunity to speak with you today.
I'm here as an independent nurse practitioner and MAID provider, and I speak with the experience of supporting access throughout Ontario.
I want to start by sharing my appreciation for your support of the CAMAP national MAID curriculum project. I also acknowledge the good work done to establish the waiver of final consent to allow patients to fully optimize their pain and symptom management without fear that a loss of capacity would limit their choices. This work can continue by establishing advance directives specifically to address patients with conditions that by their nature will progress to impair capacity.
In previous testimony, you've heard references to the mounting research on the importance of identifying patients early for palliative care. I echo those comments and fully support education to integrate a palliative approach to care in all care settings.
Practitioners involved with MAID share concerns about late referrals. Of the 3,228 patients I was involved with who expressed an interest in MAID, only slightly more than half decided that MAID was the right choice for them. Many others did not proceed but had a choice. I believe that information can be a step toward reducing fear and uncertainty. Information doesn't promote MAID. It encourages progressive discussions with care providers and loved ones and encourages informed, thoughtful patient choice.
I echo the previous testimony on the high percentage of patients receiving MAID who also receive palliative care and the suggestion that we should continue to aim higher. This isn't just measured in percentages, but also in the level of interdisciplinary supports available and the reduction of barriers. Measurement of the quality and access of palliative care should be done within palliative care. Patients who choose MAID are only a small group, so it is important not to miss the experience of others.
MAID is not a failure of care. It is a choice about how one dies. I would add that the patients most likely to receive palliative care are those diagnosed with malignancies. We need greater identification of patients with serious life-limiting chronic conditions and even more focus on our frail elderly or patients with dementia who are least likely to be identified and to receive palliative care supports.
I'd like to complete my statement today with some suggestions for improving palliative care and MAID in Canada.
We need to leverage the successes demonstrated from interdisciplinary patient-centred teams of professionals and focus on those least likely to be identified for palliative supports. Federal statistics identify that the percentage increase in MAID provisions outpaces the increase in number of providers and, in particular, the number of providers with the experience to take on the increasing complexity of this work. This data does not acknowledge the health human resources needed to provide education and assessment for those who do not proceed with MAID.
Patients seeking MAID also need integrated teams. Some provinces offer some of this integration, but others significantly less. MAID has been described as a procedure. I think that's an oversimplification of the relationships fostered and the thoughtful, careful assessments that give us such insights into patients and suffering through their eyes.
As we increase the complexity of patients who may be eligible, we need to access expertise in a variety of conditions, including services with significant waiting lists, like specialty pain and psychiatric supports. We need coordination and administrative supports; mental health, social work, nursing and social supports; and an ability for clinicians to travel and optimize virtual care to promote equity. An additional advantage of building these teams would be to provide remuneration for nurse practitioners, who remain without the independent funding support provided to physician colleagues. They play an important role in ensuring access.
We need to remove organizational barriers to integrated care that force transfers of patients in their moments of greatest vulnerability. We also need targeted federal health care transfer payments to bridge the gap between federal legislation and provincial implementation. We must ensure that integrated, interdisciplinary MAID access isn't just legal, but an available choice.
Thank you.