Thank you for the opportunity to talk about the state of palliative care as part of the statutory review of Canada’s current legislation on medical assistance in dying.
I am a palliative care expert with formal training in the field of palliative medicine and the program director for the Royal College of Physicians of Canada’s two-year residency program in palliative medicine at the University of Toronto. I am also the president of the Canadian Society of Palliative Care Physicians, which is committed to improving quality and access to palliative care for all Canadians through advocacy, partnerships, research and physician education. We are the national specialty society representing palliative care physicians, and physicians with a special interest in palliative care, throughout Canada.
I work at Toronto General Hospital and provide palliative care to patients who have been diagnosed with a life-threatening illness. Some of my patients have advanced cancer. Others have non-cancer diseases, such as chronic kidney disease and heart failure. I manage their symptoms, whether physical, psychological, social or spiritual.
The vast majority of patients and their families do not understand the role of palliative care. I spend time explaining what we do and who we are, and work on demystifying and destigmatizing our work. It is not uncommon that I have to convince patients that by managing their symptoms, I will not hasten their death. Most patients are often relieved, and are happy to continue to be followed by our palliative care team.
There are times, especially at my initial consultation, when patients tell me that they are considering MAID. It is my job to explore the reasons underlying that request and provide suggestions and support based on my expertise and formal training, not simply call the MAID team. With evidence-based psychotherapeutic options to treat depression, anxiety, demoralization and hopelessness, most patients end up not choosing MAID. This patient-centred “shared care” model of decision-making is a hallmark of quality palliative care.
I also teach and train palliative care residents as well as other clinicians who provide a palliative approach to care based on the patient populations they are looking after. This includes family doctors and specialists, such as cardiologists and nephrologists, and the many interdisciplinary colleagues who work alongside them. This work is incredibly important, as there is evidence from Canada and around the world that a palliative approach to care improves symptoms and quality of life for patients. When there are more complex issues, the way palliative care is presented to patients makes a difference to whether they will accept specialist palliative care services similar to mine.
Palliative care needs to be a distinct service from MAID, with separate funding and resources. Palliative care and MAID need to remain distinct and separate. Our palliative care community has worked hard over the past 40 years to move away from being associated with end-of-life care only. We do not want to go backwards. By separating them, palliative care can continue to be the safeguard as intended. MAID assessors and providers are in a conflict of interest if providing palliative care at the same time. This does not prevent palliative care physicians from practising MAID. However, they should not be providing palliative care alongside MAID for the same patient.
We urgently need investment in palliative care programs that are administered and funded separately from MAID so that we are not competing for the same resources. Many programs have had to divert their already scarce resources to support MAID services. This has made it even more challenging to provide palliative care when there are dire shortages in palliative care experts from coast to coast and, as a result, patients are even less likely to access palliative care. We need clear data around the quality and accessibility of palliative care and who is providing it for patients who choose MAID. This does not currently exist.
We need funding so that every Canadian has a right to high-quality, comprehensive palliative care. Our palliative care residency programs provide outstanding training experience, graduating highly skilled experts in the field. Together we provide education, guidance and clinical support to clinicians providing primary palliative care. Unfortunately, there are not enough residency positions or specialist palliative care physicians in Canada. We urgently need to invest in increasing funding for training programs across the country in order to graduate more specialist palliative care physicians and in education for all doctors who provide a palliative approach to care.
Please refer to the brief we submitted, as well as the one submitted by our past president, Dr. Leonie Herx, for more information.
Thank you.