Thank you very much, Mr. Chair.
I am very happy to be here today.
My name is Gabriel Miller. I'm the director of public issues for the Canadian Cancer Society here in Ottawa. I'm joined today by my colleague and our assistant director, Kelly Masotti. I'll be delivering our opening comments, but Kelly will be here to help me answer any questions people may have for us.
It's a privilege to be here on behalf of the Canadian Cancer Society, which is Canada's largest national health charity. Canada faces no greater health challenge than cancer. Two in five Canadians can expect to develop the disease during their lifetimes. One out of every four of us can expect to die from cancer, making it our number one cause of death.
I want to thank you for inviting us today, and most importantly, thank you for dedicating your time and attention to this important issue. You're wrestling with some of the most difficult questions any parliamentarian could ever confront, questions about who should be able to seek assistance in dying and who should be able to provide it.
These are important and urgent questions; however, we're not here to help you answer them. We have neither the expertise nor the authority.
We are here to advise you on a related issue, and that issue is palliative care—care designed to protect the quality of life of critically ill patients and their families. Any serious conversation about the needs of severely ill Canadians must include palliative care, and any responsible policy on assisted dying must guarantee access to quality palliative care for all Canadians.
Three weeks ago, we released a new report entitled “Right to Care: Palliative care for all Canadians”. The report found that due to serious gaps in palliative care across the country, thousands of critically ill Canadians are not receiving proper care. That's hurting patients and families, and it's increasing health care costs.
In the absence of clear national standards and accountabilities, individual provinces and territories and health regions are left to develop their own policies, programs, and guidelines, which is resulting in inconsistent and inadequate palliative care in many parts of the country. In Ontario, 40% of cancer patients do not receive a palliative care assessment in their last year of life. In some regions of Atlantic and western Canada, less than half of the people who die in hospital receive palliative care.
Often, palliative care can be provided most effectively and affordably outside of hospitals, yet one of every two Canadian cancer deaths occurs in acute care hospitals, despite the preference of most patients to die at home. By global standards, Canada does a poor job of providing affordable end-of-life care, ranking 27th in a recent comparison of 40 countries. By expanding home care and improving support for caregivers, Canada can reduce hospital costs while protecting families from the potentially crippling financial burden of a critical illness.
A costly and confusing system that is failing too many patients, that's what our report found. But you don't need to take our word for it. This is an area where parliamentarians have done some outstanding work over the years. As the federal panel on assisted dying pointed out in their report, the Senate published studies on palliative care in 1995, 2000, 2005, and 2010. In addition, there are the findings of the federal and provincial panels. Also, the issue of palliative care and end-of-life care was touched on, importantly, in the Romanow report on health care.
Going back to 2000, the report led by Senator Sharon Carstairs found that palliative care was often based on the luck of the draw rather than being a basic entitlement of Canadians. It found that palliative care was provided in hospitals, long-term care facilities, and hospices, as well as through home care, and that when it was provided in hospital it was fully publicly covered, but when it was provided at home, only some services and some drugs were covered, depending on the territory, province, or region.
The Romanow report found that there were considerable disparities in access to palliative care across the country, and that these services had been developed on an ad hoc basis and were limited by the financial capability of communities and charitable organizations. Consequently, many Canadians did not have access to palliative care.
The root of this issue is that only medically necessary hospital services are currently insured under the Canada Health Act, with additional care and services paid for through provincial programs and private insurers, and by patients and families themselves. This complex and piecemeal funding is particularly problematic for palliative care, which often can and should be delivered outside of the hospital setting.
Other contributing factors include a lack of national standards and data collection, insufficient training for health care providers, insufficient information and support for patients, and inadequate investment in palliative care services.
How do we fix this?
We need to begin by making palliative care a top priority for federal and provincial governments as they craft a new health accord over the coming year. Specifically, we are calling on both federal and provincial governments to enact new legislation guaranteeing universal access to palliative care; to expand palliative care generally and home-based services in particular; to increase support for patients and family caregivers; to develop and implement national palliative care standards; and to increase training for health care providers in palliative care.
Palliative care doesn't have the same complexity as assisted dying. It is simply the notion that people should be well cared for—as people—to minimize their suffering and maximize their enjoyment of life. The only enduring mystery is how Canada has failed for so long to fix its broken palliative care system.
Canadians believe in the right of all people to access reliable, affordable, high-quality medical care. Palliative care is necessary, and the need will only grow more urgent as our older population grows. It's time to recognize the right to palliative care and to build a health system that delivers it.
Thank you very much.