Mr. Speaker, it has been said that the true measure of a society is how it treats its most vulnerable. We all surely agree that this notion is very much at the heart of the Canadian ethic, an ethic of caring that guides us collectively whenever we, as a nation, develop public policy or adapt it to new and evolving realities.
I would like to take this idea a step further to say that the measure of a society, of its moral maturity and of the point it occupies on the scale of civilization is found in whether and how it provides physical and spiritual comfort to those in their final days of life. This is why I agreed to be a founding member of the All-Party Parliamentary Committee on Palliative and Compassionate Care that in 2011 issued its report entitled “Not to be Forgotten: Care of Vulnerable Canadians”. This report is the basis of the motion we are debating today, calling for a national palliative care strategy in Canada.
It is important to understand what palliative care is not. Palliative care is not euthanasia. Some describe euthanasia as “the final stage of good palliative care”, confusing palliative sedation, an infrequent use of powerful sedatives to induce artificial sleep or coma, with terminal sedation, in which a patient is sedated with the primary intention of precipitating death.
The committee's report makes a point of saying that we must deal with end-of-life issues with uncompromising clarity. Democratic choice requires clear and informed debate to be said to be truly democratic. To quote again from the report:
We recommend building a national consensus on clear, unchanging terminology pertaining to end-of life-care. Confusion as to the meaning of terms and even deliberate obfuscation of end-of-life terminology for political reasons causes much unnecessary tension in end-of-life discussions.
Nor is palliative care simply pain control. Incidentally, the committee, in its hearings, heard that chronic pain affects a surprisingly large number of Canadians. Dr. Ray Hasel, an anesthesiologist at the Lakeshore General Hospital in Montreal's West Island, who appeared as a witness before the committee, is a strong advocate for expanding public health care services to include routine treatment of chronic pain.
Governments, however, are reticent to foray wholesale into this area. This is because the problem is so pervasive that governments fear a major drain on the public treasury should they do so. To quote from the committee's report:
Chronic pain costs more than Cancer, heart disease and HIV combined.
This fear of opening the financial floodgates is no doubt one reason why governments exclude fees for physiotherapy and osteopathic treatment from the definition of tax-deductible medical expenses under federal and provincial income tax acts.
In terms of end-of-life care, there are anecdotal reports of pain relief being withheld from dying patients for fear by medical practitioners that giving powerful pain drugs could hasten death, something for which the practitioner could then be held liable. These reports are consistent with the fact that, as a rule, only 30% of ordered medication is actually given.
A relief from pain is a human right. The Declaration of Montreal, adopted on September 3, 2010 at the 13th World Congress on Pain, affirms, among other things, “the right of all people with pain to have access to appropriate assessment and treatment of the pain by adequately trained professionals”.
The declaration also affirms the obligation of health care professionals in a treatment relationship with the patient within the scope of the legal limits of their professional practice and taking into account the treatment resources reasonably available “to offer to a patient in pain the management that would be offered by a reasonably careful and competent health care professional” in that field.
What may be needed therefore is legislation to implement this human right to appropriate pain management, as well as to clarify the limits of liability medical practitioners would face when administering drugs for the purpose of relieving a patient's pain, but without intent to hasten death.
Exploring such a legislative framework could be among the goals of a national palliative care strategy, as would be developing an ethics guide and medical protocols for administering pain relief at end of life, but again, palliative care is more than pain control.
Teresa Dellar, founder and executive director of the West Island Palliative Care Residence, and Rose De Angelis, nursing director at the residence, define palliative care as follows:
Palliative care affirms life, while helping to ease the physical, emotional and social distress of the patient and his or her family....
[Terminally-ill patients look to] focus on creating life-affirming moments that bring great satisfaction, closure and even joy. ...palliative care professionals and volunteers, walk beside them and support them through...the process of dying.
Like pain relief, palliative care is increasingly becoming considered a basic human right. Dan Cere of McGill University, who testified before the committee, stated:
Palliative care is part of a movement toward fundamental justice and basic human rights for citizens facing the last fragile stage of life....
It challenges narrow, impoverished and dehumanizing ways of dealing with dying.
In the same vein, in 2003, the European Committee of Ministers, in Declaration 24, affirmed that “palliative care is... an inalienable element of a citizen’s right to health care”.
This notion of a right to palliative care was also captured in the 2000 Canadian Senate report entitled “Quality End-of-life Care: The Right of Every Canadian”. We are not doing enough in Canada to implement this right through making quality palliative care accessible to all Canadians. This is because, to quote the committee's report:
Public policy...tends to be insensible to human fragility.... Public policy decisions reflect a compromise amongst a cross section of groups, none of whom are particularly vulnerable, and none of whose economic and political interests naturally coincide with those who are. The most vulnerable in society are not part of the day to day experience of policy planners.
Consequently, palliative care remains relatively unknown and little understood. Despite the good progress that is being made by those working hard to raise its profile as an emerging health care issue, palliative care has yet to reach a threshold in public awareness that would prompt governments to accord it the attention and funding it merits. The result is that only 30% of Canadians who will die this year will have access to palliative care. Moreover, palliative care is unevenly available across the country, with access, in essence, a function of a person's postal code.
Finally, only 16% of Canadians will have access to end-of-life care in a hospice. In this regard, we are fortunate in Montreal's West Island to harbour the West Island Palliative Care Residence, the largest in Canada in terms of available palliative care beds. Supporting Teresa Dellar and Rose De Angelis in their compassionate mission to provide the community with the highest possible standards of palliative care and, at the same time, serve as a model to the country of what palliative care could and should be is a profoundly dedicated staff and corps of volunteers, not to mention an army of loyal and generous individual and corporate sponsors.
In addition to a national palliative care strategy, we need a national palliative care secretariat in Canada to put the kind of independent focus on this specialized type of health care that will not truly be possible if responsibility for palliative care policy remains within Health Canada's departmental structure. As a bonus, an independent palliative care secretariat could also be the locus for creating and implementing a national pain strategy to help Canadians living with chronic pain outside of palliative end-of-life circumstances.