House of Commons Hansard #86 of the 41st Parliament, 2nd Session. (The original version is on Parliament's site.) The word of the day was chair.


Promotion of Local Foods Act
Private Members' Business

6 p.m.


The Speaker Andrew Scheer

I declare the motion defeated.

The House resumed from May 13 consideration of the motion that Bill C-571, An Act to amend the Meat Inspection Act and the Safe Food for Canadians Act (slaughter of equines for human consumption), be read the second time and referred to a committee.

Meat Inspection Act
Private Members' Business

6:05 p.m.


The Speaker Andrew Scheer

The House will now proceed to the taking of the deferred recorded division on the motion at second reading stage of Bill C-571 under private members' business.

(The House divided on the motion, which was negatived on the following division:)

Vote #142

Meat Inspection Act
Private Members' Business

6:10 p.m.


The Speaker Andrew Scheer

I declare the motion defeated.

It being 6:14, the House will now proceed to consideration of private members' business as listed on today's order paper.

The hon. member for Yukon is rising on a point of order.

Official Report
Private Members' Business

6:10 p.m.


Ryan Leef Yukon, YT

Mr. Speaker, I am rising to correct the Hansard record at the earliest opportunity. It has been brought to my attention that I made a reference in answering a question yesterday from the member for Toronto—Danforth when I was posing a question to him. The record reflects that I made a comment that in the last election the incumbent from the Yukon spent $20,000 more than he had in the election before and that he had lost by 1,500 votes.

Mr. Speaker, I want the record to reflect that he did not lose by 1,500 votes. He lost 1,500 votes between the 2008 election and this election. I would like the record to accurately reflect that, and that there was no effort to mislead.

Official Report
Private Members' Business

6:15 p.m.


The Speaker Andrew Scheer

I appreciate the clarification on that.

The House resumed from April 1 consideration of the motion and of the amendment.

Pan-Canadian Palliative and End-of-life Care Strategy
Private Members' Business

May 14th, 2014 / 6:15 p.m.


Frank Valeriote Guelph, ON

Mr. Speaker, it is a great privilege to speak today in favour of this important motion brought forward by the hon. member for Timmins—James Bay to establish a very necessary pan-Canadian palliative and end-of-life care strategy.

The motion speaks to a real and growing issue that will impact more and more of us as our population ages and as we approach a period when not only are Canadians living longer lives, but as baby boomers reach retirement age, more Canadians than ever will be in that top tier of older age.

No one wants to think about end-of-life considerations. We all want long, happy, and healthy lives for ourselves and for our loved ones. However, mothers and fathers and sons and daughters fall ill, often unexpectedly. The onslaught of a debilitating or even terminal illness will turn lives around, regardless of age, and bring about incredibly tough questions. It is emotional. There is no doubt about that.

There are a great number of us who have had this experience. We all have stories to share.

Mine is my father Mico, a vital and active man, a long-distance runner in his youth, an established businessman and leader, and one of the longest-serving aldermen in Guelph. It shook the foundation of my entire family when he developed Alzheimer's disease. The disease and the toll it took on him fundamentally changed not only his quality of life but also altered how my brothers, sisters, mother, and I related to him.

It is impossible to live through an ordeal like that and not consider any number of options. However, I can say that as terrible as the disease was, the whole experience drew us that much closer to him and our family that much closer together. I learned through experiencing it so intensely that the process of dying and everything associated with it can most often be a process as much for the benefit of the living as it is suffering for those dying.

In that time of need is found a time to serve those dying and a time to possibly attend to unresolved issues. It is a time that would otherwise be lost if we do not care compassionately for our elderly and ailing loved ones.

This might not be the same experience for everyone. We are a diverse country with an incredibly diverse populace. This is why I believe that not only must we work with the provinces to create an integrated and flexible framework but that such a collaborative model is the one way we can fully account for the geographic differences between provinces, between cities, and even between urban and rural divides, as well as our many cultures and communities, from Canada's first nations, Metis, and Inuit, to those most recently arrived, so that good palliative care does not depend on one's area code.

The Canadian Medical Association defines palliative care as: approach that improves the quality of life of patients and their families facing the problems associated with a life-threatening illness. It involves the prevention and relief of suffering by means of early identification, assessment and treatment of pain and other physical, psychosocial and spiritual symptoms.

I believe now, as I believed when I first began working with the member for Kitchener—Waterloo and the member for Windsor—Tecumseh as co-chairs of the Parliamentary Committee on Palliative and Compassionate Care, that if people are given a reason to live, feel their lives are relevant and significant, truly do not feel that they are a burden on society or especially on their families, and are enabled to live pain-free, they just might be less inclined to turn to more desperate measures as a relief from the emotional, mental, or physical pain from which they suffer.

I call to mind a beautiful and comprehensive quote from esteemed Canadian Jean Vanier, founder of L'Arche, which accomplishes better than I might the importance of giving people who may be suffering from a serious or terminal illness a reason to carry on. He says:

Each of us is fragile, with deep needs for both love and a sense of belonging. We begin and end our lives vulnerable and dependent, requiring others to care for us. ... In our states of dependence, our need cries out for attention and care. If this need is well received, it calls forth the powers of love in others, and creates unity around us, the gifts of the vulnerable to our world. If our cry and our need are unmet, we remain alone and in anguish. ... The danger in our culture of productivity and achievement is that we easily dismiss and ignore as unproductive the gifts and the beauty of our most vulnerable members, and we do so at our own peril, dehumanizing ourselves.

To accomplish this, to elevate those suffering from their solitude and anguish, we must create a framework whereby this can be addressed while also incorporating the possible cultural and regional differences that might be present.

Over the course of our study and in the creation of our non-partisan report, we travelled across Canada, and hundreds of informed Canadians travelled to Ottawa, where we heard from witnesses from coast to coast to coast who shared their stories and experiences with palliative care, elder abuse, and mental health to assist in drafting our report, appropriately entitled “Not to be Forgotten”.

Among our conclusions after hearing from these diverse witnesses was precisely what this motion seeks to accomplish by creating a national palliative and end-of-live care strategy. It would be flexible and integrated for maximum impact on those living through end-of-life events and on the 80% of care provided by families who take up that important yet difficult responsibility.

Through collaboration, the various levels of government and health and well-being stakeholders can develop and implement a nationally recognized framework with standards of care that would improve the quality of life for patients reaching end of life, providing the necessary tools to manage pain and providing more dignity. These tools may come in the form of meaningful tax relief or employment insurance payments for those who leave work to care for their infirm loved ones or in the form of better home care provided by personal support workers, whose jobs are quickly becoming the jobs of the future, or in the form of a national standard for hospice care uniformly applied across Canada.

As the member for Timmins—James Bay highlighted in his speech on this motion, “...what we are seeing across the country is a real patchwork of services”. This was one of many conclusions reached in our report. He went on to highlight the inconsistency of strategies or even provision of services in cities across Canada. This exemplifies why the strategy must be a national one and why we must start the ball rolling here. We can start here to coordinate with the other levels of government to facilitate collaboration in research and information and to dismantle the series of silos that normally operate in isolation across the country.

For instance, one such strategy is pain management. There has yet to be a comprehensive pain management treatment strategy upon which people can rely. It is currently a hit-or-miss experience with family doctors who are yet to be completely trained in the area of pain management.

We have a responsibility as a national leader and the chief communicator in raising awareness of the issues surrounding end-of-life and palliative care, particularly given the complexities brought forward by the mix of health, emotional, financial, and social pressures. These complexities and failing to deal with them properly, whether by offering help to caregivers or hope for the dying, lead to devastating consequences of their own, consequences I examined quite specifically throughout the committee's report. It became obvious that these pressures in today's society intersect and could lead to family breakdown and even elder abuse.

Beyond this primary leadership role, it is the federal government that sets the standards for universal high-quality care. The provinces are certainly responsible for delivery, but it is delivered best in conjunction with national benchmarks. This is an issue that does or will impact every Canadian at some point, so it is the Government of Canada that needs to step into the role.

My colleague, the hon. member for Vancouver Centre, pointed out in her remarks on this topic that tens of thousands of seniors die each year in Canada, and not all of them are able to get the kind of care they need as they approach end-of-life issues.

I applaud my colleague from Timmins—James Bay for bringing this motion to the floor of the House and for helping to continue the great work done by parliamentarians from all parties on palliative care.

This motion is not the end of the conversation. I think this is just the beginning. I hope that all of us here in the House can get behind that conversation and then bring it home to our ridings and genuinely create the framework necessary to put a national palliative care strategy together.

Pan-Canadian Palliative and End-of-life Care Strategy
Private Members' Business

6:25 p.m.


Charlie Angus Timmins—James Bay, ON

Mr. Speaker, as always, it is a great honour to stand in this House, having been given the honour to represent the people of Timmins—James Bay who put their trust in me.

I want to thank my colleague from Guelph for his support for our motion, my motion, Motion No. 456, but also thank the New Democratic Party for its push to establish a national palliative care strategy.

This is an issue that transcends partisanship because it touches each one of us, and it touches us in our most personal and sacred space, which is the moment between life and death and the moment when a family deals with the loss of a loved one.

I would be remiss if I did not thank for their excellent work all the parliamentarians of all political parties in this House who have worked on the issue of palliative care.

Certainly, the language of the motion comes from the work of the all-party committee, with my colleague from Kitchener—Conestoga, my colleague from Guelph, and my colleague from Windsor—Tecumseh.

My colleague from Guelph talks about the need for a conversation. I think this is what a motion is. A motion is a statement of principle and a statement of intent by the Parliament of Canada. It can be a very profound moment when parliamentarians are asked to say what it is that we need in order to move forward as a country. Certainly, we recognize, in this federal House, that the delivery of health services in this country is better served at the provincial level. We understand the jurisdictional divisions in the country, and they make sense because, as we move health care closer to the ground level, we can certainly see more proactive and better results.

However, in terms of palliative care, we are faced with a problem because there is a patchwork response right now. All too often, on the issue of palliative care, we see it is considered some form of charity or it is volunteer work, as opposed to an essential, fundamental principle, in terms of where we need that health care in the 21st century. Particularly as we deal with an aging population, as my colleague from Vancouver East has pointed out again and again, the future of health care will be moving more and more out of the hospitals and into the need to have an understanding of ongoing care to ensure that all Canadians have the quality of life they need, particularly when they are faced with a traumatic illness.

Therefore, the mission statement that we are asking for, as all parliamentarians here, is to say that in this House, this federal House, we have a role to play in talking about what palliative care should look like. It is not to dictate how it will be delivered, but we can play an essential role, a powerful role, as a federal government in saying there are models that work.

We see in various parts of the country that the delivery of palliative services is done in an integrated fashion, and where the services are integrated, families are able to receive the care and the support they want and need. However, where the services are not integrated, this money is still being spent. In fact, I would argue, and medical doctors would agree, that we are spending more money and yet people are still falling through the cracks.

So, the palliative solution is the common-sense solution staring politicians in the face. They just need to say, at this time, that we need a political will to talk about end-of-life care.

I would like to say that when we mention “palliative” to Canadians, they suddenly think, “Oh, God. Why are you talking about death?” It will do us good, I think, to look at some of the fundamental definitions, for example, used by the Canadian Medical Association.

When it talks about palliative care, the word “death” is not there. It is about life. It is: approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification, assessment and treatment of pain and other symptoms, physical, psychosocial and spiritual.

I would also point out the definition of “dying with dignity”, which has been a term that we see often in the media. The Canadian Medical Association says:

“Dying with dignity” indicates a death that occurs within the broad parameters set forth by the patient with respect to how they wish to be cared for.... It is NOT synonymous with euthanasia or physician assisted death.

This is a very powerful statement that the Canadian Medical Association has brought forward for us.

I would like to speak a little bit about the amendment that was brought forward by my colleague from Vancouver East, who has been so committed to the issue of ongoing care and has done much more work on the issue of palliative care than I have over the years. In her amending language to this, she would clarify:

That, in the opinion of the House, the government should establish a Pan-Canadian Palliative and End-of-life Care Strategy by working with provinces and territories on a flexible, integrated model of palliative care that: (a) takes into account the geographic, regional, and cultural diversity of urban and rural Canada as well as Canada’s First Nation, Inuit and Métis people; (b) respects the cultural, spiritual and familial needs of all Canadians; and (c) has the goal of (i) ensuring all Canadians have access to high quality home-based and hospice palliative end-of-life care, (ii) providing more support for caregivers, (iii) improving the quality and consistency of home and hospice palliative end-of-life care in Canada, (iv) encouraging Canadians to discuss and plan for end-of-life care.

Tonight, I would just like to focus for a second on the importance that we recognize in the House the cultural, spiritual, and familial needs of families. This is not just about the individual. The death of a loved one and the passage through to that other place is one of the defining moments in the life of a family. When there is palliative care and support, it can be a very transformative moment. When the support is not there, it can be a moment of crisis that families sometimes never recover from.

I would like to say that this motion, as I said at the beginning, is not about the partisanship in the House. This has been a very bitter and toxic Parliament, but we all need to say that we are going to put some of our own political agenda aside.

I know that some of my colleagues in the Conservative Party are made nervous by the word “strategy”. The strategy is the language that came from the all-party committee, and I certainly believe that the notion of strategy is important. Some of our Conservative colleagues would prefer to use the word “framework”. It does not matter to me if it is a strategy and/or framework. What matters is that we stand in this House and say that we will support this.

I would like to try to find a way that, tonight, we can make an agreement. I would like for us to find the language that makes everyone comfortable so that we will all stand in the House. No matter what happens with this motion, we have to show Canadians that we understand this.

The simplest way to do this is to ask for unanimous consent for the following motion: that, notwithstanding any Standing Order or usual practice of the House, the amendment to Motion No. 456 standing in the name of Ms. Davies of Vancouver East be deemed adopted, and that the main motion as amended be further amended by adding after the word “Strategy” the words “and/or Framework”.

Pan-Canadian Palliative and End-of-life Care Strategy
Private Members' Business

6:30 p.m.


The Deputy Speaker Joe Comartin

Does the hon. member have the unanimous consent of the House to move the motion?

Pan-Canadian Palliative and End-of-life Care Strategy
Private Members' Business

6:30 p.m.

Some hon. members



Pan-Canadian Palliative and End-of-life Care Strategy
Private Members' Business

6:30 p.m.


The Deputy Speaker Joe Comartin

The normal practice once the motion is moved, whether it is accepted or not, is that it ends the member's standing on the floor. We will now resume debate.

The hon. member for Saskatoon—Wanuskewin.

Pan-Canadian Palliative and End-of-life Care Strategy
Private Members' Business

6:30 p.m.


Maurice Vellacott Saskatoon—Wanuskewin, SK

Mr. Speaker, I am quite pleased to be able to speak this evening to this very important topic and this motion put forward by the good member for Timmins—James Bay. This motion we have before us calls on the federal government to develop a nationwide palliative and end-of-life care framework or strategy, “framework” being what we Conservatives prefer. Either way, we do need to get this under way in our country, based on some very good recommendations from a committee of this House.

As mentioned before, in 2010 several members of Parliament formed that all-party Parliamentary Committee on Palliative and Compassionate Care, and in 2011 they published their report, “Not to be Forgotten: Care of Vulnerable Canadians”. Several of their excellent recommendations are embodied in this motion before us. As was mentioned, the Conservative member of Parliament for Kitchener—Conestoga co-chaired that committee, and Motion No. 456 benefits from the excellent work done by a number of other members from all parties in the House. Other Conservative members, as I note, included my colleague from Saskatoon—Rosetown—Biggar and the MP for Newmarket—Aurora.

I do want to thank the member opposite, the NDP MP for Timmins—James Bay, for bringing this motion forward. It is time for this discussion to be had in the country. In fact, it is just on the very front edge, thankfully we think, but not any too soon.

The committee's comprehensive report came out with 14 recommendations, including:

Developing and implementing a National Palliative and End-of-Life Care Strategy; ...the development of a flexible integrated model of palliative health care delivery, able to take into account the geographic, regional and cultural diversity of Canada; ...strengthen the home care delivery program for First Nations, Métis and Inuit communities, developing home delivered palliative care resources, sensitive to community, cultural, familial and spiritual needs. ...expand the provisions of the E.I. based compassionate care benefit... ...set up a Canada Pension credit for family caregivers....

That is a pretty big package of things, actually. However, we are focused today on a framework, from a Conservative point of view, whereby we have the provinces and we have these various people co-operating, working together, and sharing what is already out there such that the public is better informed and better understands those resources.

We see various priorities reflected in Motion No. 456, calling for:

...working with the provinces and territories on a flexible, integrated model of palliative care that: (a) takes into account the geographic, regional, and cultural diversity of urban and rural Canada; (b) respects the cultural, spiritual and familial needs...

It has:

...the goal of (i) ensuring all Canadians have access to a high quality home-based and hospice palliative end-of-life care, (ii) providing more support for caregivers, (iii) improving the quality and consistency of home and hospice palliative end-of-life care in Canada; (iv) encouraging Canadians to discuss and plan for end-of-life care.

I had the privilege, in a younger era of my life, of working in seniors care homes as a health care worker, as an orderly in a hospital and also in a seniors care setting. In those early days when I thought the whole of my life stretched before me, I was a young guy with all these possibilities and was also interacting with, serving, working with, and ministering to those who were in their sunset years of life. As I had those interactions and got good advice from people and enjoyed the conversations and the wisdom of their years, I also began to more and more realize that I was vulnerable, that I was not invincible, and that I would not live forever. My parents, thankfully, and others had informed me of that same thing already, but it kind of affected me a little more as I looked into the wrinkled faces and frail eyes of the individuals who were in those home care situations.

There is all the more need today, as we have the aging baby boomers moving to retirement years. More pressure is being placed on society and on governments to discuss the needs and the concerns, including end-of-life care. The issue of euthanasia keeps coming up, and assisted suicide. Elder abuse and quality of life are things we should be talking about, and we should be standing in the way of abuse of our dear senior people as they live out their final golden years.

An aging population means that doctors and nurses will be increasingly facing the population and the public with end-of-life issues. I believe that at the core and heart of it is support for human dignity, being that we are all individuals made, in my view, in the image of God, from a Judeo-Christian point of view and that of some of the other world religions as well. So there needs to be that respect and support for human dignity and quality of life, with investments in pain management and other palliative care tools. That is where the Canadian conversation definitely needs to go.

We do not want to go down the dangerous and failed route of assisted suicide or euthanasia tried by other countries. We need better, consistent, end-of-life and palliative care in Canada. Palliative care and emotional support are necessary and appropriate responses to those who suffer from terminal illnesses and are near death.

Effective palliative care will also reduce the pressure to legalize assisted suicide and euthanasia. The Canadian Association of Palliative Care distinguishes four main reasons that patients request death: pain and physical suffering; loss of control over their illness, their lives, their bodies; the desire not to be a burden; and depression and psychological distress linked to their illness.

Palliative care is the most prominent alternative to the legalization of assisted suicide and euthanasia. As opposed to therapeutic obstinacy, aggressive treatment that might prolong a patient's life to the detriment of his or her quality of living, palliative care instead aims to provide “better medical care for pain and symptom control and to attend more appropriately to the personal, emotional and spiritual issues at the end of life”.

Advance care directives are also important to talk about in this conversation. I am sure members in the House are familiar with that, so that should take place well before the time comes for any of us. I do not have an advance care directive, but I am certainly reminded in the midst of these days and this topic that every one of us should be having those discussions with a spouse, our children, and with loved ones, about the kinds of measures that can be taken and the kinds that are beyond what we would want or require, the heroics, so to speak, that sometimes do not end in proper end-of-life care.

As an end-of-life treatment, it addresses the psychological and existential factors that influence requests for assisted suicide and euthanasia. We need to have instead these other topics of discussion: advance care treatment, advance care directives and also the kind of palliative care and pain relief that we would desire. Palliative care targets the sources of a patient's anxiety, therefore renewing his or her will to live, the overall quality of his or her life and ultimately, the quality of his or her death.

I would like to share a couple of brief anecdotes that look at life on the ground in Canada as Canadians serve those who need special care at the end of their lives. these accounts come from the March/April issue of the magazine Faith Today.

In the small eastern Ontario town of Perth, the O'Dacre family provides care at the end of life. They operate a funeral home, and they are supporting an initiative to bring a hospice to their community. Janey O'Dacre and her husband John both worked as nurses who provided palliative care prior to entering their present field.... “Our focus is supporting families with end-of-life decisions”, she explains. “But we're not just there for families when there is a death. We know exactly what it's like to be caregivers to the dying too, how emotionally, spiritually and physically exhausting it can be in that role”. They look forward to the day when local families who can't tend to dying loved ones at home can select hospice care, rather than hospitals or long-term care facilities.

The author of the article about palliative care also shared her own story, concluding this way. She said:

I'll forever be grateful for the privilege of helping to care for my father during his last days. As his life ebbed, he continued to communicate love for his family, and to receive the love we offered through our care. That exchange of love was a final, precious and intimate gift. And when he died, we found solace knowing that we would see him again, and that we had eased his final journey.

The world of palliative care continues to grow as the need expands and technology advances, but much more is needed. In recent years, each time the budget period rolls around, I have been urging the finance minister to commit more funds to palliative care. The passage of this motion would be a clear indication of Parliament's support for such a move.

Much more could be said in the way of dignity therapy, and members can google this. I would have mentioned in my speech, had I had more time, the work of Dr. Harvey Max Chochinov of the University of Manitoba, a very novel therapeutic intervention for suffering and distress at the end of life. Much can be said about pain relief at the end of life and there is a lot that can be done that is not much understood by the Canadian public, a crucial part of palliative care and what we need to be doing to provide the end-of-life relief for people as they fade from this life to the next.

Pan-Canadian Palliative and End-of-life Care Strategy
Private Members' Business

6:40 p.m.


Francis Scarpaleggia Lac-Saint-Louis, QC

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.