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.

Topics

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

6:30 p.m.

NDP

The Deputy Speaker NDP 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 StrategyPrivate Members' Business

6:30 p.m.

Some hon. members

Agreed.

No.

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

6:30 p.m.

NDP

The Deputy Speaker NDP 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 StrategyPrivate Members' Business

6:30 p.m.

Conservative

Maurice Vellacott Conservative 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 StrategyPrivate Members' Business

6:40 p.m.

Liberal

Francis Scarpaleggia Liberal 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.

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

6:50 p.m.

NDP

Mylène Freeman NDP Argenteuil—Papineau—Mirabel, QC

Mr. Speaker, the motion by my colleague from Timmins—James Bay is extremely important to me and the people in my riding of Argenteuil—Papineau—Mirabel.

Motion No. 456 calls on the government to 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.

First of all, it is important to clearly define palliative care, since the debate could easily get off track and begin focusing on medical procedures that do not constitute palliative care.

According to the Réseau de soins palliatifs du Québec, palliative care is:

...any intervention required to improve the quality of life of people with life-threatening illnesses and their loved ones, in all areas of their lives.

According to the World Health Organization, palliative care is:

...the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms and of psychological, social and spiritual problems is paramount. The goal of palliative care is the achievement of the best possible quality of life for patients and their families.

In both of these definitions, palliative care is focused on the person's quality of life. Palliative care reduces families' emotional and financial stress. It focuses on the patient and the patient's family and reduces the cost of care by 50% or more, while mitigating the emotional stress of those who are trying to deal with the loss of a loved one.

I would like to take the time to talk about the difficulty of obtaining palliative care in many areas of Canada, Papineau being one of them. Papineau is a large, rural regional county municipality. It does not have much in the way of palliative care, since the only facilities offering this type of care are in Gatineau. That is far away, which makes it very difficult for families to be close to their dying loved ones. In the Outaouais region, the number of available spaces and beds does not meet the demand.

The community has rallied around a project to build a palliative care hospice, called Le Monarque, in Plaisance. The community is eagerly awaiting the construction of a palliative care hospice for the area covered by the Centre de santé et de services sociaux de Papineau, which includes Buckingham, Vallée de la Lièvre and Vallée de la Petite-Nation in the Outaouais. There are many working groups made up of numerous volunteers and stakeholders from throughout the Outaouais and the community who are working towards that goal.

So far, through the volunteers' hard work, a piece of land that is suitable for a palliative care hospice has been purchased, a business plan has been created and various funding, promotion and construction options for the hospice have been developed. The land is in Plaisance.

I would like to point out how great a challenge this project is. The goal is to offer palliative care, free of charge, to every resident of the area covered by the CSSS de Papineau. The demand is so great that the organization has even found a temporary solution for providing care until the hospice is built. Six beds are going to be set up in an old convent.

Manon Cardinal, the chair of Le Monarque's board of directors, is working tirelessly on this project. She is going to great lengths to make it happen. I commend her and the entire board of directors on their work. They are committed to this project and are working hard to make it reality. They entire community has come together.

We are participating in a number of fundraising events to help fund the project. One of those events had former Canadiens player Guy Lafleur as honorary chairman. He is a proud native of the area.

For six years, people have been collecting money through fundraising events. However, Le Monarque is struggling to come up with the money to construct the building in Plaisance, a project estimated to cost $1.8 million.

Ms. Cardinal is now trying to find less expensive contractors, which could help lower the cost of construction.

For example, they found someone who will dig a foundation for free and an electrician who will provide them with free labour. It is not just social and political community players who are involved in this project. This project is truly important to and driven by the community of the RCM of Papineau. This community spirit is very representative of the wonderful Petite-Nation region, where people really like to help each other out.

These dedicated volunteers have to go the extra mile because of this government's utter lack of a planning strategy. They have to perform miracles with very little in the way of resources. I commend them for their work. The federal government should show some leadership on this because the situation could be much better.

Despite the extraordinary work being done by various groups in Canada, we have an unacceptable patchwork of services, and the end-of-life care that is provided is not subject to any standards really. Only a small number of provinces consider this type of care an essential service.

That means that only 16% to 30% of Canadians have access to palliative and end-of-life care services, depending on where they live in Canada. However, there is consensus in Canadian civil society: 96% of Canadians support palliative care.

The time has come for the federal government to show leadership on this. Unfortunately, in 2007, the government cut funding from the Secretariat on Palliative and End-of-Life Care. However, in June 2011, the all-party Parliamentary Committee on Palliative and Compassionate Care recommended that the federal government restore the Secretariat on Palliative and End-of-Life Care in order to develop and implement a national palliative care and end-of-life care strategy. This committee did excellent work and truly enjoyed the co-operation of the House. You know that, Mr. Speaker. You were part of it.

I was a member of the Standing Committee on the Status of Women when it studied the issue of elder abuse. We consulted this report and understood how important end-of-life care is. I greatly appreciate the work that was done by this all-party committee. It proves that we must show some real co-operative leadership. That is what Canadians deserve and want.

The NDP believes that quality palliative and end-of-life care should go hand in hand with huge changes in our public health care system, including the expansion of quality home-based long-term care services, affordable medications and better access to primary care. We also believe that we have to take into account the geographic, regional and cultural diversity of urban and rural Canada and respect the cultural, spiritual and familial needs of first nation, Inuit and Métis people.

We must also aim at ensuring that all Canadians have access to high-quality home-based and hospice palliative end-of-life care, providing more support for caregivers and improving the quality and consistency of home and hospice palliative end-of-life care. Finally, Canadians must be encouraged to discuss and plan for end-of-life care.

I will close with the hope that this issue that is so important to my riding, and to all regions of Quebec and Canada, will be overwhelmingly supported by all members of all parties in the House. A pan-Canadian palliative and end-of-life care strategy is necessary. We must implement it, of course, together with the provinces, the territories and first nations for the benefit of all Canadians.

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

7 p.m.

NDP

The Deputy Speaker NDP Joe Comartin

Resuming debate, the hon. member for Kitchener—Conestoga. I would advise the member that because the member for Timmins—James Bay has a five minute right of reply, the member for Kitchener—Conestoga will have about seven to seven and a half minutes.

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

7 p.m.

Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

Mr. Speaker, I am pleased to rise today and join the debate on Motion No. 456, on palliative care.

As you know, Mr. Speaker, over the past five years a number of parliamentarians from all parties joined together to produce the Parliamentary Committee on Palliative and Compassionate Care report. I joined as a co-chair with the member for Guelph and also the member for Windsor—Tecumseh, whom I believe you know very well. It was a real honour for me to join with that group and many other colleagues from all parties to produce the report on palliative and compassionate care.

I want to read a bit of the introduction of that report to give Canadians an idea as to how this came about and the actual work that was done. It states:

The Parliamentary Committee on Palliative and Compassionate Care (PCPCC) is an ad hoc, all party group of MPs, dedicated to improving care for elderly, dying and vulnerable Canadians. It is unique in the history of the Canadian Parliament as it was formed by the MPs on their personal initiative and funded out of their member office budgets.

The committee is an example of what is possible when MPs work closely across party lines on issues of profound concern to everyone. The spirit of non partisan collaboration exhibited by the members of the committee is a great example of what parliament is at its best.

Receiving testimony from hundreds of people at twenty four hearings, and local round tables, MPs were profoundly impressed by the dedication and depth of concern expressed by Canadians for issues surrounding the way palliative and compassionate care is practised in our country.

Also, over the course of this study, I had the opportunity to visit different palliative care places and hospices across the country. One that sticks out in my mind was when I visited a hospice in the riding of Sarnia—Lambton. My colleague there hosted us for one of the round tables and then we visited the hospice. I was deeply moved by the compassion and empathy that the medical personnel, especially the doctors, showed for their patients, as well as the nurses and other support personnel as well.

These kinds of examples are multiplied across the country. Our task is to see that these are replicated in many more communities, especially in our rural communities, across Canada. This is at the heart of what the motion, and the recommendation of the committee, is all about.

Our government recognizes the growing need of Canadians for compassionate end-of-life care. There is no doubt that care should be there when people really need it, but it should also be the best care possible and made available at a reasonable cost to Canadians.

Despite the fact that most people say they would prefer to die in the comfort of their own home, the truth of the matter is that about 60% of Canadians spend their last days in a hospital setting. This is clearly not the preferred place to be, for a variety of reasons. Care at the end of life in hospitals can take a toll on patients, their families and other caregivers and is particularly taxing on the health care system. Additionally, it has implications on hospital wait times for emergency services and may limit the availability of hospital beds.

One of the solutions to address this issue and its unintended consequences is palliative care services. Palliative care focuses on relieving suffering and improving the quality of living and dying. It benefits people of all ages dealing with life threatening conditions, such as AIDS, cancer and cardiovascular disease. Palliative care treats the physical, psychological, social, spiritual and practical needs of the person who is dying. It also recognizes the needs of that person's family and other loved ones.

While many people associate palliative care with hospices and hospitals, it can be delivered in a variety of settings, including long-term care facilities, or even in one's own home. Again, I would just like to refer to a quote from the report, which states:

The palliative care philosophy is person-centred, family-focused and community-based. The philosophy moves us from disease or condition specific care to person-centred care. No longer will we refer to “the cancer patient in bed 4A” or “the heart patient going down to pre-op” or “the broken arm in 6B getting a cast”.

One doctor, Dr. John Meenan, from Kitchener, Ontario stated, “Doctors need to move beyond the model of glorified mechanics—

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

7:05 p.m.

NDP

The Deputy Speaker NDP Joe Comartin

Order, please. I have been advised that the member for Timmins—James Bay will not be using his five minutes of right of reply, so the member for Kitchener—Conestoga will have his full 10 minutes. That means he has about six more minutes.

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

7:05 p.m.

Conservative

Harold Albrecht Conservative Kitchener—Conestoga, ON

I appreciate your compassionate care, Mr. Speaker.

Science and technique are important, but people are more important, and it is people who get sick. Sickness almost always goes beyond the purely physical and purely mechanical. The mind, the heart, the will, and the human need to be put back at the centre of the doctor's vocation. I think that captures very well what palliative care is.

Palliative care has been in Canada for several decades, yet it is estimated that about 70% of Canadians do not have access to it. Access is particularly limited in rural and remote areas.

Historically, palliative care in Canada has focused on care delivered in hospitals by specialists. Thus far, the main recipients of palliative care have been cancer patients who are battling for their lives against this potentially fatal disease.

Today there is increasing demand to make palliative care services available to all people with life-threatening conditions and to have options as to where Canadians will spend the last days of their lives.

A recent survey commissioned by the Canadian Hospice Palliative Care Association showed that the topic of end-of-life care is an important one for Canadians. This survey also highlighted that Canadians have a general understanding of palliative care and overwhelmingly support it. However, the survey also revealed that people need more information about how to access the care available where they live.

Like other healthcare services, delivery of palliative care is mainly the responsibility of provinces and territories.

As members have heard from my colleague, the parliamentary secretary, some time ago, this government is already supporting initiatives aimed at enhancing greater capacity in our healthcare system to provide palliative care. While there is still work to do to improve end-of-life care, I am happy to be able to illustrate to members that progress has been made.

All provinces now offer palliative care services to some extent, and there are some promising practices that I would like to highlight. For example, Fraser Health in British Columbia and Niagara West in Ontario have adopted models that seek to integrate palliative care across all care settings and for all types of diseases.

In my own home region of Waterloo, I am aware of a number of services that are available. HopeSpring Cancer Support Centre is providing support for those who are newly diagnosed with cancer. Lisaard House is a hospice. I have heard many positive stories and have had personal contact in terms of patients who have been served by Lisaard House in the Waterloo Region, and I am very grateful for that. Also, Hospice Waterloo Region, Qualicare, Sunnyside Home, and the Grand River Regional Cancer Centre provide hospice care.

These health authorities are also building capacity by partnering family doctors with palliative care specialists. Knowing that they can draw on this expertise gives family doctors the support they need to continue to provide high-quality, personalized care to their patients.

As a routine part of care, physicians are also encouraged to have discussions with patients about their end-of-life care preferences before an illness occurs so that they can better understand their patients' wishes.

Resources that were once spent in hospitals are now being used to support the delivery of services in the community. This has resulted in an overall improvement in the quality-of-life care provided to patients as well as an increase in the number of people accessing end-of-life care services.

In Winnipeg, the palliative care program offers round-the-clock coverage for people who wish to spend their last living days at home. To enable this process, a palliative care doctor issues a medicine kit for use in the patient's home equipped with all the medications an individual might require to control symptoms for a period of 24 hours. If necessary, a palliative care nurse can perform a home visit and use this kit on the patient. If a symptom crisis occurs, it can be handled right in the patient's home rather than having them rushed to the emergency department that may be either just around the corner or far away from the patient's home.

In Montreal, the palliative care program at the Jewish General Hospital follows 500 patients in their homes. That is 500 people who are not in hospital beds. However, they will fast-track admission to the palliative care unit for patients who need it, and when they need it.

Nova Scotia and Manitoba have expanded access to palliative care drugs in home settings. All other provinces have similar programs. This means that at the end of life, people will not have to enter a hospital to get access to required medication or to simply have the cost of these prescription drugs covered.

As well, in our budget 2014, we invested $3 million in a community-based model for palliative care to help the Pallium Foundation in its work.

Changes such as those I have just described mark improvements in the options available to Canadians as they plan for end-of-life care.

Each province and territory recognizes the value of palliative care and has made significant advances in this area, often tailored to the unique character and composition of its population. A federal framework, and I would urge that we use “framework” for palliative care, would respect jurisdictional boundaries, complement these provincial and territorial initiatives, and provide additional information about federal activities and research.

I call on all members to support Motion No. 456 in the interest of caring for some of Canada's most vulnerable citizens.

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

7:10 p.m.

NDP

The Deputy Speaker NDP Joe Comartin

There has been a bit of a misunderstanding. The member for Timmins—James Bay has now opted to take his right of reply. However, he will only have three minutes in his right of reply.

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

7:10 p.m.

NDP

Charlie Angus NDP Timmins—James Bay, ON

Mr. Speaker, thank you for your excellent work tonight. I would like to thank my colleagues who spoke, from the other parties, for their support for this motion.

Once again, this is a moment in the House when we need to move beyond partisan games and say that we recognize the importance of this common sense solution. We need to get a national discussion on palliative care. I again reference the excellent work the committee did before me.

It has been amazing on this journey that it is not an issue that seems to exist within the Ottawa media bubble. It is not something that is perceived as perhaps hot enough or interesting enough. However, when we have gone out into communities and talked with the faith groups and the people who are dealing with it in their communities in rural and urban Canada, we have seen the same conversations in downtown Toronto as we have seen in rural areas. They are about the importance of supporting families and having the measures in place that help families, not just individuals, deal with pain and the heavy psychological and medical issues in facing life-threatening illnesses. They are about the need to support families in those moments so that they can have that period when their loved one can be taken through and the family can be taken through in a manner that allows them come out whole on the other side.

This is bigger than any of us individually. It is bigger than any of our individual parties. It is a moment when we have to try to work together. I would like to think that we will stand in the House and do that.

I would like to thank my colleagues who have done the work. We have gone back and forth on language and what the language means. Certainly, as someone who considers himself a wordsmith, I understand the importance of language. I also understand that there is a moment when the motion has to be put, when people have to stand and say that in the Parliament of Canada in 2014, we recognize this important, fundamental fact.

Simply making a palliative care strategy and/or framework motion will not be the solution. The solution will come from all the civil society groups that will look to Parliament and say that we made that commitment to the Canadian people, and now it is time to follow through. They are the same groups that will go to the provinces and regional health bodies and say that the Parliament of Canada spoke on the vision of comprehensive, supportive, palliative care that respects the familial, spiritual, and cultural needs of Canadians. It will be those people who then will put the pressure back on us so that we deliver on this promise.

Today is the first part of that commitment to Canadians to say that we get it. We understand that we need to start pushing out and speaking about the importance of the common sense solution. It maybe is not seen as a hot button issue or a sexy issue, but it is an issue that touches all of us. Civil society, faith communities, and rural and urban people will then come back to us and say, “this is what it looks like”.

Within our role in the federal government, we do not deliver the health services on the ground, nor should we, but we have a role to play to say that these models and options work. By working together with the provinces and territories and respecting their jurisdictions, we can actually establish frameworks that will help ensure that all Canadians are able to really and truly, when they need it, die with dignity, and families will be able to move forward in healing.

I am asking my hon. colleagues for their support on Motion No. 456.

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

7:15 p.m.

NDP

The Deputy Speaker NDP Joe Comartin

It being 7:18 p.m., the time provided for this debate has expired.

Is the House ready for the question?

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

7:15 p.m.

Some hon. members

Question.

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

7:15 p.m.

NDP

The Deputy Speaker NDP Joe Comartin

The question is on the amendment. Is it the pleasure of the House to adopt the amendment?

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

7:15 p.m.

Some hon. members

Agreed.

No.

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

7:15 p.m.

NDP

The Deputy Speaker NDP Joe Comartin

All those in favour of the amendment will please say yea.

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

7:15 p.m.

Some hon. members

Yea.

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

7:15 p.m.

NDP

The Deputy Speaker NDP Joe Comartin

All those opposed will please say nay.

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

7:15 p.m.

Some hon. members

Nay.

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

7:15 p.m.

NDP

The Deputy Speaker NDP Joe Comartin

And five or more members having risen:

Pursuant to Standing Order 93 the recorded division stands deferred until Wednesday, May 28 immediately before the time provided for private members' business.

A motion to adjourn the House under Standing Order 38 deemed to have been moved.

Fisheries and OceansAdjournment Proceedings

7:20 p.m.

Liberal

Scott Simms Liberal Bonavista—Gander—Grand Falls—Windsor, NL

Mr. Speaker, I rise today to follow up on a question I asked some time ago regarding the fisheries in Newfoundland and Labrador. There are two issues at play in my riding and for the northern coastline, even in southern Labrador through to the Northern Peninsula and the rest of Newfoundland. Basically, we are looking at fishing areas 2J, 3K, and 3L.

The first issue is with respect to the shrimp fishery. It suffered a big cut in the inshore fishery of 30%, whereas the offshore fleet was left out of it by only 2%.

The other major issue is ice compensation, which I asked about in the House last week. I spoke to a fish harvester in my riding, Ron Coles, who lives not too far from me. Ron updated me on just how bad it is with the ice forming now in all the major harbours. I am talking about White Bay, Green Bay, Notre Dame Bay, and even around the cape toward Bonavista Bay. The ice is hampering the crab fishery, no doubt, as well as the other fisheries involved. A lot of people cannot get out. As a result, it is a devastating situation.

Many people who rely on fishing EI benefits have not received a cheque since the middle of April, and now it is a month since that time. They have had no income for about a month. This is affecting the harvesters, the crews on their boats, and hundreds of plant workers.

My question, once again, is for the parliamentary secretary. When can we get an answer on what should be an ice compensation package to get some income for these people who have been devastated by the ice?

Fisheries and OceansAdjournment Proceedings

7:20 p.m.

Pitt Meadows—Maple Ridge—Mission B.C.

Conservative

Randy Kamp ConservativeParliamentary Secretary to the Minister of Fisheries and Oceans

Mr. Speaker, I thank my colleague for the question again. We have had this dialogue more than once, but I appreciate his persistence on this matter and I know he represents his constituents well.

I can assure the member and the Speaker that the Minister of Fisheries and Oceans shares the member's concern that ice conditions have delayed the opening of some fisheries, thereby affecting their ability to earn a living.

Let me stress, however, that ice packs are a common phenomenon of the environmental conditions in Newfoundland and Labrador. I know my colleague knows this. It is not unheard of for the start of the fishing season to be delayed by heavy ice, but conditions can change and do change significantly, depending on a number of factors, including wind conditions and currents.

In fact, such was the case in 1997, 2000, 2003, and 2008. In those years, requests for compensation were made, but in those instances it was determined that the situation did not warrant special compensation, given that ice conditions seemed to be lasting for perhaps only four or five weeks.

It is true that in some years that extreme conditions have prompted income compensation for fish harvesters. Fisheries and Oceans Canada provided compensation in 1984, 1985, 1991, and 2007. The last compensation program, delivered in 2007, was in response to exceptional conditions, the ice packs having delayed some fisheries in Newfoundland and Labrador and northeastern Quebec until the late spring and early summer.

Under the current employment insurance program, EI benefits for fishers are dealt with separately under the Employment Insurance Act. In fact, fishers are able to make claims and receive benefits twice each year for up to 26 weeks each time. This reflects the unique nature of the fishing industry, which has a summer and a winter finishing season.

As pointed out by the hon. member, major delays in fishery openings that are normally scheduled for early May or mid-May could have economic repercussions, and that is why Fisheries and Oceans is monitoring the situation very closely.

I have been told that current ice conditions on the northeast coast of Newfoundland indicate less ice now than at the same point in 2007. Latest forecasts of warm weather should also help break up the ice and facilitate the beginning of the fishery.

In closing, I will say again that DFO is continuing to monitor the ice conditions carefully. However, given that only a few fisheries have been affected by ice conditions so far and given marked improvements in ice conditions to date, ice conditions do not appear to be of sufficient scope or severity to warrant temporary assistance at this time.

Fisheries and OceansAdjournment Proceedings

7:25 p.m.

Liberal

Scott Simms Liberal Bonavista—Gander—Grand Falls—Windsor, NL

Mr. Speaker, in 2007, conditions were worse well into June. I can only assume that would be case here again, but I am not sure if I am reading this correctly. Is the door closed on this?

When I spoke to Ron Coles from Embree this morning, he mentioned this devastating situation, and it is not really warm weather that is needed. If we ask the fishermen, they will say they need a couple of storms, those strong winds to get the ice out into the ocean and away from the harbours. That is the key here.

I thank the parliamentary secretary for coming in to do this, but my question is, very pointedly, if this situation we have right now persists, is the possibility still open to provide ice compensation, as was provided in 2007 and 2009? Let us bear in mind that I now have close to 200 calls in my offices alone over ice compensation and how nobody can get out there on the water.