House of Commons Hansard #130 of the 42nd Parliament, 1st Session. (The original version is on Parliament's site.) The word of the day was treatment.


Controlled Drugs and Substances ActGovernment Orders

5:15 p.m.


Colin Carrie Conservative Oshawa, ON

Madam Speaker, my colleague and I serve together on the health committee. I would like to thank him for a lot of the good work that has been done.

As my colleague from Calgary said, we are all in agreement with much of what Bill C-37 contains, but one of the things we are not in agreement with is the Liberals' idea of a consultation process. During the election campaign, they said they would consult with Canadians. We saw them do that with their policy on pipelines, but here, on something to do with public health, the bill basically guts the consultation process.

From the testimony we heard in committee, my colleague knows it is essential that there be community buy-in for these injection sites or consumption sites to be successful. Everybody wants anything to do with addicts to be successful in its implementation.

If an injection site goes into a community, it is going to be the local community that will have to pay for police enforcement. The province has to put out money for these things.

Ottawa, for example, has a Liberal mayor who is on the record as saying he is opposed to having an injection site in this community. The chief of police and the former chief of police have also stated that they are not in favour of this type of intervention in this community. Because the Liberals have cut the consultation process on this issue, does my colleague think that if the mayor, the chief of police, and stakeholders who are going to be responsible for enforcement and payment, are not onside with it, the minister should still put an injection site in Ottawa?

Controlled Drugs and Substances ActGovernment Orders

5:15 p.m.


John Oliver Liberal Oakville, ON

Madam Speaker, it is a pleasure to serve with the member on the health committee. We have worked together to make some really good recommendations and directions in our report.

With respect to supervised consumption sites and harm reduction, we heard from many witnesses how important these sites are as part of early treatment and early intervention and better management for people who are consuming.

We also heard from witnesses that the previous government's Respect for Communities Act, Bill C-2, introduced such stringent rules and 26 application criteria that we have not been able to open a new safe consumption site across Canada since Bill C-2 was introduced. The Supreme Court has ruled on this and Bill C-37 would simply enshrine the court's ruling.

I would note that one of the five criteria is support and expressions of community support for the centre. I do believe there is appropriate response to community concerns and that part of the process of approval deals specifically with hearing from and looking for communities' expressions of support or their expressions of opposition.

Controlled Drugs and Substances ActGovernment Orders

5:20 p.m.


Don Davies NDP Vancouver Kingsway, BC

Madam Speaker, I would also like to express my appreciation to the hon. member for his contributions on the health committee. It is truly a pleasure working with him and note his leadership not only on the opioid file but on other issues that have come before our committee.

I do want to take issue with one fact that he represented in his speech, which is that the Minister of Health is doing everything possible under the circumstances. He specifically mentioned that the federal Minister of Health has implemented every single request that has been made by a provincial minister of health, but that is demonstrably not true. The provinces and cities have requested a number of things from the federal government, including improved treatment options, setting up a national command centre, requesting daily Health Canada briefings, and declaring a national public welfare emergency. The minister of health from my province of British Columbia specifically asked for that declaration. We know that the federal health minister has thus far rejected that request, so she is not doing everything that could be done.

Does my hon. colleague know how many of the 38 recommendations from the health committee, which he sat on, including the very first one which was to declare a public health emergency, the government has implemented to date?

Controlled Drugs and Substances ActGovernment Orders

5:20 p.m.


John Oliver Liberal Oakville, ON

Madam Speaker, likewise, it is an honour to serve with the hon. member on the health committee. I do find that we work together quite collaboratively on these issues.

It is really important that we remember in the House as we are debating Bill C-37 that there are federal and provincial jurisdictions at work here. Many of the situations and cases that the hon. member mentioned are really provincial authority. We are in the middle of a health accord negotiation. There is $6 billion available for mental health and addictions for provinces from the federal government which would go a long way toward implementing the treatment programs and services that some of these people need.

Controlled Drugs and Substances ActGovernment Orders

5:20 p.m.


The Assistant Deputy Speaker NDP Carol Hughes

Before I recognize the next member on debate, I just want to advise him that unfortunately, I will have to cut the debate off, but he will be able to continue the next time the bill is before the House.

Resuming debate. The hon. member for Brampton East.

Controlled Drugs and Substances ActGovernment Orders

5:20 p.m.


Raj Grewal Liberal Brampton East, ON

Madam Speaker, before I present my thoughts on Bill C-37, I do want to say that I come from Brampton East, which has the second most diverse population in the entire country. We have five Sikh gurdwaras, four Hindu temples, four mosques, two churches, and we all live in great harmony. The events that happened in Quebec affected all of us across this country. A place of worship where people go to pray is no place for violence. We stand with our Muslim brothers and sisters and we pray for all of them that we recover united as Canadians.

I am pleased to rise today to speak to Bill C-37, an act to amend the Controlled Drugs and Substances Act and to make related amendments to other acts.

The bill proposes important legislative changes that would help to support the new recently announced Canadian drugs and substances strategy, a comprehensive, collaborative, and compassionate strategy made up of the four key pillars of prevention, treatment, harm reduction, and enforcement, all of which are built on a strong foundation of evidence.

We are in the midst of a national public health crisis in Canada. In 2016, thousands of Canadians tragically died of accidental opioid overdoses, and more will die this year. Just last year in British Columbia alone, more than 900 people died from drug overdoses. That is an 80% increase from 2015. This is proof that the situation is getting worse. Deaths from overdoses will now be greater than deaths by car accidents. This tragic crisis continues to move eastward in Canada, with increasing drug seizures of fentanyl across our country.

As every member in this House knows, problematic substance use and addiction are serious public health issues. It seems that not a day goes by without seeing a story published in a Canadian newspaper about yet another overdose, another life lost, or another new dangerous drug on the streets. At the heart of these stories are everyday Canadians, their families, our communities.

Our government has taken action from day one. We are building on our five-point action plan to address opioid misuse. We have taken concrete steps, such as granting section 56 exemptions for the Dr. Peter Centre and extending the exemption for Insite for an additional four years. We made the overdose antidote more widely available in Canada. Last autumn, the Minister of Health co-hosted a conference and summit on opioids which resulted in 42 organizations bringing forward concrete proposals of their own. However, we must continue to respond to this tragedy in a way that is comprehensive, collaborative, and compassionate.

Bill C-37 would provide the government and law enforcement with the tools needed to support Canadian communities in addressing problematic substance use, including the opioid crisis.

With the dramatic increase in overdose deaths due to opioids occurring in Canada right now, it is crucial that the bill be passed swiftly.

Bill C-37 would demonstrate true support for communities grappling with the crisis by, among other things, removing unnecessary barriers to establishing supervised consumption sites. These barriers were put in place by the previous government in 2015.

When Bill C-37 passes, it will streamline the application process for supervised consumption sites by replacing the current 26 criteria set out in the Controlled Drugs and Substances Act to establish such a site with the requirement to submit evidence related to the five factors set out by the Supreme Court of Canada in its 2011 decision regarding Insite. These factors include: impact on crime rates; location conditions indicating need; a regulatory structure in place to support the facility; resources available to support its maintenance; and expressions of community support or opposition.

By reducing the number of criteria, the administrative burden on communities seeking to establish a supervised consumption site would be lessened. However, the health and safety of those operating these sites, their clients, and the surrounding community would not be compromised.

I want to take a moment to address the misunderstanding about these proposed amendments.

Some members of this House have contended that the views of a community would no longer be important in the assessment of an application to establish a supervised consumption site. Nothing could be further from the truth. The Supreme Court of Canada determined that the Minister of Health must consider expressions of community support or opposition when reviewing such applications.

Our government is respecting the Supreme Court of Canada's decision by proposing to include these factors in the legislation. The Government of Canada supports the need for community consultation in the application process for considering the establishment of supervised consumption sites. We understand and respect that communities may have valid concerns about a proposed site and that these concerns deserve to be heard and should be adequately addressed by applicants in their applications.

The proposed amendments would demonstrate that respect for communities is a multi-faceted issue. Yes, it means that the concerns of the community must be considered and addressed by the applicants; however, it also means that the federal government should not place any unnecessary barriers in the way of communities that want to establish a supervised consumption site as part of their local drug strategies.

Under Bill C-37, communities can be assured that their voices will be heard and that each application will be subject to a comprehensive review, yet it would do so without inevitably stalling the implementation of these life-saving programs in communities where they are wanted and needed. Just like any other regulated program, our government has a responsibility to the public.

Controlled Drugs and Substances ActGovernment Orders

5:30 p.m.


The Assistant Deputy Speaker NDP Carol Hughes

The member will have two and a half minutes to finish his speech and five minutes for questions and comments the next time this bill is before the House.

It being 5:30 p.m., the House will now proceed to the consideration of Private Members' Business as listed on today's Order Paper.

The House resumed from November 28, 2016, consideration of the motion that Bill C-238, An Act respecting the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercury, be read a third time and passed.

An Act respecting the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercuryPrivate Members' Business

5:30 p.m.


François Choquette NDP Drummond, QC

Madam Speaker, before I begin my speech, I will take a moment to express my sincere sympathy for the families of the victims of the shooting at the Centre culturel islamique de Québec. The tragedy has shaken us all. We are all aware of the importance of continuing to strive to live together in harmony and understanding, and to be united in the face of this tragedy. There are no words to describe the horror of this act. It is important for us as parliamentarians to say that we must always fight against hateful messages and hate directed at those who are a little different from ourselves. We are all united in asserting that. I wish a speedy recovery to those who were wounded in that unspeakable attack.

I am pleased to rise in the House to speak to Bill C-238, an act respecting the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercury. As we know, mercury is a dangerous substance. It is an incredibly dangerous neurotoxin, which can cross the placental barrier and endanger the fetus, and can be found in breast milk. Therefore it should not be taken lightly. Very minor exposure to traces of mercury can damage the nervous system and even lower IQ levels. It can also cause tremors, insomnia, memory loss, neuromuscular changes, headaches, and other problems. It is not a substance to be taken lightly. That is why having a strategy for the safe disposal of certain lamps containing mercury is very important.

I support the bill of the Liberal member for Dartmouth—Cole Harbour, who took this initiative. It is very good and a step in the right direction. The NDP supports all initiatives relating to sustainable development. We want to minimize the presence of toxic substances that can threaten the balance and viability of our ecosystems. Unfortunately, biodiversity is currently diminishing from year to year. It is really something we need to consider. As you know, the NDP has always been a leader in environmental protection. We have put forward many bills to protect the environment. We have been working very hard on this for a long time, which is why we must figure out solutions to the unsafe disposal of mercury component lamps.

I, myself, was on the Standing Committee on Environment and Sustainable Development when this bill was being studied. I asked questions about certain aspects of the bill that might be improved, to ensure that we had a sounder approach.

To explain the bill a little, it requires that the Minister of the Environment and Climate Change develop and implement a national strategy for the safe disposal of bulbs containing mercury. It asks the minister, in cooperation with the provinces, the territories, industry stakeholders, and environmental groups, to work on establishing a national strategy for the safe disposal of bulbs containing mercury. It also asks the minister to monitor and rigorously evaluate the effectiveness of the strategy.

On that point, I would personally have preferred that there be regulations to implement the strategy, but there are none in the bill. It is hard to have tangible action when there are no stringent regulations to be followed. This is one of the points in the strategy that could have been improved. As I was saying, this is a start, but the bill could have been tougher, firmer, and more rigorous. This is one of the first points.

Another point is that even though this is a federal responsibility, we are ultimately asking the municipalities to take action.

The risk is that the financial responsibility will be foisted on the municipalities. In reality, this is a federal government responsibility.

This is a concern I have shared with my colleague. Unfortunately, my concern has not been allayed and I am still worried. The financial burden of this federal responsibility should not be off-loaded on our colleagues in the municipalities. As we know, our colleagues in the municipalities already have their hands full and they have a lot of things they have to look after. They do not have a whole lot of ways to raise funds. We have to be careful not to weigh them down with more responsibilities.

I am going to talk a little about an extremely important principle when it comes to the environment: the expanded responsibility assigned to producers. It is important to understand this process, so that as little waste as possible ends up in landfill sites and so that it does not pollute those sites. That is why it is important to change the way we look at things. Unfortunately, we too often think that items that are no longer useful are trash or waste, when they should be thought of as resources. We should see trash as resources that can be reused at a later time.

Extended producer responsibility means that producers have to think about the parts or residual materials of an object that could be used for other purposes and that will be easy to recover and reuse at the end of the object's useful life. That is called extended producer responsibility. It is also known as cradle to cradle or circular economy. Instead of producing objects that will end up in the garbage and the landfill at the end of their useful life, producers should instead ensure that the various components of the object can be recovered later. This is especially important when there are other problems related to landfill sites, which are not easy to manage.

It is extremely important to ask questions in order to convert our economy into a circular economy. Producers need to take on extended responsibility. We cannot afford to keep throwing everything out. The planet has a lot of resources, but we must take better care of it than we are right now. It is extremely important.

Since 2001, the Canadian Council of Ministers of the Environment has been promoting standards to reduce the amount of mercury in lamps sold in Canada. Those measures were introduced a while ago. Unfortunately, things are moving too slowly, and there is still a long way to go. There are far too many lamps containing mercury in landfills. We will need to work much harder on this.

I will close by saying how tremendously important it is for the government to raise awareness. Without an awareness campaign, if people do not know where to take lamps containing mercury for safe disposal and potential reuse, the strategy will fail. It is vital that we back it up with a public awareness and information campaign so that everyone knows how to dispose of lamps containing mercury.

As I said, municipalities are doing excellent work in waste management, but managing waste, or, as I prefer to say, resources, containing mercury is the federal government's job. The feds must not download this responsibility on to municipalities. It is extremely important for the federal government to step up and support municipalities on this.

An Act respecting the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercuryPrivate Members' Business

5:40 p.m.


Mike Bossio Liberal Hastings—Lennox and Addington, ON

Mr. Speaker, I am pleased to have the opportunity to speak today on the bill brought forward by the member for Dartmouth—Cole Harbour, an act respecting the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercury.

Bill C-238 would build upon efforts already under way across Canada to reduce mercury emissions to the environment. Reducing mercury emissions is an important goal, given the serious effects mercury can have on human health and the environment. Mercury is a potent neurotoxin. It can cause damage to the brain, central nervous system, kidney, lungs, and is particularly damaging to the development of the human fetus, infants, and young children.

In terms of environmental impacts, mercury biomagnifies as it moves up the food chain, meaning that higher levels of mercury are found in animals higher on the food chain. This can lead to increased exposure for fish and wildlife, as well as humans who consume certain kinds of fish. Increased exposure means increased health problems, including slower growth, reproductive failure, and the development of abnormal behaviours. Mercury can travel long distances in the atmosphere. It has been found to accumulate in Canada's Arctic.

Given these impacts on human health and the environment, the Government of Canada is committed to minimizing and, when feasible, eliminating human sources of mercury emissions.

Domestic mercury emissions have been reduced by approximately 90% since the 1970s, thanks to a wide range of initiatives to address mercury emissions. However, more can be done.

In 2010, the Government of Canada released the risk management strategy for mercury. The strategy provides a comprehensive description of the government's plans and progress in managing the risks associated with mercury. One example is the products containing mercury regulations, which came into force in November 2015. These regulations prohibit the manufacture and import of products containing mercury, with some exemptions for essential products that have no technically or economically viable alternatives. In the case of lamps, the regulations set mercury content limits for fluorescent and other types of lamps that require labels to inform consumers about the presence of mercury.

In April 2016, Environment and Climate Change Canada published the proposed code of practice for environmentally sound management of end-of-life lamps containing mercury. The code provides guidance and information relevant to managing these lamps at the end of their life. The final code of practice was expected to be published by the end of 2016.

International initiatives to address mercury pollution are another important element of the Government of Canada's approach. It is estimated that 95% of human caused mercury deposits in Canada come from foreign sources. To help reduce the impact of transboundary pollution on Canada, and particularly impact on Canada's Arctic where mercury tends to deposit, the government signed the Minamata convention on mercury in 2013. We are in the process of finalizing the necessary implementation measures required to ratify the treaty.

The bill introduced by my colleague, the member for Dartmouth—Cole Harbour, would complement these and other existing measures to address mercury pollution by focusing on one particular source of emissions, light bulbs. Many energy efficient bulbs, including compact fluorescent lamps used in the homes and workplaces of many Canadians, contain a small amount of mercury. This mercury may be released if the lamp breaks or is improperly disposed of as regular garbage.

The bill would mandate the development of a national strategy for the safe disposal of lamps containing mercury. Amendments made to the bill at committee serve to reinforce the purpose of the bill and the need for co-operation across jurisdictions in the development of a national strategy. For example, the bill now speaks of safe and environmentally sound disposal.

The environmentally sound end-of-life management of lamps containing mercury involves a range of activities, including collection, processing, recycling, diversion, and storage. The national strategy contemplated by the bill would capture any number of these activities, rather than the disposal of lamps containing mercury in a landfill. This terminology is consistent with the proposed codes of practice for end-of-life lamps containing mercury.

The amendments made at committee also strengthen the bill by recognizing the jurisdiction over the protection of the environment, including matters related to waste management, is shared among all levels of government in Canada. Removing the requirement on the minister to implement the national strategy recognizes this fact as the minister cannot implement the national strategy on her own. As a result, the bill would require the Minister of Environment and Climate Change to work with other parties, including the provincial and territorial governments, in developing a national strategy.

The bill also intends to capture other interested governments such as municipal and indigenous governments that may have important roles in the implementation of a national strategy. The minister will need to co-operate with them, but also consult with other interested parties, including stakeholders, in developing a national plan of this kind.

The bill lists examples of the kinds of things that the national strategy could include. Possible elements set out in the bill will not only help guide collaboration and consultation with other interested parties, including stakeholders, but will also help ensure that the national strategy does not duplicate efforts already under way.

The strategy can evolve to ensure that the range of perspectives are considered in the development of the strategy. One possible element of the national strategy is a plan to promote public awareness of the importance of disposing of mercury containing lamps safely and in an environmentally sound manner. Many Canadians are currently unaware that these bulbs should not be disposed of in regular garbage because they may break and release mercury into the environment.

The bill sets out a flexible framework for development the national strategy, but also contains important mandatory requirements. In particular, it requires the Minister of Environment and Climate Change to develop and report on the national strategy.

The first report to Parliament setting out the national strategy must occur within 15 sitting days of December 31, 2018, or within two years after royal assent, whichever is later. Every five years following the initial tabling, the minister must report on the strategy, including his or her conclusions and recommendations regarding the strategy. These reporting requirements promote transparency and accountability, and will help ensure that the national strategy achieves its intended purpose.

I sit on the environment committee along with the member for Dartmouth—Cole Harbour. As we were going through the bill to make amendments, the importance of this issue became really apparent. I happened to be looking up at the ceiling and I noticed all the lights. I started to count them. There were over 70 fluorescent lights in the one committee room. Then I just happened to be in the Library of Parliament, looking over the speech. when I looked up and started counting lights. I got to over 250 and I still had not counted all of them. These are just two rooms in the millions of rooms in up to 10 million homes in our country that presently use compact fluorescent light bulbs.

It is so important that we develop a national strategy that can work with industry, that can work with all levels of government, that can work with innovation to try to drive forward new technologies, as we are presently, which are more efficient and more cost effective and will eventually eliminate the need for fluorescent bulbs altogether.

Once again, I would like to thank the member for Dartmouth—Cole Harbour for bringing the bill forward. The government supports the bill, as amended, and looks forward to working with other governments, indigenous groups and stakeholders to develop an effective national strategy for the safe and environmentally sound disposal of lamps containing mercury.

An Act respecting the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercuryPrivate Members' Business

5:50 p.m.


John McKay Liberal Scarborough—Guildwood, ON

Mr. Speaker, I am pleased to rise today in support of Bill C-238, the national strategy for Safe and Environmentally Sound Disposal of Lamps Containing Mercury act.

First, I want to thank my colleague, the member for Dartmouth—Cole Harbour, for bringing the bill forward. The bill serves an important purpose by contributing to efforts to reduce mercury emissions and releases. Mercury is a toxic subject that is harmful to the environment and human health, which is why the Government of Canada is committed to eliminating human sources of mercury emissions when feasible.

Bill C-238 calls for a national strategy for the safe and environmentally sound disposal of lamps containing mercury. The bill would fill gaps within the existing framework governing management of mercury in Canada. Although robust measures are already in place to manage mercury emissions and products containing mercury, many Canadians are unaware of the dangers of improper disposal of lamps containing mercury. Many Canadians do not have ready access to facilities where lamps containing mercury can be disposed of safely and in an environmentally sound manner.

The Standing Committee on Environment and Sustainable Development studied the bill. I was there for one meeting. In a very collaborative way and arguably a way which all committees ideally would operate, adopted amendments that would facilitate a co-operative and collaborative approach to the development of the national strategy. These amendments are consistent with the purpose of the bill. The member for Dartmouth—Cole Harbour has noted that the bill is meant to be the beginning of a conversation. The amendments made at committee facilitate that goal by expanding the range of perspectives to be considered in the conversation and by ensuring flexibility in determining the elements of the national strategy.

The amendments made at committee strengthen the bill by recognizing that jurisdiction over waste management is shared between different levels of government. The national strategy is to be developed by the Minister of Environment, in cooperation with representatives of provincial, territorial, and other interested governments. The addition of “other interested governments” improves the original bill by capturing other governments, such as municipal and indigenous governments, that would like to have a role in developing and implementing the national strategy.

A related amendment is that the minister shall consult with “all interested persons and organizations”, rather than only requiring consultation with environmental groups and industry. This would help to ensure that a range of perspectives would be considered in the development of the strategy.

There are a number of reasons why the co-operative, flexible framework set out in the bill is essential to the success of the national strategy.

First and foremost, co-operation is important because jurisdiction over matters related to waste management is shared among different levels of government. The Government of Canada currently regulates international and interprovincial movements of hazardous waste, manages waste on federal lands, and has extensive authorities to regulate toxic substances and products that contain them. Provincial and territorial jurisdictions regulate waste management operations and facilities and the end-of-life management of products. Municipal governments collect and manage waste for recycling and disposal. Bill C-238 recognizes that these various levels of government have a role to play in the safe and environmentally sound disposal of lamps containing mercury.

A collaborative approach to managing mercury emissions is nothing new. For years, important work has been coordinated by the Canadian Council of Ministers of the Environment to address various sources of mercury pollution, including lamps containing mercury.

One example of action at the CCME level is the Canada-wide action plan on extended producer responsibility. In 2009, all provinces and the federal government committed to implementing the Canada-wide action plan, which includes action on mercury lamps. Extended producer responsibility, or EPR, is an approach where producers are responsible for dealing with products at their end of life. Essentially, EPR shifts responsibility for dealing with waste products upstream to the producer and away from municipalities and general taxpayers. EPR can be an effective way to divert certain products from landfills and we have seen some success in the context of mercury lamps. Four provinces, British Columbia, Manitoba, Quebec, and Prince Edward Island, have implemented specific regulatory programs to collect and recycle mercury lamps.

This brings me to another reason why the co-operative approach put forth in the bill is so important. This approach recognizes that a number of efforts are already under way in different jurisdictions to minimize pollution from lamps containing mercury. Some provinces, and even certain areas within provinces, are further ahead than others in terms of managing lamps containing mercury in an environmentally sound manner. In other areas, such as much of the north, the infrastructure to properly divert these lamps from landfills simply does not exist.

There are also a number of federal initiatives to address mercury lamps. For example, in April of 2016, the Government of Canada published a Proposed Code of Practice for the Environmentally Sound Management of End-of-life Lamps Containing Mercury. I do not know how these titles are arrived at. It seems there is kind of an art form that goes with the creation of law that there has to be a title that runs for about four paragraphs.

The code of practice is a voluntary tool developed to complement provincial, territorial, and municipal initiatives and to promote the best practices for managing lamps containing mercury at the end of life. By setting out a co-operative framework, the bill would allow the national strategy to complement, rather than duplicate, existing federal, provincial, and municipal efforts to manage lamps containing mercury. The bill would not mandate what the national strategy must include. Instead, it would require that the strategy be developed co-operatively.

The bill would provide guidance by setting out certain elements that could be included in the national strategy. For example, the national strategy could include guidelines for facilities involved in the safe and environmentally sound disposal of mercury. This could be a facility like the recycling facility in Dartmouth—Cole Harbour and similar facilities across Canada. However, the elements of the national strategy are not predetermined by the bill. Rather, the strategy may include any elements to reflect the work and consultations that the minister will undertake with provinces, territories, municipalities, and other interested parties in the development of the strategy.

The bill focuses national attention on an important issue, an issue on which we have a real opportunity to reduce mercury emissions. I want to again thank the member for Dartmouth—Cole Harbour for his initiative and for bringing the bill forward. I expect that a national strategy will have an important impact on ensuring environmentally sound management of lamps containing mercury.

An Act respecting the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercuryPrivate Members' Business

5:55 p.m.


The Assistant Deputy Speaker Liberal Anthony Rota

Seeing no one rise on debate, the hon. member for Dartmouth—Cole Harbour has five minutes of reply.

An Act respecting the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercuryPrivate Members' Business

5:55 p.m.


Darren Fisher Liberal Dartmouth—Cole Harbour, NS

Mr. Speaker, I am sure I will not need a full five minutes. I will say that I am truly humbled to rise again in this place to speak to Bill C-238, a national strategy for the safe and environmentally sound disposal of lamps containing mercury act. The member who spoke previously is correct; it is a mouthful.

I would like to start by thanking my amazing family. It is not always easy to come here to Ottawa. In fact, I am missing my son's hockey game right now; he will take the ice in about a minute. We miss a lot of things by coming here to do the good work for the people in our communities, and I am proud to do the work for the people of the community of Dartmouth—Cole Harbour.

I have to thank the members of my team for their incredibly hard work on Bill C-238. This started out as nothing more than a bright idea, and they have been able to turn this into something tangible, into a private member's bill that is now at third reading and hopefully, fingers crossed, knock on wood, on its way to becoming a law.

My riding of Dartmouth—Cole Harbour inspired this bill. We have many innovative businesses in the Dartmouth Burnside industrial park. One of them, Dan-X Recycling, caught my eye. I have mentioned Dan-X before, but this facility is able to efficiently dispose of mercury-bearing light bulbs in a safe and environmentally sound way. This facility is an excellent example of the clean tech industry, and I am proud to have it in my riding. Just think, if Bill C-238 passes, we could improve the green economy by encouraging more facilities like Dan-X right across the country. Now that is a clean economy.

I have stated before that Bill C-238 is about working together, but I do not think I realized how true this would be. I have been humbled by the supportive and kind words I have received from colleagues throughout this House. Bill C-238 as amended passed unanimously at the Standing Committee on Environment and Sustainable Development. Many members have spoken to this bill in the several readings in this House, but my favourite comment so far has to be from the member for Yellowhead who said, “this bill is a winner”. I thank my friend for that comment. I would be remiss if I did not mention the member for Abbotsford, who through this process has become a friend. He sits on the environment committee with me and he has had some very good, supportive words to say about this bill.

Bill C-238 has created an incredible dialogue around mercury pollution, but it has also shown that when we care about the environment, when we care about Canadians, and when we care about making real change, we can work across party lines to make it happen. This is what Canadians want and this is what they expect from us in this House. I firmly believe that Bill C-238 has the potential to solve the issue of mercury-bearing light bulb pollution in our lands and in our waters. I encourage all members of this House to support Bill C-238, regarding the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercury act.

Let us continue to work together. Let us solve this issue together to ensure that we leave this country a better place for all Canadians to enjoy.

An Act respecting the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercuryPrivate Members' Business

6 p.m.


The Assistant Deputy Speaker Liberal Anthony Rota

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

An Act respecting the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercuryPrivate Members' Business

6 p.m.

Some hon. members


An Act respecting the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercuryPrivate Members' Business

6 p.m.


The Assistant Deputy Speaker Liberal Anthony Rota

(Motion agreed to, bill read the third time and passed)

An Act respecting the development of a national strategy for the safe and environmentally sound disposal of lamps containing mercuryPrivate Members' Business

6 p.m.


The Assistant Deputy Speaker Liberal Anthony Rota

Pursuant to Standing Order 30(7), the House will now proceed to the consideration of Bill C-277 under private members' business.

The House resumed from November 23, 2016 consideration of the motion that Bill C-277, An Act providing for the development of a framework on palliative care in Canada, be read the second time and referred to a committee.

Framework on Palliative Care in Canada ActPrivate Members' Business

6 p.m.


The Assistant Deputy Speaker Liberal Anthony Rota

Resuming debate. The hon. member for Abitibi—Témiscamingue has eight minutes to complete her speech.

Framework on Palliative Care in Canada ActPrivate Members' Business

6 p.m.


Christine Moore NDP Abitibi—Témiscamingue, QC

Mr. Speaker, I did not think I would have the chance to complete this speech, so I am pleased to use the eight minutes I have left to do that.

In the first part of my speech, I had noted some things that the bill’s sponsor could come back to in committee. I had also suggested that she include the first nations governments in the consultation, because that is crucial. Often, the cultural approach to death is not really incorporated. Given the federal government’s duty to the first nations communities, it is essential that they be at the discussion table to express their needs.

In addition, there are enormous needs for palliative care in indigenous communities, because there are virtually no projects. Often, the communities are too small, so the feeling is that resources cannot be allocated specifically to palliative care. A number of first nations communities have no long-term care facility. Elders are therefore cared for by their province’s health care system.

When we go out and meet with the people who provide palliative care, we see that they are interested in developing projects. I have been to the Maison du Boulot Blanc in Amos, right next to the community of Pikogan. It sometimes takes in people from the Pikogan indigenous community who need its services. The people who work there are very happy to do that, but they say themselves that it is not the same, that the community is much more involved and there are a lot of people who come to support the dying person.

They do what they can in terms of needs, but if there were some openness to allocating federal funds for specific projects for the first nations, they would very definitely be open to having a room set up and decorated based on the person’s needs. That would reflect the desired approach, which is to accommodate clients who need palliative care.

This is something that will have to be discussed in committee. I urge my colleague to give immediate thought to people from indigenous communities who might be interested in talking about their situations and how they could be involved in delivering palliative care.

Although the administration of palliative care itself falls under provincial jurisdiction, I believe that the federal government has a role to play in bringing all the stakeholders together to discuss best practices. It is not about taking a paternalistic approach and bringing everyone together to tell them to look at the best practices happening elsewhere. It is about creating room for dialogue, where everyone can share their successes and failures in order to move palliative care forward.

We often forget certain particularities associated with palliative care. Pediatric palliative care is extremely difficult. How do we support a child who is dying of cancer or some genetic disease? We have a lot to learn by sharing ideas on this.

For instance, it is important to ensure that children who need palliative care are not forced to choose between being close to home or in a pediatric care centre. They are often hospitalized for long periods and find themselves far from home. Parents sometimes decide to bring their child home when it is time for palliative care to begin. When we talk about a special client group, it is often those in remote areas who have a hard time getting the care they need.

It would be helpful, then, to be able to talk about our practices in order to overcome these challenges. If the various ministries, provinces, and agencies involved could share tools with the rest of the country, we would all be better off.

Other patients are often neglected. For example, how does one help a person with a fairly serious intellectual deficiency prepare for death?

I have had to do it over the course of my career and it is not easy. Caregivers do not always have all the tools they need. They are used to working in a context where the person understands death and what is happening to him or her. However, it is often more difficult to help someone outside that context. I therefore think it is important for caregivers to have that skill.

When it comes to palliative care, for example, some deaths will affect caregivers more than others. That is why it is also important to talk about the distress they experience. Regardless of where the caregiver works, some cases will cause a lot of pain and sorrow. It is also important to be able to talk about that aspect of palliative care so that caregivers do not carry that pain and sorrow with them throughout their careers and can resist breaking down at some point.

Take, for example, soldiers who are deployed overseas and who have to be there for someone who is dying because there is no other choice. Sometimes these experiences are traumatizing and become difficult to live with after many years in the field.

In my opinion, it would be worthwhile adding this other element to the bill on palliative care, that is, monitoring the distress of caregivers, because we are hearing more and more about this issue.

Working with death every day is difficult. I believe it would be beneficial to monitor the distress of caregivers, especially those working in palliative care centres and paediatric and neonatal departments, who do their best to save infants, but are sometimes confronted by the reality that there is no other option but to let them go. These life situations can be difficult, and it would be advisable to monitor this aspect of public health.

I would like to thank my colleague and the House once again for letting me finish my speech. I look forward to my colleagues' comments.

Framework on Palliative Care in Canada ActPrivate Members' Business

6:10 p.m.


Bernard Généreux Conservative Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

Mr. Speaker, I am pleased to rise in the House today to support my colleague, the member for Sarnia—Lambton, and her Bill C-277, an act providing for the development of a framework on palliative care in Canada.

Before continuing, I must first congratulate my colleague for her hard work since she was elected in 2015, and for earning the title of most collegial MP. She was awarded that title by her colleagues in the House, from all parties, when the prize was given by Maclean's and L'Actualité last fall. It speaks to the unstinting work done by my colleague, particularly on her present bill.

We are therefore very happy to have an engineer in our Conservative caucus as opposition science critic. That is why I am happy to speak today in support of her Bill C-277, a bill that has attracted attention from key health care stakeholders in my riding, Montmagny—L'Islet—Kamouraska—Rivière-du-Loup.

Like a number of rural ridings in Canada, we find that we have an aging population, and we can already anticipate that the demand for palliative care will rise considerably over the coming years. It has already started. It is therefore important to talk about it and give ourselves time to be well prepared.

Following a Supreme Court decision in Carter, last year, this Parliament passed Bill C-14, which provided a legislative framework for physician-assisted dying. Although the bill was well received by some people who wanted to avail themselves of this right, others had some concerns, because they wanted to make sure that this was not the only option available. In my riding, just like elsewhere in Canada, this is a real question: will we provide only a bill like that, or will we provide other types of care? The other types of care are much needed.

As my colleague from Sarnia—Lambton noted, in the final report of the external committee on options for a legislative response to Carter v. Canada, the Supreme Court stated that a request for physician-assisted death cannot be truly voluntary if the proper palliative care is not available to alleviate the suffering of patients.

This is where we are today. The bill proposed by my colleague seeks to improve the options available to Canadians at the end of their lives. It truly seeks to encourage consultations and dialogue with the provinces to develop a national framework so that palliative care is a real option. In fact, the plan highlights the importance of having access to palliative care of higher quality than what is currently available.

It is important that our seniors and other people with terminal illnesses are protected with healthy, safe, and comfortable options in the last stages of their lives if they do not wish to avail themselves of medical assistance in dying. This is an extremely important point. People must have access to high-quality care to be able to live as long as possible in palliative care facilities. This will prevent many people from even thinking about requesting that their lives be terminated. The dignity of people depends on it.

I would like to highlight the incredible work done in my riding by the Maison Desjardins de soins palliatifs in Rivière-du-Loup, which has provided an enormous amount of care since it opened in 2009. I should also mention the mission of the Fondation Hélène-Caron, which will soon be serving the region of Montmagny and l'Islet through the Maison d'Hélène. Passing Bill C-277 will send a message to organizations like those, all across Canada, that their work is recognized and greatly appreciated.

Last month, Dr. Louise La Fontaine, vice-president of the Société québécoise des médecins en soins palliatifs and a resident of Notre-Dame-du-Portage in my riding, wrote to me to say that Canadians across the country have joined together to draw attention to the importance of palliative care.

She recommends that a national policy be developed in order to considerably improve the quality and consistency of palliative care and access to it. She recommends examining and assessing new models of integrated care, broadening accreditation standards throughout the entire health network, and focusing on areas such as symptom management and advance care planning. Practitioners must also be trained so that they can work in accordance with the various models for integrating palliative care into the management of severe chronic illness.

That is convenient because many of the things she mentioned would be part of the legislative framework if my colleague's Bill C-277 passes.

By asking the Minister of Health to consult with her provincial counterparts, we can ensure that every region of Canada is included in the discussion and that best practices and innovative ideas in the palliative care field are shared. I want to emphasize that because it is an extremely important aspect of the bill. My colleague who just spoke mentioned first nations. Canadian regions differ from one another, of course. One feature of this bill is that it takes all those differences into account and creates a framework for sharing the good practices that some regions are using and looking at which ones would work elsewhere.

I encourage all of my parliamentary colleagues to join me in supporting Bill C-277 so that we can help people across our great nation. If passed, this legislative framework will meet their medical needs and give us a plan that reflects the looming new demographic reality.

I will close by saying that the Lower St. Lawrence region, where my hometown of La Pocatière is located, is the oldest in Canada. What my colleague wants to put in place to facilitate the aging of the population affects us in particular. The bill proposes to provide quality care and enable people to make a fully informed and conscious decision, and to live out their days in an environment where their dignity will be respected.

My brother-in-law died last year after having cancer for seven years. He was treated at a hospice in the Eastern Townships. I had the opportunity to visit him twice. My sister stayed with him for three months.

The Eastern Townships, where Magog and Sherbrooke are located, is well developed. The care offered in the region is already excellent. The experience that these people have developed over the years can most certainly be shared with Canada's other regions.

From what I could see, the quality of care that my brother-in-law received was incredible. I think it is important to mention that.

My colleague came to my riding last week. Our plan was to have her come to my riding to visit palliative care homes, but unfortunately, the weather did not co-operate. I want to thank her for making the effort to meet with my constituents, who have spent a great deal of energy and time fundraising. Palliative care homes are often autonomous thanks to the donations they receive. Donations keep these homes open and operating, as is the case in Rivière-du-Loup.

In Montmagny, Hélène Caron, who is in charge of the project, has cancer. She gives a lot of her time to ensuring that this home exists. It is not a self-serving gesture. She devotes her time to the people and the good of her community.

The bill is unifying. I think that all parties should support it and see it through. Then we could have a national framework for all palliative care homes and the necessary funding to ensure that they are operational.

Framework on Palliative Care in Canada ActPrivate Members' Business

6:20 p.m.


Francis Scarpaleggia Liberal Lac-Saint-Louis, QC

Mr. Speaker, a few years ago, members from all parties in the House, including myself, established a committee on palliative and compassionate care. The mandate of the committee was to study the nature and scope of palliative care in Canada. I would like to congratulate the member for Sarnia—Lambton for following up on the committee's work with this important initiative.

My inspiration for joining the all-party parliamentary committee on palliative care, which was an ad hoc committee, was Teresa Dellar, a friend and Montreal social worker who founded the West Island Palliative Care Residence in my riding of Lac-Saint-Louis in Montreal's West Island

The residence has 23 beds making it the largest palliative care facility in Canada. It is a model for palliative and end-of-life care across Canada and throughout the world.

I had the joy and honour of being present at Rideau Hall this past November 25 with Teresa's husband, Gavin Fernandes, and sons Jonathon and Nicholas, when Teresa was awarded the Meritorious Service Cross by the Governor General for her vision and pioneering work in palliative care—and I would underscore that the member for Sarnia—Lambton happened to be there as well that day.

Some amendments will be necessary to make the bill better fit the constitutional and practical realities of health care in Canada.

For example, clause 2(1) calls on the Minister of Health to:

develop and implement a framework designed to give Canadians access to palliative care—provided through hospitals, home care, long-term care facilities and residential hospices—that, among other things,

(a) defines what palliative care is;

Unfortunately, it is not within federal jurisdiction to give, or require provinces and territories to give, access to palliative care.

That said, the federal government is well placed to support the efforts of the provinces and territories and stakeholder organizations, by focusing on aligning and extending federal levers in relation to health care system improvements.

We have already seen the government move in this direction during negotiations over a new health care accord, when it offered $5 billion over 10 years to the provinces for home care, a commitment that Marie-France Juneau, executive director of NOVA West Island, formerly the Victorian Order of Nurses, no doubt welcomed.

NOVA West Island offers indispensable services in a home setting to Montreal West Islanders dealing with cancer and other debilitating diseases like ALS.

Federal funding would benefit NOVA and its patients and leverage the efforts of its volunteers. In 2015–16 alone, 16,532 volunteer hours were donated by 232 active volunteers lending a hand with respect to a number of NOVA's services.

Clause 4(1) of the bill also requires amendment. Currently, it requires that the Minister of Health undertake a review and table a report on the effectiveness of the stipulated palliative care framework every five years. However, this would require the minister to report on progress in an area where the government has few levers to directly make change.

Instead, therefore, it would be more advisable to have the government simply report on the state of palliative care in Canada after five years, in this way aligning the bill with the law on medical aid in dying, which requires a parliamentary review on the state of palliative care in Canada within five years of its coming into force.

The federal government is also not in a position to dictate to the provinces what specifically constitutes medically necessary services that must be provided to be eligible for federal funding under the Canada Health Act.

It is further worth noting that there is, in fact, no positive right to publicly funded health care in Canada. This was affirmed in the 2005 Chaoulli decision, where the Supreme Court said, “The Charter does not confer a freestanding constitutional right to health care”, even though medicare is rightly considered a de facto right by Canadians—an entrenched, morally rooted societal norm, I would argue.

The federal government has never waded into defining what actually constitutes a medically necessary service. Nonetheless, I believe Canadians will come to expect palliative care as something that should morally and ethically be broadly made available to them at end of life—in other words, a de facto right.

The question is how this right will come to be realized. Some believe it will materialize through the courts. There are those who argue that under section 7 of the charter, the section that affirms the right to life, liberty, and security of the person, individuals must be afforded autonomous choice at the end of life, the basic principle at the core of the medical aid in dying legislation. However, if the degree of pain control provided by palliative care is not available, an individual's choice has in fact been limited.

In terms of section 15, the charter's equality provision, others make the argument that current provincial palliative care programs, although not technically viewed as medically necessary since the aim is not to cure but to care, de facto discriminate according to disability because they are generally aimed at those dying from cancer. It is interesting to note in this regard that the West Island Palliative Care Residence, once again a leader, caters not only to cancer patients but also to those with other terminal illnesses. A 2014 Globe and Mail article highlighting the residence stated:

At the outset, 98 per cent of palliative-care patients had terminal cancer...Increasingly, however, the hospice is seeing more patients with end-stage cardiovascular and renal disease, and with conditions such as ALS and multiple sclerosis

Also, palliative care is generally needed by those who are older. Therefore, some argue that the absence of broad access to palliative care amounts to a form of age discrimination.

I would like to take a moment to discuss the West Island Palliative Care Residence's vision for expanding palliative care in Canada. I believe it dovetails with the general framework and intent of Bill C-277. In particular, I would like to propose that the government partner with the residence, given its reputation as a national leading edge centre of excellence in palliative care, in advancing the palliative care agenda in Canada.

The residence draws on a community, namely Montreal's West Island, which harbours a critical mass of resources, including the leadership talents of medical practitioners connected to the McGill University and Université de Montréal medical centres. The residence has an important role to play in education and training and in the transfer of practice-based research and knowledge to the broader Canadian community. It intends to play this role by creating a newly formed division called the Montreal institute for palliative care. It is my hope that the minister will seize the opportunity to partner with the institute in fulfilling the government's expressed commitment to palliative care.

It is often said that the measure of a society's degree of enlightenment and civilization is found in how it treats its minorities and the extent to which it internalizes the principle of the equality of all its citizens, in the manner in which it accepts and integrates those with disabilities, physical and intellectual, and in how compassionately it embraces those struggling with mental illness. However, I would add to this list how it supports and comforts its citizens at the most vulnerable moment of their life; that is, at the end of life itself.

I recently read some interesting words of our Governor General, His Excellency, the Right Hon. David Johnston, which I am paraphrasing now. He said that the idea of Canada was worthy of expression and refinement. If the Canadian idea is embodied in, among other things, our national publicly funded health care system, then to make palliative care a more prominent part of that system is to further refine the idea of medicare and of what it means to be Canadian.

Let Canada show the world once again, like we have so many other times before, what it means to be a profoundly civilized nation, a nation that gathers its collective resources to enhance the dignity of the individual at the very moment when dignity itself is everything.

Framework on Palliative Care in Canada ActPrivate Members' Business

6:25 p.m.


Cheryl Hardcastle NDP Windsor—Tecumseh, ON

Mr. Speaker, anyone who has watched a loved one suffer through the ordeal of a terminal illness understands the profound importance of palliative and hospice care on behalf of the patient and for the families and loved ones.

I join my caucus in stressing, over the course of this debate, the fundamental right we also stressed in debate on Bill C-14. The New Democrats believe that every Canadian has a right to high quality end-of-life care.

According to the government's own mortality projections, the mortality rate will increase by 33% by 2020, making the need for palliative care as a thoughtfully laid out national strategy an increasingly urgent one, even more imperative within the context of medical-assisted dying.

Current, nearly 25% of the total cost of palliative care is borne by families, and significant disparities remain across Canada with respect to access to end-of-life care, quality of care and those out of pocket expenses. At least 50% of hospice palliative care services are funded by charitable donations, which continues to restrict the size, scope and access Canadians have to palliative programs.

Very few Canadian provinces have designated hospice palliative care as a core service under their provincial health plan. In the remaining provinces, hospice palliative care may be included in provincial home care budgets or other health service budgets, leaving the funding vulnerable to redistribution and cuts. That is why the New Democrats believe we must have a national strategy that can protect the palliative care of Canadians who have access to it, expand access to care for Canadians who do not have it, and improve the quality and affordability of care for all.

I am happy today to speak in support of the bill.

The New Democrats were surprised to find this year's federal budget contained zero federal funds earmarked for palliative care, especially after we fought to incorporate palliative care into the Liberal majority joint committee report on physician assisted dying.

Earlier this year, New Democrat Charlie Angus tabled Motion No. 46, which would accomplish much of what this bill would.

Framework on Palliative Care in Canada ActPrivate Members' Business

6:30 p.m.


The Assistant Deputy Speaker Liberal Anthony Rota

I just want to remind the hon. member that it is the member for Timmins—James Bay and she should not mention his name.

Framework on Palliative Care in Canada ActPrivate Members' Business

January 31st, 2017 / 6:30 p.m.


Cheryl Hardcastle NDP Windsor—Tecumseh, ON

I am sorry, Mr. Speaker. It was a slip of the tongue.

Among other things, the motion called for the government to work with the provinces and territories on a flexible integrated model of palliative care by establishing a universal right to palliative care and by implementing a pan-Canadian palliative and end-of-life care strategy that would be tied to dedicated funding.

As I said, we expected this funding to be in the government's first budget but it was not. Here we are in the House debating a private member's bill from a member of the Conservative caucus, which indicates to me that we are at a momentous point in time. There is broad agreement across party lines on this issue and so it is time to face our responsibility to governance that makes progress on human rights and end-of-life care. That we are ready to be progressive on palliative care is momentous and I applaud my hon. colleague for utilizing her private member's bill for this noble initiative.

I was disconcerted when the previous Conservative government eliminated the federally funded national secretariat on palliative end-of-life care. Had it left the support funding intact, maybe we would not be discussing this matter today but would have a resolution and the member for Sarnia—Lambton would not have had to table this bill. I am sure she has other noble causes she could turn her attention to.

As for the current government, the Liberals have had ample opportunity to enshrine quality palliative care as a right for all Canadians, no matter where they live. They could have developed a national strategy that would have eased the burden on both the dying and their families on one end and health care providers on the other, but it was not a priority. I am still flabbergasted when I think of the callousness demonstrated as debate on Bill C-14 was introduced with absolutely no indication that anyone in the government understood the responsibility to secure end-of-life care standards for human beings.

The most significant reason I asked to speak to the bill today was I wanted to lament the unnecessary suffering in the reality of our systemic inadequacies. A national strategy would address these sufferings. I want to hear in person the government's rationale for choosing not to act on this issue.

The New Democrats were surprised to find that the 2016 federal budget contained zero federal funds earmarked for palliative care, especially after we fought for the joint committee on physician-assisted dying to incorporate palliative care.

Given the lack of health care spending in the federal budget, it is no surprise that palliative care was missing. Hopefully by now all of us understand this, that home care is very relevant to this issue. The fact that the Liberal promise of $3 billion for home care turned out to be fiction is also very disconcerting as we take stock of our health care system, its mandate and purpose and know that to move forward we have to include palliative care options that patients and their families deserve to expect.

The Canadian Cancer Society has stated that improvements to the palliative care system in Canada are desperately needed. Without clear national standards and accountabilities, individual jurisdictions are left to develop their own policies, programs, and guidelines, resulting in inconsistent or inadequate access across the country.

In Ontario, for instance, 40% of cancer patients do not receive a palliative assessment in their last year of life. In some regions of Atlantic and Western Canada, administrative data showed that less than half of people who died in a hospital received palliative care. Remarkably, there are many jurisdictions in the country where we do not even know how many Canadians receive quality palliative care. We lack consistent and ongoing data collection at a systematic level, which leaves us unable to more effectively hold our health care systems accountable to make positive changes.

Also, it is not just an issue of data collection. It is vital that any national palliative care strategy takes into account the geographic, regional, and cultural diversity of urban and rural Canada. It must respect our diverse cultural, spiritual, and familial needs, including Canada's first nations, Inuit, and Métis people.

According to Dr. Mary Lou Kelley, research chair in palliative care at Lakehead University in Thunder Bay, the federal health care dollars that would help indigenous people receive end-of-life care at home have not kept up with the increasing demand. Health care for first nations is the responsibility of the federal government, and it does provide some home care services, but the system was never designed to provide complex health care to people with chronic or advanced terminal diseases.

Members might imagine my disappointment that the words “indigenous”, “first nations”, “Inuit”, or “Métis” do not appear anywhere in the text of Bill C-227. However, that is not a deal breaker because it is something that can be addressed meaningfully as we move forward on a national strategy.

New Democrats believe strongly that any legislation that deals with the matter of palliative care must take into account the geographical, regional, and cultural diversity of our urban and rural Canada, and Canada's first nations, Inuit, and Métis people.

As our population ages, palliative care will become an ever-increasing function of the health care system. The federal government needs to support health care workers with the training and resources necessary to deliver it all across Canada. All Canadians deserve to live their final days in dignity and comfort. That is why there is an urgent need to address the significant disparities that remain across Canada with respect to end-of-life care, quality of care, and out-of-pocket costs.

For years now, New Democrats have worked to improve palliative care services for patients and their families. As the party that founded public health care in Canada—