Mr. Speaker, I rise today to speak to Bill C-277, an act providing for the development of a framework on palliative care in Canada.
The legislation would require the Minister of Health to develop and implement a framework designed to give all Canadians access to palliative care provided through hospitals, home care, long-term care facilities, and residential hospices. The bill would also require the health minister to convene a conference within six months of the act coming into force, with provincial and territorial governments and palliative care providers, in order to develop a framework on palliative care in Canada. Finally, the bill would require the Minister of Health to table the framework in Parliament within a year and post the framework online within 10 days of tabling it.
New Democrats will be supporting the legislation because we believe that palliative care is a vital part of comprehensive health care provision, and we believe that every Canadian has a right to high-quality end-of-life care. New Democrats have a long history of strong advocacy for better palliative care services for Canadians. We are proud of the New Democrat motion adopted in the last Parliament with all-party support, which laid out a pan-Canadian strategy for palliative and end-of-life care. Launched October 31, 2013, my colleague the member for Timmins—James Bay's Motion No. 456 called for the establishment of a pan-Canadian palliative and end-of-life care strategy in conjunction with provinces and territories on a flexible and integrated model of palliative care. It passed with almost unanimous support on May 28, 2014.
At present, only 16% to 30% of Canadians have access to formalized palliative or end-of-life care services. Even fewer receive grief or bereavement services. With the subsequent legalization of physician-assisted dying, the provision of high-quality palliative care services has now become more important than ever, since it provides meaningful options for end-of-life decisions. It is well past time for the federal government to act.
Palliative care is the health discipline focused on improving the quality of life for people living with life-threatening illness. The World Health Organization defines it as follows:
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:
provides relief from pain and other distressing symptoms;
affirms life and regards dying as a normal process;
intends neither to hasten or postpone death;
integrates the psychological and spiritual aspects of patient care;
offers a support system to help patients live as actively as possible until death;
offers a support system to help the family cope during the patients illness and in their own bereavement;
uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
will enhance quality of life, and may also positively influence the course of illness;
is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.
There is consensus among academics, health professionals, and the public that improvements in the palliative care system in Canada are desperately needed. Without clear national standards, individual jurisdictions are left to develop their own policies, programs, and approaches, resulting in inconsistent and 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, data shows that less than half of people who die in a hospital receive palliative care.
The number of individuals actively caring for a friend or family member is expected to increase as Canada's population ages. On average, Canadians estimate that they would have to spend 54 hours per week to care for a dying loved one at home, and two-thirds say they could not devote the time needed for this care. Currently, family caregivers provide more than 80% of care needed by individuals with long-term conditions at home, in long-term care facilities, and in hospital. Replacing family caregivers with a paid workforce at current market rates and usual employee benefits has been estimated to cost about $25 billion.
Furthermore, according to a synthesis of the empirical literature, palliative family caregiving for older adults is gendered. When acting as caregivers, women experience a greater degree of mental and physical strain than their male counterparts. This is linked to the societal expectation that women should provide a greater degree of care at the end of life for family members.
Remarkably, there are many jurisdictions across the country where we do not even know how many Canadians receive quality palliative care. We lack consistent and ongoing data collection at a systemic level, which leaves us unable to effectively hold our health care systems accountable.
Indicators such as location of death, use of acute care before death, and referrals to formal palliative care show that there is significant room for improvement. Many Canadians who require palliative care receive it in acute and emergency care, if they receive it at all. Not only are acute care settings more costly than dedicated palliative care, but they are also not as well equipped to provide the most appropriate treatment and care for patients and their families.
It is vital that any national palliative care strategy take into account the geographic, regional, and cultural diversity of urban and rural Canada. It must also respect the cultural, spiritual, and familial needs of Canada's first nations, Inuit, and Métis people. According to Dr. Mary Lou Kelley, research chair in palliative care at Lakehead University, 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, of course, 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.
Finally, I would be remiss if I failed to note that, although the bill is sponsored by a Conservative member, the previous government eliminated the federally funded national secretariat on palliative and end-of-life care when it first took office in 2006. If it had not been for this cut, we would have developed a palliative care framework a decade ago.
From 2001-06 the federal government funded the secretariat through Health Canada with an annual budget ranging from $1 million to $1.5 million, virtually nothing in terms of the federal budget. However, when the Conservative government disbanded the end-of-life care secretariat, it stopped working on a national palliative and end-of-life care strategy.
In 2011, the Conservative government made a one-time commitment of $3 million to fund the study and framework creation of community integrative models of hospice palliative care. This initiative was led by the Canadian Hospice Palliative Care Association, but according to Dr. Greg Marchildon, Ontario research chair in health policy and system design at the University of Toronto:
There is no national policy on palliative care in Canada. Instead, there are national guidelines developed by community-based palliative care organizations operating at arm's length from government.
Although Conservative support for palliative care had previously been absent, it is certainly better late than never. That is why New Democrats reached across the aisle at the health committee to successfully move an amendment to the bill requiring the federal government to evaluate the advisability of re-establishing Health Canada's secretariat on palliative and end-of-life care.
I will give credit where credit is due. The member for Sarnia—Lambton responded to our proposal thoughtfully, saying: “I'm a fan of doing that. As I said, I was not here during the Harper regime, so I can't fix the past. I can only improve the future.”
New Democrats, in keeping with that sentiment, will work together to improve the future. I will conclude my remarks by reiterating the NDP's support for this vital initiative and affirming that all Canadians deserve to live their final days in dignity and comfort. We look forward to contributing to the framework development process and sincerely hope that it will provide the strongest possible palliative care strategy for every Canadian from coast to coast to coast.