Medical Assistance in Dying committee  Mr. Chair, I think we've come a long way in the last two decades. I've been doing palliative care since 1995, and over the years I've worked really hard to try to get palliative care integrated into curricula. It's a real challenge, and Dr. Roy alluded to some of that challenge as well, but there are ways of doing it.

Medical Assistance in Dying committee  Yes, sir, I am. It would take a few days, because I have some family priorities I have to deal with.

Medical Assistance in Dying committee  If you look at jurisdictions that have done very well in exercising palliative care, they've developed specialist palliative care services and have also ensured that all health care professionals are getting basic training so that they can identify earlier the patients who would benefit from palliative care.

Medical Assistance in Dying committee  All right. The authorities that oversee the medical schools and residency programs have incorporated palliative care as a core competency, but we struggle as educators to get palliative care content inside the curriculum to get our rotations done. There are a number of barriers, and one of them is insufficient faculty.

Medical Assistance in Dying committee  Mr. Chair, I'd like to thank the member for that excellent question. I think what that illustrates is that contrary to what a previous panellist said, which was that there are no solutions or approaches to addressing existential distress, there are, and there are growing numbers of them.

Medical Assistance in Dying committee  Madam Chair, I think it's important to say that autonomy and the patient being at the centre of the care have always been a foundational piece of palliative care. I think we need to ask ourselves whether there are limitations as well. Are there things that we are missing? Are there opportunities that we are missing?

Medical Assistance in Dying committee  Madam Chair, I would disagree. With regard to the 80% access, I think we need to stop and look more closely at that number. We don't know what the quality of the palliative care is there. Often it is very late. Often people have suffered for months and months, leading to suffering that then reaches a point where palliative care is finally adjacent.

Medical Assistance in Dying committee  I have read it through, and I was actually part of it, so I am very much aware of it. I think it's important—

Medical Assistance in Dying committee  Yes, Madam Chair, I would agree with that—

Medical Assistance in Dying committee  —in some cases.

Medical Assistance in Dying committee  Yes. It's not only professional societies or associations of palliative care; it's also the World Health Organization that doesn't see MAID as part of it. I believe that there is a distinction between the two. I understand that in a democratic society one can have access to it, but it doesn't mean that they have to be associated.

Medical Assistance in Dying committee  Yes, certainly. A study of world rankings has been published recently. There was a large Economist study done and published in 2015. Canada stands at about 10th or 12th on the list overall, but we start dropping in certain areas. For example, in funding for private care resources, we've dropped down to the 20th spot, so there's room for improvement.

Medical Assistance in Dying committee  —and in Canada, we still have a long way to go to ensure that is occurring.

Medical Assistance in Dying committee  Yes, I have, and I've also had colleagues share similar experiences. I'll give you an example. I was working for two years in a palliative care unit in my region, and in the palliative care unit, MAID is done. Patients are referred from other hospitals and other settings to the units to receive MAID.

Medical Assistance in Dying committee  Thank you, honourable chairs, and thank you to the committee for the invitation to discuss palliative care in Canada. As you've heard, I'm professor and director of palliative care at McMaster University, and I'm also co-founder and scientific officer of Pallium Canada. I have dedicated most of my career to improving palliative care in Canada and abroad, and I've worked in different clinical, education, research and leadership roles in several Canadian jurisdictions.