Canada needs national palliative care plan, CMA urges

The Canadian Medical Association is calling for the creation of a national palliative-care strategy to ensure people across the country have access to a high-quality, dignified end-of-life experience.

The CMA is also warning that strong safeguards must be put in place if physician-assisted dying is legalized in Canada. Last week, Quebec became the first province to allow physician-assisted death.

The association made the call in a national report, "End-of-Life Care: A National Dialogue," created after town-hall meetings were held across the country to solicit opinions on such highly charged issues as physician-assisted dying and palliative care.

The report urges all Canadians to discuss their end-of-life wishes with family members and create an advance-care directive, which sets out what steps should be taken in the event they are incapacitated.

The report also notes Canadians are "diametrically opposed" when it comes to legalizing assisted suicide. Physician-assisted dying refers to doctors knowingly administering or providing a patient with the means to end his or her own life. Under federal law, assisted suicide is considered a criminal act.

The CMA report says restrictions should be put in place if physician-assisted death is allowed. Quebec's newly passed Bill 52 states that an individual requesting medical help to end his or her life would have to be a terminally ill adult of sound mind in constant and unbearable pain, and in "an advanced state of irreversible decline in capabilities."

Although the federal government doesn't appear willing to reopen the debate – a spokeswoman for Justice Minister Peter MacKay said in an e-mailed statement that Criminal Code restrictions against assisted suicide and euthanasia help protect people, including those made vulnerable by illness – CMA president Louis Hugo Francescutti said the Quebec legislation will force the federal government to have a discussion on assisted suicide "whether they like it or not."

Later this year, the Supreme Court will hear arguments in an appeal case looking to legalize assisted suicide. And Conservative MP Steven Fletcher, who is a quadriplegic, has put forward private member's bills that seek to legalize doctor-assisted death in some cases.

Many people wrongly view palliative care and assisted suicide as an "either or" debate, Dr. Francescutti said. Any legislation allowing physician-assisted death does not negate the need for proper palliative care services, and right now, even in Quebec, access to those services is often lacking, he said.

A national strategy should ensure that Canadians have access to pain and symptom management that places a priority on quality of life, whether they live in urban centres or in remote, rural communities that often lack palliative care services.

"Canadians expect more of the health-care system," Dr. Francescutti said. "They expect more of our politicians to provide access to quality palliative care for all Canadians, regardless of what your postal code is."

Palliative care, which can be offered in conjunction with treatment for a disease or as a patient is dying, focuses on helping patients maintain quality of life by treating pain and preventing suffering. Even though surveys show most Canadians want to die at home, the majority die in hospitals while hooked up to machines, unable to spend quality time with family members or friends. Too often, the report says, the health-care system is focused on technology, machines and curing or treating disease rather than the emotional and physical well-being of the patient.

Another major challenge, according to the report, is the fact doctors do not receive extensive pain-management or palliative-care training.

In a statement, Health Minister Rona Ambrose said the federal government has been investing in palliative-care research and delivery, and that it will continue working with provinces to "ensure that Canadians continue to receive the highest level of care."