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Canada Canadians lack proper access to palliative care, study finds

Canadian Cancer Society study finds gaps in the system and a lack of information on available care.

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Thousands of Canadians are suffering unnecessarily each year because they do not have access to palliative care, says a new study by the Canadian Cancer Society that calls on governments to make end-of-life care part of a new federal-provincial health accord.

The new study, which was released Tuesday, comes one week before provincial health-care ministers sit down in Vancouver with their federal counterpart to discuss a new deal on health. It also comes as governments consider new laws to allow doctor-assisted death in response to last year's landmark Supreme Court of Canada ruling. That ruling, which removes physician-assisted death from the Criminal Code, is set to take effect next month, but on Monday the court heard arguments from Ottawa asking for a six-month extension of that deadline.

With end-of-life issues now on the national agenda, the cancer society says it's time for governments to guarantee all Canadians access to palliative care through new legislation.

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The new study finds there are gaps in the system, there is no common definition of palliative care and there is a lack of information on what is available where. It recommends that a national standard be developed that includes clear measures.

It is expected that 75,000 Canadians will die of cancer this year, but about half will spend their final hours in an emergency room or acute-care hospital bed, said Gabriel Miller, director of public issues with the cancer society. This, even though studies show most patients want to die at home.

"It has been a shameful secret of Canadian health care for many years that there are massive holes in the way that we care for our very sickest people, especially as they approach the end of life," Mr. Miller said. "This issue is now getting some attention because the courts have forced governments to grapple with end-of-life issues, and now it is up to governments to act."

While some pockets of the country are addressing the issue, including Quebec – which has included palliative care as part of its new law on doctor-assisted death – the study finds there is inconsistent and inadequate palliative care in many parts of the country.

The federal government has promised to invest $3-billion over four years in home care, and Mr. Miller is hopeful some of that will be earmarked for improvements in palliative care.

"If we can't do something to make end-of-life and palliative care better in this country at this moment, we will never do it," Mr. Miller said.

Maureen Taylor, co-chair of the provincial-territorial expert panel that made recommendations late last year on the issue of physician-assisted death, stressed it should not be framed as an either-or debate.

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The top recommendation of the panel was a national strategy for palliative and end-of-life care that includes physician-assisted dying.

Ms. Taylor became an advocate for medically assisted dying following the death of her husband, well-known Toronto physician Donald Low, and said that even with a robust system of palliative care, some patients will choose assisted death.

As well, she said some patients who die without palliative care may have rejected the option when it was offered. More education is required among the medical community and patients and their families about the benefits of palliative care, she said.

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