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Framework on Palliative Care in Canada - Third Reading

Honourable senators, I rise today to speak in support of Bill C-277, An Act providing for the development of a framework on palliative care in Canada.

I will not speak long, but I would like to review some of the discussion at the Standing Senate Committee on Social Affairs, Science and Technology during its study of the bill.

Introduced by Sarnia-Lambton MP Marilyn Gladu, Bill C-277 is a simple bill, but its impact could be profound. The bill requires the Minister of Health, in consultation with her provincial and territorial counterparts and palliative care providers, to develop a framework to support improved access to palliative care for Canadians.

This framework must define palliative care, identify the training and education needs of caregivers, promote research and data collection, identify measures to ensure consistent access across Canada, take into consideration existing frameworks, strategies and best practices and evaluate the advisability of re-establishing the Department of Health’s Secretariat on Palliative and End-of-Life Care.

It also requires the minister to initiate consultations within six months of the date the act comes into force and requires a report to Parliament setting out the framework within a year.

Within five years after the report is tabled in Parliament, the Minister of Health must prepare a report on the state of palliative care in Canada. In essence, the bill establishes the priorities and sets a deadline to achieve them.

Witnesses who appeared before the Social Affairs Committee were clear: These are the right priorities and now is the time to act. As Ms. Gladu noted before the committee, the money is there, with the announcement of $11 billion in the 2017 Budget to be spent on home care, palliative care and mental health treatment. The timelines in the bill are designed to ensure action follows the funding announcement.

The witnesses who appeared before the committee, a wide range of experts and stakeholders, were universal in their support of this bill. There were some witnesses — and some senators, I might add — who would prefer stronger language than that contained in Bill C-277, and that led to three observations in the committee’s report.

First, there was some concern that the consultations required under clause 2(1) of the bill should include stakeholders who represent the interests of the patients. The committee in its observations urges the Minister of Health to permit patients and groups representing their interests to participate in the development of the framework. I believe the language in the bill is sufficiently flexible to allow that to happen, and I’m confident that it will.

Second, the committee is concerned about the lack of access to palliative care in some areas and urges the federal government to provide additional funding for rural, remote and indigenous communities.

Third, the committee urges the federal government to re-establish the Secretariat on Palliative and End-of-Life Care within Health Canada.

I agree with these objectives, and I think they are appropriately dealt with as observations rather than as amendments to the bill.

A bill proposing the expenditure of public funds must be accompanied by a royal recommendation, which can be obtained only by a minister. So there are good reasons why Bill C-277 is not more definitive on these matters.

Ms. Gladu had to make certain compromises to win the support of the government. This bill would not be before us today if she had not done so. Bill C-277 received unanimous support in the other place thanks to her skillful navigation of the parliamentary process. I thank her and commend her for the work she has done.

I would also like to thank the stakeholders and experts who helped her craft the bill, who supported it at committee and who will do much of the work to develop and implement the framework. In its present form, the bill provides the impetus to collect the data, to identify the gaps in the system, to improve education, to ensure some regions or groups of people such as First Nations are not left behind.

It need not become a top-heavy bureaucratic enterprise. It’s a matter of pulling together the knowledge and expertise that are already out there in communities and organizations right across Canada.

Honourable senators, our courts have told us that it is a violation of our Charter rights to be denied medical assistance in ending our life, that we must be offered that choice. Yet we have no similar right to palliative care.

As Dr. Henderson, President of the Canadian Society of Palliative Care Physicians, told the committee, medically assisted dying “. . . is actually not a choice when there is no other choice.”

People should not have to choose medically assisted death because they do not have access to high-quality palliative care. Yet that is the situation for two thirds of Canadians. Unless we act now, this is a problem that will get worse.

As Dr. Henderson noted, 14 per cent of Canadians were aged 65 or older in 2011. By 2025, 20 per cent will be that age, rising to 25 per cent by 2061. We are facing a demographic time bomb, and simple economics alone dictate that we should move as quickly as possible to implement high-quality, accessible palliative care across the country, care that will allow people to spend their final months or days in their home or in a hospice at a cost of $200 or $300 a day, as opposed to an acute-care hospital bed at a cost upwards of a $1,000 a day.

Of course, it goes beyond cost. It’s a matter of dignity. As MP Gladu said at committee:

. . . when people have good quality palliative care, 95 per cent of them will choose to live as well as they can for as long as they can . . .

Passing this bill is a step toward ensuring people are able to make that choice to live as well as they can for as long as they can. So I ask this chamber, colleagues, to vote in favour of Bill C-277.

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