Speech on Bill C-277 An Act Providing for the Development of a Framework on Palliative Care in Canada

January 31, 2017

This private member’s bill aims to establish a national framework for hospice palliative care. My predecessor, Frank Valeriote, co-chaired an all-party parliamentary committee on palliative and compassionate care along with members from Kitchener—Conestoga and the former MP from Windsor—Tecumseh. Together the committee took the lead in crafting a report called “Not to be Forgotten” which forms the foundation of Bill C-277.

The hard work demonstrated by this committee cannot be overstated. After a year of travelling, town halls, and consultations, the committee drafted a report which addressed at length the issues facing vulnerable Canadians, such as elder abuse, pain management, and family caregiver support. In speaking to Frank Valeriote about this, and this bill coming back to Parliament, he said that it was one of the best experiences he had while he worked in this place.

This report establishes a clear and comprehensive guideline for the government to establish a national framework that will reinforce the fact that every Canadian life matters. This bill would reject the notion that Canadians who choose hospice palliate care are a burden on their families and on society. In fact, this bill acknowledges that palliative care offers patients time to live with dignity and share precious time with loved ones.

Canadians deserve the freedom to make this fundamental decision about life and death without fear that their personal choices will be obstructed by politics or government. With 70% of Canadians left without access to adequate palliative care, we have a responsibility to act in the interest of patients and their families. This is why our government supports both access to palliative care and to medical assistance in dying.

End-of-life issues are as diverse as Canadians themselves, meaning it is our responsibility as a government to provide as many options as possible for Canadians so that they can take these deeply personal choices and make them their own. This means that we must work with the provinces and territories to develop a flexible integrated model of palliative health care delivery that takes into account Canada’s geographic, regional, and cultural diversity, along with a funding strategy for implementation. As was mentioned earlier, we have to work out how we work with provinces and territories on how we can deliver these services together. This system must be responsive to the needs of patients and create an environment that creates comfort and reassurance.

As discussed in the report, a hierarchy of care environments is an excellent example of how palliative care can adapt to the needs of patients and their care givers. These environments offer a range of choices from one to eight.

It is not the quality of care that determines why level 1 is better than level 3. For many people, level 1 or 2 is the best, since location keeps them at home where they can receive good physical, emotional, and spiritual support as well as informational care.

Level 7 is a more traditional hospital environment with more involvement of expert care, which comes at the expense of a familiar environment to the patient. Patients have described being removed from their preferred surroundings as in itself a kind of dying, because removing what is valued increases the expectation that they will die sooner rather than later. This system provides an appropriate space for terminally-ill patients so they can have access to the support they need and the dignity they deserve while retaining as much of their home environment as possible.

Therefore, it is crucial that this palliative care framework provide for the medical, emotional, practical, and spiritual needs of the patients. These are the four pillars of hospice palliative care.

Canada has played a proud role in developing modern hospice palliative care. Even the word “palliative” is a Canadian invention developed in Montreal in the 1970s. Now we must take the final steps needed to make hospice palliative care available to all Canadians.

Many here in this House have heard me speak at length about the importance of innovation; and here too it has a role to play. Innovation can do more than grow our economy, it can also revolutionize how we protect and care for the most vulnerable in our society, including first nations and people who have difficulty getting to care.

A perfect example is the virtual hospice, an online exchange where ordinary people communicate with palliative care professionals to improve care. The virtual hospice uses readily available technologies to help Canadians living in remote areas access the medical professionals they need while remaining in the comfort and security of their own home and their own communities.

Moreover, Dr. Valerie Schulz of the Schulich School of Medicine and Dentistry, in London, Ontario has developed a simple and effective way to get medical students interested in palliative care. Each year 12 students from the undergraduate program become hospice volunteers. Each student undergoes 30 hours of training, being mentored by an experienced hospice volunteer. The experience is priceless for the future doctors, as it gives them a chance to meet and converse with people outside the clinical environment, and without the need to bring a clinical perspective to the relationship. Thankfully this practice has taken root with great success in hospices across Ontario and develops the relationships that future doctors will have with their patients facing similar challenges.

Students relate to the hospice clients as persons, learning how they feel and react to the prospect of dying. Friendships are formed, and lessons learned, which will be of lifelong value to the future doctors. The clients also are transformed, touched that a future doctor who cares enough to spend time with them in a companion role. This program is worth emulation and broader application.

In my riding of Guelph, Hospice Wellington has been in existence for over 30 years. Their residential program is noted for being one of the best, if not the best performing, in the province and it serves over 300 individuals and their families.

It is my hope that this bill will allow terminally ill patients to receive this kind of care from cost to coast to coast. I am proud of the work the government and this Parliament have initiated with respect to end-of-life issues. Bill C-277 will provide Canadian patients with a comprehensive system of palliative care as a first option before they consider other options, such as medical assistance in dying.

Additionally, this approach emphasizes the importance of living with dignity before dying with dignity. By creating a national framework for end-of-life treatment, Canada will plug the gap in its medicare program, ensuring all Canadians, from the very beginning unto the very end, have access to the compassionate care they are entitled to under our Charter of Rights and Freedoms.

I thank the member for Sarnia—Lambton for bringing this forward for us. I will be supporting this bill as it comes forward with amendments.