TORONTO - When a patient battling lung cancer came into a Swiss hospital requesting physician-assisted suicide, Dr. Jose Pereira and his palliative-care team made a counter-offer.

“We said there are still a lot of things we can do to control your pain,” Pereira, one of Canada’s leading palliative care doctors, recalls in an interview from Ottawa.

The patient relented and agreed to let the team help. The man was a card-carrying member of Exit , a Switzerland-based group that lobbies for physician-assisted suicide and euthanasia where these practices are legal. Within two days, the man took back his request, reversing Exit’s complaint to hospital administration to respect the man’s original request. The patient, Pereira said, even wrote to the local newspaper advising others to be cautious about signing up with the group because suffering is not something to be treated lightly.

Pereira, 45, has been one of palliative care’s strongest advocates in Canada. He is a recipient of the Canadian Hospice Palliative Care Association ’s 2002 Award of Excellence and the 2002 Queen’s Golden Jubilee Medal, awarded by the Governor General of Canada.

Pereira says Canada needs to fix the gaps in its palliative care system with more government funding, a strengthened national secretariat on palliative care and more public education. Although Canada has “come a long way,” there is still “a long way to go” in improving its level of palliative care, he said.

The approach to palliative care is “very piecemeal,” although Pereira noted that Edmonton and Calgary are national leaders in the provision of hospice beds. Meanwhile, in Ottawa, where Pereira is the head of the University of Ottawa’s Division of Palliative Care and medical chief of palliative-care programs at Bruyere Continuing Care and Ottawa Hospital, Pereira said there are only 24 hospice-type beds. Given the region’s size, he said 80 to 88 beds are required.

On the political side of palliative care, he said a national strategy is needed, even though health care is a provincial responsibility. But political will appears to be lagging.

At the national level, federal purse strings have been tightening over the past two years. Health Canada’s Secretariat on Palliative Care and End-of-Life Care is “poorly funded.”

According to Pereira, there appeared to be more federal focus on palliative care four years ago when a portfolio in palliative care was established by the Liberal government.

Yet there is no equivalent portfolio in the current federal cabinet.

On the shortage of palliative-care doctors, Pereira said there are insufficient funds from the health ministry to hire more doctors who specialize in this field.

Another challenge is that many provinces don’t have remuneration for doctors who see patients for this type of care.

“If jurisdictions are relying upon doctors to come forward as palliative care physicians on a fee-for-pay service, (doctors) can’t make ends meet. It’s an inappropriate model,” Pereira said.

And few doctors want to pursue palliative care because it is not seen as a “high status speciality,” he said.

Among the solutions, Pereira suggests having a Canada-wide registry of palliative care to help in developing an effective national strategy. In this way, doctors can survey patients, know what their needs are and be able to address them.

“Before we can start debating assisted suicide or euthanasia in the country, we still have to fill a lot of gaps,” he said.

Pereira adds that he doesn’t see doctor-assisted suicide as being part of palliative care.

Another potential solution lies in the education of palliative care, he said. Over the last three years, medical schools have improved their training of palliative-care doctors, mainly because of a federally funded national project.

The federal government has provided more than $1 million to establish teams across the country in each university to move forward in the palliative care agenda in their curricula, Pereira said, adding that it’s more steps like these that will improve the level of palliative care.

Sheila Dabu Nonato, The Catholic Register Sheila Dabu Nonato is a reporter for The Catholic Register. A graduate of the University of Toronto's international relations program (M.A.) and Carleton University's School of Journalism (M.J.),  she has worked at The Canadian Press, CBC Ottawa, The Toronto Star, The Jordan Times and IRIN Middle East. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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