Canada’s assisted-suicide legislation is being seen as a catalyst by those involved in end-of-life care to ensure people have access to quality palliative care. CNS photo/Courtesy of Rick Musacchio, Tennessee Register

Euthanasia bill a kickstart to examining end-of-life options

By 
  • May 14, 2016

As the federal government prepares to pass new legislation for physician-assisted suicide by the Supreme Court’s June 6 deadline, Catholics are growing nervous about what options they have for the future.

In a way, this is a good thing, said Nancy Lefebre, chief clinical executive and senior vice president of knowledge and practice at Saint Elizabeth Health Care.

“It’s a good thing because I think it will help catalyze what needs to happen within the end-of-life palliative care community across the province,” she said. “It’s somewhat of a catalyst for us to ensure that people are talking about palliative and end-of-life care, that people do have good access to end-of-life palliative care, that they know about it, they know where they can go for it, they know what it’s all about, they know how to access it and that it is available.”

Saint Elizabeth Health Care announced a series of initiatives to keep the conversation going. In early May, it announced a $4-million investment into local hospice care within the next two years.

Lefebre said Saint Elizabeth is looking to invest in palliative care programs in residential hospices across the country. Part of the investment will go towards Saint Elizabeth’s new collaboration with Hospice Palliative Care Ontario to create an online training program for hospice palliative-care volunteers. There are currently 13,000 volunteers in Ontario and all are required to take a 30-hour course to become a hospice volunteer. The online training program will allow future volunteers to complete their training on their own time, in the comfort of their own home.

“The challenge for some of them is that they live in remote areas and don’t have access to the training,” said Lefebre. “It’s a great way to build capacity and competency in the hospice palliative volunteer group.”

Rick Firth, president and CEO of Hospice Palliative Care Ontario, said the organization has been working on this project since its first prototype in 2011. However, it wasn’t until partnering with Saint Elizabeth that the project got its legs.

“The beneficial thing about working with Saint Elizabeth is that they already have a very well-respected and extensive program within First Nations communities across the country,” said Firth.

The online program is set to launch by next month.

“The Way Forward National Framework,” a 2015 national framework study conducted by the Canadian Hospice Palliative Care Association (CHPCA), is the result of a three-year initiative supported by the Government of Canada to create a series of recommendations to improve Canada’s palliative care system.

The CHPCA framework study said that in order to ensure that all Canadians have access to an integrated palliative approach, it will require significant shifts in the health-care system.

“One of the things that we have in Canada is a problem with transitions between care settings,” said Sharon Baxter, CHPCA executive director. “If you’re wanting to stay at home and you’re close to the end of your life and you need to go into long-term care, it’s really complicated and if you end up in hospital and you want to go home... we don’t do a great job of providing the amount of home-based care that you might need.”

Baxter said that although only a small portion of the Canadian population will need complex, intensive hospice palliative care teams, all Canadians will be able to benefit from a more integrated system. As the population ages, there is a greater urgency to make sure that everyone has equitable access.

“One of the things that we’re saying as a national association is that it would be a shame if a Canadian chose physician-assisted death, if they’ve had a poor experience in pain management and have never been referred to palliative care,” said Baxter. “The onus on us to provide the best health care possible at the end of life is even more prevalent than it has ever been.”

The CHPCA report recommends a culture shift that encourages people to look at advanced-care planning. This kind of shift requires the right resources to educate individuals about the options they have in setting goals for their end-of-life care.

Many frontline organizations already have programs in place that are working towards a more integrated approach. However, in order for the government to play its role in improving end-of-life care for Canadians, Baxter said it has to start with better data.

“Right now, we don’t even know how many Canadians have access to palliative care programs and services because there’s nobody measuring that,” said Baxter. “One of the things we’re talking about is that the governments, federal and provincial, need to invest in better monitoring of indicators for people that need end-of-life care.”

The Liberal government has promised $3 billion over four years for a new Health Accord that “will make home care more available, prescription drugs more affordable and mental health care more accessible.”

However, with the focus of drafting new legislation for physician-assisted suicide, many are concerned that palliative care will take a backseat in the debates.
NDP MP Charlie Angus has regularly put pressure on the Liberal government’s commitment to palliative care, and the Conservatives before them.

“It was actually quite surprising that on the day that the assisted-death bill came in, the government stood up in the House (of Commons) and said they were committed to palliative care,” said Angus. “Well, commitment can’t be shown by words. It has to be shown by the concrete funds.”

Angus criticizes the Liberals for excluding palliative care in the federal budget, along with many other health commitments they originally campaigned on. He said without new money in health care, we will eventually see services deteriorate.

“They haven’t started these discussions on updating the new Health Accord with the provinces,” said Angus. “If the money ain’t there, it just ain’t there.”

Last March, Ontario Ministry of Health parliamentary assistant John Fraser released a report based upon a series of consultation meetings which began in November 2014 to gather community recommendations for end-of-life care. The report reiterates the lack of consistency in the delivery of end-of-life care services. The report also recognized the most common solution was to create a single provincial partnership to oversee the services.

Michèle Boulva, executive director of the Canadian Organization for Life and Family, said these reports and promises are not enough. She said what is needed is action.

“It will be very important to develop palliative-care centres that would not be dependent of government money,” said Boulva, adding that any institution that gets money from the government is beholden to government policy.

In addition to raising awareness and putting pressure on local government representatives, Boulva said supporting Catholic institutions working to provide end-of-life care services is an urgent need.

“We’ve got to make euthanasia and assisted-suicide irrelevant, that people will not even want it because people will feel loved and accompanied,” said Boulva.

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