The Sunday Magazine

Dying in Canada isn't what it used to be - Michael's essay

The national focus is on doctor-assisted suicide. But according to the Canadian Cancer Society, thousands of Canadians suffer unnecessarily each year, because they do not have access to quality palliative care. Canada used to be a leader in the field, but no more.
The struggle for better palliative care in Canada has been ongoing: this photo is from September 2004, when members of the Palliative Care Coalition addressed the media on their national report on hospice and palliative care at a news conference in Ottawa. (Credit: Tom Hanson/Canadian Press)

If you have to die, do it some place else; don't do it in Canada. Unless you are lucky enough to keel over on the golf course, most of us, about 85 per cent, will die in an acute care hospital bed, surrounded by strangers.

Last fall, The Economist issued its second annual Quality of Death Report. It looked at 80 countries and ranked them in terms of end of life care. Canada, which used to be a world leader in palliative care medicine, didn't even make the top ten. The world leader was the United Kingdom, followed by Australia, New Zealand, Ireland and six others. The United States barely made it at number nine.

The Quality of Death findings were echoed earlier this month in a devastating report by the Canadian Cancer Society. The Society concluded that thousands of Canadians are suffering each year because they do not have access to quality palliative care.

As we get older, there will be a growing need for end of life care, far more than we have at the moment. End of life issues are now on the national agenda but the focus is all about  physician assisted suicide. It was on the agenda this week at a meeting of provincial and federal health ministers. Palliative care - hardly a mention.

There is not the same attention paid to improving palliative care and making it accessible to all Canadians in all parts of the country. Montreal physician Dr. Balfour Mount has spent much of his medical career, indeed his life, advocating for high-quality palliative care. In fact he literally invented the term. Dr. Mount was in large part, the reason that Canada was a leader in the field.

Forty years ago, the first comprehensive palliative care program in the international community was initiated at McGill University's Royal Victoria Hospital. The world looked to Canada as an innovator, not only a pioneer. Sadly this is no longer the case. There are a number of reasons. For example when cuts to the health care budget are made, palliative care is low down on the priority list. At the same time, Canadian medicine is focussed on the disease, not the patient, according to Dr. Mount. 

Palliative care medicine is not considered a separate and special discipline in medical schools. In 1987, palliative medicine was recognized as a medical specialty in  the United Kingdom. In 1992, a task force recommended that it become a  full medical specialty, fully funded and resourced with qualified professors. It never happened. In Canada, palliative medicine remains a subspecialty, not a speciality.

Part of the problem lies in the fact that there is no national end of life care strategy. Planning seems to be ad hoc, with each province  developing its own program. The Cancer Society report recommends a guaranteed, fully accessible national palliative care program through provincial and federal legislation.

The Liberal government has promised to invest $3-billion in home care over the next four years. A large chunk of that money should be directed at high quality palliative care. After all, we're all going to need it at some point.

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