Canada’s health-care system favours the cradle and ignores the grave

David Henderson and Susan MacDonald
Special to The Globe and Mail
Published Thursday, May 26, 2016 10:39AM EDT 
Last updated Thursday, May 26, 2016 1:28PM EDT 

David Henderson is the president of the Canadian Society of Palliative Care Physicians. Susan MacDonald is the organization’s past president.

While our parliamentarians and media pundits focus on the narrow machinations of Bill C-14 that deal with medical assistance in dying, we palliative-care physicians continue to try to give birth to a long-overdue national discussion on holistic and compassionate end-of-life care for all Canadians.

Each day we face desperately ill patients and their anguished families, who literally beg us for help – with their pain, their nausea, their mental torment and the financial burden of their illness. The agony of suffering ravages their bodies and often saddles their families with immense guilt born of helplessness and a sense of isolation.

This is a national failure to address dying with dignity from an ethical, funding and continuum-of-care perspective. This failure must be acknowledged and corrected in the current discussions around a new health accord between Ottawa, the provinces and territories and our indigenous peoples.

As a country, our public policy and health system choices have favoured our collective cradle but eschewed our inevitable grave. Pre-birth programs, newborn immunizations and early childhood interventions across our health-care, social-welfare and education systems are laudable and should be expanded. This same dedication of resources must also underpin our approaches to better pain and symptom management and a range of palliative-care options for us, our loved ones and friends as we bravely face our own mortality.

But this is not the case in Canada today – and it is the pinnacle of injustice. While Bill C-14 is in the process of becoming law, palliative-care units in Ontario are closing due to funding cuts, and there is no law on the table about the right to palliative care. Tragically, many people die at home, with no access to palliative-care supports such as home-care nursing or visits from a family doctor or, when needed, a palliative-care team.

In this context, how is opting for medical assistance in dying voluntary when your only other choice is suffering?

Palliative care must be embedded in the next health accord in a substantial manner. While medical science in pharmacology, genetics, nanotechnology and a host of other fields strives to extend life, we cannot escape the certainty that death awaits us all. Wellness and health include dying and death.

Canada needs national leadership on this issue – ideally a federal, provincial and territorial palliative-care secretariat. This secretariat would work to address gaps in education for undergraduate and postgraduate health-care professionals (doctors, nurses, pharmacists and allied health and social-welfare professions); highlight best practices in palliative care; drive the establishment of specialty teams for complex care patients; collect relevant data; and work with public and private employers, insurers and civil society organizations to strengthen palliative-care policy understanding, supports and resources in our workplaces and communities.

Dying is a part of living, and everyone who reads this will die at some point. We should not let our incomes, our postal codes or family support networks determine how well or poorly we die. We need to think about this, discuss it and fix it. The time is right to insist that our health ministers address this issue in Canada’s new health accord.