National Pensioners Federation | Federation Nationale des Retraites

 

FOR IMMEDIATE RELEASE

TORONTO April 13, 2016

Seniors, physicians, ethicists, disabled rights groups nation-wide call for including a right to palliative care in assisted dying legislation: Open letter to PM, Justice and Health Ministers

National seniors groups, physicians, ethicists and disabled rights groups released an open letter calling on the Prime Minister and justice and health ministers to include a legislated right to palliative care in their legislative response to Carter v. Canada[Please see attached news release from Quality of Life.]

QUOTE:

“National Pensioners is pleased to be part of the collaboration committed to ensuring that comprehensive high quality palliative care is universally available to all Canadians. Assured access to high quality palliative care should always be one of the choices available to all Canadians as they face avoidable suffering. Our members have experienced first hand what is involved at the end of life and they are concerned that palliative care will be side-lined in the rush to facilitate assisted dying.”

– Herb John, President, National Pensioners Federation

QUOTE:

“Physician assisted death and palliative care are mutually exclusive – legalizing one [PAD] does not mean we can ignore the other [palliative care]. The lack of access to good quality end of life care is a national disgrace. Yet, palliative care seems to be lost in the public discourse around facilitating physician assisted death. To give true meaning to the idea that people who request physician assisted death have chosen freely, we have to ensure that they have other means of alleviating their suffering and that means the right to palliative care must be legislated.”

– Susan Eng, Seniors Advocate, counsel to National Pensioners Federation

National Pensioners Federation is a national, non partisan, non sectarian organization of 350 seniors chapters, clubs, groups, organizations and individual supporters across Canada with a collective membership of 1,000,000 seniors and retirees devoted entirely to the welfare and best interests of ageing Canadians.

For more information, please contact:

Herb John President, National Pensioners Federation
(519) 350-3221
herb.john@npfmail.ca
www.nationalpensionersfederation.ca

Susan Eng Counsel, National Pensioners Federation
(647) 988-3595
susan.eng.to@rogers.com

 

FOR IMMEDIATE RELEASE

TORONTO April 13, 2016

Seniors, physicians, ethicists, disabled rights groups nation-wide call for including a right to palliative care in assisted dying legislation: Open letter to PM, Justice and Health Ministers

National seniors groups, physicians, ethicists and disabled rights groups released an open letter [attached and at: http://www.bakerlaw.ca/quality-of-life-collaboration/openletter/] calling on the Prime Minister and justice and health ministers to include a legislated right to palliative care in their legislative response to Carter v. Canada.

Minister of Justice and the Attorney General of Canada, Jody Wilson-Raybould and Dr. Jane Philpot, Minister of Health, were tasked by Prime Minister Trudeau with drafting legislation to provide for physician assisted dying by June 6, 2016, the deadline imposed by the Supreme Court of Canada in Carter v. Canada. The draft legislation is reportedly being released this week.

Quality of Life is a collaboration of seniors groups, including the National Pensioners Federation and the Congress of Union Retirees of Canada, which together represent over a million seniors across the country, Council of Canadian with Disabilities and Canadian Association for Community Living, and a growing number of physicians and ethicists, committed to ensuring that comprehensive high quality palliative care is universally available to all Canadians.

One way to ensure universal access to palliative care is to include it as a medically necessary service in the Canada Health Act. Alternatively, the right may be included as part of the legislative response to Carter v. Canada as it was in Bill 52, the Quebec Act respecting end of life[1] .

In receiving the Special Joint Committee’s report on physician-assisted dying, the ministers issued a statement that: “It is important that we protect people’s choices and freedoms in a way that makes sure our society protects the most vulnerable.

QUOTE:

“We agree with the Ministers. Assured access to high quality palliative care should always be one of the choices available to all Canadians as they face avoidable suffering. Our members have experienced first hand what is involved at the end of life and they are concerned that palliative care will be side-lined in the rush to facilitate assisted dying.”

– Herb John, President, National Pensioners Federation
herb.john@npfmail.ca (519) 350-3221

QUOTE:

“Its a fact of life that all of us will die. Most of us will have a chronic condition long before our lives end, and with that condition will come suffering, both physical, emotional and spiritual. Some day, you, those you love, and those you know will need good palliative care and we need to ensure that it is available to everyone. The recent Carter decision has shifted the emphasis away from palliative care to physician hastened death. Perhaps up to 3 % of Canadians may ask for assistance in hastening their deaths, while all Canadians can benefit from an integrated palliative care approach. To give Canadians true choice, we should ensure a right to palliative care when we create a right to hastened death.” 

– Dr. Susan MacDonald, President, Canadian Society of Palliative Care Physicians

QUOTE:

“As doctors, our duties include alleviating pain and suffering while helping people live as well as possible as they approach death. It is frustrating seeing that a patient would benefit from a team approach to palliative care, when such teams may not be readily available for that patient. We want to see much better patient access to palliative care programs within hospitals, at patients’ homes, in hospices and in continuing care facilities. We also need better palliative care training for all providers, whether they focus their practices in palliative care or not.”

– Eric Wasylenko, MD CCFP BSc MHSc (bioethics); Clinical Lecturer, Division of Palliative Medicine, Department of Oncology, University of Calgary; Clinical Lecturer, John Dossetor Health Ethics Centre, University of Alberta eric.wasylenko@albertahealthservices.ca

QUOTE:

“Physician assisted death and palliative care are mutually exclusive – legalizing one [PAD] does not mean we can ignore the other [palliative care]. The lack of reasonable access to good quality end of life care is a national disgrace. Yet, palliative care seems to be lost in the public discourse around facilitating physician assisted death. To give true meaning to the idea that people who request physician assisted death have chosen freely, we have to ensure that they have other means of alleviating their suffering. Despite all the recommendations and fine words over the years, there is still no national standard nor reasonable guarantee of access – that means a right to palliative care must be legislated.”

– Susan Eng, Seniors Advocate, counsel to National Pensioners Federation Susan.eng.to@rogers.com 647-988-3595

Quality of Life maintains that access to palliative care should be a constitutional right. The Council of Canadian with Disabilities and the Canadian Association for Community Living are preparing to file a constitutional challenge based on the exclusion of palliative care from the list of medically necessary insured services in the Canada Health Act which results in palliative care neither being reasonably accessible nor available on uniform terms and conditions to all Canadians.

QUOTE:

“There have been lots of promises to improve access to palliative care but we still have an inadequate patchwork of services that barely meets the needs of today and is woefully inadequate to the looming increase in need as the Boomer generation ages. Until there is a legislated mandate, the health care system will continue failing to provide palliative care to all Canadians who need and want it. We are prepared to launch a Charter challenge to back this up but we hope that we will not need to.”

– Joy Bacon, President, Canadian Association for Community Living

QUOTE:

“Without a right to palliative care, Canadians will soon be receiving publicly funded physician assistance to die because it is not available. This will infringe their s. 7 Charter right to life, liberty and the security of their persons and their s. 15 equality rights as Canadians with disabilities and seniors”

– David Baker, B.A., LL.B., LL.M., L.S.M., counsel Canadian Association for Community Living, Council of Canadian with Disabilities dbaker@bakerlaw.ca

The issue is a matter ethics and free choice. A growing chorus of ethicists and religious commentators make this clear. For example,

Shimon Koffler Fogel, the CEO of the Centre for Israel and Jewish Affairs in Toronto has this to say in http://www.cbc.ca/news/canada/manitoba/physician-assisteddying-jewish-community-perspective-1.3509370

“…physician-assisted dying must not be the only, nor the default, end-of-life option available to patients. While respecting the division of jurisdictional responsibilities, the federal government should do its utmost to ensure that palliative care of the highest quality is universally accessible and that first-rate psychosocial supports are made available to all Canadians separately from physician-assisted dying. While it may be impossible to achieve consensus on many of the issues surrounding physician-assisted dying, surely we can all agree that every Canadian should have access to other means of alleviating suffering before contemplating a physician-assisted death.”

Cardinal Thomas Collins Archbishop of Toronto in announcing that the archdiocese of Toronto pledged $1 million to Providence Healthcare in Toronto to help fund the expansion of its palliative care facilities said: “This is where our efforts should be focused — fostering a culture of love and care for those who are dying, ‘I believe that it is critical that faith communities take a leadership role in promoting expanded palliative care.’… Society must ‘respectfully express its deep concern about assisted suicide and euthanasia,” but it must do more by providing the alternative of enhanced palliative care. ‘We should contact our elected officials and ask them to make this a priority,’” http://www.catholicregister.org/item/21209-canadians-need-to-reflect-aboutthe-future-of-canada

The Canadian Cancer Society released its report on the state of palliative care in Canada earlier this year, stating “critically ill Canadians are falling through the cracks when it comes to palliative care. Improvements are desperately needed to Canada’s costly and inconsistent patchwork of palliative care, which is bad for patients and for the sustainability of our healthcare system. ‘Many of our sickest and most vulnerable citizens are not getting the kind of care they need when they need it most,’ says Gabriel Miller, director of public issues at the Canadian Cancer Society. ‘It’s time to fix Canada’s failed approach to palliative care, which is inconsistent and has a hefty price tag’… ‘All Canadians should have a guaranteed right to timely, high-quality palliative care,’ says Miller. ‘As our federal and provincial governments start hammering out a new national health accord, they need to put fixing palliative care at the very top of their to-do list.’” https://www.cancer.ca/en/about-us/for-media/mediareleases/national/2016/palliative-care-report-2016/?region=on

For Media Inquiries, please contact:

Sydney Baker
Tel: (416) 533-0040 ext. 230
sbaker@bakerlaw.ca

April 13, 2016

To:

The Honourable Justin Trudeau
Prime Minister of Canada
And to:
The Honourable Jody Wilson-Raybould
Minister of Justice and the Attorney General of Canada
And to:
The Honourable Dr. Jane Philpot Minister of Health

Dear Prime Minister and Ministers:

We are calling on you to include a legislated right to palliative care in your legislative response to Carter v. Canada. In receiving the Special Joint Committee’s report on physician-assisted dying you stated that “It is important that we protect people’s choices and freedoms in a way that makes sure our society protects the most vulnerable.” We agree. Assured access to high quality palliative care should always be one of the choices available to all Canadians as they face avoidable suffering[2].

Canada is a signatory to the World Health Assembly resolution WHA67.19 calling for Strengthening of palliative care as a component of comprehensive care throughout the life course. The resolution acknowledges that “palliative care is an ethical responsibility of health systems, and that it is the ethical duty of health care professionals to alleviate pain and suffering, whether physical, psychosocial or spiritual, irrespective of whether the disease or condition can be cured, and that end-of-life care for individuals is among the critical components of palliative care”[3] .

The Parliament of Canada passed a motion M-456 on May 28, 2014 to establish a Pan-Canadian Palliative and End-of-life Care Strategy. Despite all-party support for the resolution, access to palliative care has not materially improved. This is why the right to palliative care must be legislated[4] .

One way to ensure universal access of palliative care is to list it as a medically necessary service in the Canada Health Act. Alternatively, the right may be included as part of the legislative response to Carter v. Canada as it was in Bill 52, the Quebec Act respecting end of life[5]. The World Health Assembly acknowledged that palliative care must be integrated into the healthcare system to ensure access, writing at page 2 of its resolution: “Realizing the urgent need to include palliation across the continuum of care, especially at the primary care level, recognizing that inadequate integration of palliative care into health and social care systems is a major contributing factor to the lack of equitable access to such care”.

Regardless of how it is accomplished, there must be recognition that access to palliative care should be a fundamental right. The Council of Canadian with Disabilities and the Canadian Association for Community Living are preparing to file a constitutional challenge based on the exclusion of palliative care from the list of medically necessary insured services in the Canada Health Act which results in palliative care being neither reasonably accessible nor available on uniform terms and conditions to all Canadians.

The lack of access to quality palliative care was canvassed in the recent discourse on physician assisted dying. Indeed, research shows that one of the reasons given by those seeking assisted death was lack of alternative treatment and care options. The inadequacy of palliative care services was a factor in Canada’s mediocre ranking among high-income peers in the Quality of Death Index 2015 published by the Economist Intelligence Unit which also found in its review of 80 countries that “National policies are vital for extending access to palliative care”. Canada’s overall ranking was 11th, a drop from 9th five years ago and 18th in palliative care access[6] .

In his book Being Mortal, writer and surgeon Atul Gawande writes: “Our ultimate goal, after all, is not a good death but a good life to the very end”. That is the promise of quality palliative care for any Canadian who needs it regardless of circumstance or geography.

Quality of Life is a collaboration of community based organizations who endorse this initiative calling for a legislated right to palliative care.

Respectfully submitted:

Canadian Association for Community Living
Council of Canadian with Disabilities
National Pensioners Federation
Congress of Union Retirees of Canada
Canadian Society of Palliative Care Physicians
Palliative Care medical professionals and ethicists:

Dr. Eric Wasylenko, MD CCFP BSc MHSc (bioethics); Clinical Lecturer, Division of Palliative Medicine, Department of Oncology, University of Calgary; Clinical Lecturer, John Dossetor Health Ethics Centre, University of Alberta
Dr Jessica Simon, FRCPC; Associate Professor, Division Head Palliative Medicine, Oncology
Gary E. Frank, Nurse Consultant Palliative Care
Jean Fergusson Nurse Consultant Palliative Care Dr. Patrick R. Mayo, Clinical Practice Leader – palliative care, pharmacology
Dr. Linda Fong, MD, FCFP Hospice physician
Janet M. Vandale, RN Nurse Clinician, Palliative Care Consult Service–Acute Care Foothills Medical Centre
Lori MacIsaac Clinical Nurse Specialist, Palliative Care Consult Service
Dr. Amanda Roze des Ordons, MD, FRCPC, MMEd Critical Care Medicine, Palliative Care Clinical Assistant Professor, University of Calgary
Dr. Vincent Thai Associate Clinical Professor, Palliative Care Medicine Department of Oncology University of Alberta Hospital
Dr. Tessa Van Rooi, MD CCFP Family doctor

BACKGROUNDER

There is urgent need for a right to palliative care in Canada. Palliative care is understood to be a vital component of comprehensive health care throughout the life course. However, palliative care is neither reasonably assessable to all Canadians nor consistently provided across all Canadian jurisdictions. Nationally and internationally the Parliament of Canada expressly supports strengthening palliative care services; however access to palliative care across Canada has not materially improved. Now, with the Supreme Court of Canada’s decision to legalize physician assisted death, there has never been a greater need for a right to palliative care in Canada.

What is Palliative Care?

Palliative care is a relatively recent health care model, developed out of a changing medical landscape. It emerged in Canada in the 1970’s when “greater attention and priority was devoted to managing the pain and other symptoms of cancer patients.”[7]

The World Health Organization defines Palliative care as “an approach that improves the quality of life of patients (adults and children) and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.”[8] End-of-life care is among the critical components of palliative care. [9] Rather than focus on curing a patient’s condition, palliative care focuses on maintaining quality of life for the patient and his or her family. Care is designed to minimize pain and maximize comfort for patients and their families.

Palliative care takes a multidisciplinary approach to patient care. It is provided by a team of specialists that may include: physician, nurse, pharmacist, social worker, spiritual counsellor, bereavement support worker, home care worker, nutritionist, physiotherapist, occupational therapist, volunteers and informal caregivers.[10] A multidisciplinary approach allows a palliative care team to address physical, emotional, spiritual, existential and social concerns that arise with advanced illness, by developing a care plan to relieve suffering in all areas of a patient and his or her family’s lives.

The benefits of palliative care are numerous: “[e]mpirical research has found that palliative care is associated with better outcomes for patients (symptom management, quality of life, overall satisfaction), family caregivers (reduced burden) and the healthcare system (reduced hospital admissions).”[11] Research indicates that palliative care is more cost-effective than hospital care. The daily average cost of a hospice, palliative care bed is roughly $460 per day compared to the $1,100 per day expense of a hospital bed.[12]

Palliative Care in Canada

There is no right to palliative care in Canada.

No Federal Model to Fund or Implement Palliative Care in Canada

The two-tiered legislative approach to health care in Canada, as set out in the federal Canada Health Act (CHA),[13] results in inconsistent availability of palliative care services across Canada. Both federal and provincial governments fund health care services; provincial governments receive money from the federal government via the Health Transfer payments set out in the CHA. The provinces must allocate health care funds in accordance with the CHA’s guidelines.

The CHA contains five governing principles: reasonable accessibility, public administration, comprehensiveness, universality, and portability[14]. The criterion of reasonable accessibility, comprehensiveness, universality and portability only apply to insured health services.

Palliative care is not specified as an insured health service in the CHA. Therefore, provincial governments have defined it as falling under the CHA’s definition of “extended health care services”. Because the onus is on each province to determine if and how ‘extended health care services’ will be funded, and the criterion of reasonable accessibility, comprehensiveness, universality do not legally apply, Canada does not have a consistent approach to the delivery and availability of palliative care. This leaves palliative care programs at the mercy of budget cuts within the regions that the care is administered.

Canada’s Current Palliative Care System

Palliative care in Canada is often described as a “patchwork quilt” or as “a work in progress.”[15] As few as 16-30% of all Canadians have access to some level of palliative care.[16] Experts report that palliative care is required in 90% of all deaths.[17] Despite this, reports estimate that “the health system is currently unable to provide palliative care to 70% of those in need.”[18]

The Special Joint Committee on Physician-Assisted Dying (the Committee), appointed by the Parliament of Canada to make recommendations on the legislative response to Carter v. Canada, heard from many witnesses who identified a need for adequate palliative care in Canada.[19] The Committee found that “many Canadians do not have access to high quality palliative care when they need it.” [20]

The federally appointed External Panel on Options for a Legislative Response to Carter v. Canada[21] noted: “[u]nquestionably, too many Canadians and their families do not have access to good quality palliative care and hence, have less than ideal and sometimes even tragic end-of-life experiences.”[22] As a result, end of life patients are unnecessarily hospitalized; 60% of deaths occur in hospitals despite the fact that many of these deaths are “not sudden and could have been planned to occur elsewhere”.[23]

Closely linked to accessibility and service provision is labour availability. Notably, by international standards Canada has fewer doctors specializing in palliative care than comparable countries such as the United States and Australia:  Out of approximately 77,000 physicians in Canada, a recent survey identified just 51 palliative care specialists, as well as 123 family physicians whose practices focus on palliative care. The survey also identified another 931 family physicians and specialists (e.g., oncologists, pediatricians) who provide some palliative care as part of their practices, but two-thirds of this group reported having no training in palliative medicine. [24]

Populations particularly vulnerable and often under-served at the end of life include people living outside of urban centres, indigenous people, children and new Canadians.[25] In its recommendations, the Committee specifically highlighted the need to ensure “culturally and spiritually appropriate end-of-life care services, including palliative care” services are available to the Canadian Indigenous population.[26]

Access to Palliative Care in Canada Has Not Materially Improved

In many instances the federal government and its appointed bodies have reviewed Canada’s provision of palliative care and made recommendations. But movement beyond broad visions and loosely defined milestones and towards specific targets has not materialised.

With the rare support of all parties, the Parliament of Canada passed Motion-456 on May 28, 2014, which called for a Pan-Canadian Palliative and End-of-life Care Strategy. This strategy would work with the provinces and territories on “a flexible, integrated model” of palliative care that:

(a) takes into account the geographic, regional, and cultural diversity of urban and rural Canada as well as Canada’s First Nation, Inuit and Métis people;

(b) respects the cultural, spiritual and familial needs of all Canadians; and

(c) has the goal of

  1. ensuring all Canadians have access to high quality home-based and hospice palliative end-of-life care,
  2. providing more support for caregivers,
  3. improving the quality and consistency of home and hospice palliative end-of-life care in Canada,
  4. encouraging Canadians to discuss and plan for end-of-life care.[27]

In March 2015, the federal government funded the report “The Way Forward National Framework: A Roadmap for an Integrated Palliative Approach to Care” (The Way Forward).[28] This report discusses the benefits inherent in an integrated approach to palliative care. The report states that a “system-wide shift” is required to achieve integrated palliative care. This shift would facilitate the understanding that palliative care is an extension of health care rather than a form of boutique care only required for some individuals.

Many of the recommendations in The Way Forward focus on accessibility and universality. It recommends integrated palliative care be available to patients and families at appropriate times in their lives or during an illness in all care settings. [29] The report discusses that all health care practitioners should be providing many elements of palliative care, separate from complex palliative care skills that will require extensive training.[30] The Way Forward sets out a vision for palliative care in Canada including a number of goals and principles, none of which are binding. Under the report’s Framework in Action for Federal, Provincial and Territorial Governments, it suggests, amongst others, that legislation and regulations be created, and policy expectations for all care settings and providers be established. To date, no legislation has been enacted further to this federally funded report.

Almost two years after Motion-456 was passed, on February 25, 2016, the Special Joint Committee on Physician-Assisted Dying recommended: “that Health Canada re-establish a Secretariat on Palliative and End-of-Life Care; and that Health Canada work with the provinces and territories and civil society to develop a flexible, integrated model of palliative care by implementing a pan-Canadian palliative and end-of-life strategy with dedicated funding, and developing a public awareness campaign on the topic.”[31] On the issue of palliative care, the Special Joint Committee found that Canada “could and needs to do more in this area.”[32]

The Parliament of Canada has yet to initiate a pan-Canadian palliative and end-oflife strategy, nor enact a legislative response to integrated palliative care.

Post-Carter, Lack of Alternative Care Creates Urgent Vulnerabilities

Physician assisted death was never intended as a substitute to palliative care. Even Wanda Morris, past-CEO of Dying with Dignity Canada stated: “[n]obody should have to choose an assisted death because the medical system has failed to give them other options.”[33]

In 2015, the Supreme Court of Canada found the prohibition against physician assisted death was unconstitutional.[34] Federal legislation to regulate physician assisted death will be in force no later than June 6, 2016.

Canadians suffering pain, whether physical, emotional, spiritual, existential or social, may now seek physician assisted death when their pain is more appropriately addressed with palliative care. Studies show that patients with fractured dignity are significantly more likely to report a desire for death, loss of will to life, depression, hopelessness and anxiety.[35] These same studies find that terminal patients who receive state-of-the-art palliative care are less vulnerable to assaults on their sense of dignity.[36]

Palliative care and physician assisted death are not mutually exclusive. The three committees established to consider the legislative outcome of Carter heard extensive evidence and made findings specifically related to palliative care.[37] Significantly, all three committees found access to quality palliative care across Canada must be increased despite new access to physician assisted death.

The Special Joint Committee views access to palliative care as an important consideration in assessing whether a patient gave informed consent to physician assisted death.[38] The Committee heard many witnesses discuss palliative care as a safeguard to reducing vulnerabilities experienced by patients. Adequate palliative care and full information about alternative care must be provided to ensure a patient’s decision for physician assisted death is “genuine choice.”[39]

The External Panel agreed: “[p]hysician-assisted dying must not become an indication of the system’s failure to provide adequate end-of-life care. There appeared to be overall consensus among those who expressed their views to the Panel that a truly informed decision can be made only when the individual is aware of and understands meaningful alternatives.”[40]

The province of Quebec recognized its obligation to confer a right to palliative care as an essential element of its Act Respecting End-of Life Care,[41] which came into effect in December 2015.

If the Federal Government Will Not Legislate, Canadians with disabilities are prepared to Mount A Charter Challenge for a Right to Palliative Care

It is anticipated that the legislated response to the Supreme Court’s decision will be that physician assisted death will immediately become an insured service under the CHA. The lives of Canadians are threatened every day that physician assisted death is available and palliative care is unavailable. Granting the right to one without the other makes people vulnerable to making choices they would not willingly have made. Palliative care must be a Canada-wide right.

If the federal government will not include a national right to palliative care in its legislative response to Carter, [42] the Council of Canadians with Disabilities and the Canadian Association for Community Living are prepared to challenge the federal government’s decision to exclude palliative care from the legislated response to Carter. The decision to exclude palliative care will negatively affect the choices of all people and it is particularly discriminatory against persons with disabilities and the elderly. The decision to exclude palliative care threatens the life, liberty and security of person of all Canadians, as well as their right to equality.[43]

Canadians with disabilities are requesting that all Canadians join with them in requesting that the federal government confer a right to needed palliative care as part of its legislative response to the Supreme Court of Canada’s decision in Carter[44] .

[1]http://www.assnat.qc.ca/en/travaux-parlementaires/projets-loi/projet-loi-52-41-1.html

[2] http://news.gc.ca/web/article-en.do?mthd=tp&crtr.page=1&nid=1036139&crtr.tp1D=1

[3] http://apps.who.int/medicinedocs/en/d/Js21454ar/

[4]http://www.parl.gc.ca/Parliamentarians/en/members/CharlieAngus%2825470%29/Motions?sessionId=151&documentId=6261234

[5]http://www.assnat.qc.ca/en/travaux-parlementaires/projets-loi/projet-loi-52-41-1.html

[6]http://www.eiuperspectives.economist.com/healthcare/2015-quality-death-index

[7] Federal, External Panel on Options for a Legislative Response to Carter v. Canada, Consultations on PhysicianAssisted Dying Summary of Results and Key Findings Final Report (Her Majesty the queen in Right of Canada, 15 December 2015) at 122- 123 [The External Panel].

[8] WHO, Strengthening of palliative care as an component of integrated treatment within the continuum of care, EB134.R7, session 134th, Agenda item 9.4:, 23 January 2014 [WHO]. [9] Ibid.

[10] The External Panel, supra note 1 at pg 123.

[11] Ibid.

[12] Ontario, Auditor Genera of Ontario, 2014 Annual Report of the Office of the Auditor General of Ontario (Ontario, 2014) at pg 265 [AGO Report].

[13] RSC, 1985, c. C-6 [CHA].

[14] ss. 12, 8, 9, 10 and 11 respectively in the CHA, supra note 7.

[15] The External Panel, supra note 1 at pg 124.

[16] Ibid.

[17] The Way Forward Framework: A roadmap for an integrated palliative care approach (March 2015), page 9 [The Way Forward].

[18] Improving Access to Palliative Care in Ontario (McMaster University,2013) pg 6 [McMaster Health Forum].

[19] Federal, Report of the Special Joint Committee on Physician-Assisted Dying, Medical Assistance in Dying: a Patient-Centred Approach (Parliament of Canada, February 2016) pg 15 [The Special Joint Committee].

[20] Ibid at pg 33.

[21] 2015 SCC 5, [2015] 1 S.C.R. 331 [Carter].

[22] The External Panel, supra note 1 at pg 124.

[23] AGO Report, supra note 6 at pg 264.

[24] The External Panel, supra note 1 at pg 124 (emphasis our own).

[25] The External Panel, supra note 1 at pg 124.

[26] The Special Joint Committee, supra note 13 at pg 33 (recommendation 18).

[27] Pan-Canadian Palliative and End-of-life Care Strategy41st Parliament, Private Members’ Motion-456, 41st Parliament, 2nd Session.

[28] The Way Forward, supra note 11.

[29] Ibid at pg 14.

[30] Ibid at pg 16.

[31] The Special Joint Committee, supra note 13 at pg 33 (recommendation 19).

[32] The Special Joint Committee, supra note 13 at pg 33.

[33] The External Panel, supra note 1 at pg 122.

[34] Carter, supra note 15.

[35] HM Chochinov, Dignity in the Terminally Ill: a developing empirical model” (2002) 54(3) 433-443.

[36] Ibid.

[37] The Special Joint Committee, supra note 13 at pg 33, The External Panel, supra note 1 at 121- 125, ProvincialTerritorial Expert Advisory Group on Physician-Assisted Dying at pg 20.

[38] The Special Joint Committee, supra note 13 at pg 18.

[39] The Special Joint Committee, supra note 13 at pg 16.

[40] The External Panel, supra note 1 at pg 121.

[41] RSQ c S-32.0001.

[42] Carter, supra note 15.

[43]“The Right to Palliative Care Think Paper” (2015) http://www.bakerlaw.ca/wp-content/uploads/The-Right-toPalliative-Care-Think-Paper.pdf

[44] Carter, supra note 15.

 

Susan Eng LLB LSM
647-988-3595 | susan.eng.to@rogers.com