On March 3, Liberal Senator Sharon Carstairs, head of the Senate committee responsible for palliative care in Canada, gave the Cardinal Ambrozic lecture at St. Michael’s College at the University of Toronto. In her talk, entitled, “The State of Palliative Care in Canada: End of Life Care,” Carstairs said Canada is not in a favourable position to engage in a debate on assisted suicide until national standards for palliative care are in place and Canadians who are approaching the end of their lives are assured of adequate care.

Speaking to an audience of pro-life activists and health care workers, Carstairs, formerly chair of the special Senate committee on euthanasia and assisted suicide, confirmed that her earlier support of euthanasia has been significantly moderated by her work and discussions with the dying and their families. Since starting in 1995, her emphasis, which has become a crusade, has been to improve medical, social and spiritual care for terminally ill Canadians.

Palliative care – that given to patients whose medical prognosis is considered “hopeless” – is a relatively new concept in medicine. Medical practice has traditionally emphasized the attempt to cure disease and injury and to restore health as its sole concerns. But the emphasis on cure has left the dying subject to unnecessary, unwanted and extraordinary medical interventions. At the same time, pressure is mounting to legalize assisted suicide and euthanasia.

The issue is shortly to become critical. Canada’s population is aging. By 2026, eight million Canadians will be over age 65, approximately 20 per cent of the population. The aging of the Canadian population is a subject that has alarmed demographers and economists, but the issues surrounding caring for elderly patients are among the more neglected in the larger debate around reforming an already-overburdened public health care system. Canada is in a race, with its aging population on one side and a new recognition of the urgency for palliative care on the other.

Before the January federal election, and the change in government, Bloc Quebecois MP, Francine Lalonde had brought forward a bill in the House of Commons that proposed to legalize assisted suicide and broadly expand its definition.

Carstairs said, “Unless every single Canadian can be guaranteed quality end-of-life care, in which they have a legitimate choice to make, then I would suggest that we cannot start the debate (on euthanasia). We aren’t there yet. We are a long way from being there yet.”

She said when a person expresses a desire to commit suicide, it represents a serious societal failure. When a patient’s needs are addressed, the demand for assisted suicide will be greatly reduced, she said.

Canadian palliative care is in its infancy, but rapidly growing. The system, as it is now, relies heavily on local jurisdictions, voluntary health care networks of nurses, doctors, patients’ families and advocacy groups. A national palliative care organization, the Canadian Hospice Palliative Care Association, was established in the mid-1990s.

Lori Ives-Baine, the palliative care and bereavement co-ordinator of the neonatology program at Toronto’s Hospital for Sick Children, said the dialogue is improving between ground-level health care workers and higher levels of government. Ives-Baine said, “Palliative care is way more on the agenda politically and socially than it has ever been.”

Ives-Baine, a registered nurse, said attitudes are changing in the health care community toward a greater acceptance of end-of-life care. “When I was trained as a nurse, we were trained to care for people and make them better. Physicians have the oath to cure. It’s a growing development. It’s always been there; people have always died. We’re just learning how to do it better.”

The groundwork for a national association was laid in 1987 at the National Palliative Care Conference held in Ottawa, at which time there were only three provincial organizations and no national organization. The Canadian Palliative Care Association (CPCA) opened the first office in Ottawa in February 1994. In 2002, the CPCA proposed a set of guidelines for establishing national standards, which, according to Carstairs, is a major priority for her committee.

The progress is slow, however, and individuals are often bogged down in a big government bureaucratic morass. The federal government, for example, established the Compassionate Care Benefit, which proposed to enable Canadians temporarily to leave their jobs to care for a dying family member for eight weeks while being supported by the federal Employment Insurance program.

The program has come under criticism from palliative care and hospice advocates, who point out that eight weeks become six, due to a two-week waiting period and the maximum benefit that can be collected under the program is only 55 per cent of regular wages. They also say that many who are actually caring for the dying are unable to gain access to the benefit, because they do not fit the definition of a caregiver as established by the program.

Annalise Stenekes, of Bayview Community Hospice in Toronto, said that local networks emphasize working with families, individual doctors and personal connections that naturally grow up around patients. “It’s about continuing service, not the hospital versus the community,” Stenekes said.

Much needs to be done to educate physicians to accept the value of palliative care, said Ives-Baine. “Yes, you do everything you can (to cure). But there is a responsible use of medical technology and when we know that we can’t fix what is wrong, you go into a care mode, instead of curative.”