Good evening.

I would first like to thank the members of the committee for inviting me to participate in this meeting.

I am a family physician. I have been providing palliative care for 20 years. I provide it in hospitals, at home and in a hospice. I am the medical director of the Maison de la Sérénité. I am also a researcher on the steering committee of the Quebec Network for Research in Palliative and End-of-Life Care, or RQSPAL, in Quebec.

First of all, I would like to say that I fully support what Dr. Kaya has said. So I'm not going to repeat everything she just said.

I would like to make a slight correction to what Mr. Thériault and Dr. Viens said, when they said that Quebec has made medical assistance in dying part of a continuum of care. If we rely on the Act Respecting End-of-Life Care—we must refer to the act, not its interpretation—the definition is clear. As Dr. Downar said, it is end-of-life care, and in the act it is clearly stated that there is palliative care and medical assistance in dying. So they are two different entities. This does not mean that just because we make them two different entities, we are opposed to them. It is important to say that. Indeed, every time we make the distinction between the two entities, some people seem to think that we are opposed to them, but that is not the case at all. According to the definition of “palliative care” in the End-of-Life Care Act, it is care related to the respect of a natural process. We are there to alleviate whatever discomfort there is, without hastening death or prolonging life. It is about respect for the natural state of advanced illness.

In 20 years, I have never seen so much confusion about these two concepts as I do now. Tonight, it's clear from listening to you that it all sounds a bit confusing.

When the term “palliative care” is used, far too many people think that it is given for a few hours, days or weeks before a patient dies. Palliative care is not just that. It is indeed end-of-life palliative care, but it has a different option, which is medical assistance in dying. The use of palliative care is a palliative approach and it takes place for months or even years before the patient dies. The palliative approach, which we could call an integrated palliative approach, aims to ensure that the patient with an advanced illness, who begins to have symptoms of discomfort affecting his or her quality of life, can eventually seek palliative care, knowing what it can offer. If they don't know, they can't ask for it, and if the patient feels that it is just end-of-life care, they won't ask for it sooner.

This lack of information results in patients not being identified, and this lack of early identification is costly to the health system. The patient, who should not be in intensive care, given his condition, ends up undergoing a lot of suffering. Instead, they should be in a hospice or simply at home, surrounded by their family, with appropriate care for their condition.

The resources are there, but they are deficient, because the population is aging and the needs are only increasing. So we need to inject money into the system. Above all, it is important to know that the patient's condition and the type of care must be matched so that the patient is in the right place and can access the right resources. You have to protect the quality of life of patients for two, three, four or five years, as long as the patient is going to need it. That's what good palliative care is all about.

One of you asked what is meant by “having good palliative care”. I think it is having access to enough resources, both material and human resources, and having access to all the places that provide such care for all diseases, not just cancer. I am thinking in particular of patients suffering from heart failure. Take the example of a heart failure patient whose heart is quietly dying. He may have two, three or four years to live. If he has symptoms of discomfort, he should have the option of seeing a palliative care physician.

Will this patient be able to access a specialist palliative care doctor? It is quite possible that they will not. This is where we see the need. Indeed, the complexity of cases sometimes requires the ability to access a specialist palliative care physician with experience in this area.

There should be a national awareness campaign about palliative care. Clearly, in Canada, we don't have a good understanding of what palliative care is. We rely on some people's interpretation and say that's what we're doing, when we're kind of misrepresenting what palliative care is.

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