My apologies. There were serious technical problems, but I was on the whole time.

Good morning and thank you for asking me to appear before you today.

My name is Sandy Buchman. I'm a palliative care physician and the chair and medical director of the Freeman Centre for the Advancement of Palliative Care at North York General Hospital in Toronto. I'm also the former president of the Canadian Medical Association. I spend much of my time providing home-based palliative care, and for a number of years I have provided care to those experiencing homelessness. I am also a MAID assessor and provider.

My comments today may be appreciated through the lens of three important areas for both palliative care and MAID: access, equity and compassion. I will also share some of my concerns regarding current and future states of practising palliative care in MAID.

In Canada, we have several exemplary palliative care frameworks, such as Health Canada's 2018 framework on palliative care in Canada, as well as many province-specific documents. They all recommend innovative and cost-effective ways to improve equitable access and save vast amounts of money in adopting a palliative approach to care when indicated. However, despite dedicated professionals and volunteers having worked so hard for so many years to create these reports, most of these ideas and plans never see the light of day—certainly not in the world in which I work. Why is that? We rarely see the dollars to fund these evidence-based recommendations.

Let me share a personal, concrete example. About seven years ago, I co-founded a new hospice residence in our community of North York called Neshama Hospice. Best practice suggests 10 to 12 end-of-life beds for 100,000 population. In North York, we have a population of about a million and should therefore have 100 to 120 beds. I will tell you that there are zero palliative care unit beds and zero hospice residence beds in our area. We have raised $18 million so far for our new hospice, but now with inflation, several million more have to be raised. We are to receive $2 million in provincial government funding, which will amount to less than 10% of our costs. Operational dollars will not make up even 50% of our costs. The majority of Canada's patients at end of life—up to 70% in many areas—die expensively in hospital because of inadequate funding of community supports like hospice or home care.

Why is it that essential, high-quality, appropriate and very cost-effective palliative care is mostly charitable? If we want to improve access, equity and compassionate care for Canadians, I believe the federal government has an important role to play in setting national standards and providing funding, through the Canada health transfer, to be directed to palliative and hospice care, enacting its own framework. It's beyond time to walk the talk.

The average expected life span for those entering long-term care is only 18 months. If that does not require a palliative approach to care, I'm not sure what does, yet very few long-term care facilities practise such an approach. This often results in many of our elderly and frail citizens being sent to emergency rooms when their clinical conditions worsen. They are admitted to an acute care bed in hospital where they may remain for weeks or months, not being able to return to their home facility as they decondition so quickly.

A recent C.D. Howe report showed that about 40% of these patients have less than a 90-day prognosis. For a moment, please recognize that if we had more options for care in the community, we could do so much more to relieve our collapsing health care system. This alone would make a significant dent in freeing up acute care beds, and would impact the current capacity challenges and wait times in our hospital system.

Recently, stories have appeared in the media about people with a chronic disease or disability who lack necessary social supports and resources to live a quality of life they deem worth living. Thus, they request MAID, usually through track two. I have every sympathy for these individuals and believe that many are suffering intolerably. Although I've heard about a few of these tragic cases, in reality they are also relatively few in number. Indeed, many say they don't really want MAID but would rather die than continue to live in their impoverished circumstances. This is the basis of their intolerable suffering.

Critics of MAID legislation cite that it is easier to access MAID than adequate health, social and financial supports, and indeed that may be true. Their proposed solution is to toughen up our MAID laws. However, the problem is not the MAID legislation per se, as a person still has to meet all the eligibility criteria. I believe a lack of adequate and appropriate housing, financial supports, access to timely and consistent addiction, mental health and rehabilitation services and access to palliative care are really at the root of their requests. Inadequate and insufficient health, social and financial supports drive death. They do not drive MAID. If we want to prevent needless deaths, let's adequately fund social support and health services. More people will live longer and better lives.

Finally, there is one issue I'd like to highlight with respect to current MAID legislation.

The waiver of final consent, meant to ensure that an eligible patient's wishes for MAID are honoured if they lose capacity, has been an extremely valuable amendment to our MAID laws, but it may also have a flaw. There have been anecdotal reports of this waiver being applied to procedures months later, and even two to three years into the future, after the patient has been found eligible but may not want MAID just yet. It has become a de facto kind of advance consent, in my humble opinion. This was not the intention of this amendment, of course. I bring it to the committee's attention as I think it needs to be explored and studied further.

Thank you for this opportunity to appear before you today to share my perspectives on palliative care and MAID.