In an effort to introduce to you the history of end-of-life care, as it has developed within Canada, and specifically Ontario, the following is a very brief summary of some of the highlights of the palliative care movement that has come into existence over the last 30 years. Historically, within Canada, end-of-life care developed within communities across the country to meet the needs of the people living within these particular communities. The hospice palliative care movement came about as a result of the rapid expansion of cancer treatment programs in the 1970s. By 1991 the Canadian Palliative Care Association (CPCA), now known as the Canadian Hospice Palliative Care Association (CHPCA), was formally established, and in 1995 the Senate of Canada published a report entitled Of Life and Death in an effort to address end-of-life care issues within Canada.
In June of 2006, the Senate updated this report and published the Quality End-of-Life Care: The Right of Every Canadian, with the goal of improving upon the plans and policies of the previous 1995 document. Then, in March 2001, Senator Carstairs was appointed as Minister with Special Responsibility for Palliative Care. This position is responsible for assisting the Health Minister in supporting the federal government’s interest in the development of palliative care by working with provinces, territories, and nongovernmental organizations to ensure that palliative care is meeting the needs of Canadian patients, families, and caregivers.
Now, even with all of these efforts in place, the province of Ontario has been characterized by a lack of coordination, organization, and consistency of end-of-life services. Historically, there has been a lack of integration between the multiple health sectors and palliative care service providers, unrelieved pain, inadequate symptom management, a lack of education and training in palliative care and a lack of health care professional capacity. The supports and services that are available within Ontario are hardly universal – availability is unique to each region and reflects the capacity and evolution of the health care system. Moreover, the system is difficult to navigate.
What are the consequences of this lack of integration? There are many and these consequences are felt hard by dying patients, their families and caregivers! To name a few, this lack of integration results in late referrals to care, unnecessary delays for treatment and symptom control, delays in transfers to appropriate settings of care and unnecessary suffering and cost. In addition to these issues, Ontario faces the challenges that come with adequately addressing the unique end-of-life care issues that face minorities, Aboriginals, those with mental health issues, and those who wish to choose their own time of death (euthanasia, assisted suicide). (To name a few!)
It is imperative that Ontario, and Canada as a whole, develop a plan to address these issues that affect so many people at such an important time in their lives! A first step in a positive direction came from the McGuinty government in 2004. This is the year in which the McGuinty government announced that they would be investing 115.5 million dollars over three years to improve end-of-life care services for 6000 more Ontarians, at home and in the community. This is most definitely a step in the right direction but there is even more that must be done. Hopefully these issues and possible solutions will become clear as we generate this blog!