Implementing assisted-dying legislation in a social policy vacuum - Policy Options - 0 views
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As Canada’s aging population grows, our assisted-dying dying legislation cannot stand in isolation – the federal government must do its part to ensure doctors, health-care providers and families receive adequate options and pathways for care at the end of life. So, what are some of the social policies that are needed to support the assisted-dying dying legislation? In its nationwide consultations, the Canadian Medical Association (CMA) identified the importance of advance-care planning (ACP), palliative care, long-term care, home care, a national seniors’ strategy, and research and investment in Alzheimer’s as parallel issues to assisted dying.
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While the medical and legal frameworks for ACP are a provincial jurisdiction, the federal government should at a minimum support the forthcoming assisted-dying dying legislation by investing in ACP education and training for health-care professionals and launching public awareness campaigns. We have a lot to learn from other jurisdictions, including the United Kingdom’s Gold Standards Framework training institute and Australia’s National Framework for Advanced Care Directives.
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While there are innovative models of delivering palliative care, actual access to high-quality palliative care varies by region and health provider. We need a Pan-Canadian palliative and end-of-life care strategy. In 2014, NDP MP Charlie Angus successfully moved such a strategy in Private Members’ Motion M-456. Dealing with issues of access, funding and standardization, Angus’s motion was nearly unanimous, but nonbinding. It calls for support for family caregivers and increased access to home-based and hospice-based palliative care. Canada’s assisted-dying legislation would only be strengthened with national direction on palliative care, which is long overdue.
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Calls for a Canadian national seniors’ strategy intensified in 2015 – everyone from the CMA to the IRPP held consultations across the country, identifying key issues and laying impressive groundwork for a future strategy. Lack of political will, however, holds us back – discussion of a national seniors’ strategy during the federal election was very limited, and it is still a political black box. An effective seniors’ strategy would provide a framework for all of the issues I have described – access, affordability and advance planning.
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The long-term-care sector will be a critical partner for implementing, supporting and evaluating assisted-dying requests when the proposed legislation becomes law. Home-care workers and health-care providers in long-term-care facilities, alongside family members, are often the last to care for dying patients outside hospital settings. For many Canadians, long waiting lists to access limited long-term-care spaces are a significant barrier. Regional disparities in access, quality and affordability also exist, and multiple advocacy organizations have emphasized the need for national leadership on issues of elder abuse and neglect in long-term-care facilities.
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A national senior’s strategy will be essential to improving seniors’ quality of life, supporting families and caregivers, and planning for Canada’s rapidly aging population. Canada currently has one geriatrician for every 15,000 Canadians, and there are significant gaps across the country in the quality, cost and access to care.
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ith Canada’s assisted-dying dying legislation currently before Parliament, it becomes increasingly urgent for the Liberal government to make substantive commitments to policies and programs that will support this sea change in the health-care system.