Hon. Betty Unger: Honourable senators, I would like to speak in support of Senator Eaton’s amendment. When I was appointed to the Senate, I hoped that I might make a difference in some way — perhaps Senate reform, which Albertans have wanted for decades. I never, however, imagined this nightmarish scenario. I am dismayed that Parliament’s gift to Canada on its one hundred and fiftieth birthday is going to be the dark scourge of physician-assisted suicide and euthanasia. I had hoped for so much better.
Today I stand in support of this amendment because I believe we must make certain that no one is ever forced to request a physician’s assistance in dying simply because they have not received palliative care.
In my view, this amendment is imperative. Providing assistance to end a person’s life without first providing assistance to alleviate their suffering is to deny the person the option of living. Such a situation would be incomprehensibly unjust, and yet this is exactly what will happen if we do not amend this bill.
We have never been on this path before. We do not know all the consequences that will arise now that the Supreme Court has launched us down the road of euthanasia and assisted suicide.
We are undertaking a dangerous societal experiment. Personally, I don’t think this road will lead anywhere good. I believe that future generations will judge us harshly for our cavalier attitude toward the sanctity of life.
We must be certain that we do all we can to minimize the damage and unintended consequences. Safeguards around this legislation must be strong, sufficient and secure. If we are going to err, let us err on the side of caution, not on the side of ambivalence. Life is far too valuable to do otherwise.
The value and importance of palliative care have been widely acknowledged during the debate over physician-assisted dying. There is broad support for palliative care and an overwhelming recognition that more needs to be done.
In its report to Parliament, the External Panel on Options for a Legislative Response to Carter v. Canada said it this way:
. . . a request for physician-assisted death cannot be truly voluntary if the option of proper palliative care is not available to alleviate a person’s suffering.
The Special Joint Committee on Physician-Assisted Dying also underscored the importance of palliative care, noting that “there was an overwhelming consensus among witnesses that palliative care needs to be improved”, and that “many Canadians do not have access to high quality palliative care when they need it.” Their recommendation “to develop a flexible, integrated model of palliative care by implementing a pan-Canadian palliative and end-of-life strategy with dedicated funding, and developing a public awareness campaign on the topic” is an excellent goal.
In 2015, in a one-day House of Commons debate on physician-assisted dying, palliative care was mentioned 115 times. Conservative MP Harold Albrecht said: “. . . I could not agree more that we need a better palliative care system in this country.”
Liberal MP Carolyn Bennett, now Minister of Indigenous and Northern Affairs, stated: “We have to know that real choice in end of life does not happen if people do not have optimal palliative care . . . .”
These are just a couple of examples.
Honourable senators, there is no debate over the importance of palliative care. The debate is over. The question is what are we going to do about it?
Ironically, it was our current Prime Minister who stated last year that: “. . . we cannot have any responsible conversation about physician-assisted death and not have a full discussion of palliative care in this country. . . . it should never be a conversation where we have one without the other.” He promised that $3 billion would be invested in palliative care, and yet there was nothing in the budget and today we still see nothing. Was his promise fiction or reality?
We find ourselves here today being asked to consider a bill which contains no safeguard to ensure that palliative care services are available to those desiring physician-assisted suicide.
I am aware that the House of Commons Standing Committee on Justice and Human Rights added two amendments to the bill related to palliative care. One is found in the preamble and one is found in the body of the bill. Both are welcome amendments, but they do nothing to prevent the tragedy of a physician killing a person without first making them aware of their other options.
This is not an academic scenario, fellow senators. This is real life — and I would add death.
Allow me to illustrate this by reading from an e-mail sent to me by a registered nurse:
I first heard of him from my colleague — the symptom control nurse at the cancer clinic.
She was very concerned about his escalating symptoms which would likely soon be beyond what their outpatient clinic could control. She had encouraged hospice registration but the young man, and his loved ones would have nothing to do with hospice because they were focused on life, and despite assurances otherwise, they were certain that involvement with hospice meant hastened death.
As feared, his symptom burden became such that they were desperate for help.
This was certainly not a case for the emergency department, and the acute care wards are simply not trained and equipped to deal with this complex of a case.
I had multiple telephone discussions with loved ones regarding how medications could safely be used to ease his distress, and that palliative care was not about hastening the death of this beloved boy.
It was with fright and despair that they brought him to the hospice unit, but then something happened — something amazing. The medications worked!
Although, he continued to deal with obstacles that any of us would have found horrendous, in a very short time, he was able to be out in the hospice lounge, hanging around with his ever present family and friends, playing music.
This young man continued to be so full of life that soon they all felt that he was safe in our care.
He was discharged home, and readmitted a few times over several weeks, when he wasn’t with us he chose to “couch surf” with loved ones. One fine day he left the unit on a pass with his friends. They all came bustling back in the evening. And then, after some laughter and settling in, he suddenly, quietly, and naturally died.
This is a success story of hospice palliative care, and it underscores the need for this amendment. How can we, as a society, possibly endorse public policy which says to those who are suffering terribly: “Here, we have a doctor available to help you die. But, sorry, we have no doctors available to help you live.” Or, “We have allocated resources and public funds to make sure that you can die prematurely, but unfortunately we are short on resources to help you live as comfortably as possible.”
We must not allow such an injustice to happen.
Let me be clear: This is not an attempt to block access to a physician’s assistance in dying; it is a necessary measure to make sure that no one chooses death due to pain or suffering which couldn’t be alleviated.
Obviously, the person can refuse palliative care and that would not affect their eligibility for medical assistance in dying. To not alleviate someone’s pain when it is entirely possible to do so would be terrible, but to offer them death without first offering pain management should be criminal.
I fully realize we have some distance to go before palliative care is available to all who need it, but I would suggest we have to start somewhere, and Senator Eaton had some excellent recommendations.
We have passed the expiry date of the Supreme Court’s four-month extension. There is no need to rush. Let’s take the time to get it right, and make sure that we get it right.
However, there is a misunderstanding. Effective pain management is available. Pain management in palliative care is making great strides. Let me give you an example.
Dr. Neil Hilliard is a palliative care consultant physician in Abbotsford, B.C., and the program medical director for the Palliative Care Program at Fraser Health. In 2014, Dr. Hilliard had a female patient with locally advanced cervical cancer and uncontrolled pelvic pain. As her disease progressed, the patient’s pelvic pain intensified, despite many different treatments. However, when treated with a continuous subcutaneous infusion of dexmedetomidine, the patient’s pain and delirium cleared. The treatment was successful in fulfilling the patient’s goal of care, which was not to be deeply and continuously sedated but to be rousable and of clear mind while still having good pain control.
This is an example of how proper palliative care enabled an end-stage cancer patient with intractable neuropathic pain and delirium to be successfully managed during the last three weeks of her life, with no need to hasten her death. While this is just one example, it illustrates how proper palliative care can reduce suffering while improving the quality of living and dying.
Honourable senators, in its ruling, which legalized physician-assisted death, the Supreme Court of Canada said that the government should enact stringent safeguards to protect the vulnerable. There are many such safeguards that could and should be enacted but perhaps none as important as what this simple amendment provides, that the offer of palliative care must precede medical assistance in dying.
I support this amendment and I urge you to do so also.