Volume 24, Number 4, April 2023 Supplement - Section II: Opinions

North America

If palliative care is not a national priority, given the demographics and our underfunded health care system, I don’t know what is.

Monica Do Coutto Monni
Executive Director, Near North Palliative Care Network, Ontario, Canada

We, at the Near North Palliative Care Network, align with the IAHPC Position Statement on palliative care and euthanasia, as we do with statements by the Canadian Hospice and Palliative Care Association, Hospice Palliative Care Ontario, European Association of Palliative Care, World Hospice Palliative Care Alliance, and the United Nations' World Health Organization. All agree on the necessity of prioritization of funding for palliative care, and extension of palliative care to all in need, starting early in the life-threatening illness.

Based on our daily experience on the field and the facts presented, here are some personal reflections.

Canada’s 2021 census estimates that there will be 8.44 million “baby boomers”—those born between 1946 and 1965—as of 2029, and 4.1 million of them age 80 or more in 2045. It is estimated that 34.4% of all baby boomers will need palliative care in Ontario, Canada’s most populous province. Yet Ontario currently has just 491 hospice beds and 4,000 hospital hospice beds.

If that is not a provincial and national health care priority, then I don’t know what is.

All humans have this deep, hard-wired instinct to stop all we are doing and rush to help the dying. Death stops us all on our tracks. We cannot go on just talking about the death of millions of Canadians around meeting tables as if these were mere numbers.

Our political leaders must juggle many concurrent pressures when budgeting for national and provincial priorities. They must take into consideration the aging population and its needs: a graphic, concrete reality. Human beings, Canadian citizens, ageing and vulnerable, who are afraid of pain and fearful of dying. Lonely. Often abandoned. Who are, or will be, in immediate, practical need of daily nutrition, hydration, changing, dressing, help with household chores, and with mobility. They are, or will be, in need of company and meaning for their last days, in need of belonging and hope: in need of receiving the quality of life they deserve in their final years.

The world looks to Canada, a wealthy country, as a role model. During the outbreak of COVID-19, colleagues in palliative health care from all over the world contacted me to ask what we were doing here, in the hope of learning from us. How we treat our elderly now and in the near future will be an example globally for subsequent generations. Canadians have a tradition of rising to the occasion in serious emergencies, like the sacrifices our ancestors made in the Second World War to protect and secure our freedoms and rights today. I hope that we consciously decide to rise to the occasion again, and make the necessary sacrifices in our national and provincial budgets to give enough and proper care to our older citizens. We need that to happen now!

This requires a concerted effort of many sectors of society, starting with politics, educational institutions, and the pharmaceutical industry. In face of this momentous priority, true representatives and leaders must leave their comfort zone and make the necessary call to collective action and sacrifice. Enough funding must be allocated to: educate, train, and hire more medical doctors, nurses, and personal support workers; create enough infrastructure in hospitals, long-term care and assisted living residences, and support for independent living; and secure raw materials and manufacture enough drugs used for pain and symptom control at the end of life.

We must come to the aid of health care professionals now in the field, who are burning out and acquiring workplace trauma due to stresses in the health care sector. These heroic soldiers should be considered as collateral damage. They courageously fight for our immediate lives daily in the trenches of health care, a fact proven a million times over during the COVID-19 pandemic?

I hope that we choose the highest standards of human ethics and morals. I hope that we choose life, and life in abundance, to the end. I hope that Canadians choose to be a shining historical example of sacrificing ourselves, once more, for the sake of our loved ones. The way we treat our elderly now will decide the future, the freedoms, and the rights of generations to come.

We do not want to be covered in shame for turning our eyes away from our ancestors on their deathbeds, when they need us the most, after they helped advance our freedoms and rights with long lives of hard work to make this nation even more prosperous. Who will be able to justify that to our descendants?

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