Opinion: Canada needs a palliative-care strategy and focus on pain relief

Categories: Care.

This notion very much guided the creation of the all-party Parliamentary Committee on Palliative and Compassionate Care, which in 2011 issued its report titled Not to Be Forgotten: Care of Vulnerable Canadians.

We must deal with end-of-life issues with uncompromising clarity. Democratic choice requires clear and informed debate in order to be said to be truly democratic.

Palliative care is not euthanasia. Some define euthanasia as the “final stage of good palliative care,” confusing palliative sedation, an infrequent use of powerful sedatives to induce artificial sleep or coma, with terminal sedation, in which a patient is sedated with the primary intention of precipitating death.

Nor is palliative care simply about pain control. While helping manage pain is one aspect of this form of patient-centred, end-of-life care, which includes tending to spiritual and psychological needs, chronic pain is an issue in its own right that affects a surprisingly large number of Canadians.

Governments are reticent, however, to offer routine treatment for pain as a core health-care service. The problem is so pervasive, there is concern that doing so would drain the treasury. The committee heard that “chronic pain costs more than cancer, heart disease and HIV combined.” Not wanting to open the financial floodgates in an area of such great demand is no doubt one reason why governments, for example, exclude fees for physiotherapy and osteopathic treatment from the definition of tax-deductible medical expenses.

In relation to end-of-life situations, anecdotal reports are not unknown of pain relief being withheld from dying patients by medical practitioners who fear that giving powerful pain drugs could hasten death, something for which the practitioner could then be held liable.

But relief from pain is a human right. The Declaration of Montreal, adopted on Sept. 3, 2010 at the 13th World Congress on Pain, affirms, among other things, the “right of all people with pain to have access to appropriate assessment and treatment of the pain by adequately trained professionals.”

What may be needed to ensure this right is legislation to guarantee, in practice, the provision of appropriate pain management, as well as to clarify the limits of liability that medical practitioners could face when administering drugs for the purpose of relieving a patient’s pain but without intent to hasten death.

Francis Scarpaleggia is the Liberal MP for Lac-Saint-Louis riding. He is a founding member of the all-party Parliamentary Committee on Palliative and Compassionate Care.

To read the full opinion piece, please visit The Montreal Gazette.

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