Palliative care: The elephant in the room in the assisted dying debate

Two months ago, 54-year-old Marlene Miller was in so much pain she could barely get out of bed.

Her breast cancer had returned after five years of remission, and had spread to her lymph nodes and bones. But when her doctor suggested she start palliative care, Miller resisted.

“I was like, ‘well I’m not ready to die yet.’ That’s what I thought palliative care was going to be about,” she said.

When she finally relented and started to feel better, Miller realized she had misconceptions about what palliative care really is. Her nurse and doctor are on call 24 hours a day, 7 days a week. They help regulate her medications and make sure she feels comfortable and empowered.

She can now do some of the things she loves again, like gardening and shopping.

“It has alleviated so much of my stress and fear,” Miller said. “Even as this progresses, I know I’m going to be looked after by these angels that are palliative care.”

Palliative care is not just about managing symptoms as death draws near. It’s a whole approach to care that takes into consideration physical, psychological, social and spiritual needs. When started early, studies show it can not only improve quality of life — in some cases, it can extend it.

But Miller is in the minority.

Only 15-30 per cent of people dying in Canada have access to hospice palliative care services, according to the Canadian Hospice Palliative Care Association.

A recent report from the Canadian Cancer Society paints a grim picture of access across the country. With no federal guidelines, most provinces have developed their own strategies, leading to a patchwork of care. Despite many investments in recent years, the availability, accessibility and quality of care still depend on where you live.

Quebec is the only province that has passed a law guaranteeing end-of-life care for the terminally ill.

The consequence? The majority of gravely ill Canadians are dying in emergency rooms. With an aging population, experts say we simply can’t afford the status quo.

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