(August 2021) Congratulations to the Canadian Partnership Against Cancer on release of a Canadian Interdisciplinary Palliative Care Competency Framework. Included are palliative care competencies for nurses, general physicians, social workers, personal support workers who are currently in practice, and volunteers. In their release, CPAC acknowledged CSPCP as a major contributor to framework. CSPCP Board members assisted throughout the process and helped refine the physician competency section to align as closely as possible with the existing national palliative competencies used by many of Canadian medical schools: EFPPEC competencies for undergrad medical education, and PACE competencies for postgrad.
The report features many new practices and innovative tools that can improve the future of home and community-based palliative care – for example, making virtual care more accessible, increasing the availability of palliative symptom management kits, and giving family caregivers adequate support to provide palliative care for loved ones at home. It is hoped that sharing some of these new practices and tools may inspire readers to use and adapt them as required, or develop and share their own innovations. By sharing knowledge and experience, together we can come out of the pandemic stronger than before.
Thank you to Dr. Stephen Singh for participating in the discussions on behalf of the CSPCP.
(March 2021). Bill C-7, An Act to amend the Criminal Code (medical assistance in dying) became law on March 17, 2021. Several of the amendments may have a significant effect on the practice of palliative care.
Key changes are summarized below.
Removal of reasonably foreseeable death criterion. The law no longer requires a person’s natural death to be reasonably foreseeable as an eligibility criterion for MAID (Medical assistance in dying).
Removal of the 10-day reflection period. For those whose natural death is reasonably foreseeable, the 10-day reflection period is no longer required between the written request for MAiD and the procedure.
Waiver of final consent for MAiD. For those whose natural death is reasonably foreseeable, the requirement for consent at the time of MAiD procedure has been waived.
Change in requirement for witness signing a request for MAiD. Only one instead of two independent witnesses are required to verify written consent for MAiD and that witness may now be a paid health care worker.
New safeguards for those without a reasonably foreseeable natural death. There must be 90 days between the first assessment and MAiD procedure, which can be shortened if an individual is at risk of losing capacity to consent. The individual must have been seen by a medical professional with expertise in their underlying condition.
Sunset clause on the exclusion of mental illness as a sole underlying diagnosis in 24 months. Individuals with mental illness as a sole underlying diagnosis will be eligible to qualify for MAiD starting on March 17, 2023.
The CSPCP presented to the responsible committees studying the Bill for the House of Commons and the Senate. Our written briefs and oral presentations are posted here: https://www.cspcp.ca/cspcp-input-to-justice-committee-re-bill-c-7/. We also signed onto the attached Open Letter “Bill C-7 is not the answer”, prepared by the Vulnerable Persons Standard. While we do not support some of the language used in the letter, especially as it relates to Long Term Care, we felt it important to lend our support because of the implications this Bill may have on the practice of palliative care.
Ontario Bill 3,An Act providing for the development of a provincial framework on palliative care passed third reading in the Ontario legislature and will become law. The purpose of the Act is to develop a framework to ensure that every Ontarian has access to quality palliative care. The Act requires the Minister of Health to develop a provincial framework designed to support improved access to palliative care. The Minister must table a report setting out the provincial framework in the Legislative Assembly within one year after the Bill comes into force. Within three years after the report is tabled, the Minister must prepare and table a report on the state palliative care in Ontario. Each report must be published on a Government of Ontario website.
Passing of the law sets a positive precedent for other provinces and shows demonstrate provincial government support for palliative care. The Bill was supported by 40 stakeholders, including Canadian Society of Palliative Care Physicians, Canadian Cancer Society, Canadian Hospice Palliative Care Association, ALS Canada, and health professionals from across the province.
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