Category Archives: Advocacy & Partnerships

Bill C-7 Update

(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.

  1. 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).
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.


Links for more details:

Department of Justice Web page “Canada’s new medical assistance in dying (MAID) law”.
The Bill and its amendment: https://parl.ca/DocumentViewer/en/43-2/bill/C-7/royal-assent

CSPCP’s Advocacy:

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.

Compassionate Care Act becomes law in Ontario

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.

CSPCP Input RE Bill C-7

(November 2020). The Parliament of Canada is currently reviewing Bill C-7, An Act to amend the Criminal Code (medical assistance in dying). Parts of the proposed Bill have significant implications for palliative care and despite the very tight timelines involved, the CSPCP has been actively working to provide input accordingly.

The first step in the parliamentary process was review by the House of Commons Standing Committee on Justice and Human Rights. The CSPCP submitted a written brief (English; French). We were subsequently invited to give a 5-minute presentation to the Committee and to participate in a question period. CSPCP President Dr. Anne Boyle and CSPCP Member Dr. Harvey Chochinov represented the CSPCP. They focused on the evidence in the literature that addressed the Government’s proposed changes to the law. (View proceedings here. CSPCP presented at 12:25:45)

The second step was review by the Senate Standing Committee on Legal and Constitutional Affairs. The CSPCP submitted a written brief (same as the one above). CSPCP Past-President Dr. Leonie Herx gave a 5-minute presentation and participated in the question period that followed. Dr. Herx summarized the CSPCP’s concerns and recommendations for safeguards to minimize harm. View her presentation here. (Full proceedings here: SenVu (parl.gc.ca)).

Advocacy for Palliative Care during COVID-19

(Updated August 5, 2020) The CSPCP Board and staff have been working hard to bring palliative care issues to as many national planning tables as possible. We are actively involved in a variety of advocacy issues, including drug shortages, access to PPE, and palliative care standards and education needed for COVID-19.

On April 22, The CSPCP sent a brief “Immediate Issues and Recommendations Regarding Provision of Palliative Care During the COVID-19 Pandemic”to the federal Standing Committee on Health, Health Canada, the federal Ministry of Health, and the CMA. The response has been impressively fast. Updated examples:

Palliative Care Drug Shortages. On the day the brief was circulated, the CSPCP was invited to join a new Tier Assignment Committee (TAC)” for Palliative Care Drugs that is being struck by the Drug Shortages Unit at Health Canada. Its first meeting took place on April 28th. The CSPCP provided asummary of issuesand requested that phenobarbital and methotrimeprazine be considered for Tier 3 status*. These drugs were subsequently added, and dexamethasone was added recently. The team is looking closely at supply and distribution of these drugs and working with a multi-stakeholder group to mitigate. Reports from CSPCP members indicate that there have already been improvements in the supply. We are working with many partners to keep it that way.*

On the clinical side, the CSPCP has reached out to national and provincial pharmacy regulatory authorities regarding two issues that they could help to resolve. We continue to work on drug monitoring and conservation strategies, in collaboration with numerous federal and provincial groups. We co-hosted a webinar with Pallium on July 29th to share some of the work that is happening. You can view the recorded webinar at: https://www.youtube.com/watch?v=RIShme7fN6c.

Personal Protective Equipment for Palliative Care. Health Canada and Public Services and Procurement Canada (PSPC), with the support of Global Affairs and at the advice of the Public Health Agency of Canada (PHAC), are leading efforts on PPE procurement nationally and internationally. They are also supporting the retooling of national industry for the production of PPE, as well as preparing guidance and supports for decontamination and re-use of respirators. The CMA represents physicians with Health Canada and PHAC, individually as well as on various committees. The CMA and the federal government agencies are aware of the PPE shortages that palliative care teams have encountered, especially in community but also in hospitals. They are working to facilitate equitable access to PPEs in the challenging context of national and worldwide shortages.*

Public Health Agency of Canada.
The CSPCP was recently added to a stakeholder group that is engaging with the Public Health Agency of Canada (PHAC). We attend regular teleconferences where PHAC updates participants on latest evidence and recommendations which are summarized in their publicly-posted Guidance Documents for Coronavirus Disease.

Palliative care is included in the PHAC guidelines as a consideration for older persons, but there is no mention of it for other age groups. The CSPCP submitted input to PHACasking to include a palliative approach to care for all people with difficult-to-treat symptoms, regardless of age. We heard back immediately and were invited to review recommendations that are being developed for long term care. Our input has also gone to other appropriate groups with in PHAC. The guideline for long term care settings was released in late July and it includes substantive recommendations regarding the role of palliative care for symptom management and end of life care. (French)

Online Community of Practice: The Canadian Palliative Care Exchange (www.cpcexchange.ca). The Canadian Palliative Care (CPC) Exchange is a moderated online community of practice offered collaboratively by the CSPCP and Pallium, with support from Canadian Medical Association, Scotiabank, and MD Financial Management. The Exchange enables interactive, online national dialogue between health care professionals across Canada regarding COVID-related topics in palliative care.

Future planning. The CSPCP believes that palliative care should be a fundamental part of pandemic planning and response, not an afterthought or a luxury. We are advocating for this at every opportunity. Influential groups we have reached out to include PHAC (above), the federal Standing Committee on Health, Health Canada, and the CMA.

Finances. The CSPCP prepared two proposals seeking support to expand our services to CSPCP members and other physicians. We have also written twice to a number of federal leaders, including Bill Morneau about the impact of COVID-19 on our finances and have requested financial assistance. In spite of the significant financial impact of COVID-19 on the CSPCP, we do not qualify for any of the programs that are currently available. We are working with other national organizations to try to change this.

*To report shortages of medications and/or personal protective equipment in palliative care settings, contact Kim Taylor ed@cspcp.ca

Announcing the Canadian Palliative Care Exchange

(July 2020) With support from the Canadian Medical Association, Scotiabank, and MD Financial Management, CSPCP and Pallium have launched a moderated online community of practice—The Canadian Palliative Care (CPC) Exchange (http://www.cpcexchange.ca). The Exchange will support interactive, online national dialogue between health care professionals across Canada regarding the most relevant COVID-related topics in palliative care.

The Exchange is a professional learning site, moderated by members of the CSPCP, and open to all health care professionals including physicians, nurses, social workers, and pharmacists.

There is no cost to participate.

Join the Exchange now to:
• Ask questions about palliative care during the COVID-19 pandemic
• Share your experiences
• Teach and learn with colleagues from across Canada

Join now: http://www.cpcexchange.ca