Tag Archives: palliative care

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.

First Annual Report on MAID in Canada (2019) – from Health Canada

The first federal Annual Report on Medical Assistance in Dying in Canada (2019) was released on July 24, 2020.

ENG: https://www.canada.ca/en/health-canada/services/medical-assistance-dying-annual-report-2019.html
FRE: https://www.canada.ca/fr/sante-canada/services/aide-medicale-mourir-rapport-annuel-2019.html

If you have questions about the report, please contact the End-of-Life Care Unit in Health Canada: hc.eolc-sfv.sc@canada.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