While our parliaments and our media focus intently on medical assistance in dying, another important end-of-life question needs to be brought to the forefront: How do we build a high-quality palliative care system?
Palliative care is the part of our health care system that deals not only with death, but with quality of life when people are nearing the end of life. This extends beyond relief from pain and discomfort to include psychosocial and spiritual care: It's about improving the quality of life for those facing life-threatening illness, and providing support for their families.
Our healthcare system has responsibility for 'cradle to grave' care but far more attention has been placed on the beginning of life, and the events during life, than at the end. Without sacrificing the gains we have made and the progress still to be made at the start of life and during life, we also need to create a strong focus about what high quality care looks like as people are diagnosed with serious illness and get closer to death.
A focus on death and dying may have seemed contradictory to the traditional essence or focus of what a health care system is designed to do -- provide health and healing. However, modern medicine has extended our lives in ways that once would have been unimaginable.
With the changing nature of disease, and chronic illness at the root of most deaths, we now have the ability to much better predict end-of-life. This means that there is a tremendous opportunity for palliative care to begin much sooner in the course of disease, and for people to understand its benefits -- care that not only helps patients with their pain and symptoms, but also helps them and their families through a difficult time of loss and grief.
Health Quality Ontario's latest report looks at palliative care in the province. We look at the care and services people received during their last month of life, and ask: How are we serving those who are nearing the end of their lives?
What we've found is much room for improvement.
Of the 95,000 people who died in Ontario in 2014-15, only about half received some form of palliative care. And of those people, half did not begin receiving this care until their last month of life.
This statistic alone is revealing.
We also report that nearly two-thirds of those who'd received palliative care had unplanned emergency department visits in the last month of life. While it is unlikely the number should be zero, the current rate is almost certainly higher than a well-performing palliative care system would aim for. Another area for improvement is our finding that nearly two-thirds died in hospital although we know most people's preference is to die at home.
Getting care when it's needed, where it's needed, and by well-trained people are hallmarks of quality health care. We need to build a health system that provides quality care at the end of people's lives.
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