1. The Big Issues: Palliative Care Perspective MONICA BRANIGAN, MD, MHSC CHAIR, CANADIAN SOCIETY OF PALLIATIVE CARE PHYSICIANS WORKING GROUP ON HASTENED DEATH

2. Top three issues 1.Access to high quality palliative care #1 priority 2.Balancing patient access and physician conscience 3.Balance autonomy and harm reduction

3. Access to high quality palliative care

4. Access to palliative care The issue of true choice Physician hastened death is distinct from palliative care Equitable access to resources

5. My recommendations Right of access to palliative care National Palliative Care/End of Life Strategy Separate parallel provincial service with multiple access points to provide ◦Information ◦Counselling ◦Referral/access to willing provider list ◦Initial monitoring and documentation

6. Balancing patient access and physician conscience

7. Effective referral or effective access? Moral distress with duty to refer Alternatives: ◦Duty to inform: ◦separate parallel system ◦“patient advocate” ◦designated member of the institution ◦Team duty rather than duty of individual MD

8. My recommendations Clear policy from Colleges about responsibilities of all health care providers with examples Concept of effective access

9. Balancing autonomy with harm reduction

10. Potential harms and recommendations Preventing possible premature death ◦Proportionate waiting times ◦Access to appropriate consultations ◦Education at all levels ◦Monitoring access to and quality of palliative care Potential harm to palliative care ◦Separate, parallel service ◦Shared responsibility of the whole profession

11. Potential harm to families ◦Attempt to include ◦Provide grief counselling Potential harm to other HCP ◦Need equal protection under the law

12. Consider graduated implementation ◦Start with physician hastened patient administered death ◦Then physician hastened physician administered ◦Then mental health suffering

13. CSPCP Submission to the Federal Panel http://www.cspcp.ca/wp-content/uploads/2014/10/CSPCP-Federal-Panel-Submission-Oct-22- 2015-FINAL.pdfhttp://www.cspcp.ca/wp-content/uploads/2014/10/CSPCP-Federal-Panel-Submission-Oct-22- 2015-FINAL.pdf