First of all, my most sincere condolences to the members of the Bourassa family. I would also like to thank them for their courage, that of raising the red flag on a situation to be decried: the lack of access to palliative care.
It seems that no one will come out of this life “alive” and yet the healthcare system was not designed to accommodate death as much as it was built to resuscitate and save lives. Of course, I, like all of us, celebrate a system that works to prolong our healthy lives. But, considering that death awaits us all, isn’t it surprising that so few resources are allocated to palliative care? Let us agree, palliatives, not in opposition to acts with curative aims, but rather as a good friend who knows how to accompany us throughout the continuum of care and who deploys her meaning when the disease can no longer be cured.
Let us first address the situation of palliative care in establishments (eg in hospitals) and in palliative care homes. All resources combined, in Quebec, we only have 23 beds for 500,000 inhabitants. To compare, let’s take the example of Australia which has 33 and the United Kingdom, 54…1
These very disappointing statistics and well below requirements (remember the aging of the population and the fact that death spares no one…) force us to establish fairly strict admission criteria.
For example, most palliative care resources require a vital prognosis estimated at less than three months (read the life time that doctors estimate you have left). This criterion, used rigidly for lack of resources, is often very difficult to apply. Although in medicine, we often like to play gods, here nature takes back its rights and often shows us that our science is no match for the story of the dying that unfolds before us. In short, estimating a prognosis is difficult and many do not draw the correct number in the palliative care admission lottery.
This leads us to solution number one: increase the number of palliative care beds AND provide less restrictive admission criteria.
Let’s be inclusive because death is. Simple to state, I agree, but shouldn’t we start somewhere and dream that we finally allocate a few dollars?
Palliative care at home
Let us now address the situation of palliative home care. The statistics speak for themselves here again. Although a large majority of people want to die at home, less than 10% succeed…2
This brings us to solution number two: focus on home care. I mean now and massively, not just for one term. While the government is pulling out all the stops so that all doctors work in the office, in the face of a flagrant shortage of resources, who will treat our patients with loss of autonomy who cannot set foot outside to go to the clinic? Logically, these patients will be forced to go to the emergency room by ambulance for nothing. It is therefore urgent to distribute medical resources, at least equally, between the population still on foot as well as for those who are bedridden.
I take this opportunity to reflect on the situation of the number of physicians working in palliative care in Quebec.
Imagine that for the whole of Quebec, according to an internal survey by the Quebec Society of Palliative Care Physicians, only 50 physicians provide palliative care full-time and 200 physicians provide it on an occasional basis.
In addition, every year we train specialty residents in palliative care and they have difficulty finding positions due to government constraints. With this too small number, it is impossible to meet the needs of the patients, it is also impossible to provide education to those uncomfortable with the accompaniment of the dying.
This brings us to solution number three. Considering death as an inevitable avenue could be a driver for an overhaul of training for caregivers. Why not include the teaching of palliative care very early and embed it in each of the subjects studied and this throughout the educational path of health workers? Death is everyone’s business, not just palliative care professionals.
It is up to us, as future dying, to take our courage as human beings to visualize our end and that of our loved ones in order to discuss their wishes and ours now, this evening.
The vital notion of allowing a dignified end of life is certainly an individual question, but make no mistake, it is also a political question of the allocation of resources.