More palliative care services needed in Manitoba, some help on way

As the deadline for legislating assisted suicide approaches, health care experts in Manitoba are boosting services and the profile of palliative care.

Jocelyn House, a hospice in south Winnipeg, is hoping to expand its facility, from four to 24 beds.

"We are within days of presenting a proposal to the WRHA [Winnipeg Regional Health Authority] through a partnership with the Catholic Health Corporation," said Jackie Stephen, executive director of Jocelyn House.

"We are hoping for a new 24-bed facility that Jocelyn House would operate. It could be a separate location, or we may expand this one as well." 

Jocelyn House has also launched a new website and Hospice and Palliative Care Manitoba rebranded with a new website earlier this year.

The Canadian Virtual Hospice is a website designed and based in Winnipeg with international reach. The site helps people with concerns and questions about palliative care.

Patients, family members and caregivers can ask a question and get a personal answer within a couple of days from a specialist. The site gets 10,000 hits a day, some from as far away as China and Australia. 

Manitoba has lowest support for assisted dying

The interest in palliative care seems to be there, but according to a poll of 2,500 people carried out for Dying with Dignity, more than 80 per cent of Canadians support the concept of assisted dying.

The lowest support in the country is in Manitoba, with 79 per cent.

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"It's hard to be a strong voice when it seems in opposition to what the public wants," said Dr. Mike Harlos, the director of Palliative Care for the WRHA. 

"People in our program are concerned about this. They are not wanting to be part of it. They think it should be outside of the spectrum of palliative care and perhaps outside the spectrum of medical care. It should be somewhere else."

But some want to see assisted suicide as part of the health care spectrum in Manitoba hospitals, personal care homes and special clinics.

"Personally I would like to see some palliative care doctors who would be willing to participate. I see it as a possibility," said Paul Henteleff, a retired doctor and the former head of palliative care at St. Boniface Hospital.

Henteleff, now the medical advisor to Dying with Dignity in Manitoba, which supports assisted suicide, promoted his position called "Why Assisted Suicide?" at a senior's home and a church this month.

Dr. Harvey Chochinov, Canada's research chair in palliative care, is calling for judicial oversight to prevent abuse of the vulnerable.

"A court needs to determine if I can get a variance on placing a fence. Why shouldn't the court determine if somebody meets criteria so they can receive assisted dying?" said Chochinov, who is also a professor of psychiatry at the University of Manitoba.

More training needed

Ahead of the legislation, health care experts want to train more doctors in pain management and palliative care.

All of this at time when they are faced with an aging population and a minimal increase in the palliative care budget.

"We need a voice in influencing legislation and the regulatory framework. And we need that voice now," said Harlos.

"There is an urgency to this. What will physicians think of this if it becomes part of the expected spectrum of care? Who at the university is going to teach assisted suicide?

"There has to be a curriculum. There is nobody in the country who knows how to do this."

Chochinov said the issue of dying in Canada and palliative care has been studied for years.

"Over a decade has passed and we haven't got it right. I am not sure the court stipulating that we have a year to get the assisted suicide thing right is going to allow us to get our entire palliative care house in order," he said, adding better training for doctors in end-of-life conversations, treating distress and treating pain is needed.

"And in the absence of that, doing this seems the equivalent of addressing homelessness by letting down the guard rails on bridges," Chochinov said.

"We are devising a means by which people may end their lives but we aren't giving them the way of mitigating the kind of suffering that may be driving them towards making those choices."