But First, Why Palliative Care?
In 1974, Canadian surgical oncologist Dr. Balfour Mount introduced the term “palliative care” to describe the specialized practice he established at Montreal’s Royal Victoria Hospital to support terminally ill cancer patients. Dr. Mount drew inspiration from the work of Dr. Elisabeth Kübler-Ross, an American psychiatrist who emphasized treating dying patients with dignity, respect, and open communication. Before their efforts, the medical culture of the 1950s and 1960s often excluded patients and families from decision-making, disregarding their values and preferences. Physicians rarely disclosed the realities of failing treatments and frequently neglected effective pain and symptom management, leaving patients to suffer needlessly.
Palliative care sought to reverse these cultural norms. Its primary goal was to improve the quality of life for patients with terminal illnesses, which are incurable and lead to death. Five decades later, palliative care continues to fulfill this core mission for patients with various life-limiting conditions, including but not limited to, cancer, advanced lung, heart, or neurological diseases. As a recognized medical subspecialty, palliative care is intended to alleviate pain and physical symptoms while addressing emotional, psychological, social, and spiritual needs. It is delivered in various settings, including homes, hospices, long-term care facilities, and hospitals. Additionally, it extends support to caregivers, offering bereavement counseling and fostering open conversations about death and grief. Most importantly, it places patients and their families at the center of decision-making, respecting their values and priorities when developing treatment plans.
A Canadian Problem
The benefits of palliative care are well-documented. A 2010 study observed that lung cancer patients receiving early palliative care alongside standard cancer treatment experienced fewer depressive symptoms, improved quality of life, and longer median survival compared to those receiving standard care alone. Similarly, a 2014 study found that patients with congestive heart failure who received integrated palliative care reported greater symptom relief, enhanced quality of life, and fewer hospital readmissions than those receiving standard care. However, despite its recognized benefits and Canadian origins, palliative care is not equally accessible to all Canadians. A 2023 report by the Canadian Institute for Health Information (CIHI) highlighted inconsistencies in the availability, quality, and timeliness of palliative care across the country, revealing systemic barriers that exacerbate these disparities.
One major challenge lies in the division of healthcare responsibilities. Since palliative care falls under provincial and territorial jurisdiction, its cost and quality vary widely across Canada – disproportionately affecting those who rely on affordable care. For example, the British Columbia (BC) Palliative Care Benefits allow BC residents of any age to access free palliative care upon diagnosis. If they have reached the final stage of a life-threatening illness, they can receive free services, medication, equipment and supplies at home, assisted living residence, or a hospice. While Alberta offers a similar program, prescription drugs must be included in the Alberta Drug Benefit List for full insurance coverage. Moreover, certain medical supplies are either subject to coverage limits or excluded entirely, placing a great financial burden on those requiring these services. In Newfoundland, medication and equipment needed for at-home palliative care are only covered for the last month of a patient’s life. Additional support services are covered for 219 paid hours during that month. For patients who outlive these timelines, Newfoundland’s Central Health advises them to consult private insurances and social agencies.
The disparities among Canadian provinces and territories are also evident in their hospital infrastructure. In August 2024, the Canadian Broadcasting Corporation (CBC) reported a case in Nova Scotia where a terminally ill patient was denied admission to a hospital with a designated palliative care unit due to staff shortages. The patient was instead placed in an emergency department with limited privacy and facilities, eventually receiving a private room just eight hours before his passing. This case underscores ongoing challenges despite Nova Scotia’s efforts to improve access – such as opening a five-bed palliative care unit at Fishermen’s Memorial Hospital in 2021. Unfortunately, Nova Scotia remains the Maritime province with the fewest palliative care beds relative to its population. This outcome is likely due Nova Scotia’s chronic underfunding for public health services, which was reported in the Canadian Journal of Public Health in 2021.
More Hurdles to Overcome
In addition to geographic location, factors such as disease type, ethnic background, and socioeconomic status present significant barriers to equitable palliative care. According to CIHI’s 2023 report, patients with cancer are more likely to access palliative care than those with other diseases. The report highlighted that patients with dementia were the least likely to receive palliative care in their final year of life, possibly due to differences in disease trajectories and the unpredictability of outcomes. Unlike many other illnesses, cancer has a relatively well-defined progression, making its palliative needs more predictable. The report also revealed that marginalized groups—including recent immigrants, people of color, First Nations individuals, and the unhoused—face disproportionately poor access to palliative care. These disparities often force affected individuals to leave their communities to access services, endure extended hospital stays, and die in facilities far from home and without adequate social support.
The Path Forward
Palliative care is essential to improving the quality of life for patients and families during life’s most vulnerable and challenging moments. However, disparities in provincial policies, hospital infrastructure, and care for marginalized groups create significant hurdles to providing equitable access. Fortunately, Canada is making slow but positive progress. In 2021–2022, 58% of those who died (89,000 people) received some form of palliative care, an increase from 52% in 2016–2017. Despite this improvement, more challenges persist. For example, many patients only access palliative care late in their illness. Across the country, eligibility requirements restrict access until patients are near the end of life and currently, half of patients die within just 22 days of being identified as palliative. Considering such challenges, Canada must improve timely access and ensure care is equitable and consistent. By doing so, the country can honor its legacy in palliative care and ensure every Canadian receives compassionate and dignified support.
References
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Jennifer Ahn
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