Palliative care is paramount in any consideration of medical assistance in dying

Dear colleagues,

The Supreme Court of Canada’s ruling that struck down laws prohibiting physician assistance in dying (within certain parameters) has ignited debate and national discussion about what it means to have a good death, and Canadians’ right to one.

I don’t think we can talk about medical assistance in dying without also considering the areas it intersects. This includes things like a national seniors’ strategy (as brought to prominence by the Canadian Medical Association), opioids and strategies to manage pain in different populations (like cancer, chronic disease, etc.), and moreover, palliative care services1.

A report released by the Canadian Cancer Society earlier this year highlighted nationwide inequalities in access to palliative care services, and significant disparities for this care across the country. The Federal Government campaigned on a promise to infuse three billion dollars over four years into home care services. Health Minister Jane Philpott, as recently as last month, restated the government’s commitment to bolstering palliative care in a new health accord with the provinces. Discussions are ongoing.

I firmly believe that improving, extending and investing in palliative care services is paramount in order to properly address questions in medical assistance in dying. I don’t think patients or families should be put in the position of having to choose between unreasonable pain and suffering, or applying for medically-assisted death. I think palliative care, based on good Palliative Medicine, needs to be available to all patients to help them with end-of-life decisions and actions.

I say these words as someone who spent his professional practice seeing the positive effects of good palliative medicine and the dreadful consequences of its absence.

As some of you may be aware, the bulk of my fulltime professional practice as a clinical hematologist was devoted to the care and treatment of leukemia and other hematologic malignancies, usually in the context of a stem-cell transplant program. The patients that I cared for required, accessed, and benefited from palliative care services. Part of my commitment to patient care has always been to make more and better palliative care available.  

As the nation continues to discuss medical assistance in dying, palliative care services and support must also be brought to the forefront. Palliative care services need to be made more accessible to all Canadians and available at earlier stages to provide symptom management, assistance in dealing with psychosocial issues and/or spiritual care. These services are important components of quality living and, when the circumstances require, comfortable death.


Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer



Royal College developments that touch on palliative care include collaborations in education and training:

  • Conjoint training program in Palliative Medicine: We have been in regular discussions with the College of Family Physicians of Canada about continuing the conjoint one-year training program in Palliative Medicine. This program has been available at several academic health centres for a number of years. While most of the trainees are from Family Medicine, it has been an important opportunity for Fellows who want to do more in this important area.
  • Subspecialty in Palliative Medicine: Another dimension is the recent development of a Royal College subspecialty in Palliative Medicine. We look forward to this subspecialty providing opportunities for research and academic leadership for palliative care in Canada.
  • MOC and CPD programs: In addition, we will explore how our Maintenance of Certification (MOC) Program and continuing professional development (CPD) activities support end-of-life content areas. We would like to be able to produce more modules in our bioethics program directing our practising specialists to useful resources in the field of Palliative Medicine and medical assistance in dying.

1Both a national seniors strategy and pain management (with and without the use of opioids) are important areas that are being discussed and actioned by medical organizations, including the Royal College’s new subspecialty in Pain Medicine. Each one could be a topic in and of itself. The focus of this message on palliative care should not be interpreted as it having more importance than these other topics.