What is the Last Stages of Life Project?
The Law Commission of Ontario (LCO) is Ontario’s leading law reform agency. The goal of our Improving the Last Stages of Life project is to identify and recommend law reforms in the “last stages of life.” This is a broad and inclusive term that allows us to look at rights and legal issues in end-of-life planning, palliative care, medical assistance in dying, and other issues. An important aspect of this is establishing a public health approach to palliative care, the subject of this backgrounder. This backgrounder is one of a series of consultation documents the LCO has developed for this project.
This document is a brief overview intended to raise issues and stimulate discussion for the purposes of LCO’s consultations. This document should not be relied on as a source of law.
What is a public health approach to palliative care?
The public health approach to palliative care aims to have palliative care treated and promoted as a matter of broad public interest.
There are many overlapping interests and values between the public health approach and palliative care. Both recognize the limitations of traditional models of health care delivery. Some of the principles shared between palliative care strategies and this approach include person- and family-centred care, involvement of non-specialists (such as primary care providers, social workers and PSWs), and equitable access for the entire population.
The public health approach has a distinctive focus on social aspects of care: it seeks to integrate palliative care into everyday living through raising public awareness, supporting healthy attitudes about death and dying, and fostering community engagement. The public health approach overlaps with initiatives that go by the terms, “compassionate communities”, “compassionate cities”, and “health promoting palliative care.”
The public health approach views the responsibility to care for persons who are dying and their supporters not only as a responsibility for government, but also for surrounding community, including neighbours, workplaces, schools, local businesses and others. This does not mean “offloading” or “downloading” responsibility onto others. Rather, it is understood as an empowerment model that strengthens community capacity for care around these issues.
What are some examples of the public health approach in practice?
Various “compassionate communities” projects have been initiated in Ontario. Pallium Canada and the Hospice and Palliative Care Ontario have established provincial programs and community of practice. A project in Windsor-Essex involves mobilizing youth, faith, cultural, senior and informal social networks to generate volunteer opportunities; introduces a phone service for advice in distressing situations; and includes the formation of care networks for people in the last year of life with dementia or who need personal support with daily living activities. In other areas, a “Compassionate Cities Charter” is being used by local governments to assist them formulate and achieve related goals.
The public health approach has been tendered as a framework for “age-friendly communities” that promote participation and autonomy for older persons nearing end-of-life. Community-mobilization has also been used to empower First Nations health care providers to create culturally appropriate locally designed and controlled palliative care programs in four diverse First Nations communities in Ontario.
Public awareness and education is another core feature of the public health approach to palliative care. In Ontario, public awareness of palliative care is limited. A lack of knowledge or misperceptions can inhibit access to services and supports, and foster misperceptions that view palliative care as a “final option when nothing else is working.” The public health approach recognizes the need for better understandings of palliative care, but it also focuses more specifically on the need for transformational change in the public’s perceptions of death, dying, loss and bereavement.
Where can I get more detailed information on this topic?
The LCO’s Improving the Last Stages of Life Discussion Paper (May 2017) discusses the public health approach to palliative care in greater detail. Specifically, see the discussion at chapter 4.C.
What kinds of questions is the LCO asking?
Ontario’s various laws that apply to palliative care are in a state of change. A key question for the LCO’s project is how the public health approach to palliative care would feature in a regulatory framework for health care planning and delivery, if it were determined to be beneficial for Ontarians.
For instance, it is unclear to the LCO whether proponents of this approach seek to replace palliative care models with something wholly different or to complement dominant models with improved government support for community engagement and public education. In either case, we would like to know more about what these proposals would require in practice in terms of laws, policies, funding and service delivery.
In this light, the LCO is interested in hearing your thoughts:
- Should a public health approach to palliative care be integrated into Ontario’s regulatory framework, and how would it look on the ground?
How can I share my views on this issue?
LCO’s formal consultation period runs from May – September 2017. The LCO invites your participation through:
- The project website at http://www.lco-cdo.org/laststages
- Written submissions at any time to firstname.lastname@example.org
- Watch live and archived webcast consultation sessions
- Complete the consultation survey on your mobile, tablet, or computer
- Propose an in-person focus group for your community
- Contacting Project Research Lawyer Ryan Fritsch through the contact information below
Law Commission of Ontario Toronto (416) 650-8406
Project on Improving the Last Stages of Life Toll-Free (866) 950-8406
2032 Ignat Kaneff Building
Osgoode Hall Law School, York University Fax (416) 650-8418
4700 Keele Street, Toronto, ON M3J 1P3 E-mail: email@example.com
Written submissions will be accepted until September 29, 2017