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“A healthy life, a good death”: CMA’s end-of-life dialogue begins

A true Newfoundland mix of snow, freezing rain and rain could not keep St. John’s residents from attending an informative and sometimes emotional town hall meeting on end-of-life (EOL) care issues Feb. 20. The meeting was the first in a series of five town halls the CMA will be hosting as it seeks to launch a national dialogue on the topic.

Maclean’s editor Mark Stevenson, the meeting’s moderator, said the timing for the first meeting “couldn’t be more appropriate” because it was being held the same day the Quebec General Assembly had adjourned without voting on Bill 52, the only legislation pending in Canada that would legalize physician-assisted dying under certain circumstances.

The town hall, held in partnership with Maclean’s and in association with the Canadian Society of Palliative Care Physicians and the Canadian Hospice Palliative Care Association, was also webcast live, allowing viewers across Canada to pose questions and offer comments. It was the first time the CMA has used the technology to engage the public.

The main goal of the town halls is to determine Canadians’ views on issues ranging from physician-assisted dying to palliative care and advance-care planning.

“Most of the attention has been focused on the question of physician-assisted dying, and we’re concerned the end-of-life debate is being oversimplified,’’ CMA President Louis Hugo Francescutti said when he announced the national dialogue in a speech the day before the St. John’s meeting. “We need to hear more from Canadians about how their health care system can ensure not only a long, healthy life but also a good death.’’

Francescutti opened the meeting with an account of the exemplary palliative care received by his 83-year-old mother before she died from cancer in Montreal last June. He noted that such care is only available to about 30% of the Canadians who need it.

“We are going to have a respectful, frank discussion on a subject nobody wants to talk about,” he explained. “The CMA wants to hear what Canadians have to say.”

The meeting’s panellists were Jeannette Holman-Price, past president of the Brain Injury Association of Canada, Dr. Jeff Blackmer, the CMA’s executive director of medical ethics, and Dr. Susan MacDonald, medical director of palliative care for Newfoundland’s Eastern Region and president-elect of the Canadian Society of Palliative Care Physicians.

To provide background and context on EOL care, the CMA will be screening a pair of videos at all the town halls in order to clarify the language used when such care is being discussed. Those attending the meetings will also be asked a series of questions to help the CMA gather information about the availability and quality of palliative care services in their communities and the importance of advance care planning.

Holman-Price, who experienced the sudden death of a daughter, talked about witnessing very productive discussions about advance-care planning in families. “It’s a very important discussion and we all need to pay more attention to it.”

MacDonald said Canadians should spell out their desires surrounding EOL care while they are capable of doing so, and not force others to make the decisions for them if they become incapacitated.

“Death should be as natural for us to discuss as birth control or sexually transmitted disease,” one audience member said. “We need to able to say the word ‘death’ and not run away from it.”

Many audience members spoke of their own intensely personal experiences dealing with family members’ EOL care , while others spoke about the inadequate funding and resources available for palliative care services. MacDonald said such services are much harder to provide in rural Newfoundland and Labrador than in St. John’s, where the service level is good.

On the more controversial topic of physician-assisted dying, audience members who spoke were unanimous in opposing both it and euthanasia.

Future town-hall meetings will be held in Vancouver, (March 24), Whitehorse (April 16), Regina, (May 7) and Mississauga, Ont. (May 27).

In addition to the public town-hall consultations, the CMA is consulting members via a parallel series of meetings and is hosting an online consultation for physicians at

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