First, we argued that our policies and practices should increase the likelihood that Canadians get the natural death. This is death by natural causes in a natural setting surrounded by natural caregivers. Of course, there are numerous reasons such a death might not work or even be in a given person’s best interests. Indeed, several of the interviewees reiterate this point: for many, the most “natural” death may very well be in a hospital bed! Our argument, however, concerns those deaths in hospitals that could be avoided. To achieve this will require public-awareness campaigns, better advance care planning, more efficient and effective gathering and disseminating of data on end-of-life care, and the introduction of new benefits and programs that provide financial and other resources in order to better support communities of natural caregivers.6
Second, we need to think better about how the full range of social institutions can be equipped and enlisted so that natural deaths are more available in Canada. End-of-life care, then, needs to be embedded within the institutions of our civic life—banks, schools, libraries, art galleries, churches and places of worship, and so much more.7 This is not simply a health-care-system issue; it’s one facing all of us.
Third, and finally, we need to think of the various institutions on offer for end-of-life care not as competitors, but as differing options on a continuum of care. Again, the hospital has a valuable place within this continuum, but we must recognize that end-of-life care involves numerous institutions across our civil society. It involves families, schools, art galleries, churches, community centres, family practices, and so much more. Since death is something that faces all of us, we are all to some degree “stakeholders” in how we think about and plan for dying.
As sociologist and professor of palliative care Allan Kellehear argues, when we become completely reliant on professional services for our care, we do not recognize or use the resources and abilities that exist in our natural communities. Rather, we encourage others to define our needs in terms of their inabilities to meet them, and we do not develop relationships between professional services and communities.8 Kellehear’s work is pertinent for Canadians, especially today, and we would do well to heed his warnings that “the social and economic costs in permitting this ‘professionalization’ of death to continue are unimaginable.”9
In lieu of this “professionalization,” Kellehear advocates for the creation of compassionate cities, an idea “derived from a global public health approach to the promotion of community-wide strategies for health.”10 In fact, the World Health Organization (WHO) created the Healthy Cities projects in an attempt to fulfill the Ottawa Charter for Health Promotion (1986).11 Yet absent from these discussions of healthy cities was any discussion about the proper place of death and dying. The working assumption that health is the absence of disease, and the corollory that death is a failure, are not, Kellehear suggests, the solutions our cities need.12 In fact, such mindsets are indicative of the problems that beset us as death becomes highly medicalized and health is increasingly professionalized.
In distinction from the healthy city, then, the compassionate city is one in which people quite literally “suffer with” their neighbours.13 Yet what does this look like? In addition, if cities are only as compassionate as their populace, how do we track this over time as people come and go? The following reports are interested in these and other questions as they relate to Hamilton and Ottawa.
Signs of Hope: Compassionate Care Act
Perhaps one of the most positive “signs of life” that the concerns raised in our 2015 national report are being addressed provincially in Ontario is the introduction and passing of Bill 182: the Compassionate Care Act.14 As was the case with the federal “Not to Be Forgotten” report, the issues addressed in this act are of concern across party lines. The collaboration of MPPs Sam Oosterhoff (PC), John Fraser (Liberal), and France Gélinas (NDP) including many others from these parties is a strong indication that there is collective will in Queen’s Park and in the various regions of Ontario to address the growing concerns about end-of-life care in the province be adequately addressed. The Compassionate Care Act, which passed Second Reading unanimously as of December 14, 2017, is designed to ensure that the provincial government develops a framework that will lead to improved access to and education about hospice and palliative care in Ontario.
The bill calls on the minister of health and long-term care to develop a “provincial framework designed to support improved access to hospice palliative care, provided through hospitals, home care, long-term care homes, and hospices, among other things.” This framework requires a definition of what hospice palliative care is and the training and education needed to equip both health-care providers and other caregivers (particularly family members). Throughout the bill, it is noted that the minister will work in collaboration and consultation with health-care professionals, and also other community care providers in order to publish a report that sets out the provincial framework. Again, as in regard to the hospital, we would also note in regard to the provincial legislature: improving our health care is not their sole responsibility.