Pan-Canadian Strategy on Palliative Care

On May 28, 2014 the motion M-456 introduced by NDP Member of Parliament Charlie Angus (Timmins-James Bay) was passed. The motion called for:

A Pan-Canadian Palliative and End-of-life Care Strategy by working with provinces and territories on a flexible, integrated model of palliative care that: (a) takes into account the geographic, regional, and cultural diversity of urban and rural Canada as well as Canada’s First Nation, Inuit and Métis people; (b) respects the cultural, spiritual and familial needs of all Canadians; and (c) has the goal of (i) ensuring all Canadians have access to high quality home-based and hospice palliative end-of-life care, (ii) providing more support for caregivers, (iii) improving the quality and consistency of home and hospice palliative end-of-life care in Canada, (iv) encouraging Canadians to discuss and plan for end-of-life care.

Read our open letter to the Minister of Health below on the development of this strategy and why it must include consideration of the unique needs of the homeless. 

October 1, 2014

The Honourable Rona Ambrose

Minister of Health

House of Commons

Ottawa, Canada

K1A 0A6

Dear Minister Ambrose:

I am writing to you on behalf of Inner City Health Associates (ICHA), a group of more than 60 physicians who work in over 40 shelters and drop-ins across Toronto.  We recently launched a palliative care program, called Palliative Education And Care of the Homeless (PEACH), which aims to provide end-of-life care to homeless and precariously housed individuals in Toronto.

Homelessness among the elderly is on the rise; between 2009 and 2013, the proportion of homeless people in Toronto over the age of 50 rose from 20 to 29 percent, and those over age 60 rose from 5 to 10 percent1.  Moreover, among the homeless, the mortality rate is estimated to be 3.4 to 4 times the rate for the general population2.  There is currently a large gap in access to quality end-of-life care among the homeless and precariously housed in both our city and across the country.

We therefore call on the Minister in developing a Pan-Canadian Strategy on Palliative Care as called for in M-456, to ensure that the unique needs of the homeless are accommodated.  In our experience, this requires training for mainstream palliative care providers, services that incorporate a harm reduction model, and flexibility in service delivery models that accommodate those living in shelters.

The United Nations Committee on Economic, Social and Cultural Rights has reaffirmed the necessity of healthcare throughout the life cycle as fundamental to human rights paradigms, including "attention and care for chronically and terminally ill persons, sparing them avoidable pain and enabling them to die with dignity"3.  We believe that all Canadians, regardless of their housing status, have a right to this important care.


Dr. Samantha Green

Primary Care Lead

Inner City Health Associates


1. City of Toronto (2013). Streets needs assessment: results. Toronto, Ontario: Shelter Support & Housing.

2. Early Onset Illness and Mortality Working Group (2011). Forty is too young to die: a call for action from Toronto’s early-onset illness and mortality working group. Toronto, Ontario.

3. United Nations. (2000). The right to the highest possible standard of health: Article 12 of the International Covenant on Economic, Social and Cultural Rights, General Comment No.14. Retrieved from,