Canada needs a new approach to frailty
Canadian healthcare is growing frail, and so are the people it serves.
They share a human right that’s being ignored, and it’s the silent elephant behind rising acute care costs, overwhelmed primary care, and calls for administrative reform.
Access to palliative care, integrated early across chronic disease and all causes of frailty, is a human right. It shouldn’t be reserved for the final days. It is a kindness we will all need — especially for our now frail system.
How we treat the most vulnerable sets the culture we live in. It is the right to have our passions and purposes for living fully not fall away as time makes us more frail. Rather, that right, and a system honouring it, should always be present with us. Not just for a “sick population,” but for each of us, now and later, when frailty risks stripping us of dignity and agency.
This idea is not new. The 2013 Prague Charter, backed by Human Rights Watch and major palliative care associations, named access to palliative care a human right, drawing on the right to health in international law. Bill C-277, the Framework on Palliative Care in Canada Act, received Royal Assent in 2017 with unanimous support, written partly on the premise that a choice around assisted dying cannot be truly voluntary unless good palliative care is genuinely available first.
A significant moment. Yet the framework has become another well-worded promise without the funding or priority it needs, particularly for people living with chronic illness. Our frailest people receive care driven by their pathology rather than by their own sense of what living means.
Care should recognize who they are as individuals, alongside their symptoms and the uncertainty they face.
When we forget we are mortal, we forget we can adapt as time changes us. In its place grows a presumption that frailty is preventable, and that trying harder is the solution. This excludes the people who need our system most, for the reason they need it.
It affects all of us — even caregivers and taxpayers. While frailty has many causes, we can only influence it for a while. But in the end, time has the final say for each of us.
That understanding leaves space to adapt as time unfolds. When we offer prevention and cure but not care that adapts to what time is taking, we neglect basic needs. We ignore both the ravages and the opportunities of time, and fail to see each other as we are, in the time of life we are each living in.
That gap, that opportunity, is not at the end of life. It is upstream. Palliative approaches are still triggered mostly by a cancer diagnosis or imminent death, though the evidence points the other way.
A landmark 2010 randomized trial in the New England Journal of Medicine found that people with metastatic non-small-cell lung cancer who received early palliative care alongside standard treatment reported better quality of life and lived significantly longer than those on standard care alone. A finding that striking, from a drug, would become standard of care overnight.
The same logic reaches well beyond cancer. Heart failure, COPD, dementia and multi-morbidity follow long on uneven trajectories, not the predictable decline our palliative triggers assume. People live years with unaddressed suffering and fragmented care before anyone asks what matters most to them — connecting beyond pathology, to a wellness we can share.
If we take this seriously, change follows. Palliative approaches must be embedded in chronic disease and frailty pathways as part of care, not added on at the end. Primary care teams need training, time and support to bring a trauma-informed and curious approach to these conversations. One that draws out what matters most, so each person can live, and die, having lived a full life.
Done well, this is a life-changing intervention. When we see each other as whole and capable people rather than sick patients, we will be in a new and healthier time.
Canada already has the evidence, the legal language and the early legislative gesture. What will it take for media, legal and political leadership to honour people to live and die as people rather than as patients?
Each of us has the right to be asked and heard, early and always.
Dr. Greg Andreas is a family physician and palliative care lead in Cranbrook, BC, focused on palliative and person-centred care. He is a LEAP facilitator and master Serious Illness Conversation Guide practitioner.
The views expressed are those of the author(s). Canada Healthwatch publishes a range of perspectives and does not necessarily endorse the opinions presented.
