In January, the news cycle was dominated by stories of individuals being forced to undergo grueling and often painful transfers to access their right to assisted dying because their hospital, hospice or long-term care home refused to allow it on-site. In this blog post, Dr. David Amies explains why creative thinking might be the pathway forward on the issue of forced transfers for assisted dying — and why the status quo just won't do.
It is with mounting revulsion and amazement that one reads more stories about the trials very sick and dying patients, wishing to escape from their hopeless situations through assisted death, are forced to undergo because they reside in publicly funded institutions that object to medical assistance in dying (MAID). Two prominent instances were featured in the news in January.
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The first was that of Barry Hyman, an 83-year-old man from British Columbia, who had been incapacitated by a stroke and had then developed lung cancer. He decided that life had lost its savour and applied for and was declared eligible for MAID. Unsurprisingly, he opted to access his right to a peaceful death at home. But home happened to be a room in the Louis Brier Home and Hospital, also known as the Jewish Home for the Aged. The board of this institution maintained that the provision of MAID on its premises violated the values and traditions of Judaism.
Mr. Hyman’s family then faced a difficult choice: transfer him to an unfamiliar location or invite Dr. Ellen Wiebe into Louis Brier to help him access his right. (Dr. Wiebe is a well-known Vancouver physician and MAID provider.) They chose the latter and so spent the last few minutes of Mr. Hyman’s life terrified that a nurse would stumble into his room while Dr. Wiebe was doing her work. The following day, Dr. Wiebe reported details of his death to Vancouver Coastal Health. The management of the home was duly outraged when they learned what had happened and filed a complaint about her conduct with the British Columbia College of Physicians and Surgeons.
This is an extraordinary story that seems to belong more in the realm of fiction than to real life and was brought about by a dying man’s unwillingness to be thwarted in his last wishes by the religious sensibilities of the management of his home.
Three forced transfers
The second case concerns Ian Pope, who was living with end-stage multiple sclerosis. He had been admitted to St. Paul’s Hospital in Vancouver after a fall because it just happened to be the closest hospital to his apartment. He opted for MAID. St. Paul’s is a Catholic-run institution whose rules permit neither MAID assessments nor the actual process to be carried out on its premises. The institution is largely funded by public money.
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Mr. Pope was sent by taxi to see Dr. Wiebe at a downtown clinic for his first assessment. While on the journey, his urinary catheter bag ruptured and it was necessary to use a vase to catch leaking urine. He became noticeably exhausted during the assessment. Dr. Wiebe informed the authorities at St. Paul’s after the first excursion that it would not be wise to transfer him for further assessments because of his enfeebled state. His doctors were willing to meet Mr. Pope in his hospital room, but St. Paul’s refused to allow it. So he underwent a second transfer to secure the second mandatory assessment on another day. Finally, he endured a third transfer back to his near-empty apartment, uninhabited for several months, where a doctor administered the drugs that ended his life.
According to The Globe and Mail, St. Paul’s appears not to have been proud of its handling of this case and has since introduced policy amendments to ensure that future patients are fit enough to endure such transfers. However, it claims that, “It is doing its best to uphold the church’s values while respecting the rights of grievously ill patients who want to die with the help of a doctor.”
It is my view that neither of these cases reflects much credit on either of the institutions concerned because both appear to place their doctrinal positions ahead of the welfare of those they are supposed to be caring for. Their arguments that publicly funded health care institutions have the right to pick and choose what legal medical procedures they are prepared to provide or allow, purely on the grounds of the religious or moral reasons that their boards of management hold, have not yet been tested in court. Until they are, it is likely that such cases as those of Mr. Hyman and Mr. Pope will continue to make the news. This writer’s first reaction to such stories is one of anger and horror. But, anger and horror are not going to solve this very complicated dilemma. Some creative thinking is needed.
"Creative thinking needed"
In an increasingly secular world, institutional religious intransigence is unlikely to prevail indefinitely. Meanwhile, a means of arranging affairs surrounding MAID that allows health care professionals to carry out their legitimate business, without placing gravely ill persons under additional strain, and which also allows institutions to conduct their affairs in accordance with their beliefs, is required. It might be necessary to seek answers to such conundrums from examples in history.
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Consider, Princess Margriet, daughter of Queen Juliana and Prince Bernhard of the Netherlands, who was born in Ottawa in 1943. The Dutch royal family had taken refuge in Canada from Nazi Germany. The maternity ward of the Ottawa Civic Hospital was temporarily declared to be ‘extraterritorial,’ and as a result, outside Canadian jurisdiction. Consequently, the Princess had only Dutch citizenship by inheritance from her parents and not Canadian citizenship as well by virtue of having been born in a foreign country. This was important as she held a place in the Dutch royal succession.
Now, if cooperation between the Dutch and Canadian authorities were able to bring about this neat piece of administrative legerdemain to the satisfaction of all parties, would it not be possible for the managements of faith-based hospices, hospitals, elder hostels and the like to adopt similar measures and thereby allow sick and dying persons to retain their rooms and to receive the attention of assessors and providers of MAID in situ? Faith-based actuated managements could with all probity declare that the legal death had been brought about outside their jurisdiction and not in their premises. Granted, such arrangements would require the goodwill of all concerned as well as the ingenuity of canon lawyers and it is to be hoped that faith-based persons and institutions would recognize the wisdom of them. Surely, they do not want to go on receiving strings of negative media comments that will inevitably arise when cases like those of Mr. Hyman and Mr. Pope appear.
Some kind of face-saving mechanism is essential if a way out of the current impasse is to be found so perhaps the suggestion made above points to a possible pathway.
Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.