Public healthcare facilities that ban assisted-dying services on their premises and force sick and frail patients to go elsewhere to access their right to choice are failing to provide patient-centred care, writes Dr. David Amies.
Two distressing stories have appeared in the media recently concerning officials employed by Alberta’s Covenant Health who actively sought to prevent two severely ill and suffering patients from applying to end their lives with medical assistance in dying (MAID).
Covenant Health is the largest Catholic healthcare provider in Canada. It is operated by a board of 11 directors, appointed by and answerable to the Catholic Bishops of Alberta. It has 16 facilities in 11 communities across Alberta. It provides a third of all palliative care beds in the province. It is very largely funded by the public purse.
- Unassisted death: Read Doreen Nowicki's story
- "He couldn't verbally scream or he would have": Read Bob Hergott's story
In May 2017, Doreen Nowicki, a woman suffering from amyotrophic lateral sclerosis (ALS), was a patient in the Edmonton General Continuing Care Centre (EGCCC) — previously the Edmonton General Hospital, run by the Grey Nuns of Montréal. Her condition deteriorated to the extent that she decided to seek MAID, a legal process since Bill C-14 came into effect in June 2016.
For a patient to proceed with MAID, two separate medical assessments are necessary, and the assessors have to agree that the patient qualifies. (Details of the qualifications can be found here.) Catholic healthcare facilities are averse to MAID. Church doctrine holds that MAID is sinful because it considers the taking of human life in all circumstances to be reprehensible. That’s why many faith-based healthcare facilities have prohibited the necessary assessments for MAID and its actual implementation on any of their premises.
In spite of this attitude, the administrators at EGCCC decided to allow Doreen to undergo the necessary assessments in her room. However, their thoughtful and compassionate consideration was abruptly cancelled at the last minute for reasons that have not been made clear, and arrangements were suddenly put in place to transfer Doreen to a non-Catholic facility. The family was “blindsided” and told a little more than an hour before the assessment was scheduled to take place.
Unfortunately, in the ensuing chaos and confusion, logistical problems occurred, and Doreen and the medical assessors were forced to conduct her sensitive, private business on a sidewalk bench outside the facility. Doreen was so distressed by the experience that the assessment had to end early. Thankfully, despite the obstacles and inhumane treatment she faced, Doreen was eventually able to receive and complete the necessary assessments and later exercised her right to an assisted death in another facility in June 2017.
The second story concerns Bob Hergott, a 72-year-old man suffering with ALS. He had been a patient in Edmonton’s St. Joseph's Auxiliary Hospital for five years when he opted to ask for MAID. Covenant Health, the operators of St. Joseph's, took a very hard-nosed stance with him, even refusing to let him complete the official request form for the procedure in his room. He was forced to mount his motorized wheelchair and go across the street to meet the two witnesses. It was pouring rain, and he and the independent witnesses had to take refuge in a bus shelter where the paperwork was completed.
Whatever did the staff of St. Joseph's think they were doing when they refused to allow Bob Hergott to complete his request form for MAID? He was filling out a legal government form! Do hospitals or hospices have the right to stop such activities? That action was positively Orwellian and badly misjudged.
Bob was also forced to leave St. Joseph’s for his assessments and later took a cab to the Royal Alexandra Hospital where he received MAID. His transfer was “horrible for him,” according to his best friend, who said Bob “couldn’t verbally scream or he would have.”
"Healthcare in Canada ought to be patient-centred"
Reviewing this pair of harrowing stories, I find it hard to believe that I'm describing events that took place in Canada in the 21st-century. These appalling stories are examples of forced transfers for assisted dying. Such transfers occur when frail, sick people seeking the relief of MAID are obliged to vacate beds in healthcare facilities because their desires run counter to the views — often religious, but not always — of those operating the institutions in which they are lodged.
The conflict between patients’ legitimate desires and rights and the conscientious objections of organizations such as Covenant Health is complex. Citizens of this country are free to hold religious beliefs and to act accordingly. On the other hand, the very sick are now entitled to seek a medically assisted death. Occasionally, these competing desires and beliefs will clash. As yet, we are uncertain how frequently such clashes occur, but it will be in everyone's best interest to find an acceptable way through these dilemmas.
A few fundamental principles are worth stating. Healthcare professionals and organizations must put the needs and desires of their patients above all other considerations. Healthcare in Canada ought to be patient-centred. Forcing the very sick and frail to leave a facility in which they may have been living for months or years to seek assessments or even to go and die is cruel.
Forced transfers are very stressful and such stress may even lead to a loss of capacity rendering the person incapable of giving the necessary, legally required, informed consent immediately prior to undergoing MAID. It is absolutely not the business of the facility’s management to interfere in the discussions a patient may wish to have with an outside clinician, even when that clinician has come to discuss MAID or to make an assessment for that purpose. Such transactions are private and confidential. Neither do dissenting organizations have the right to prevent their patients from completing legal paperwork on their premises.
When health practitioners are faced with requests that they in all good conscience cannot fulfill, then it is their duty to ensure that the patient is informed of or put in touch with an alternative source of help. They cannot and must not put their own desires and wishes first. If that is too hard, perhaps their choice of profession was misguided.
Dr. David Amies
Indeed, John Savelescu, a formidably credentialed professor of philosophy at Oxford, holds that the care received by a patient should not be determined and influenced by the personal and private beliefs of the professional he or she happens to encounter. He goes further and maintains that healthcare workers have a duty to avoid appointments to posts where they are likely to be faced with complex ethical problems that challenge their beliefs. For example, some Catholic physicians working in gynaecology are going to have their religious ideas tested repeatedly by the desires of their patients. Savelescu even suggests that selection panels should ensure that applicants for appointments or training should do their best to screen out those whose belief systems are likely to clash with patients’ expectations.
Organizations such as Covenant Health are historical relics and might do well to phase themselves out of the healthcare field and allow secular organizations to replace them. Since almost all of their funding comes from the public purse, the additional costs faced by the governments after their withdrawal would be minimal. A frequent complaint from the public is that publicly funded organizations ought to do what the public wants.
The two stories that prompted this piece do not do much credit to the reputation of Covenant Health or its masters. Such stony-hearted treatment of the most grievously afflicted members of society is hardly consonant with Christian doctrine and does little to enhance its reputation. Organizations like Covenant Health are going to be around for a while yet and the demand for MAID is not going to disappear. Unedifying clashes such as those that so badly affected Mrs. Nowicki and Mr. Hergott may become more frequent. Some constructive imagination is required to find a solution.
May I suggest that Covenant Health and others of its ilk consider administratively excising from their religious control those rooms in which patients seeking MAID are lodged until the assessments and procedure are completed? Once the patient has died, the room would be “returned” to the institution. In that way, the sufferer would not be unjustly treated and be forced to move, and the institution's conscience would be clear. Such a process would be immeasurably kinder and more considerate than the ghastly travesties that took place in Edmonton. This solution would require some sophistication to put into place, but it would not be the first time that useful lateral thinking has been employed to get around awkward situations.*
Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWDC's Clinicians Advisory Council.
*Princess Margriet of the Netherlands was born in Ottawa in 1943 while her family was in exile. She was heir to the Dutch throne and it was essential that she have full Dutch citizenship. The Canadian government of the day declared the hospital in which she was born to be extra-territorial in order to bring this about.