Impasse between Fraser Health and hospice continues

A year after Fraser Health told hospices and other care facilities to stop transferring clients for medically assisted deaths, the Delta Hospice Society continues to openly defy the edict.

Operators of many palliative care hospices — even those that are non-denominational — refuse to provide medical assistance in dying (MAiD) because they contend it conflicts with their principles that death shouldn’t be hastened.

Freedom of information documents (FOI) obtained by Dying With Dignity show there appears to be ongoing confusion about the process when it comes to patients seeking MAiD in facilities like the Irene Thomas Hospice in Ladner (operated by the society) that don’t want to provide it.

Each month, patients in pain are being moved from hospices to places like Queen’s Park Care Centre in order to get their dying wishes respected, the documents requested by Dying With Dignity reveal. The problem with transfers is that they’re uncomfortable and distressing for patients and their families.

“The documents speak to why Fraser Health made its decision late last year (to compel MAiD to be provided where patients reside), and they also complicate the Delta Hospice’s narrative that forced transfers for MAiD are not harmful and not a significant problem,” said Dying With Dignity’s spokesman Cory Ruf.

“I would say that the conflict between the health authority and the hospice is unique and potentially nationally significant. I’m not aware of any instances of a hospice battling a regional health authority over the provision of assisted dying,” he said, referring to the fact that Delta Hospice Society leaders have repeatedly stated they will not provide MAiD. The society’s leaders couldn’t be reached for comment Tuesday but in previous interviews Delta Hospice society operators complained they were victims of Fraser Health bullying and MAiD activists who want the service provided in all hospice palliative care facilities.

The FOI documents show that just over 20 per cent of MAiD deaths in the region between June 2016 (when MAiD became legal) and December 2017 (when Fraser Health told facilities to stop making transfers) involved a transfer from a hospice. During that 18-month period, 107 people reportedly used MAiD in the Fraser region. And of those, 27 involved transfers to homes, hospitals and other facilities so the service could take place. 

“This number is astounding,” said Ruf, adding that while transfers are occurring across the country since many faith-based facilities are opting out of MAiD, hospices haven’t been given an exemption since they’re usually non-denominational.

“As an organization, we find it extremely problematic that people at end of life are being discouraged from getting, or are being denied access to, hospice palliative care simply because they’re considering a request for MAiD.”

Hospices are places where individuals go to receive palliative care for pain and symptom management of their life-limiting illnesses. Average stays are usually about two weeks. The goal is to offer physical comfort and emotional support at the end of life when dying is a “normal” process.

Fraser Health didn’t respond to questions about the controversy Tuesday, nor did the Ministry of Health.

The Ladner hospice has a contract with Fraser Health to supply 10 beds; it derives a sliver under half its income from the health authority while the rest comes from charitable donations and fees.

Ruf said transfers aren’t unique to Fraser Health. Dr. Ellen Wiebe, a Vancouver MAiD provider, said her patients are being transferred from hospices “on the last day of their lives.”

“People are in hospice because they are at the end of life and cannot manage at home. In hospice, they have comfortable private rooms with staff to help them. To be forced to transfer into a wheelchair or stretcher, travel by van to another facility, and then transfer to another bed can be exhausting and excruciatingly painful for someone at the end of life. In the last hour of his life, one of my transferred patients had to wait for an elevator beside three men using jackhammers. Another was so weak and exhausted after the trip that, although he had transferred himself at the hospice, he could not do so at the other facility and fell. This kind of suffering is preventable and unacceptable.”

On Vancouver Island, Dr. Tanja Daws said there are no non-denominational, non-Catholic hospital or hospices in Comox to deliver MAiD to her patients and in one case recently an individual had MAiD in the lobby of a funeral home while another had to be transferred from a hospice to a conference room where the board table and other furniture had to be moved around. “The janitor was just outside, in the hallway, and we had no choice but to try to keep him away.” 

The FOI documents Ruff obtained show that there have been complaints over various matters, including one family being told in error that paying for the transfer was their responsibility when in fact that facility doing the transfer is obliged to pay.

“One social worker with the FHA’s MAiD program wrote that a transfer involved moving mountains and expressed concern that these policies don’t represent a patient-centred approach to care,” he said.

The federal legislation states that no individual can be compelled to provide medical assistance in dying. But it doesn’t define where assisted dying should be provided. It’s up to provinces and health authorities to figure out how to deliver services and to create policies.

The federal governments latest report on MAiD shows that across Canada there were 3,714 MAiD deaths from December 2015 to the end of 2017. Hospitals and homes are the preferred setting, each accounting for about 42 per cent of MAiD cases while hospices account for only three per cent of cases in Canada (five per cent in B.C.) B.C. and Ontario led the country in MAiD cases. There were 365 cases in the last half of 2017 in B.C. and about 100 more than that in Ontario.

Alex Muir, a Dying with Dignity volunteer in Vancouver, has sent a letter to the premier, health minister and other B.C. officials, describing procedures that are limiting access to MAiD. Patient transfers are a big problem, he says, because if a frail person nearing the end of life needs hospitalization and paramedics take them to St. Paul’s, a Catholic-based Providence Health facility, then they won’t get MAiD there since the hospital has been given a religious-based exemption by the province.

Patients must then be transferred to Vancouver General Hospital or some other facility. 

“The transfer itself can be physically brutal for the patient and emotionally draining to that person and their loved ones,” he said.

As well, since patients awaiting subsidized residential-care beds can’t always choose the facility where they will be admitted, they may end up in one that doesn’t allow MAiD, “again resulting in a forced transfer if they choose this path.”  

The forced transfers should end, Muir says.

“While the government has allowed clinicians who oppose MAiD to opt out of directly participating in it, this right should not be afforded to facilities. An individual has a conscience. Bricks and mortar do not,” Muir said.    

Twitter: @MedicineMatters 

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