Local health regions are making significant progress in boosting the number of patients dying in place rather than being moved to facilities to obtain medical assistance in dying.
The Fraser Health region, where palliative care hospices have been especially resistant to providing medical assistance in dying (MAiD) on site because of philosophical opposition, has drastically reduced the number of patients transferred to other facilities on their last day or days of their lives, going from 27 transfers in 2017 and part of 2016 to only six in 2018, according to new data provided by the health authority.
“In each case, we carefully consider how to offer MAiD in the most patient-centred way we can as we strongly support the patient’s right to choose to access these services,” said Fraser Health spokeswoman Jacqueline Blackwell.
It has been one year since Fraser Health told hospices and other care facilities to stop transferring clients out for MAiD services. While some like the Irene Thomas Hospice in Ladner remain defiant, the latest data on the distressing, disruptive transfers that were occurring with much regularity last year show it is now becoming a more infrequent occurrence.
“We have been able to limit the number of transfers by understanding our patients’ end-of-life wishes and ensuring they receive care in a facility that can support them,” said Blackwell, referring to facilities that receive taxpayer funding.
“We believe hospice care is a critical part of the continuum of care, and we value those who provide this vital service, including the care providers, the volunteers and the administrators. We understand there are controversies surrounding this legal obligation and where and how to implement this. (But) we also respect that individuals and faith-based health care organizations can conscientiously object and not participate in the direct provision of medically assisted deaths, while providing safe and timely transfers for patients for further assessment and discussion of care options, if required.”
Between the time when MAiD was legalized midway through 2016 to Oct. 31, 2018, 257 medically assisted deaths were provided in Fraser Health. Half of those were conducted in 2018.
While there are still some holdout hospices in the Fraser region, hospices in the Vancouver Coastal Health (VCH) region are providing MAiD except for those that are faith-based facilities; from those, 17 patients have been transferred so far this year.
Overall in 2018, there have been 131 provisions of MAiD within Vancouver Coastal, including the 17 affected who wanted it but had to go elsewhere.
Vancouver Coastal Health spokeswoman Carrie Stefanson said the health authority does not allow publicly funded facilities to deke out of MAiD responsibilities unless they have a religious exemption:
“VCH policy, and the B.C.’s health sector generally, respects that individuals and faith-based health care organizations can conscientiously object and not participate in the direct provision of medically assisted deaths while providing safe and timely transfers for patients for further assessment and discussion of care options if required.”
Mark Warawa, Conservative MLA for Langley-Aldergrove, said in an interview that hospices providing palliative care in the Fraser Valley don’t want to offer MAiD because it is inconsistent with their mandate to provide a haven for “a natural death” process and not to hasten death.
He said he believes residential homes and hospitals are the best places to offer MAiD. “This shouldn’t be forced on hospices,” he said, referring to an edict a year ago from Fraser Health that patients should not be transferred out of their last health care setting in order to get MAiD.
Warawa said over the last 18 months, his office staff has tried to reach out to provincial Health Minister Adrian Dix multiple times to discuss the hospice issue. Dix said in an email that he has spoken with Warawa and knows about his beliefs.
Dix said B.C. has been leading the country in end-of-life matters and enabling individuals to “make choices in how they unfold.”
“We are a leader in organ donation. And through B.C.’s Representation Agreement Act, we are a leader in how we set out in our wills our wishes and instructions for key parts of our end-of-life medical care. Ensuring that MAiD can be accessed by patients who meet the stringent criteria puts the onus on us — and our health-care facilities — to ensure patients’ move to this end-of-life choice is free of friction and the additional suffering it causes.”
Warawa said provinces have been given plenty of time to build enough capacity into the health care system for “assisted suicides” and if hospitals and non-denominational facilities don’t have enough resources for MAiD requests, then it may be time to build stand-alone “centres of excellence” for MAiD services.
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