Medical Assistance in Dying – local hospices grappling with dictum
by Marion Van Driel
The Fraser Health Authority (FHA) is flexing its muscle with a mandate to provide Medical Assistance in Dying (MAiD) services in many facilities, including hospice residences. Nancy Macey, founder and executive director of Delta’s Hospice Society has been in the news to respond, and she is not alone. Prince George and Langley Hospice Societies have issued statements indicating their refusal to provide this service, with potential for further pushback from additional hospice societies currently formulating their positions.
Hospice care becomes an option when medical procedures are no longer helpful for sustaining the life of a patient. From its outset, the premise of hospice care has been to provide end-of-life comfort to patients, “neither prolonging life, nor hastening death”. Hospice care is a holistic program that includes physical, psychosocial and spiritual care of patients and their families. Hospice care is life affirming, affording patients every opportunity to be comfortable and well cared for in a safe, stress-free environment. It offers time for patients and their loved ones to share words of reconciliation, respect, affirmation and enduring legacy. Hospice work is sacred work, respecting life as it moves towards its final and natural conclusion.
When MAiD became a legal right in Canada, the FHA, in consultation with stakeholders, agreed not to impose the service at hospice facilities. Then in December, without any further consultation, it issued a new directive and change of heart. Faith-based facilities have remained exempt. Macey believes hospice, too, should be included in this exemption, pointing out that one’s faith is what one believes in – one’s values – and that the main value of hospice is affirmation of life.
Janice Strukoff, on staff at Delta’s Hospice Support Center says, “It’s not about whether you agree with MAiD or not. It’s about the proper place for it.” Providing this service in a hospice setting is tantamount to throwing a pebble in a still pond, the effects rippling out to future patients, volunteers, financial supporters, staff, and possibly, the viability of hospice care itself.
Patients and family
Between one and five percent of hospice patients request MAiD. These patients’ wishes are respected; they are provided information, assessment, education, counseling, and timely transfer to have the service provided. Patients currently receive access to MAiD at hospice facilities, which meets with the requirement of Bill C-14 and the Canada Health Act to “reasonable access to health services without financial or other barriers”. What is not provided is actual termination of life within the hospice facility. Here’s why:
For the other 95-99 per cent of patients and their families, awareness that MAiD is provided at the hospice potentially places them in a position of vulnerability, doubt and fear. Hospice needs to be a safe place for those who are in end-of-life stages. To have patients afraid to access hospice care could eventually put BC in a similar situation to Belgium and the Netherlands. In these countries, where euthanasia is a long-standing practice, hospices have all but disappeared. Strukoff recommends the book, It’s Not that Simple: Euthanasia and Assisted Suicide Today (Echlin/Gentles) which cites up to 40 percent of patients in hospice in the Netherlands are receiving euthanasia without requesting it. “That’s frightening…so frightening,” she adds. As a result, the terminally ill prefer to suffer anguish at home rather than seeking care and relief in a facility where they feel at risk of being euthanized against their wishes. We must wonder how long before the option for MAiD dangerously morphs into pressure to make a choice which a patient or their family has no desire to make – where the “right to choose” becomes a “duty to choose”.
Hospice care providers
Physicians, staff and volunteers provide round-the-clock care for hospice patients, working together with one purpose, as a team. The choice to do hospice work is, for many who do it, based on the principles of neither prolonging life nor hastening death. Many who believe strongly in the foundational premise of the hospice definition may find themselves morally unable to continue doing this invaluable work. Since Canada’s constitution provides for freedom to live out our beliefs, it would seem unconstitutional and unethical to force hospice centers to provide MAiD.
The FHA provides less than half the funding required to operate the Delta’s hospice. It was built from community support to the tune of $8.5m. Another $12m of community funds has since supported the hospice program. This is simply an example of one hospice of 11 in the FHA. A non-yielding stance by FHA could jeopardize community funding.
Death and taxes
It is said none of us can escape these two things. With an overwhelming aging demographic, we and our family members will be significantly impacted by the outcome of this issue. How would your parents feel about spending their final days in a hospice where physician-assisted death takes place? Would they feel safe? Would you? If not, you may choose to spend your last days at home, cared for by your family or a private nurse, but without access to an effective pain management protocol. Or you may end up going to the hospital emergency department over and over, in desperation, hoping for some relief. Your caregiver may suffer the effects of burnout, unable to manage your care, and you may block an acute care hospital bed. The health care system has potential for greater costs and shortages should people fear accessing hospice care. Better to learn from mistakes made by those who pioneered this service.
Strukoff explains that decisions are being made daily regarding this issue, so time is crucial. Options to support the hospice stance include:
Contacting your local hospice society with your feedback. Contacting your MLA with feedback and concerns, and have them forward it to Adrian Dix, Health Minister and your Health Authority Board. Send letters to your local paper advocating for hospice palliative care in your community.