Hey there, time traveller! This article was published 1/1/2018 (1059 days ago), so information in it may no longer be current.
The policies religious health-care facilities have put in place to handle assisted dying requests are indefensible and obstructionist, advocates say.
Policies have been appearing on hospital and personal care home websites over the last month in keeping with a Manitoba Health directive that facilities that do not offer medical assistance in dying (MAID) must have protocols in place to respond to inquiries and requests.
Although there is variation — some allow the provincial MAID team to do on-site assessments of patients, while many do not — there is at least one constant: by receiving care at a faith-based facility a patient runs the risk of being denied access if they are deemed to ill or too frail to be transferred.
"Who is medical assistance in dying for, if not people who are incredibly ill and often incredibly frail?" said an audibly frustrated Shanaaz Gokool, CEO of Dying with Dignity Canada.
"What we see in Manitoba with this appalling hodge-podge approach in these long-term care facilities is incredibly obstructionist."
It is, in effect, telling your patient "tough luck," said Arthur Schafer, founding director of the Centre for Professional and Applied Ethics at the University of Manitoba.
"The most vulnerable patients will lose their access to MAID if they’re unable to be transferred," he said. "That’s a pretty heavy price to be paid by a patient who is with a grievous medical condition, who’s suffering intolerably."
There are 34 faith-based health-care facilities in Manitoba, according to a provincial list: five hospitals, three health centres, and 26 personal care homes. Most missed Manitoba’s Nov. 26 deadline to have a policy in place. While some have been finalized and were made public in December, others are awaiting approval this month, and the Winnipeg Regional Health Authority’s deadline for facility-specific policies isn’t until Feb. 15.
That’s to give facilities time to adjust their working policies to be compliant with the regional one, said Réal Cloutier, interim president and CEO.
The health authority’s region-wide policy was approved following a one-month consultation period on Dec. 19. Cloutier said the MAID team was "very much involved" in that process, which proved useful in making sure everyone was having the same conversation.
"It was actually quite helpful in terms of clarifying what MAID is and isn’t," he said, "and also making sure there was a common understanding of the language we were using within the policy."
What emerged is similar to what’s been approved at a regional level in Prairie Mountain Health and Southern Health, the only other health authorities that have faith-based facilities. In short, nobody with a conscientious objection is required to participate, staff must acknowledge inquiries, explore expressions of interest, and respond to requests, and no patient shall face retaliation or the threat of retaliation for inquiring about or asking for medical assistance in dying.
Health Minister Kelvin Goertzen has made it clear in the past few months that the province is "trying to strike the right balance between those medical professionals who do not want to participate, while recognizing there is a legal obligation for access." For the most part, he has said, he believes that balance has been struck.
But dig further into site-specific policies approved in Southern Health and Prairie Mountain Health and many seem fairly one-sided, Schafer said, spelling out protections for those who do not wish to participate but not for those who do.
He pointed in particular to the policy for the Menno Home for the Aged in Grunthal, one of the few facilities so far that allows for the MAID team to come on site "as long as it is done discreetly and in the privacy of the elder’s room."
While the policy notes Menno Home will not impede anyone from seeking referrals, residents must be aware that all of the site’s "employees, contracted employees, etc. are prohibited from participating in the MAID process" including making referrals. Per the personal care home’s policy, it will direct patients to an off-site "data source that can provide them with the information they require."
Still, Schafer said, there’s ambiguity there about whether the ban on employee and contract employee involvement extends beyond working hours and the phrasing "looks intimidating."
Employees can do as they like when they are off-site, clarified Menno Home CEO Lisa Martens, even accompanying residents as emotional support so long as they do so on a personal basis.
"If Menno Home staff choose on their own time or as a human being to participate they are more than welcome to do that," Martens said. "They have to make sure that they’re not saying they’re an employee of Menno Home. They’re just there as a friend."
The latest updates on the novel coronavirus and COVID-19.
It’s one thing for facilities to abstain from the process, but it’s quite another for them to put up what Gokool sees as roadblocks to access.
Facilities like Menno Home and Tabor Home include a provision in their policies that anyone who expresses a desire to die will be referred to either a chaplain, a social worker or a spiritual advisor "to determine if the desire is borne out of a spiritual and/or social issue that can be resolved." The policies then stipulate meetings will follow to see about other options to alleviate discomfort.
This is a version of the type of evaluation already done by the MAID team when assessing a patient. The full process includes a formal inquiry followed by a medical-chart review, then two independent assessments and a 10-day reflection period.
By the WRHA’s count, 54 people who reached out to the MAID team died without assistance between January and June of this year. Of that number, 23 were in the process of being assessed.
"What we can’t encourage are policies that further delay people getting the help that they need," Gokool said.
Faith-based health care facilities in Manitoba
Winnipeg Regional Health Authority:
St. Boniface Hospital
Misericordia Health Centre
St. Amant Centre
West Park Manor PCH
Saul & Claribel Simkin Centre
St. Joseph's Residence
Pembina Place Mennonite PCH
Holy Family Nursing Home
Golden West Centennial Lodge
Fred Douglas Lodge
Donwood Manor PCH
Bethania Mennonite PCH
Actionmarguerite St. Vital
Actionmarguerite St. Boniface
Prairie Mountain Health:
Winnipegosis General Hospital
St. Rose General Hospital
Winnipegosis & District Health Centre
Dr. Gendreau PCH
Rock Lake Health District Hospital
Eden Mental Health Centre
Tabor Home Inc.
Rest Haven Nursing Home
Prairie View Lodge
Menno Home for the Aged
—source: Manitoba Health
A snapshot of the regional medical assistance in dying policies:
Winnipeg Regional Health Authority
Facilities that will not offer MAID must develop, maintain and make easily accessible to the public and their staff a clearly articulated, official written policy relating to MAID. To that effect, it must be posted on the facility's webiste or — if the facility has no website — it must be on an easily accessible public bulletin board.Abstaining facility policies must include a statement that makes it clear individuals may not be able to access medical assistance in dying if they are too ill or too frail to be transferred.
Facilities cannot disqualify or prohibit an individual from being admitted to their facility on the basis they have expressed an interest in MAID and may ultimately choose to receive it.
Facilities cannot prohibit inquiries or discussion about MAID between individuals and staff.Where a patient, or a member of the family of the patient, expresses an interest in the provision of MAID, requests information on MAID, or otherwise pursues the assessment process and/or the provision of MAID, staff and PMH facilities shall not take or threaten any discriminatory or retaliatory action or cause the patient to be discharged or transferred exception when done as part of an approved plan for MAID.
Prairie Mountain Health
Where a patient, or a member of the family of the patient, expresses an interest in the provision of MAID, requests information on MAID, or otherwise pursues the assessment process and/or the provision of MAID, staff and PMH facilities shall not take or threaten any discriminatory or retaliatory action or cause the patient to be discharged or transferred exception when done as part of an approved plan for MAID.When a patient or family member requests a referral, the staff member must notify their direct supervisor who will, in turn, notify the CEO via email.
A staff member who invokes conscientious objector status shall file their objection in writing to their direct supervisor who will, in turn, provide a copy to the vice-president of human reosurces. They will not be expected to actively participate in either the process or providing information about the process.
Where a patient, or a member of the family of the patient, expresses an interest in the provision of MAID, requests information on MAID, or otherwise pursues the assessment process and/or the provision of MAID, staff and PMH facilities shall not take or threaten any discriminatory or retaliatory action or cause the patient to be discharged or transferred exception when done as part of an approved plan for MAID.
A conscientious objector will not be required to provide any detailed information, support or counseling about MAID or participate in the assessment process or any aspect of MAID.
Anyone under the policy must provide basic information about MAID when requested by a patient or their family member.
Where any patient or family member expresses interest in the provision of MAID, doctors and nurses will explore the reasons for the requests to see whether there are any unmet needs. That process may lead to referrals to specialists, experts and teams including, but not limited to, those of mental health, spiritual care and palliative care. If, after that, the person wants MAID, then they will be referred to the provincial team.
Full policies are available on all health authority websites and, where approved, on individual facility websites.