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This article was published 19/6/2017 (362 days ago), so information in it may no longer be current.
If his term as the medical staff president at St. Boniface Hospital wasn’t at an end, Dr. Marcus Blouw likely would have resigned from the board after it was stacked to overturn a vote allowing assisted dying in "rare circumstances."
Blouw’s internal memos, which were obtained by Dying with Dignity Canada and given to the Free Press last Friday, described a hospital in turmoil over polarizing discussions about whether the Catholic health facility should or shouldn’t offer the service.
"I have been told that I cannot understand the implications of this decision because I don’t appreciate the value of redemptive suffering… I don’t comprehend how the strength of the community can overcome the suffering of the individual," Blouw told the Free Press Monday of high-level meetings at St. Boniface that he’s been privy to for the last year.
"I think those are horribly antiquated statements that are inflammatory to a huge proportion of the Canadian populace."
Board members reminded of 'pledge of confidentiality'
Despite a June 1 letter from Catholic Health Corp. of Manitoba CEO Daniel Lussier reminding board members of the "pledge of confidentiality they each took" and asking them to keep quiet about the initial vote, Blouw said he felt compelled to speak publicly because he no longer trusts the corporation.
"Their actions in stacking the board with new membership who would follow the Catholic health corporation dictates without taking the time to get informed on the issue speaks to just the lengths that they’re willing to take to maintain the status quo," said Blouw, who will continue to practise at St. Boniface Hospital when his term as medical staff president expires at the end of the month.
Most people, Blouw continued, don’t understand how the status quo works.
By and large, he said, patients wind up at a certain hospital because they’re in the facility’s catchment area or because they need a certain service in which the hospital specializes. While St. Boniface is the go-to centre for palliative care in the province, patients who need other services will likely go elsewhere.
Most patients and staff don’t pick St. Boniface because of its Catholic underpinnings, Blouw said. They pick it because they need help, they need palliative care or — in his case — it’s a great place to work.
But when it comes to understanding the organizational structure that governs St. Boniface, Blouw said, "that’s a super complicated question."
Publicly funded with private oversight
While St. Boniface is a publicly funded hospital populated by medical staff hired by the Winnipeg Regional Health Authority, it has a non-devolved board, meaning instead of WRHA oversight, it answers to the Catholic health corporation.
When the hospital board met May 29 to consider a policy that would allow staff to advise patients on assisted dying — even directing them to the provincial team that advises, assesses and ultimately ends the life of the terminally ill — a small group on the board brought forward an amendment that would see the service allowed at the hospital under "rare circumstances."
When that amendment narrowly passed, the corporation responded by adding 10 new members to the hospital board — all of whom are already members of the corporation’s own board — and forcing a revote. The board’s chairperson resigned, writing "any ability to influence St. Boniface Hospital policy has been eliminated with the new board composition."
According to a leading Canadian health-care ethics and law expert, the Manitoba government’s response to the controversy so far fails to address the actual issue.
Health Minister Kelvin Goertzen’s spokesperson rebuffed requests for an interview both Friday and Monday, instead sending a statement that failed to mention the board maneuvering, only reiterating the government’s commitment to respecting "the decisions of medical professionals and health-care facilities that may elect to not provide medical assistance in dying."
"That’s not what’s at stake here," said Jocelyn Downie, a health ethics and law professor at Dalhousie University. "This is an institution not providers… we’re fighting about supposed conscience rights of institutions."
The discussion that’s needed, she said, is around the public funding of faith-based health care. By agreement, the WRHA has very little involvement in the operational control of facilities like St. Boniface. In Winnipeg, there are more than half a dozen facilities that receive funding and staff but are outside the authority’s purview: St. Boniface, Concordia Hospital, Seven Oaks General Hospital, the Misericordia Health Centre, the Manitoba Adolescent Treatment Centre as well as the bulk of the city’s personal care homes.
'Faith-based agreement' with gov't not unique
Per a WRHA statement, the Manitoba government signed a "faith-based agreement" in 1996 that would fund the facilities while allowing them operational control so as to "maintain their respective mission, vision and culture."
Such agreements are hardly unique across the country; faith-based health care has a long history in Canada dating back more than a century. However, institutional faith values increasingly conflict with the right-to-access services, such as abortion and assisted dying, giving rise to questions about whether institutions can have conscience rights. Downie said the Supreme Court has not conclusively weighed in — and what accountability those institutions owe to the public that funds them.
Downie described a situation in Nova Scotia where a faith-based maternity care facility was ordered to provide abortions and closed rather than offer the service. The Manitoba government should consider opening the door to "negotiations for the transfer of business," she said, so the WRHA can take back operational control of faith-based facilities.
At minimum, Downie said, the provincial government needs to make it clear to the public that there are accountability measures in place.
When asked about accountability, Lussier said "this is a rare situation on a fundamental principle and we thought it prudent to act swiftly and quickly so that there would be no confusion."
As to what accountability Lussier feels the Catholic corporation has to the Manitoba public, he cited the longstanding agreement it has with the provincial government that "very clearly states we’re a valued partner in this integrated system."
Gov't, WRHA says agreement must be obtained through formal Freedom of Information request
Manitoba Health declined to provide a copy of the 1996 faith-based agreement to the Free Press. When asked, the WRHA said it had been advised by the province to tell reporters to file a request for it through the Freedom of Information and Protection of Privacy Act.
"Right away we should have a concern that there is a binding agreement that is so opaque that we can’t even as taxpayers, as the funders of this institution, understand what agreements have been made between the government and the governing body of the institution," Downie said.
If "they think they have a contract right… show us how that right is expressed because we all have a right to know how broad it is. What else are they going to claim that they’re not allowed to provide?"
That question of access is one that most concerns Blouw. As he sees it, the Catholic health corporation is "allowing the government to provide publicly funded services on their property but with these ethical strings attached" that hurt some of the province’s most vulnerable patients.
"I think that medically assisted dying, including the assessment and the procedure, should be available in any publicly funded health-care institution in this country," he said.
Jane likes to dig and she likes to write. She does her best work reporting at the intersection of health and human rights and she can tell you a story in 140 characters or in 2,000 words.