By Christine Rousselle
Canadian hospice is at risk of losing its government funding over its refusal to euthanize patients who request an “assisted death.”
Fraser Health Authority, a publicly-funded organization responsible for administering healthcare for 1.6 million people in the western Canadian province of British Columbia, is ordering the Irene Thomas Hospice, a 10-bed hospice facility, to offer euthanasia to its patients.
The hospice is operated by the non-profit organization the Delta Hospice Society, which is opposed to Canada’s “Medical Assistance in Dying” (“MAiD”) laws.
In September 2016, about three months after euthanasia became legal in Canada, Fraser Health introduced a new policy which required all hospices receiving more than 50% of provincial funding for their beds to offer euthanasia to their residents. The hospice receives $1.4 million of its $3 million operating budget from the Fraser Health Authority, and Fraser Health funds all 10 of the beds at Irene Thomas Hospice.
Faith-based healthcare organizations, as well as medical professionals opposed to MAiD, are not required to euthanize patients in Canada. Doctors, however, must refer patients seeking an “assisted death” to a healthcare provider who is willing to euthanize them. The Delta Hospice Society is not affiliated with a religion, but is opposed to euthanasia as a matter of principle.
Euthanasia is readily available at Delta Hospital, which is a one-minute drive or four-minute walk away from the Irene Thomas Hospice.
Dr. Leonie Herx, a palliative physician and the president of the Canadian Society of Palliative Care Physicians, told CNA that less than 30% of Canadians have access to palliative care.
Unlike other healthcare services, including MAiD, which are fully funded and accessible to all by the Canada Health Act, disability care, palliative care, and homecare services are not guaranteed or accessible everywhere.
“So while MAiD needs to be funded provincially and accessible to all Canadians, the same does not apply to palliative care,” said Herx.
“The rights of individuals to autonomy and their ‘right to die’ therefore seems to trump the right to assistance in living,” she added.
Herx said that presently, palliative care organizations throughout Canada are pushing for more funding for palliative care, to better assist patients in need.
“MAiD was legalized before we had broad uptake of and access to palliative care,” she said.
“The government missed an opportunity when crafting the Canadian MAiD legislation and could have made these important safeguards of ‘care’ (which we know mitigates desire for hastened death in many cases) also part of the Canada Health Act.”
In Canada, unlike assisted suicide laws in the United States, those who opt for an “assisted death” are not required to self-administer the lethal medication. The vast majority of Canadians who have an “assisted death” do so by euthanasia and do not self-administer.
Herx said that misconceptions about the purpose of palliative care can push people away from pursuing hospice care. The addition of MAiD into hospice settings makes the confusion worse.
“Some patients are already afraid that palliative care will shorten their life and these worries can be intensified when MAiD is provided in that same palliative care centre,” she said.
Considering that less than 2% of deaths in Canada each year are from MAiD, the “vast majority” of the remaining, “natural” deaths could serve to benefit from palliative care.
The number of Canadians who chose MAiD during the first 10 months of 2018–2,613 people–is four times the total number of homicides in Canada in 2018. That year, 651 people were the victims of homicide.
Herx told CNA that “the healthcare authority in British Columbia is not recognizing the unique approach to care that is at the core of hospice palliative care.”
Speeding up death, she said, is never the aim of palliative care. Herx said there was “no reason” to mandate that hospices perform euthanasia, as it is already widely available at hospitals and in patient homes.
Herx pointed to “strong lobbies” which are backing this new effort to expand MAiD into additional institutions which receive provincial funding, including faith-based hospitals or hospices. She warned that the pressure on all such institutions to offer assisted dying would continue.
“This current case in Delta Hospice may set the precedent for other non-religious hospices,” said Herx.
“But then, faith-based institutions may be next.”