Adrian Dix: Medical assistance in dying: Compassion and balance put patients first
Credit to Author: Hardip Johal| Date: Sat, 22 Feb 2020 02:00:55 +0000
Whether it’s due to the advancing age and changing health of our parents, or the realization that we’re approaching certain milestones, at key points along the way, many of us talk about wills and advanced healthcare planning for when our good health turns, or our lives are near their end.
It’s a serious undertaking, thinking about these kinds of healthcare decisions. And it should be. There are medical procedures, policies and choices available to us on how we manage our care and our lives that didn’t exist even five years ago. Medical assistance in dying is one of them.
In 2016, the federal government passed legislation making it legal for Canadians who meet very specific criteria to have a medical practitioner or nurse practitioner assist them with their death. This action followed a unanimous decision by the Supreme Court of Canada in the Carter Case. Medical Assistance in Dying (MAiD) is a service that is provided in all provinces to any individual who requests and meets the stringent criteria. In B.C., patients can access the service through our regional health authorities, their facilities and their staff, or the patient’s physician.
The federal law acknowledges the profound and complex issues involved in this patient end-of-life choice, giving primacy to the suffering and foreseeable death of an end-of-life patient. Last fall, the federal government accepted a provincial court ruling that language limiting access to MAiD is unconstitutional, and committed to changing the MAiD law for the whole country. It has confirmed that its update of the MAiD law will expand eligibility for MAiD.
The crucial point is that it is the patient’s interests and choices that matter most. This is a patient’s personal decision made in consultation with their doctor or nurse practitioner and family. It is not a decision that any organization can influence or impose on patients.
The recent decision by the Irene Thomas Hospice in Delta to ignore the choice of an individual to have access to MAiD services at its facility is contrary to our provincial policy. Put simply, an individual has the right to make a choice to receive medical assistance in dying where they reside in B.C. This includes patients receiving publicly funded services in a non-denominational hospice setting. This is not about making the Irene Thomas Hospice deliver these services. It is about allowing an individual to choose to access this service while residing at the hospice.
It is a choice that many individuals in Canada and in B.C are making. Between 2016 and November 2019, about 3,000 British Columbians made the choice to have medical assistance in dying, the majority of those choosing to do so at home. For many of those British Columbians facing end-of-life situations, “home” may well be a residential care facility or a hospice, and these patients also have access to MAiD.
Existing faith-based health facilities, such as hospitals, long-term care homes, and hospices were allowed to opt out of the provision of MAiD, but all are required to safely transfer care of any patient requesting MAiD to a medical practitioner, nurse practitioner, or medical facility that does provide the service. Patients have a medical assistance in dying choice, enshrined in law, and our medical system must provide patients with access to that choice.
Across Canada, there are regional differences in those who choose MAiD, as there are here in B.C. To me, this speaks to the highly individual decision to choose a deeply and profoundly personal end-of-life path. People choose to come to B.C. for the opportunity that exists, and for the quality of life possible. For British Columbians, this same quality of life must also include the end of one’s life.
Where we are today in B.C. is in no small way due to the care the former B.C. Liberal government took with converting federal law to B.C. practice. Former Health Minister Terry Lake introduced MAiD in a sensible and sound fashion, and spoke sensitively to what is for us all, the most solemn choice we can make in our healthcare. Putting the interest of the patient first is at the heart of B.C.’s policy.
In B.C., the system and safeguards include:
• Medical assistance in dying is a legal, end-of-life choice.
• Each health authority has care coordination teams in place to help patients and healthcare providers access MAiD, including all faith-based organizations, hospitals, long-term care homes, and hospices.
• Medical practitioners and nurse practitioners, including those working in faith-based institutions, that conscientiously object to MAiD must ensure that any patient in need of information or MAiD care is safely transferred to another practitioner willing to provide MAiD, in accordance with the regulatory standards. Neither individuals nor organizations can abandon members.
• If a hospice or care facility’s beds are more than 50 per cent publicly funded, they must allow access to MAiD in their facility. If a hospice or healthcare facility has fewer than 50 per cent of their beds funded by a health authority, they do not have to provide access to the service on site, but must inform patients about MAiD and the role of health authorities in care coordination to assist the requesting patient with access to MAiD.
There are deeply held feelings and differing views on end-of-life care, but at the core is the certainty that whichever option a patient chooses for their end of life, they receive the best and most compassionate care possible for a dignified death — be this at home, in a long-term or assisted-living facility, in a hospice, or a hospital. This is what patients deserve, and it’s an outcome their healthcare providers are committed to, and access that the B.C. healthcare system is ensuring.
British Columbia is a leader in taking on the difficult task of educating people about these significant end-of-life and healthcare issues and allowing them 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 healthcare facilities — to ensure that every patient’s legal right to this end-of-life choice is informed, free of friction, moral suasion, and additional suffering.
For all of us, there is more consideration of, and action towards, end-of-life choices and the health services to attend them. Medical assistance in dying is a complex issue but it is now part of that consideration. In the short time since the federal legislation was passed, B.C. is fulfilling the commitment to provide medical assistance in dying to those who request it. Putting the patient first — guided by the rule of law and all that makes us a compassionate society — will continue to move us forward.
And by continuing to work together to perfect that balance, the end of a patient’s life will be as compassionate and sympathetic to the individual as we would want the living of that life to be.
Adrian Dix is B.C.’s minister of health.