Christopher De Bono’s Policy Options article on medical assistance in dying (MAID) attempts to persuade us that there is no problem with health care providers refusing to allow MAID in faith-based institutions. I am a MAID provider in the Comox Valley in British Columbia. Until two months ago our local acute care hospital, the only hospital in our community, was Catholic. It prohibited MAID. Fortunately, that hospital, St. Joseph’s, has now been replaced by a new secular facility, the Comox Valley Hospital. Our hospice is still in Catholic hands.

I believe that no individual health care worker should be required to take part in MAID, be they a physician, a nurse, a pharmacist or any other practitioner, and De Bono would agree.

Where he and I part company is over faith-based institutions. An individual health care professional — the actual hands-on provider of health care — has a conscience, and for some this means they cannot take part in MAID. Bricks and mortar cannot have a conscience, however. Neither can the institutions housed within those bricks and mortar. Institutions and facilities can possess an ethos — not a conscience — but this must not be allowed to interfere with the rights of individual patients seeking legal treatments and with the staff willing to provide them. This is especially true when almost all the funding of the work of the institutions is provided by the general public, as is the case for most hospitals and hospices across Canada.

A few figures for context: Providence operates in British Columbia. In an Ipsos Reid poll in 2014, 87 percent of British Columbians supported the legalization of MAID. Across Canada, 84 percent of people supported it. So did 84 percent of Catholics.

De Bono makes much of a question in a different poll that asked if faith-based nursing homes should be allowed to refuse to provide MAID and allowed to require a person to move to a different facility for it. Fifty-five percent of respondents said such homes should be allowed to refuse. Setting aside the fact that the question was about nursing homes and not acute care hospitals, no attempt was made in the question to ask people to imagine the circumstances in which an assisted death might be requested.

I have now provided MAID for nearly 20 people. I count it an honour and a privilege to have been allowed into the lives of these people and to help them and their families consider their options at the end of life. After I have spoken with people who are requesting MAID, most — but not all — do choose MAID. Knowing that their suffering will end at a time of their choosing is an enormous comfort to them. Simply knowing that they are eligible often helps them to bear their suffering a little longer and to be less distressed by it. MAID deaths are peaceful.

MAID deaths are occasions that quite literally bring families together. These individuals have chosen to die before they have completely withered away, sometimes in great pain, and they can enjoy their last day and take great comfort from the presence of their family and friends.

Transfers can be horrible. They generally involve pain and psychological distress for the patient and incomprehension on the part of the family that such a thing could be forced upon a dying person.

De Bono implies that MAID transfers are simple affairs, almost administrative. They are not. I have been involved in three. Transfers can be horrible. They generally involve pain and psychological distress for the patient and incomprehension on the part of the family that such a thing could be forced upon a dying person. Because the law requires that the person must have capacity to consent at the time of MAID, caution must be exercised in the use of strong painkillers and sedatives that might otherwise be used to ease the pain of transfer. In our community, one patient did not have a home to return to where they could receive MAID. Transfer out of the community was not acceptable to them. A meeting room in the local nursing centre had to suffice.

De Bono writes, “Of course, transfers of care for MAID must not be onerous, nor should they impose undue hardship on patients and families. Finding workable solutions has certainly been Providence’s practice when it comes to managing requests for MAID when they occur — and they do — in our Catholic sites.” For him to say this without explaining that the solution never involves permitting MAID on an individual basis is dishonest.

I stood in the office of the CEO of the former St. Joseph’s Hospital, begging to be allowed to provide MAID for a man who under any other circumstance would be deemed too sick to move. I was refused. So strong was his desire for MAID that he opted for transfer. He deteriorated during the transfer and died before MAID could be provided. These are the realities of transfers for MAID.

Finally, it is also important to understand that faith-based health care facilities are only very rarely staffed or used exclusively by adherents of that faith. In the Comox Valley, only 12 percent of the population is Catholic. Certainly, when a colleague and I started to provide MAID in the community, we were pleased by the number of supportive comments we received from those staff. Freed now of the restrictions on their practice in the Catholic hospital, many former members of the St. Joseph’s staff are helping with the development of a MAID program in the Comox Valley Hospital. But my saddest conversations are with the staff of the still-Catholic hospice, the great majority of whom support MAID. They must see patients they have cared for, but whose suffering has proven too great and who have therefore chosen to ask for MAID, being forced to leave the hospice for distant secular hospitals. These nurses want to be allowed to care for their patients up to and including their medically assisted death. They may not.

The history of the development of health care across Canada, which involved faith-based organizations, should not tie us. Neither should the personal beliefs of the few men and women who head these organizations; to present this as an issue of “diversity” is disingenuous. MAID is strongly supported by Canadians. Suffering Canadians should not be forced to endure unnecessary additional pain and distress to satisfy the tenets of any faith. Either the faith-based organizations should permit MAID, or they should stop providing health care and instead donate their hospitals, hospices and residential care homes to the communities they serve. The bulk of their work is already being publicly funded so the provinces would not be faced with any significant additional expense.

Photo: Shutterfly/by

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Jonathan Reggler
Dr. Jonathan Reggler is a MAID Provider from Courtenay, BC, and a director of the Canadian Association of MAID Assessors and Providers. He is a director of Dying With Dignity Canada and the chair of its Physicians Advisory Council.

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