Expansion brings assisted-dying issue to fore

The planned expansion of the Comox Valley’s hospice beds has sparked a heated debate about medical assistance in dying, which isn’t allowed at the Catholic hospital that runs the facility.

Medical assistance in dying is not provided at Hospice at The Views, which is co-owned and operated by St. Joseph’s General Hospital. The facility hosts the only four hospice beds in the region, which could soon be expanded to six.

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The Comox Valley is one of the only hospices on the Island where you can’t access medical assistance in dying, said Terri Odeneal, executive director for the Comox Valley Hospice Society.

“We believe that hospice palliative care in the Comox Valley should not be different than other communities on Vancouver Island, now that medical assistance in dying is legal throughout the country,” Odeneal said.

Federal legislation came into effect in June 2016 giving individuals the right to assisted deaths, but like several Catholic organizations across the country, St. Joseph’s has declined to provide the procedure, claiming freedom of conscience and religion.

With promised provincial funding for two new hospice beds this year, plus a restructuring planned that would see St. Joseph’s join a larger Catholic health-care organization, some say it’s time to uncouple the hospice from the faith-based institution. “This is an opportunity for something that doesn’t have to be part of St. Joe’s to go somewhere else,” said Dr. Jonathan Reggler, a physician who resigned from St. Joseph’s ethics board because it wouldn’t consider assisted deaths.

But while a compromise might mean leaving the four beds with St. Joseph’s and setting up two new ones in a secular space, that could result in sub-optimal care, said Odeneal.

“A program of care is developed around staff that’s well-trained and understands hospice palliative care and meets the needs of patients and their families. To do that, you have to create an environment of care, rather than having a couple of beds interspersed within a long-term care facility,” Odeneal said.

Only 11.5 per cent of Comox Valley residents identified as Catholic in the 2011 census.

Eighty-eight physicians in the valley have signed a letter to Island Health that calls for a non-religious site to host hospice.

In addition, 90 per cent of physicians who responded to the Comox Valley Family Physicians’ survey said they thought hospice should be run by a non-faith-based provider. The survey was sent to 139 physicians, 67 of whom responded.

“Hospices are not medical-assistance-in-dying destinations. We’re not talking about sending people to hospice for [medical assistance in dying]. But if somebody is in hospice, they ought to have the right to have a medically assisted death in that place. What we’re asking Island Health to do is make sure that all six beds are in a place where that is permitted,” Reggler said.

Hospice at The Views opened in July 2015, through a partnership between the Comox Valley Hospice Society, St. Joseph’s General Hospital and Island Health.

St. Joseph’s CEO Jane Murphy said the organization doesn’t take requests for medical assistance in dying lightly.

“We take very seriously any request for MAiD and are respectful and compassionate related to those requests and work with the patient, loved ones and providers to really address their needs. In a small number of cases, we do, if necessary, arrange for a transfer to another facility,” Murphy said.

Some say those transfers are unnecessarily painful. Lisa Saffarek said moving her dying father out of St. Joseph’s General Hospital to Nanaimo for an assisted death was stressful, beginning with his efforts to discuss his options with staff who treated it as a taboo subject.

“There was a lot of extra expense and it’s horrible to transfer a dying man. It was very anxiety-provoking. His respiratory condition was very fragile, so I was very concerned about him losing capacity and access to [MAiD],” Saffarek said.

Her father died at 89 in December, after he was transferred but before the procedure was performed.

At the same time, a restructuring of health services in the Comox Valley is underway that could mean an expansion of faith-based residential care in the valley, as well as potential new space for hospice beds.

Beginning this fall, the new Comox Valley Hospital will take over all acute-care responsibilities from St. Joseph’s, which will refocus on seniors’ and hospice care. St. Joseph’s short-term plans include replacing The Views — the 117-bed care home that also hosts the hospice — with a new purpose-built facility more appropriate for dementia patients.

Its longer-term plan involves merging with Vancouver-based Providence Health Care and Glacier View Lodge. Providence operates 17 facilities in B.C., including St. Paul’s Hospital, while Glacier View is a secular, publicly funded care home with 102 beds.

Together, they would create a “campus of care” on the 17-acre property that currently hosts The Views, with everything from seniors’ housing to hospice care.

The first opportunity to start expanding — beyond The Views replacement project — comes in a recent request for proposals issued by Island Health, calling for up to 70 new and replacement residential-care beds for seniors. St. Joseph’s submitted a proposal. But some, like Reggler, say it’s the perfect opportunity to create a secular space for hospice. A contract is expected to be awarded this month.

Elin Bjarnson, executive lead for end-of-life and medical quality at Island Health, said the health authority won’t say where the two new hospice beds will end up until it determines the contract for the request for proposals.

She also said the health authority has no plans to compel St. Joseph’s to give up its hospice beds. “We have a contract with St. Joseph’s in relation to the delivery of that service. So any decision to look at changing that arrangement is a significant decision,” she said. “We’re most focused right now on the allocation of the remaining two beds and ensuring that we make that decision in a way that best supports our patients.”

According to Island Health, about three per cent of deaths on the Island are medically assisted. About one in five assisted deaths on the Island occur in a hospice or palliative-care facility, and one in 20 occur in a care home. Just over half occur at home and the remainder occur at acute facilities such as hospitals.


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