BC Health Minister says he will force the Delta Hospice to kill.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Sign the petition: Hospice Organizations Must NOT be Forced to do Euthanasia (Link).

The BC Health Minister, Adrian Dix, declared yesterday that the BC government will take action if the Delta hospice refuses to kill its patients.

Adrian Dix has suggested that they will stop funding the 10 bed Delta Hospice if it refuses to kill.

On December 2, I reported that the Board of the Delta BC Hospice Society that operates the Irene Thomas Hospice in Ladner BC, renewed its position opposing euthanasia (MAiD) while supporting excellent care. The Board stated:

MAiD is not compatible with the Delta Hospice Society purposes stated in the society's constitution, and therefore, will not be performed at the Irene Thomas Hospice.

In its recent Call to Action, the Canadian Hospice Palliative Care Association and the Canadian Society of Palliative Care Physicians stated that MAiD (euthanasia) is not part of hospice palliative care. They stated:

MAiD is not part of hospice palliative care; it is not an “extension” of palliative care nor is it one of the tools “in the palliative care basket”. National and international hospice palliative care organizations are unified in the position that MAiD is not part of the practice of hospice palliative care. 

...Hospice palliative care sees dying as a normal part of life and helps people to live and die well. Hospice palliative care does not seek to hasten death or intentionally end life. 

The Delta Optimist newpaper reported, on December 7, that Fraser Health informed the Delta Hospice that their position is at odds with the policy of Fraser Health. A spokesperson for Fraser Health told the Delta Optimist that:

The region noted it fully supports a patient’s right to receive medical assistance in dying wherever they may be, including in a hospice setting.

The position of the Delta Hospice is not new. In February 2018, the Delta Hospice was ordered by Fraser Health to provide euthanasia. The Delta Hospice did not comply with the Fraser Health edict.

If the Delta Hospice closes, the residents of Delta will lose the 10 bed hospice that is known for providing excellent end-of-life care.

If the Delta Hospice is forced to do euthanasia, then all Canadian Hospice groups will be forced to do euthanasia.

Sign the petition: Hospice Organizations Must NOT be Forced to do Euthanasia (Link).

Delta Hospice Must Not Be Forced to do Euthanasia.

Alex Schadenberg

Executive Director, Euthanasia Prevention Coalition

Sign the petition: Hospice Organizations Must NOT be Forced to do Euthanasia (Link).

In February 2018 the Board

of the Delta BC Hospice was given an Edict from Fraser Health to provide euthanasia (MAiD).

At that time, the Board of the Delta Hospice decided not to do euthanasia and continued its good work.
 

Recently, the Board of the Delta Hospice re-stated its opposition to euthanasia. The new board passed a resolution stating:

MAiD is not compatible with the Delta Hospice Society purposes stated in the society's constitution, and therefore, will not be performed at the Irene Thomas Hospice.

A spokesperson for Fraser Health told the Delta Optimist that:

it fully supports a patient’s right to receive medical assistance in dying wherever they may be, including in a hospice setting.

The order by Fraser Health is contrary to the stated purpose of the Delta Hospice Society constitution.

Sign the petition: Hospice Organizations Must NOT be forced to do Euthanasia (Link).

If funding for the 10 bed hospice is stopped people in the community requiring care at the end of life, will lose the excellent care provided by the Delta Hospice.

By forcing the Delta Hospice to provide euthanasia, Fraser Health is also redefining the meaning of hospice/palliative care.

In its recent Call to Action, the Canadian Hospice Palliative Care Association and the Canadian Society of Palliative Care Physicians stated that MAiD (euthanasia) is not a part of hospice palliative care. They stated:

MAiD is not part of hospice palliative care; it is not an “extension” of palliative care nor is it one of the tools “in the palliative care basket”. National and international hospice palliative care organizations are unified in the position that MAiD is not part of the practice of hospice palliative care. 

...Hospice palliative care sees dying as a normal part of life and helps people to live and die well. Hospice palliative care does not seek to hasten death or intentionally end life. 

If the Delta Hospice is forced to provide euthanasia then all Hospice Palliative Care organizations within Canada can be forced to provide euthanasia.

Hospice/Palliative Care is not MAiD. The Delta Hospice must not be forced to provide MAiD.

Fraser Health is overstepping its role as a health authority in forcing and bullying the Delta Hospice to provide MAiD.

Sign the petition: Hospice Organizations Must NOT be forced to do Euthanasia (Link).

Delta Hospice ordered by Fraser Health to do euthanasia.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Delta Hospice

On December 2, I reported that the Board of the Delta BC Hospice Society that operates the Irene Thomas Hospice in Ladner BC, renewed its position opposing euthanasia (MAiD) while supporting excellent care. The Board stated that:

MAiD is not compatible with the Delta Hospice Society purposes stated in the society's constitution, and therefore, will not be performed at the Irene Thomas Hospice.

Fraser Health, the government agency that allocates health funding in that region reacted to the Delta Hospice Society by ordering them to provide MAiD (euthanasia).

Sign the petition: Hospice Organizations Must NOT be forced to do Euthanasia (Link).

The Delta Optimist newpaper reported, on December 7, that Fraser Health informed the Delta Hospice that their position is at odds with the policy of Fraser Health.

A spokesperson for Fraser Health told the Delta Optimist that:

The region noted it fully supports a patient’s right to receive medical assistance in dying wherever they may be, including in a hospice setting.

The Delta Optimist also reported that the lobby group, Dying With Dignity, also believes that the Delta Hospice should be forced to do euthanasia:

Alex Muir with the Vancouver chapter of Dying with Dignity Canada called the new board’s vote to repeal MAiD disappointing, adding his group believes Delta Hospice should be forced to abide by Fraser Health policy that MAiD be provided in all non-faith-based facilities under its jurisdiction.

Muir then added that Dying With Dignity considers palliative care and MAiD to be essential options on a spectrum of care.

Delta Hospice President, Angelina Ireland

The position of the Delta Hospice is not new. In February 2018, the Delta Hospice was ordered by Fraser Health to provide euthanasia. The Delta Hospice did not comply with the edict from Fraser Health at that time.

Recently the Canadian Hospice Palliative Care Association (CHPCA) and the Canadian Society of Palliative Care Physicians released a joint statement upholding that hospice palliative care is not compatible with MAiD (euthanasia). They stated:

Healthcare articles and the general media continue to conflate and thus misrepresent these two fundamentally different practices. MAiD is not part of hospice palliative care; it is not an “extension” of palliative care nor is it one of the tools “in the palliative care basket”. National and international hospice palliative care organizations are unified in the position that MAiD is not part of the practice of hospice palliative care.

Hospice palliative care and MAiD substantially differ in multiple areas including in philosophy, intention and approach. Hospice palliative care focuses on improving quality of life and symptom management through holistic person-centered care for those living with life threatening conditions. Hospice palliative care sees dying as a normal part of life and helps people to live and die well. Hospice palliative care does not seek to hasten death or intentionally end life.

If the Delta Hospice is forced to do euthanasia, then all Canadian Hospice groups can be forced to do euthanasia.

Sign the petition: Hospice Organizations Must NOT be forced to do Euthanasia (Link).

Message to palliative care leaders - Hold fast to opposing MAiD.

The letter below is in support of the Canadian Hospice Palliative Care Leaders - Joint Call to Action.

Send your letters supporting the Call to Action to:

Leonie Herx MD PhD FCFP (PC)
President - Canadian Society of Palliative Care Physicians (CSPCP)
1A – 12830 – 96th Avenue., Suite 584
Surrey, British Columbia V3V 0C2
Leonie.Herx@kingstonhsc.ca

Sharon Baxter, MSW
Executive Director
Canadian Hospice Palliative Care Association (CHPCA)
Annex D, Saint-Vincent Hospital
60 Cambridge Street, North
Ottawa, Ontario K1R 7A5
SBaxter@chpca.net

Dear Dr. Herx and Ms. Baxter

I am writing to celebrate and support the joint statement of the CHPCA and the CSPCP that distinguishes the difference between palliative care and MAID.

Palliative care is one of the most important bastions of Hippocratic medicine, in which patients can be reassured that they will receive care and comfort, but not be killed. Killing does not belong anywhere in the House of medicine, especially in palliative care.

I am a psychiatrist and medical ethicist who has been very involved in the U.S. and internationally— lecturing, publishing and publically debating the issue of MAID. I argue that it is neither good medical ethics nor good public policy. Along with this, I have been promoting palliative care as an approach that needs more access, funding and training programs. Physicians and our teams certainly can get out of the way of death, without administering death to patients.

The American Psychiatric Association (APA) stands with the American Medical Association (AMA) against all forms of MAID. I helped to craft and establish the APA’s special position statement that focuses particularly on MAID for people with non-terminal conditions, such as psychiatric patients – stating that those practices are unethical: (Link)

If you would like to read more about my own efforts and on these issues there is a summary here: (Link).

Please continue to hold fast to your venerable ethical stance as pressure comes from organizations that are trying to push MAID down the slippery slope, through Palliative Care and beyond.

Regards,
Mark S. Komrad M.D., DFAPA Faculty of Psychiatry, Johns Hopkins, Tulane, and University of Maryland Author of, "You Need Help: A Step-by-Step Plan to Convince a Loved One to Get Counseling." 
www.YOUNEEDHELPBOOK.com 
@youneedhelpbook

Delta BC Hospice supports caring options, not euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Delta Hospice

The Board of the Delta BC Hospice Society that operates the Irene Thomas Hospice in Ladner BC, recently renewed a position, of the previous board that opposes euthanasia (MAiD) while supporting excellent care.

An article published by the Delta Optimist explains that last Thursday the Delta Hospice Society elected a new board. The new board met on Saturday where they passed a resolution stating that:

MAiD is not compatible with the Delta Hospice Society purposes stated in the society's constitution, and therefore, will not be performed at the Irene Thomas Hospice.

Angelina Ireland

A letter was sent out by Angelina Ireland, the new President of the Delta BC Hospice announcing their position and the new leadership team.

The position of the Delta Hospice is not new but rather a renewal of its previous position. In February 2018, the Delta Hospice was ordered by Fraser Health to provide euthanasia. The Delta Hospice did not comply with the edict from Fraser Health.

Canadian Hospice Palliative Care Leaders - Joint Call to Action.

November 27, 2019 (Link to the Joint Call to Action).

Due to ongoing confusion amongst the general public regarding Hospice Palliative Care (HPC) and Medical Assistance in Dying (MAiD), the Canadian Hospice Palliative Care Association (CHPCA) and the Canadian Society of Palliative Care Physicians (CSPCP) would like to clarify the relationship of hospice palliative care and MAiD.

Healthcare articles and the general media continue to conflate and thus misrepresent these two fundamentally different practices. MAiD is not part of hospice palliative care; it is not an “extension” of palliative care [i] nor is it one of the tools “in the palliative care basket”.[ii] National and international hospice palliative care organizations are unified in the position that MAiD is not part of the practice of hospice palliative care.[iii] [iv] [v] [vi] [vii] [viii] [ix] [x]

Hospice palliative care and MAiD substantially differ in multiple areas including in philosophy, intention and approach.[xi] Hospice palliative care focuses on improving quality of life and symptom management through holistic person-centered care for those living with life threatening conditions. Hospice palliative care sees dying as a normal part of life and helps people to live and die well. Hospice palliative care does not seek to hasten death or intentionally end life. In MAiD, however, the intention is to address suffering by ending life through the administration of a lethal dose of drugs at an eligible person’s request.

Less than 30% of Canadians have access to high quality hospice palliative care, yet more than 90% of all deaths in Canada would benefit from it.[xii] [xiii] Despite this startling discrepancy, access to hospice palliative care is not considered a fundamental healthcare right for Canadians. In contrast, MAiD has been deemed a right through the Canada Health Act, even though deaths from MAiD account for less than 1.5% of all deaths in Canada.[xiv]

We call on the federal and provincial governments to prioritize funding and improve access to hospice palliative care in Canada, and to support the implementation and action plan of the National Framework for Palliative Care in Canada.[xv] Canadians must have a right to assistance in living with hospice palliative care, and not just a right to termination of life.

Sincerely,


Sharon Baxter, MSW
Executive Director
Canadian Hospice Palliative Care Association (CHPCA)
Annex D, Saint-Vincent Hospital
60 Cambridge Street, North
Ottawa, Ontario K1R 7A5
SBaxter@chpca.net


Leonie Herx MD PhD FCFP (PC)
President
Canadian Society of Palliative Care Physicians (CSPCP)
Suite 584
1A – 12830 – 96th Avenue
Surrey, British Columbia V3V 0C2
Leonie.Herx@kingstonhsc.ca

---

[i] Buchman, Dr. Sandy. “Bringing Compassion to Medicine and to the CMA.” Canadian Medical Association, 12 Oct. 2019, https://www.cma.ca/dr-sandy-buchman.

[ii] Kutcher, Dr. Matt. “Navigating MAiD on PEI.” Canadian Medical Association, 19 Nov. 2018, https://www.cma.ca/dr-matt-kutcher.

[iii] World Health Organization (WHO). “WHO Definition of Palliative Care.” World Health Organization (WHO), https://www.who.int/cancer/palliative/definition/en/.

[iv] De Lima L, Woodruff R, et al, International Association for Hospice and Palliative Care “Position Statement Euthanasia and Physician-Assisted Suicide.” JPM Vol 20, 1:1 -7.

[v] Radbruch, Lukas, et al. “Euthanasia and Physician-Assisted Suicide: A White Paper from the European Association for Palliative Care.” Palliative Medicine, vol. 30, no. 2, 2015, pp. 104–116., doi:10.1177/0269216315616524.

[vi] Australia and New Zealand Society of Palliative Medicine (ANZSPM) “Position Statement on the Practice of Euthanasia and Physician Assisted Suicide.” 31 Mar. 2017

[vii] Canadian Hospice Palliative Care Association “Policy on Hospice Palliative Care and Medical Assistance in Dying (MAiD).” Jun. 2019

[viii] Canadian Society of Palliative Care Physicians “Key Messages: Palliative Care and Medical Assistance in Dying (MAID).” May 2019.

[ix] “Statement on Physician-Assisted Dying.” American Academy of Hospice and Palliative Medicine (AAHPM), 24 Jul. 2016, http://aahpm.org/positions/pad.

[x] Canadian Medical Association. “Palliative Care (Policy).” 2016

[xi] Shariff M & Gingerich M. “Endgame: Philosophical, Clinical and Legal Distinctions between Palliative Care and Termination of Life.” Vol. 85, Second Series Supreme Court Law Review 225. 2018

[xii] Quality End-of-Life Care Coalition of Canada and Canadian Hospice Palliative Care Association. “The Way Forward National Framework; a Roadmap for an Integrated Palliative Approach to Care.” Mar. 2015.

[xiii] Canadian Society of Palliative Care Physicians . “How to Improve Palliative Care in Canada - A Call to Action for Federal, Provincial, Territorial, Regional and Local Decision-Makers.” Nov. 2016.

[xiv] “Fourth Interim Report on Medical Assistance in Dying in Canada.” Government of Canada, Health Canada, Apr. 2019, https://www.canada.ca/en/health-canada/services/publications/health-system-services/medical-assistance-dying-interim-report-april-2019.html.

[xv] “Framework on Palliative Care in Canada.” Government of Canada, Health Canada, 4 Dec. 2018, https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/palliative-care/framework-palliative-care-canada.html.

Ontario Doctor experiences abuse with MAiD (euthanasia) law.

By Taylor Hyatt and Amy Hasbrouck
Tourjours Vivant - Not Dead Yet

Taylor Hyatt

Recently, Taylor Hyatt attended a conference for medical students, where a few lectures on euthanasia were presented. 

Taylor was moved by the talk given by Dr. David D’Souza, a chronic pain specialist in Toronto. His talk focused on eligibility for euthanasia, and he included the stories of three people considering euthanasia whom he had seen in his practice. Dr. D’Souza expressed concern that the safeguards around euthanasia eligibility were being flouted in all three cases.

The first case happened when visiting a nursing home where Dr. D’Souza met an elderly lady with dementia. Her condition had progressed “to the point where she [couldn’t] recognize her own family and [had limited] communication abilities.” Her family asked to meet with the doctor, and requested that she be euthanized. They brought a will that she had written 10 years before, while in the early stages of her dementia, which stated that she would want to be euthanized. Dr. D’Souza told the family that she was not a candidate for euthanasia. According to the eligibility criteria, the person must request MAiD themselves; no one can do it on their behalf. He also told them the law requires the person be able to give consent at the time of the procedure, which she was not competent to do. Dr. D’Souza also pointed out that, “she may have sufficient quality of life that she still enjoys.”

The second incident took place “shortly after euthanasia was legalized” in 2016. A middle-aged man who spent two months on a waiting list for palliative care, came to Dr. D’Souza. He was a wheelchair user and amputee, and he was on dialysis. The man only had his wife for support, and had “[decided] to discontinue dialysis completely.” By the time the man saw Dr. D’Souza, he hadn’t had dialysis for over three weeks, and so had “nausea, fatigue…uncontrolled pain, [and] shortness of breath.” He also reported a “low mood” along with feelings of hopelessness. The man had submitted a request for euthanasia.

His first words to the doctor were “Are you here to relieve my pain? Are you here to relieve my suffering?” Dr. D’Souza said yes. Then the man asked him whether he was “here to end my life.” Upon hearing “no,” he asked “Why not? Isn’t that part of your job? I heard about this MAID thing on TV … isn’t that what you do?” Dr. D’Souza provided palliative care for him, who then withdrew his MAiD request. Dr. D’Souza reported that “although he chose to decline further dialysis sessions, he later died peacefully and comfortably, and of natural causes, with the assistance of genuine palliative care.”

The last case is about a man in his 70's who was concerned about hardness in his abdomen. Early tests suggested gastrointestinal cancer as a possible cause. The first thing he said after receiving these test results was “I want to be euthanized.” Dr. D’Souza “tried to steer the conversation in a different direction and said to him ‘you don't qualify for that. You don’t even have a diagnosis. Let’s first figure out the diagnosis and we can talk about all that later.’” He was then sent for the scan. 

A few weeks later, Dr. D’Souza received a report from the hospital: the patient had gone there the day after his initial appointment and “demanded to be euthanized.” He was admitted to the hospital, but “refused further testing;” he also turned down meetings with a surgeon, oncologist, and psychiatrist. Instead, he met with the euthanasia team, including a nurse practitioner and a physician. They determined that he met the eligibility requirements for MAiD. 

Dr. D’Souza visited him on the day he was euthanized. Dr. D’Souza recalled that “he was in no apparent pain [or] distress. He was smiling. He was excited for the big event, and so was his family. His family was surrounding him and they had dressed him up in a very nice suit, and they were very, very excited. He told me he wanted to have a dignified death” not caused by unknown and unpredictable factors.

Dr. D’Souza pointed out eligibiity criteria that were were disregarded and safeguards that were overlooked when the request for euthanasia was approved:

• First, the person must “have a serious and incurable illness, disease, or disability.” He did not have a definitive diagnosis. “He refused investigations and specialist assessments; therefore, he did not know if he had an incurable illness.”
• Next, the person must “be in an advanced state of irreversible decline.” Not knowing his condition, it was impossible to know whether it was in decline. Even if further tests confirmed that he had cancer, his prognosis “would depend on a number of [factors, including] the primary source of cancer, presence of metastases, [and] type of tumour. These factors would then [suggest treatment] options, such as chemotherapy and/or surgery.”
• The person must also have “physical or psychological suffering that is intolerable to them.” The MAID team reported “that he was in no pain, but he was deemed to be in intolerable suffering.”

Dr. D’Souza also mentioned that he did not see a psychiatrist, so it is impossible to know whether emotional issues may have played a role in his decision to request euthanasia. Asking to die while refusing to obtain an accurate diagnosis suggests an impulsive and emotional choice, or that he was already prone to suicidal feelings. The doctor also believed the 10-day waiting period is arbitrary and inadequate. He doesn’t know “any physician who has been able to completely cure anxiety or depression in 10 days.”

These potential violations were discovered by someone with extensive experience in the medical field and knowledge of the Canadian euthanasia program, who took the time to share his insights. These case histories give us a glimpse into how the MAiD program works on the ground. Multiply Dr. D’Souza’s experience by the number of practitioners performing MAiD, and a frightening picture emerges. It also raises troubling questions: 

• Was man's euthanasia seen as compliant with the law upon review by the designated authorities? 
• How many ineligible people are being euthanized when MAiD evaluation teams don’t completely grasp or strictly apply the eligibility criteria and safeguards?

If this isn’t a slippery slope, what is?

Christian, Jewish and Muslim. Declaration against Euthanasia and Assisted Suicide.

On October 28, leaders of the Christian, the Jewish and the Muslim faiths signed a Declaration against Euthanasia and assisted suicide. (Link to the Position paper and Declaration).

Based on the arguments and justifications articulated in this position paper, the three Abrahamic monotheistic religions share common goals and are in complete agreement in their approach to end-of-life situations. Accordingly, we affirm that:

➢ Euthanasia and physician-assisted suicide are inherently and consequentially morally and religiously wrong and should be forbidden with no exceptions. Any pressure upon dying patients to end their lives by active and deliberate actions is categorically rejected.

➢ No health care provider should be coerced or pressured to either directly or indirectly assist in the deliberate and intentional death of a patient through assisted suicide or any form of euthanasia, especially when it is against the religious beliefs of the provider. It has been well accepted throughout the generations that conscientious objection to acts that conflict with a person’s ethical values should be respected. This also remains valid even if such acts have been accepted by the local legal system, or by certain groups of citizens. Moral objections regarding issues of life and death certainly fall into the category of conscientious objection that should be universally respected.

➢ We encourage and support validated and professional palliative care everywhere and for everyone. Even when efforts to continue staving off death seems unreasonably burdensome, we are morally and religiously duty-bound to provide comfort, effective pain and symptoms relief, companionship, care and spiritual assistance to the dying patient and to her/his family.

➢ We commend laws and policies that protect the rights and the dignity of the dying patient, in order to avoid euthanasia and promote palliative care.

➢ We, as a society, must assure that patients’ desire not to be a burden does not inspire them the feeling of being useless and the subsequent unawareness of the value and dignity of their life, which deserves care and support until its natural end.

➢ All health care providers should be duty-bound to create the conditions by which religious assistance is assured to anyone who asks for it, either explicitly or implicitly.

➢ We are committed to use our knowledge and research to shape policies that promote socio-emotional, physical and spiritual care and wellbeing, by providing the utmost information and care to those facing grave illness and death.

➢ We are committed to engage our communities on the issues of bioethics related to the dying patient, as well as to acquaint them with techniques of compassionate companionship for those who are suffering and dying.

➢ We are committed to raising public awareness about palliative care through education and providing resources concerning treatments for the suffering and the dying.

➢ We are committed to providing succor to the family and to the loved ones of dying patients.

➢ We call upon all policy-makers and health-care providers to familiarize themselves with this wide-ranging Abrahamic monotheistic perspective and teaching in order to provide the best care to dying patients and to their families who adhere to the religious norms and guidance of their respective religious traditions.

➢ We are committed to involving the other religions and all people of goodwill.