Thursday, August 5, 2021

Fraser Health Authority (British Columbia) reduces Hospice Palliative Care Benefit and promotes euthanasia

The following article was sent to the Euthanasia Prevention Coalition by a palliative care patient advisor who is concerned about the Fraser Health Authority criteria for palliative care.

The Fraser Health Authority (FHA) is the British Columbia regional authority that defunded the Delta Hospice Society for refusing to participate in (MAiD) euthanasia. This article uncovers the discrepancy between the BC Hospice Palliative Care benefit and the FHA residence admission criteria. 

The FHA appears to consider euthanasia as more important than palliative care. Here is the article.


The Fraser Health Authority (FHA) admitted that there is a discrepancy between information posted on the website regarding the admission criteria to hospice and the approved hospice residence admission. To date a partial list of the eligiblity criteria is posted on the FHA webpage. Although, the FHA CEO was asked by a patient partner when would the webpage reflect the approved eligiblity for hospice residence admission, the CEO refused to provide an answer.

​On May 29, 2021, a patient advisor e-mailed the Professional Practice Consultant of the Fraser Health Authority (FHA) in preparation for the What Matters To You day on June 9. This was the message of the advisor to the consultant:
Would you be able to provide a rationale why Fraser Health reduced the life expectancy admission criteria from 6 months to less than 3 months as eligibility for admission to Fraser Health Authority Hospice Residence?

I am just concerned because patients should have access to the benefits longer than 3 months, but FHA is admitting those with life expectancy of less than 3 months?

I believe timely access (in reference to the BC Palliative Care Benefit Program life expectancy criteria) to palliative care is what matters most to those patients and families who need the service

See files from my notes and the screenshots from the source.

On June 4, 2021, the FHA Professional Practice Consultant replied to the advisor:
Thanks so much for your question. I reached out to the Fraser Health Palliative Care team to ask about the discrepancy and as it turns out they need to update the Fraser Health website to reflect the attached document. As you can see, the admission criteria actually does match the BC Palliative Care Benefit Program.

Thanks for bringing this to their attention; you have such great attention to detail.
The attached document mentioned in the message shows that the eligiblity criteria was approved since December 20, 2019 but the approved criteria was not made available to the public until a partial list was posted in June.

On June 10, 2021, the webpage on Fraser Health Hospice admission appears to be a 404 page or “Page not found”. The patient advisor questioned the Fraser Health CEO and copying the BC Premier and the BC Ministry of Health. The Premier and the Minister of Health and CEO viewed the e-mail but did not reply to the patient advisor.

On June 14, 2021, the patient advisor sent this e-mail message of concern to the Professional Practice Consultant:
Thank you very much for reaching out to the FHA Palliative Care Team to ask about the discrepancy between the BC Palliative Care Benefit and the Hospice

Residence Admission posted on FHA Website. Since December 2019, it was only today that the information on the web was updated. Base the previous e-mail, the Palliative Care Team acknowledges that the web needs to be updated to reflect the document with the approved Hospice Residence Admission Criteria . Although an update was done as of today, it is not yet reflective of what was approved.

I am curious of what is the process of FHA when updating webpages for public information? Who approves the information to be posted? I am concern that partial information posted in comparison to what was approved is not consistent to messaging. Patients and family members need to know what was approved. Both patients and health care providers should have the same information.

In my previous e-mail I have notified the Patient Engagement office through the department's email address that instead of updating the website it appeared to be an page with 404 message on June 10, 2021.

To date the webpage with the hospice residence admission is updated with a partial list of what was approved.
As of August 4, 2021, here is the Fraser Health Authority hospice residence admission criteria:

In an effort that patient advisors should be acknowledged for their effort to improve the quality of the delivery of health care system, the Fraser Health Chief Nursing Executive who also leads the Patient Engagement activities of the Fraser Health Authority terminated the patient advisor from the volunteer patient engagement. The reason provided by the executive is that advisor is a risk to the health authority. The termination happened after sending the e-mail of concern of partial list posted for the public.

Although the advisor was unfairly removed and banned from all volunteer activities within the health authority, the patient advisor hopes that the Fraser Health will be transparent to the public and post to their website the full list of the eligibility for hospice residence admission and provide the meaning of Medical Orders of Scope of Treatment (MOST) M1 or M2 to the public.
· M1 means Supportive care, symptom management & comfort measures. Allow natural death.
Transfer to higher level of care only if patient's comfort needs not met in current location.
· M2 means Medical treatments available within location of care. Current Location:
Transfer to higher level of care only if patient's comfort needs not met in current location

People who have less than six months to live should be given the dignity to live the last moments of their life with their families and should be given the right to access the hospice beds when they are eligible to be admitted and not to delay the admission to the last 3 months of their life. M1 should have been the protection of those in the hospice to be allowed natural death. And M2 should have been considered that medical treatments in the hospice is intended for palliation and those wishing for MaiD, transfer is allowed as the formal transfer could be facilitated within 30 days after a medical practitioner or nurse practitioner completes the form for the reason of transfers such as facility do not allow provision of MaiD in the facility or any reasons that requires an effective transfer.

The question now is do Fraser Health go through the process of public engagement, legal and ethical review for all their corporate policy to ensure no discrepancy with any legislations?

Note: The name of the patient advisor is withheld because of an active complaint with the BC Ombudsperson regarding unfair removal of patient advisors in Fraser Health Authority following the concern about discrepancy between the BC Palliative Care Benefit and the FHA Hospice Residence Admission.


Tershia said...

Those responsible for this evil decision will not escape the wrath of God.

carole pellizzari said...

WHAT HAVE WE BECOME???????????????

Nancy said...

Fraser Health should go through the process of public engagement, legal and ethical review for all their corporate policy to ensure no discrepancy with any legislations. Who else should we tell this to, other than our MP? And, where is the petition to sign? Thank you, Alex!

Khang said...

What's a shame, we've worked all our lives to pay taxes and in our last moment of our lives, we don't have hospice to leave this world in peace! What the government has done to us???

Anonymous said...

Who is responsible and accountable for the public information posted on the Fraser Health Website? Why would the CEO take action on this matter to ensure responsible posting of correct information.

Norman said...

How would the CEO and the Chief Nursing Executive ignore the discrepancies? They are healthcare professionals but they are not taking actions.

Perleechiele said...

Looking forward for Victoria and Jacqueline to post the document that was approved on the Hospice Admission Eligibility criteria on the web. Uploading the approval shouldn't be the problem. As medical doctor and nurse, both Victoria and Jacqueline should fulfill their responsibility and accountability to the public to be truthful of what was approved by the Palliative Care Team of Fraser Health.
For patients denied of access to hospice beds because of late admissions, should contact the Patient Care Quality Office
Fraser Health
11762 Laity St, 4th floor
Maple Ridge, BC V2X 5A3

Tel: 1-877-880-8823
Fax: 604-463-1888

Marian said...

Praying for a change of heart and a gift of wisdom that key decision makers to be truthful and respect human life. Praying that medical practitioners and nurse practitioners who fulfills their oath to do no harm (not to administer lethal dose) to the patients under their care. Keeping the faith, good over evil.

tracy bn said...

That is the link to date, it is still not showing the full list.

Is this the problem-solving skills of the Fraser Health executives? The problem was a discrepancy, the solution they provided was updating with a partial list. What is the reason the CEO and Chief Nursing Executive are not taking action to post the document approved by the Palliative Care Team?

The public needs honest leaders. Honesty is the best policy. Can the Vancouver Coastal Health Authority administer health care in Greater Vancouver? The leadership of VCHA is far better. They have honest and caring leaders. The province does not need to pay two CEOs for the Greater Vancouver area.

Rina said...

What is happened to the executive leadership of Fraser Health?

Adrianne said...

When did 3 became a reflection of 6???

Mitchell said...

From Eastern Canada, we support the vision of Delta Hospice Society for a euthanasia-free hospice.

Thank you Angelina and DHS Board for protecting the real delivery of Palliative care and educating the community that MAiD is never a part of a Palliative Care.

The message of Angelina speaks the truth:

Zeint said...

Why admit in the last three months (may only have few days to live after wdmission to hospice) and not as early as the life expectancy of 6 months or less (greater chance to be discharged because condition improved, quality of life improved). Fraser health should not deny earlier admission f0r those with LIFE EXPECTANCY OF SIX (6) MONTHS.

Krista said...

I do not know if Dr. Victoria Lee CEO of Fraser Health Authority could still utter this part of her oath "If I do not violate this oath, may I enjoy LIFE and art, respected while I LIVE and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help."

Christien said...

As of August 18, 2021, the Fraser Health still have this eligibility criteria posted on their website and this is the information available to the public:

"For admission to hospice, a person must:

have care needs that cannot be supported in a community or long-term care settings.
have a life expectancy of weeks to months.
agree to Medical Orders for Scope of Treatment (MOST) M1 or M2"

It is really a shame to the executive leadership team of Fraser Health that no one or even the Palliative Care Executive Lead is taking an action to correct the information on the web even though they have promised to update the webpage. What is happening to the leaders of this health authority?

Mitch said...

On this video, Jacqueline Per of Fraser Health was mentioning about dialogue. Was there a dialogue done between Fraser Health and patient partners?

How truthful is she with her words, does she walk her talk?

Sharon said...

Supposedly Fraser Health will educate physicians as they promise:

"education for physicians on the newly implemented most (medical orders for scope of
treatment) program, focusing on the importance of providing diagnostic and prognostic
information for patients and families, and supporting and encouraging advance care planning
conversations throughout the patient’s care journey"

But, Fraser Health failed to provide this educational opportunity to physicians.Where did the budget for education of physician go?

Annie said...

Was defunding a solution to improved access to hospice beds?

It is shameful that the FHA leadership is going southward. The public pays for the salary of executives expecting to serve the vulnerable. But now the vulnerable are at risk and no safer place to die.

Meriam said...

As I was reviewing the original FHA posting, it mentioned agrees to the philosophy of hospice care. The philosophy of hospice care does not include MAiD, why would Fraser Health mandate the provision of MAiD in hospices? The mandate is not a provincial mandate, the FHA Board Chair is not true to what he is saying to the public. The province has an opt-out provision of the MAiD Policy. Contracted organizations can opt-out.

Who is responsible for defunding a hospice that adheres to the philosophy of hospice care?

Hospice is not a killing place.

Toby said...

At the end of the day, it is about living with integrity.

Wisdom is important. Lying will never put someone at peace. It is explicitly mentioned 6 months or less for the life expectancy admission criteria, it is the choice of the leaders to lie to the public.

That is very risky when the health authority have dishonest leaders.

Pray for the CEO and Chief Nursing Executive for wisdom to diacern the truth.

Alex Schadenberg said...

The issue of defunding the Delta Hospice Society for refusing to participate in (MAiD) euthanasia was based on the BC Minister of Health. Fraser Health is not innocent but they were fulfilling the demands of the Provincial Health Ministry.

Onorina said...

As posted on the Fraser Health News Release page "The termination follows the DHS board's refusal to comply with the provincial medical assistance in dying (MAiD) policy."

Too sad that Fraser Health made a decision without consulting the licensing body. The licensing body that issued a palliative care service to the Society should have the authority to determine if MAiD policy applies to the Society or should be it be the Provincial Palliative Policy? When does a MAiD policy apply to a contracted organization that OPT-OUT?
The MAiD Policy have this provision, a contracted organization can opt-out. They have the right not to provide MAiD in the facility. Was this overlooked by Fraser Health?

Ayesah said...

This is very shameful that nobody from the leaderds had the courage to speak up about ethical breaches They are might be thinking of more immediate rewards such as staying on a good footing with the powerful.Too sad. A reflection that nurses in Fraser Health are afraid to speak up with the leaderdhip style of the chief nursing executive that seens to make actions that is defined as "discriminatory action" terminating after a concern is raised.
Very shameful.

Xander said...

“It is our job to ensure that Delta residents continue to have access to hospice services upon the termination of the contract with DHS. We continue to be committed to this and are working to make it happen." Minister Adrian Dix

This was not true, because before the contract ends, the Fraser Health moved out those they referred to the Irene Thomas Hospice (operated by the Delta Hospice Society) were moved out of the hospice and transferred to a place outside the Delta community.

The Minister of Health says the contracted organization do not have the option to opt-out but the provincial policy has a provision that contracted organization can opt-out.
For British Columbians interested to have copy of the provincial MAiD policy, request a copy from the government FOI office. You can also request for provincial Palliative policy to help you discern if the message of the BC Minister of Health is consistent to provincial policies.

Grace said...

I am a member of the Society since it was founded. I know the agreement between the Delta Hospice Society and Fraser Health Authority is a Hospice Service Agreement . The Fraser Health terminated a Hospice Service Agreement following the refusal to provide the MAiD/euthanasia service. Which would have more weigh the FHA mandate to provide MAiD service (the provincial policy is subject to change) or the mutual 35-year hospice agreement between Delta Hospice Society and Fraser Health?

Why would the ministry of health use the hospice residence funds for MAiD? The funds were intended to provide hospice services which I believe that the KPI for hospice bed occupancy is 80%. Why use an 50% funding baseline to force a hospice to provide MAiD if the province is expecting 80% of hospice residence occupancy rate? Why defund the Society? Why not the health authority allocate 80% of public fund to the Society and the Society to raise the other 20% to maintain the mutual agreement? Too sad that the health authority breached the mutual agreement because of mandating a policy in 2017 (prior to the July 2018 effectivity of the BC MaID policy that allows contracted organization to OPT OUT).

Like others who commented on this blog, the Fraser Health Authirity key decision makers are a SHAME.

Rina said...

What I know is the province of BC do not have a provincial Palliative Policy.

Supposedly a provincial Palliative and Dementia Policy should have been developed and implemented in BC on April 2018. Unfortunately a government employee cobfirmed that the provincial Dementia and Palliative policy is still on its DRAFT stage since 2017.

The BC provincial MAiD policy was approved and took effect on July 2018.

This just reflect that the BC NDP government prioritize the MAiD Policy development and implementation.

Very contrary to the MAiD federal safeguards that requires access to PALLIATIVE CARE first.

Even health authorities FOI offices cannot provide a copy of provincial palliative policy. As there is no approved palliative policy in BC.

Maxime said...

The Fraser Health Licensing Office has not designated MAiD in hospices as a major service. Why would the Fraser Health Board of Directors push the provision of MAiD in hospices? The members of the Fraser Health Board do not have a healthcare and legal background. I believe the former medical expert of Fraser Health resigned from his position as leader of the Palliative Care in Fraser Health because of the failure of the Fraser Health Board to listen that MAiD should not be provided in hospices and palliative care units of the Fraser Health Authority.

Why would people with no expertise in palliative care have a voice and medical experts are being silenced or not being heard in the province?

Why would the Fraser Health Board mandate a policy before a effective date of a provincial policy? Do the Fraser Health Board thinks they have more power over the Deputy Minister of Health?

Anonymous said...

I am a patient advisor volunteer in Interior Health Authority and the health authority representatives listen to other patient advisors and they do not solely use their power to terminate a patient advisor.

The patient advisors should not be terminated for raising a concern. A concern was raised to improved admission to a hospice residence, why would the Fraser Health Chief Nursing Executive make a decision to terminate a patient advisor requesting to provide correct information to the public?

Many are very disappointed with Fraser Health Authority. I hope that the BC Minister of Health will do an audit on the information posted on the Fraser Health website. The hospice residence admission criteria may be only one of outdated information available to the public.

Let us pray that the Fraser Health webmaster will be careful on providing updated information to the public especially timely access to services such as admission to hopsice residence for those with life expectancy of 6 months or less.

Dermonteaux said...

I really cannot comprehend why Fraser Health is changing the approved wordings .

The approved wordings on the approved hospice residence is "expected to die in 6 months or less" but the information posted is very inconsistent. The Fraser Health webmaster posted "have a life expectancy of weeks to months"

The baseline is ix months or less (consistent to the BC Pallaitive Care Benefit) but Fraser health is using a baseline of weeks.

Consistent messaging is very important. The words in what was approved should be followed.

Anonymous said...

British Columbians who are seeking truth can request for the BC MAiD Policy and BC Palliative Policy by contacting:

Information Access Operations can answer your questions about requesting records from the government.

Mailing Address:
PO Box 9569
Stn Prov Govt
Victoria BC V8W 9K1

The Government of BC would be able to provide facts when the MAiD policy took effect n BC and if there was a Palliative policy that existed prior to the implementation of MAiD. The federal MAiD safeguards include access to palliative care first. Does the province have a policy on accessing palliative care similar to how the province prioritize access to MAiD?

Alex Schadenberg said...

Sorry Anonymous but the federal MAiD safeguards to not include access to palliative care first. The law says nothing about palliative care.

In fact the law says that a person does not need to accept or try any treatment.

Anonymous said...

Palliative care is mentioned as part of informed consent AND SHOULD NOT BE MISSED.

Current Eligibility Criteria
Under the current Criminal Code eligibility criteria, persons who seek to obtain medical assistance in dying must satisfy ALL of the following eligibility criteria (subsections 241.2(1) and (2) of the Criminal Code):

be 18 years of age or older;

be capable of making decisions with respect to their health;

be eligible for health services funded by the federal government, or a province or territory (or during the minimum period of residence or waiting period for eligibility);

make a voluntary request for MAID that is not the result of external pressure;

give INFORMED CONSENT after having been informed of the means that are available to relieve their suffering, including PALLIATIVE CARE;

have a “grievous and irremediable medical condition”, which is defined as:
having a serious and incurable illness, disease or disability;

being in an advanced state of irreversible decline in capability;

experiencing enduring physical or psychological suffering that is intolerable to them and cannot be relieved under conditions that they consider acceptable; and
their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.

Vincent said...

The informed consent safeguard are often missed, which should not be. The law promotes those requesting for MAiD to be provided ALL information on available options to relieve pain. Options are provided, consent is given if all information is provided with due diligence. The problem is do health authorities promote due diligence in giving ALL INFORMATION ON AVAILABLE OPTIONS SUCH AS COUNSELLING, MENTAL HEALTH AND DISABILITY SUPPORT?

Informed consent
To be eligible, you must provide informed consent to your practitioner. This means you have consented (given permission) to MAID after you have received all of the information you need to make your decision, including:

your medical diagnosis
available forms of treatment
available options to relieve suffering, including PALLIATIVE CARE
You must be able to give informed consent both:

at the time of your request
immediately before MAID is provided unless special circumstances apply

Alex Schadenberg said...

Sorry but the law does not require that someone tries palliative care or any treatment it says: 241.2 (e) they give informed consent to receive medical assistance in dying after having been informed of the means that are available to relieve their suffering, including palliative care.

Sadly, this does not require palliative care, only that people are informed that palliative care is available. There is no obligation in the law to accept effective medical treatment you only must be informed about what exists.

Anonymous said...

Yes you are right, the MAiD legislations do not require palliative care but it does require that medical practitioners and nurse practitioners to give information to the person requesting of what are the available options. The sad reality is the guidance of health authorities is towards the assumption that the person consents to MAiD without being referred to counsellors, disability support services, mental health services. If a person was given the opportunity to try counselling, disability support services, mental health services before completing the MAiD request form, this would give the person time to consider the options. But if there is no referral to those who provide counselling, disability support and mental health services, there is the pressure for those brainwashed with the "dying with dignity" that they rush into signing the request form and witness being facilitated by the Dying with Dignity Group.

There are lots to be considered before it is really considered an "informed consent"

As Dr. Harvey Schipper suggests for deeper reflection:

How do we protect the vulnerable?

How do we know that when MAiD is offered and provided it fully meets what inevitably must be stringent requirements?

What does it mean to be a healer, physician, nurse , or alternative healthcare provider who is involved in a medically assisted death?

Where do we prioritize our resources and energies in the provision of health and fostering of a quality of life?

What are the moral and ethical principles that underlie our social norms, behaviours, laws, regulations, even traditions?

How do we value life?

At the end of the day, it is not simply completing the request but helping the person access his or right to healthcare services that would benefit the person's quality of life and the person's family members quality of life.

It should be a stringent process, but the Dying with Dignity group makes the request easier to access MAiD than other options to relieve pain and suffering. This is the sad reality of failure to train MAiD assessors and providers on the value of the person as a human being. No human being should be forced to end their lives in the hands of doctors and nurses.

Sr. Angela said...

The following could prevent euthanasia:

counselling services
mental health support services
disability support services
community services
palliative care
effective referral and consultations with professionals

There shouldn't be a long wait to access preventive services.

Society needs more advocates to advocate for these services to prevent euthanasia/MAiD in Canada. In the absence of these services, there will be a spike in MAiD procedures. I hope this is not the measure of an effective MAiD delivery. The healthcare system should aim for low to zero MAiD cases. They should aim to increased funding for the above preventive measures.

Canada needs more compassionate community where people care for each other.

Bassam said...

Too sad HOSPICE BEDS MAiD EASY in the Fraser Health Region.

Iho said...

People who are considering MAiD should assert themselves to ask their doctor or nurse practitioner for a referral to a counsellor, mental health services/disability support services and community services before signing the request form
It is really sad that Fraser Healrh gives a reaource guide to those requesting for MAiD educating them that it is natural that people will hate the person requesting for MAiD. But Fraser Health do not have a patient resource guide for those consisering MAiD to educate them with information on asking for referral to see a counsellor, mental health profeasionals, social worker to connect the person to community support services

This is another case that those who develops patient education Resources in the health authority aim to educate those requesting MAiD but failed to create a resource for those considering MAiD. Those considering NAiD should have a resource guide with the information how to access alternate opriobs to alleviate paun and suffering. Too sad, doctors and nurses may not even had the time to look in the Fraser Health Guide for those requesting MAuD do not have the infoemation on alternate options. They have ignored that while the document says "requesting" the oatient education reaource assumed an approved request .

People who are contemplating MAiD deserves to feel they are loved and support are available such as counselling and not ro tell them it is natural that people will hate them for making a request. This is masking that feeling hated....this needs more counselling especially during a contemplative period.

It is really frustrating that the health authority promotes the nornaliry of being hated for those assisted by the health authority MAiD Coordination Centre.

Cwhite said...

I am a retired social worker and volunteers as a patient advisor in the BC Northern Health Authority, patient advisors are respected and heard by the patient education resource development team. One of the purposes they have explained is having the input or feedback of the advisors to be able to use plain language on info on the web.

I am surprised why Fraser Health used M! And M2, this is not plain lamguage. Not having what it means will confused the public .

The document that have the approved criteria includes some plain lamguage but was not posted on the website.

It remains a question, why the Fraser Health Authority CEO don't execute her executive power to have the full list of the approved hospice admission criteria on their website? People with chronic conditions based on the list should not be delayed for a hospice residence admission.The referral depends on the medical and nurse practitioners, we hope they will refer to hospice residences in the earliest eligible life expectancy of less than six months . If they are hesitant to tell the person of a life expectancy of less than six months, how cam this people apply for BC Palliative Care Benefit.
The Emergency Room admissions are on spike because one of the reasons is late palliative approach

Palliative care is not a care in the last three months of life . The integrated palliative care is not integrating MAiD and hospice care. The care outcomes of two are different. Hospice care values humanity and natural death. MAiD is never a "humane" killing by a doctor, even it is provided by licensed medical and nurse practitioner, it is still a physician/nurse practitioner-assisted-SUICIDE. Who performs it, those who betrays their oath to care. #carenotkill

Easineaux said...

The patient education materials they give to patients about MOST does not include the meaning of M1 or M2. Fraser Health is avoiding the term "natural death".

Very sad because the executive lead for Palliative Care Network who is not a licensed healthcare professional in a regulatory body for doctors and nurses uses the work Palliative Care Network but avoids the word "natural death" but actively promotes MAiD in all their resources on the Fraser Health website.