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What happens when a hospice rejects medical assistance in dying?

Old man lying in hospital bed holding daugher's hand
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You might think the middle of a global pandemic is less than an ideal time to disrupt the operations of a hospice where palliative care patients receive comfort as they approach death.

If so, you would not share the apparent thinking of the B.C. government or its local Fraser Health Authority, which is forcing layoffs at the Irene Thomas Hospice in suburban Vancouver. The dismissals are part of the eviction of the Delta Hospice Society that oversees the facility.

Hospice society board president Angelina Ireland has confirmed that pink slips have already gone out because the society refuses to administer medical assistance in dying (MAID) on its premises. As of Feb. 24, the society will have to relinquish the palliative care centre that it raised $9 million a decade ago to construct on Fraser Health Authority land. Its 35-year lease on the property will be nullified and its other assets expropriated, Ireland says.

She is adamant the takeover has nothing to do with the hospice society wanting to prolong the debate over the legality of MAID in Canada. It accepts the 2016 change to the Criminal Code that legalized the administration of toxic injections by health-care professionals to end patients’ lives.


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But the society’s legally-registered constitution bars it from administering MAID in the 10-bed hospice. And nothing in the law requires a change to that constitution because nothing obliges the provision of MAID anywhere, anytime for anyone who requests it.

As Ireland points out, MAID is readily available for all who seek it at a hospital barely 100 metres from the Irene Thomas Hospice. The centre has also accommodated MAID-seeking patients by transferring them home or to hospital. Of the approximately 1,000 palliative patients cared for at the facility over the past decade, “three or four” have requested MAID, she says.

“This is about the B.C. government destroying a sanctuary for dying patients who want the choice to stay in a facility where MAID is not offered,” Ireland insists. “They are being disenfranchised by the very system they pay for.”

At the very least, it seems to be about an ideology flourishing within governmental circles, as well as in the minds of many MAID proponents, that giving fatal substances to the dying must be an always and everywhere practice in Canada.


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The society was founded 30 years ago to provide end-of-life care and since then has been hailed as an exemplary organization for its adherence to palliative principles. But in 2017, nine months after federal legislative change, an edict went out from the B.C. government ordering all palliative and hospice centres, excepting those that are faith-based, to provide MAID.

Pushback was substantial. Delta Hospice Society representatives met with officials from the local Fraser Health Authority and explained their predicament: society bylaws banned MAID and to adhere to the government order would put it in violation of its standing under the provincial Societies Act.

The issue remained in equilibrium-preserving bureaucratic limbo until 2019, when agitation by local MAID activists coincided with change in the bureaucracy. The result was a comply-or-else order, which the society countered by offering to forego half its publicly-funded operating capital – $750,000 – in order to be considered a private facility. Doing so, it believed, would relieve it of the purported obligation to provide MAID.

The offer didn’t even get the courtesy of a reply. Instead, the society received a one-year notice of eviction for allegedly having breached its service contract with the local health authority. Months of court action followed until, immediately before Christmas, the eviction notice was reinforced with an order that the society vacate its building and cease overseeing the Irene Thomas Hospice by the end of February.

No one seems to know exactly what will happen to those laid off. There’s talk of some kind of transition to a facility where MAID will be on tap 24/7.

And in the midst of a pandemic, political, bureaucratic and activist advocates of MAID ubiquity will have forced a small suburban palliative care centre to bend to their will. Even as COVID-19 death rates soar, the dream of having a sanctuary for authentic palliation will have died.

As Nancy Macey, Delta Hospice Society founder and former Irene Thomas Hospice executive director, puts it: “The society has done all it can to have discussions with Fraser Health. It has done all it can to follow its service agreement and the required legislation.”

You might think in Canada that would be enough. Think again.

Peter Stockland is senior writer with the think-tank Cardus and editor of Convivium.

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Peter Stockland

Prior to joining Cardus, Peter Stockland was vice-president of English-language magazines for Readers' Digest Magazines Canada Ltd. He was also a former editor-in-chief of The Gazette newspaper in Montreal, a former editorial page editor of the Calgary Herald newspaper. He's worked as a journalist throughout Canada during a 30-year career in the media.

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