Hospital eyes lead role in assisted dying

In an effort to streamline services and help patients navigate a sometimes-daunting system, The Ottawa Hospital and the Champlain Local Health Integration Network are in talks to create a “regional care co-ordination service” for medical assistance in dying.

As the region’s largest hospital and an academic health sciences centre, the hospital has already taken the lead in medical assistance in dying since it became legal in June 2016. That puts the hospital in the position to offer guidance and education and help co-ordinate services, said chief of staff Dr. Jeffrey Turnbull.

“We believe we have a very effective model here. We would like to scale it up and work with regional partners,” said Turnbull. “We would like the whole region to have a comprehensive service. If there’s something we can do to provide compassionate, patientcentred care, we would like to do that. There’s a real need for people to understand the limitations and the opportunities and the need to provide respectful care.”

Having such a centre would not mean that everyone in the region who seeks or qualifies for medical assistance in dying would have it at The Ottawa Hospital. Rather, the hospital would share its knowledge with other health-care providers, Turnbull said.

In fact, he wouldn’t want the centre at the hospital because he wants to see smaller communities develop their own resources. A regional service would help patients navigate the system and it would help identify resources and gaps in communities. It would also allow hospitals, long-term-care facilities, retirement homes and other health-care providers to coordinate their services, as well as collect data to improve the system.

“We could be a support. This would be considered a co-ordinating centre rather than a care-delivery centre,” Turnbull said.

As it stands, The Ottawa Hospital provides the majority of medical assistance in dying assessments and procedures in the region.

While there are no definitive numbers of assisted death in the Champlain LHIN, which covers most of Eastern Ontario, the provincial coroner’s office pegged the number of cases in the region to between 61 and 78 cases as of June 30. (The number in Ontario is calculated per county. If there are less than five deaths in any county, the coroner will record these as “less than five” to protect the privacy of residents in jurisdictions with small populations — therefore the numbers are presented as a range.)

The Ottawa Hospital was the provider in 46 of these cases — between 59 and 75 per cent of all those in the region. Of the procedures provided by the hospital, 17 were in the community, including patient homes and retirement homes. The hospital’s medical team also provided 102 assessments, along with 32 social work assessments.

Another 43 requests for medical assistance in dying were processed by the hospital, but did not result in an assisted death. Some patients do not wish to proceed after gathering all the information, some lose their capacity to make the decision and are therefore ineligible, while others are so unwell that they die before receiving MAID, Turnbull said

In a report to the LHIN, the hospital noted that there have been many stories about patients who have had difficulty accessing medical assistance in dying. However, Turnbull said The Ottawa Hospital has no lack of providers and has recognized that supporting health-care workers on the medically assisted dying team is critical to maintaining a sustainable program. The hospital has even introduced “resiliency training” adapted from a model developed by National Defence, as well as support for families of patients.

“It is exceptionally rewarding but challenging,” Turnbull said. “We know it’s not for everyone. And we are sensitive to that. We don’t want to force anyone to be involved.”

Dr. Sanjay Acharya, the president of medical staff at the Queensway-Carleton Hospital, said his hospital already has a collaborative approach with The Ottawa Hospital when it comes to assisted dying. The Queensway-Carleton has taken referrals from The Ottawa Hospital when volumes were high. Assisted dying has been administered seven times at the Queensway-Carleton so far.

The informal physician network in the region is already very effective when it comes to referrals, Acharya said. “We are serving the local catchment area very well. That should equate to the region,” he said. “Anything we can do to make the system better is helpful.”

Shanaaz Gokool, the CEO of Dying with Dignity Canada, said hospitals in other large cities are also working to co-ordinate services. She applauds The Ottawa Hospital for offering to provide leadership in the Ottawa area, but says more than a year after medically assisted dying became legal, it still remains difficult for people to access information about who provides services and who doesn’t.

“The real question is why the provincial government hasn’t stepped up,” Gokool said.

Ontario offers the Care Coordination Service to connect patients with doctors and nurse practitioners who offer the services, but patients often find there are few providers on the list, Gokool said.

A spokesman from the Ministry of Health and Long-Term Care said four providers in Champlain LHIN were registered with the service as of Friday. The ministry does not have a list of hospitals that decline to offer medical assistance in dying.