Bruyère walks assisted dying ‘tightrope’

The Élisabeth Bruyère Hospital, a Catholic institution, is applauding The Ottawa Hospital’s decision to create a “regional care co-ordination service” for medical assistance in dying — and says it already considers Ottawa’s largest hospital to be a partner.

Since medical assistance in dying, known as MAID, was legalized last year, Catholic institutions have walked a fine line between patients’ legal rights and conscience rights. The Bruyère does not permit MAID on its own premises and its staff do not assess patients to determine whether they qualify for MAID. However, Bruyère has referred patients to medical assessors outside the hospital, and has allowed for some assessments to take place in the hospital on compassionate grounds.

“It’s a tightrope that can be walked,” says Dr. Carol Wiebe, Bruyère’s vice-president of medical affairs. “We look at it on an individual basis. If the patient is so frail that it would increase their distress, we have invited assessors in,” she said.

“I find by really focusing on the patient, there are a number of factors that make it easy to walk the tightrope,” she said. These factors include having outside partners like the Ottawa Hospital.

“It can be done sensitively while respecting our Catholic roots and the rights our patients have.”

When MAID became legal in Canada in June 2016, the legislation upheld the conscience rights of health practitioners to refuse to provide assisted dying. Catholic and other religious hospitals and long-term-care homes said they would not permit MAID on their premises.

Last fall, draft guidelines from the Catholic Health Association of Ontario, which represents Catholic hospitals, nursing homes and homes for the aged, discouraged conversations about assisted death in Catholic hospitals and urged that patients be transferred offsite for consultations.

Meanwhile, critics have argued that publicly-funded hospitals shouldn’t be allowed to opt out of providing MAID to patients who seek it.

Due to privacy reasons, Wiebe would only say the number of Bruyère patients who have accessed MAID is less than five.

Besides having a partnership with The Ottawa Hospital, Bruyère also has a partnership with the Montfort Hospital for assessing francophone patients.

Bruyère has also had discussions with the Queensway-Carleton Hospital.

Wiebe also declined to put a number on the requests for assessments from patients at Bruyère, but says these requests are not unusual.

“Our teams are fielding questions on a daily basis from patients and families,” she said. “We aren’t discouraging conversations, because they often provide a springboard to better understand any suffering.

“We are frank that we are not participating in assessments or provision of MAID, but in order to accompany patients on their journey, we need to be able to respond to their questions. We still transfer our patients out for MAID.”

Often requests for an assessment don’t lead to MAID. Many end-oflife patients have delirium and don’t have a clear mind necessary to make a decision, said Wiebe.

Late last month, The Ottawa Hospital presented a report on its experience to date with MAID to the Champlain Local Health Integration Network. While there are no definitive numbers of assisted deaths in the Champlain LHIN, which covers most of Eastern Ontario, the provincial coroner’s office reported between 61-78 MAID cases in the region as of June 30.

There are a number of factors that make it easy to walk the tightrope. It can be done sensitively while respecting our Catholic roots and the rights our patients have.

The Ottawa Hospital was the provider of MAID in 46 of these cases. Of these, 17 MAID deaths were in the community, including patient homes and retirement homes. The hospital’s medical team also provided 102 assessments.

The Ottawa Hospital’s chief of staff, Dr. Jeffrey Turnbull, says the regional care coordination service would use the knowledge and experience the hospital has gained to help patients navigate the system and help identify resources and gaps in the system.

It would also allow other hospitals, long-term care facilities, retirement homes and health care providers to coordinate their services.