Why you can't get a doctor-assisted death at St. Joseph's in London

Despite being allowed by law in Canada, patients at any St. Joseph's Health Care London facility must go elsewhere if they want a medically assisted death.  

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In June of 2016, Parliament passed Bill C-14, which lays out the rules that allow doctors and nurse practioners to legally end the lives of patients who are suffering and whose deaths are "reasonably foreseeable."  

Faith-based exemptions

Doctors and faith-based intuitions in Ontario that object to doctor-assisted death for religious reasons can't be forced to perform any procedure that helps a patient die. 

As a Catholic intuition, St. Joseph's won't allow medically assisted deaths to happen at its facilities, which include the main hospital, the Mount Hope Centre for Long Term Care (394 beds) and the Parkwood Institute's Main Building (14 palliative care beds and 156 long-term care beds). 

Medically assisted deaths are also not an option for patients at St. Joseph's Hospice on Windermere Road, a 10-bed facility not affiliated with St. Joseph's Health Care London. Staff told CBC News this is made clear to patients when they're admitted.

So what do hospitals that won't provide a medically assisted death do when patient asks for one? It's is a tricky business. 

No assisted-death consultation at St. Joe's

The Ontario College of Physicians and Surgeons requires its members to provide an "effective referral" when patients ask for a medically assisted death. That includes doctors who work at faith-based institutions. Some Ontario doctors opposed to medically assisted dying have refused to provide such referrals.

• Ontario doctors challenge policy forcing referrals for medically assisted dying

At St. Joseph's, policy requires staff to discuss with patients all their care options. Patients are also presented with a brochure that says "As a Catholic intuition, medical assistance in dying will not occur at any St. Joseph's location."  

St. Joseph's CEO Dr. Gillian Kernaghan said hospital staff first try to see if they can address what's causing a patient to request a medically assisted death. But what if a patient insists on having it as a care option?

"We would arrange for them to have a consult with somebody who can provide more extensive end-of-life options including medically assisted dying," she said. The doctor consultations patients must have to get a medically assisted death also can't happen at St. Joseph's.

Patients not aware of 'faith-based' rules 

To Dr. Scott Anderson, this is a problem. Anderson is a London-area doctor who has helped about 40 patients die in the past year. He feels the current law is too restrictive, and said the faith-based exemption leaves patients at risk of a bad outcome.

He said in some cases, patients unknowingly end up in care facilities where they can't get a medically assisted death. Anderson also said patients in pain with a terminal illnesses should not have to to endure a transfer to get a medical procedure that is no longer in legal limbo. 

"If the patient can be transferred to their home I'm willing to go to their home," he said. "But sometimes the reason they're in a hospital is that they're too ill to be in the home, so it's a real Catch-22 and that's not the way this should be."  

Kernaghan, however, said patient transfers from St. Joseph's facilities for doctor assisted deaths are "very infrequent." A statement on St. Joseph's website spells out the policy and says their staff will respect a patient's choice. Kernaghan also pointed to St. Joseph's strong track record of providing "excellent" end of life care.

Shanaaz Gokool of Dying With Dignity Canada says the policies of hospitals like St. Joseph's undermine the notion of universal health care.

"We're against facilities that are publicly funded opting out of what is basic health care," she told CBC London. "Transferring people in and out of those facilities can result in physical harm at the most vulnerable time in their lives."

Both Gokool and Anderson admit these are early days for legal access to medically assisted death. Anderson expects there will be more court challenges, including another Supreme Court case, to clarify some of the questions.

Despite the uneven access and legal questions, Anderson said he'll continue to help patients end their lives.

"When patients have had a peaceful death that has been what they envisioned with the people who love them around them, it's going to get out and the community will realize this is not the taboo procedure that they thought it was."

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