Critics of St. Boniface ban on medically assisted deaths 'disingenuous': ER doctor

The debate over a policy at St. Boniface General Hospital, one of only two locations in Winnipeg that offers palliative care, to ban assisted deaths appears to be far from over.

One emergency room doctor and medical ethicist argues it's "a little bit disingenuous" for people who have benefited for years from faith-based care to now criticize the hospital for its decision.

But a former chair of the St. Boniface board argues it's important that the hospital put the needs of the patient before the values of the institution.

Murray Kilfoyle resigned in protest after a June 12 vote that reversed an earlier amendment allowing assisted deaths in special cases. He said he thought of what he would want for his own mother if she were in palliative care at St. Boniface and wanted a medically assisted death, but would have to transfer to a hospital where it's allowed.

"It hurts me," he said. 

"It hurts me that a process is being imposed on them that they don't want, that they haven't requested, and that process is likely to cause them stress, burden, pain … that is not compassionate health care," Kilfoyle said Wednesday.

"The intent of the amendment was to say, in rare circumstances, if the medical team feels that a patient can't be transferred that the act would take place at the hospital."

The amendment was only overturned after the Catholic Health Corp., the organization which governs the hospital, added members to the hospital's board before a revote.

Patients at St. Boniface Hospital are now allowed to be assessed by the Winnipeg Regional Health Authority's medical assistance in dying, or MAID, team, but if they qualify for the procedure, they must be transferred somewhere else to receive it.

"Personally, I believe it's impossible for the medical practitioners to prevent that from being harmful, painful, upsetting, burdensome to the patient," said Kilfoyle. "I'm convinced of that."

He believes even moving a patient from one room to another puts stress on them, if they are sick and in pain.

That view is shared by Dr. Marcus Blouw, a former member of the St. Boniface board, who told CBC Tuesday he believes St. Boniface is violating charter rights with its new policy.

'Tremendous value' of religious organizations

Dr. Merril Pauls, a Winnipeg emergency room doctor and medical ethicist, argued what's missing from the ongoing debate is an appreciation for the great contributions the Catholic Church has made to St. Boniface Hospital.

"The conversations fail to recognize the tremendous value that religious organizations in general, and the Catholic Health Corporation with regards to St. Boniface, add to health care," Pauls said.

Records show the hospital brought in $15 million from "other income" last year, which includes donations from followers of the Catholic faith. For a point of comparison, the hospital received $352 million from the Winnipeg Regional Health Authority.

Pauls said his personal experience working at the hospital and seeing the care his relatives received there has shown it to be a compassionate place that treats patients with dignity — values rooted in Catholic traditions, he said.

"I think it's ironic, or a little bit disingenuous, that people will have benefited from that health care regardless of their religious affiliation for years and years [and] now suddenly become very upset."

Transfers common practice: ER doctor

Pauls, who describes himself as a member of a Christian church but not a Catholic, said patients are wrong to think they are entitled to medically assisted death at St. Boniface.

"I don't think it's true that people have a legal or ethical right to receive any specific intervention or care at any specific place," he said.

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Transferring patients from one hospital to another is a common practice in Winnipeg and patients who require medical assistance in dying are not unlike patients who, for example, require a special scope or test not available at their admitting hospital, Pauls said.

"There are other options, whether they are things like terminal sedation that can actually address concerns about somebody being too unstable or too ill to move," he said.

Kilfoyle, while not a doctor, thinks differently. One or two patients suffering in transit is one or two too many, said Kilfoyle, and those in their final moments who wish to end their suffering should be treated as an exception, and treated where they wish to die, he said.

He added the patients who are being transferred for the MAID service are some of the sickest and most vulnerable and are unlike other patients who might have to travel to another facility for a test or procedure.

And it's a decision based on religion — not the absence of a service or piece of equipment — that's forcing the patient to travel to another hospital to end their life the way they've chosen, he said.

Documents from St. Boniface say at least one patient has already died after being transferred from that hospital to the Health Sciences Center to receive a medically assisted death.

"We should be in the business of not harming patients and being compassionate with them. If we unnecessarily harm one patient, then that's not a good thing," said Kilfoyle.

"I'm not the only one that feels that way."