Pandemic could block access to medically-assisted dying for some Sask. patients

Valerie Scrivener said Monday that if she could die that day, it would be a huge relief. 

"That would be wonderful," she said in an interview from her hospital bed. 

Hours later, after a long illness, the 74-year-old took her last breath after doctors provided a medically-assisted death.  

In the days before, Scrivener thought the hospital's conscientious objection policy — coupled with the COVID-19 pandemic — might prevent her from getting her wish of medical assistance in dying (MAID) to avoid a drawn-out, painful death.  

COVID-19 and conscientious objection

Scrivener was in the care of St. Paul's Hospital, a faith-based facility in Saskatoon that does not perform MAID for religious reasons. 

Usually people who want MAID and are in the care of St. Paul's Hospital have to be transferred to Royal University Hospital or City Hospital for the procedure, sometimes when they are in extreme pain or discomfort. They can also go home for MAID if they are not too sick. 

Scrivener was not able to go home, but COVID-19 had raised concerns about transferring patients. She and her family were told she may not be able to have the procedure at RUH because the hospital might not accept her transfer. 

"I felt devastated," said Scrivener of the moment she was told. 

The Globe and Mail reported Friday that at least two places in Ontario have stopped providing MAID because of the coronavirus pandemic. Dying With Dignity Canada confirmed Tuesday it is aware of MAID program cancellations and disruptions.

The Saskatchewan Health Authority confirmed there was a discussion about whether the transfer should be allowed. 

"This weekend, due to the ongoing situation surrounding COVID-19, health care providers worked together to confirm that existing processes were to be continued regarding MAID transfers in order to ensure the safety of all patients and staff in all our facilities," the health authority said in an emailed response to questions. 

"Ultimately, it was confirmed that these processes were to continue."

Any future decisions or amendments to policies on MAID would be made on a case-by-case basis.- Saskatchewan Health Authority

Scrivener was transferred across the city to receive MAID. She died late Monday afternoon. 

It is not clear if similar transfers from St. Paul's will continue to be allowed in the future. 

"As the health care system continues to prepare and respond to COVID-19, any future decisions or amendments to policies on MAID would be made on a case-by-case basis," said the SHA. 

Temporary solution at St. Paul's would be 'compassionate' 

On the day she died, Scrivener said she felt the policy that prevents St. Paul's from doing MAID for faith-based reasons seems "obsolete." She spoke with few words and was at times difficult to understand. 

Her next of kin, Erinn Timpson, said Scrivener had endured poor health for a long time.

Timpson said she accepts St. Paul's policy but believes it should be put on hold temporarily to ensure MAID is available to patients despite the pandemic. 

"The COVID-19 pandemic has made everything so very difficult and we are all finding ways to cope as best we can," said Timpson.

"It would be so compassionate if St. Paul's Hospital could designate one room to the provincial health authority so the procedure could be done without having the disruption of transporting such a frail and ill person as Valerie to another location. Valerie during her life put so much love out into the world. I think we can show her some love back."

Timpson said Scrivener's family and friends wanted her to have a calm, peaceful, respectful and dignified end of life. 

Although she hopes a solution can be found for the issue around MAID and transfers, Timpson said she and Scrivener's family and friends are very grateful for the care that Scrivener received from St. Paul's Hospital.  

'An anachronism' 

Ari Avivi, whose mom June Avivi died with medical assistance in September last year, is outspoken in his opposition to the St. Paul's policy. 

June was originally in the care of St. Paul's but was able to go home and arrange for the procedure to be carried out at RUH.

"The absolute hypocrisy of that coming from St. Paul's, it blows me away," said Avivi. 

"St. Paul's, of all the hospitals they present themselves as that centre of caring where they care for the soul as much as the body and what they're doing there is they're imposing their will on someone else."

Having witnessed the MAID process with his mom, and spoken to her about her desire to have MAID, he believes someone who is eligible for the procedure but cannot access it would feel "trapped."

"St. Paul's Hospital receives public funding the same as RUH and City," he said. 

"Particularly right now when we're in this incredibly diverse, multicultural society, St. Paul's is an anachronism." 

The SHA said in its statement that St. Paul's Hospital provides holistic palliative and end of life care, including spiritual and bereavement care, healing music and art therapy. 

"If someone is considering MAID, staff at St. Paul's will compassionately care for and support them as they make their decision and facilitate their transfer to a facility where that service can be provided."

Geriatric psychiatrist Dr. Lilian Thorpe, one of a few physicians who provide MAID in Saskatoon, said she was concerned when she heard RUH may not take a patient for MAID due to concerns about transfers during COVID-19. 

She said the pandemic could affect the availability of ambulances for transfers. 

"Ambulances ... might be considered infected if somebody was coughing there recently so we don't know from day to day what ambulances might be available and whether we can transfer and so on. So it's very difficult for our patients," said Thorpe. 

Compromise?

Thorpe said it can be painful for patients, such as a person with cancer in their spine, to be transported for MAID. 

She echoed the suggestion that St. Paul's dedicate a room at the hospital to the SHA so that MAID could be carried out on site. 

"I have always hoped that we could get to the point of developing some sort of compromise because St. Paul's is a wonderful facility and they really care about patients," said Thorpe.

"Could we not arrange some sort of compromise that we would be able to do this in a way that balances their responsibilities to their organizations with the needs of the patients?"

Patients across Canada worried about access

Dying With Dignity Canada CEO Helen Long said Scrivener's situation could have been avoided. 

"A publicly-funded institution should not be able to refuse to provide that service," said Long. 

"In the event that they were providing the service the transfer wouldn't be required." 

Long is aware that some Canadian hospitals have cancelled MAID due to COVID-19.

She said Dying With Dignity Canada has been hearing concerns from people who are worried the pandemic will stop them from accessing MAID.

"We're also aware that many dedicated providers are continuing to do their best to support Canadians and we would continue to encourage the provincial regulators and institutions and clinicians to continue to recognize the suffering of people who are waiting for medically assisted death and to do whatever they can to ensure remains accessible," said Long. 

She encouraged people who are considering MAID to put their wishes into writing.