The Comox Valley’s sparkling new North Island Hospital opens this weekend, resplendent with the latest medical technology and designed to inspire happiness and hope. It’s a joyous occasion.
But with every yang, there’s also a yin.
The bright new government-run secular hospital replaces all of the acute-care beds of the community’s original, 104-year-old St. Joseph’s Hospital. And, in doing so, it may jeopardize any future health care role for St. Joe’s in this community.
A parade of ambulances, taxis and other vehicles will transport current acute-care patients to the new hospital on Sunday, Oct. 1. When they’ve finished, only 125 residential, long-term care beds and four hospice beds will remain on St. Joe’s property at the top of Comox Hill.
And all of them are tenuous.
That should be alarming to Comox Valley residents because St. Joe’s has a grand vision to reinvent itself as a much-needed campus of care specifically for the exploding senior population. Within the next 20 years, the number of Valley residents over the age of 74 is predicted to double, and one in three will suffer from dementia and need long-term care.
St. Joseph’s General Hospital has served the Comox Valley for more than 104 years
St. Joe’s vision includes a dementia village, modeled after Hogewey in the Netherlands and others throughout Canada and Washington state. These self-contained housing communities allow patients to move around freely and safely.
And they would transform the whole 17-acre site into an “aging in place” hub of compassionate care services that would benefit the Valley in many different ways.
So what’s the problem?
After the federal government passed legislation last summer that legalizes and governs Medical Assistance in Dying (MAiD), some local citizens are challenging the appropriateness of locating publicly-funded hospice beds at St. Joe’s.
Physician-assisted death is a “hard no” philosophically for most Catholic health care providers, and the Diocese of Victoria, which assumed management of St. Joe’s in 1989, when the founding Sisters of St. Joseph of Toronto withdrew, appears to be no exception.
That meant that hospice patients at St. Joe’s, who might choose and qualify for physician-assisted death under Canada’s new law, would have to be transferred to another location for the ingestion or injection of life-ending medications.
A group of Valley citizens, called the Equal Access Committee, convinced Island Health to move the four hospice beds, and two more planned for this year, to another, secular location. So far, that hasn’t happened because there is no existing alternative facility.
In fact, it could be years before the government builds a new secular facility for hospice care.
If this were only about the small number of Comox Valley hospice beds, St. Joe’s vision for a cutting edge campus of seniors health care would not be threatened.
But the Equal Access Committee wants more. They have asked Island Health to also take away St. Joe’s 125 resident care beds. Residential care, they argue, is just part of a continuum that ultimately leads to end-of-life decisions, which should include physician-assisted death.
If the Equal Access Committee succeeds, St. Joe’s will have no longer have any health care role available to pursue. Who knows what the Diocese of Victoria would do then.
But it doesn’t have to happen here, and shouldn’t happen solely because of Canada’s MAiD law.
It’s true that social values have tipped toward acceptance of a person’s right to choose a speedier death, to end their suffering. And it’s also true that Catholic health care is rooted in their faith, which commits them to certain values and behaviors.
However, some Catholic hospitals in the U.S. have employed moral ethicists to reflect the reality that they must navigate both canonical and civil laws and guidelines.
But physician-assisted death has obscured the hospice mission, and confused many hospice workers and potential hospice patients. “Do we help you die well, or do we just help you die?” they ask.
The fact is, very few hospice patients choose physician-assisted death. According to a Vancouver Island case review published last month in the B.C. Medical Journal, only 2 percent of total deaths recorded during the six-month study period were medically assisted.
Almost two-thirds (64 percent) of those 72 assisted deaths took place at home, and another quarter (21%) occurred in acute care hospitals. Only 12 percent or 8 assisted deaths took place in hospices, and only 3 percent or 2 assisted deaths took place in residential care facilities. These are Island-wide statistics.
Those numbers may grow in time, but it’s clear that the percentage of eligible people choosing physician-assisted death will remain small. For one thing, it’s difficult to qualify under the new law; natural death must be imminent.
So does it make sense to say all the good tenets of compassionate care for the elderly (including care for the body, mind and spirit regardless of the ability to pay) should be thrown out the window because of a physician-assisted death provision that only a few will qualify for and use?
Isn’t removing residential care beds from St. Joe’s akin to throwing out the old folks with the bathwater?
Shouldn’t palliative care be an effective alternative to assisted dying, one that makes MAiDs unnecessary except in the most extreme circumstances?
An issue that affects so few people should not overshadow and deny St. Joe’s the opportunity to create an innovative respite for the one-in-three of us who will eventually suffer from dementia.
Island Health has made its decision on locating hospice beds. The community should now support St. Joe’s retention of The Views, its residential care beds and the addition of 70 more, which is essential for them to fulfill their vision for a community campus of care for Comox Valley seniors.
And, for those who will want access to MAiD services, we should work together to create space for that alternative — but without jeopardizing the vital new services for the elderly that St. Joe’s has the potential to provide.
I can understand how some people feel MAiD is not an important issue to them. It wasn’t on my radar screen. However, after the way my mother died, this all changed for me. She died a few months before MAiD became law. She was in a lot of pain and asked me to put a pillow over her head and kill her. I went home had a big cry and concluded this could not be my last act with a woman I dearly loved. I watched her shrivel up eventually getting water in her lungs. I was in charge of her “Living WILL,” tried to make things as comfortable as possible for her but it was still a horrible experience/death for my mother, a women who was so feisty and independent.
Even though she had deep roots in her religious faith, if she had access to MAiD, I am positive after our talks she would have chosen this path. She was ready to go and did not want to be a burden to our medical system. Now that MAiD is here, I have committed to make sure it is available to everyone in the Comox Valley.
If The Catholic Church allowed MAiD like other faith based extended care facilities have done, I doubt we would be having this dialogue. But they won’t so here we are. Fortunately we have a new secular Hospital. The issues at hand are the proposed Island Health 70 bed extended care facility and “The Views” which represents 32 percent of all extended care beds in the Comox Valley.
In this letter I want to focus on The Views. Both myself and my spouse have volunteered at extended care facilities including The Views and we know how hard the staff works at making life the best they can for the people staying there especially with funds per bed becoming tighter during the time the Liberals were in power.
No one in the Comox Valley wants The Views closed throwing the people living there out on the street, reducing the amount of extend care beds in the Valley, and putting the employees out of work. But the issue is, The Views will have to close sooner than later because it was built under The Hospital Act. It doesn’t qualify under the Community Care and Assisted Living Act. Plus the Dec 2014 report by Lowe Hammond Rowe Architects, states it does not meet the earthquake safety requirements. A major rebuild is required. After almost 3 years with nothing done to assure the safety of the people staying there, if an earthquake happens and people are harmed, this is a class action lawsuit waiting to happen.
It is my hope and the hope of the strong majority in the Comox Valley who support MAiD that before the closure happens, one of two choices will occur:
1. The Bishop of Victoria who owns The Views and the land it sits on, gives the land to Island Health so a new secular facility can be built. In 1998, the Bishop of Victoria lost $17,000,000 to bad real estate deals and breeding Arabian race horses. He was relieved of his duties by The Vatican in 1999. The new Bishop had to sell assets and take out Bonds to keep the dioceses a float. With the financial state the current the dioceses is in, I doubt the Bishop would give the land to Island Health even though one would think he would be grateful taxpayers money in the amount of $3,200,000 is paying to tear down St. Joe’s Hospital. In his blog, the Bishop has referred to MAiD as a “dark and dangerous time.”
2. The other choice Island Health has is to find a secular location for a new facility ensuring the Seniors at The Views have a safe place to live, the staff from The Views are able to keep their jobs and MAiD access is available to all who wish to choose it.
I have heard (who hasn’t) of this conflict.
It hit me and mine more in several recent years. It’s amazing how personal experiences make decision making clearer and more necessary.
I respect both beliefs with one reservation. The end I choose should not cause grief or pain. Death is assumed there. Death is the only one that cannot be avoided.
No person is entitled to choose the when or where or how of another person’s death.
George, I wonder if you could elaborate on your opinion that we’d be throwing the baby out with the bathwater. There are other service providers equally compassionate and cutting-edge as stated in my previous post.
All 117 residential care beds at the Views are publicly funded through Island Health along with up to 80% of each resident’s personal income. Our community has been allocated and funding supplied for 374 long-term residential care beds with an additional 70 new ones approved by Island Health. This allocation that would not change if residential care services were moved from the Views. The church itself contributes nothing financially other than the land.
The Views currently operates under the Hospital Act and must be completely rebuilt to meet the stricter regulations of the Community Care and Assisted Living Act and the Residential Care Regulations. Why would Island Health not use this opportunity to seek a secular provider should the Catholic Church sticks to its “hard no” dogma and should it refuse to create space for MAiD. RC MAiD policy requires the resident to transfer to another facility for even an exploratory discussion of MAiD. This seems to be standard practice across the country in all RC institutions — finding a middle ground then could be difficult.
It’s not only MAiD that this particular Christian denomination is set against – they are also a no to same sex marriage and to transgender rights. Such is not the case with other Christian religions.
As John said in an earlier post a complete view is required – one would hope that Island Health, as the responsible organization for delivering these services, is doing just that.
Equal Access has had four goals since its inception in May 2017. Firstly residential care and hospice care is available from secular institutions where those desiring access to MAiD would be able to do so without encountering faith-based restrictions or transfers imposed by the institutions providing the care. Secondly Glacier View Lodge assets should not be transferred to a faith-based institution. Thirdly any new residential care beds created in the Comox Valley are granted to a secular institution and finally, hospice beds be located together in a secular site.
These four goals were clearly listed on a petition supported by 2869 signatures which was submitted to Island Health and to the new Minister of Health in early September. The continuum of care argument was not one of the eight arguments submitted with the petition as claimed nor did the submission specifically ask that the Views beds be “taken away”.
The arguments presented were based on an individual’s Charter Rights, accessibility and equality rights under the Medicare Protection and Canadian Health Care Act, the lack of legislative support for institutional conscientious objection, the impracticality of transfers, the future expansion of MAiD eligibility, our community demographics, contemporary Canadian public policy and finally, current BC Government priorities. The complete submission which expands these arguments is accessible on our web site at http://www.equalaccesscomoxvalley.ca.
There is no need for our community to jeopardize delivery of vital residential care services in order to have a service provider that fully supports all aspects of current Canadian rights and freedoms. Five organizations had responded to Island Health’s request for proposals for 70 additional residential care beds operating in a Community of Care model — four of those were secular organizations.
Jenny Steel
Equal Access Comox Valley
Hi Jenny — Thanks for your comments. I attended the EAC’s community meeting at the Comox Recreation Centre last summer and have in my notes that both the MC of the meeting and the MAiD providing doctor referenced continuum of care as a reason why residential care beds should be located in secular facilities.
Your figures are out of date, which is understandable as MAID is new. The current proportion of deaths on Vancouver Island that are by MAID is 4%, not 2%, as of June. This is already the same as that in the Netherlands, where MAID has been practised for over 20 years. It is a matter for celebration that so many people have been able to avoid intolerable suffering in this way. The proportion is likely to rise further.
The prohibition of MAID at St Joseph’s caused great distress to patients (who had to be moved, often in pain), their families, and to staff who hated having to transfer out patients whom they had been caring for; they wanted to continue to do so, including the provision of MAID. It is particularly instructive to note that the staff of the hospice are, based on my conversations with as many of them as possible, strongly in favour of MAID and disapproving of the hospital’s stance. People should not have to move away from their home for treatment that is easily available in their own home; a long term care patient’s home is the facility in which they reside. They certainly should not have to do so because of the religious beliefs of their landlord. (A banal but entirely reasonable question: should a young renter be disallowed from taking the birth control pill because her landlord is a fervent Catholic?).
Until last week it was the intention of Providence Health Care to receive the Glacier View Lodge site ($12 million) in what would effectively have been a donation as part of a merger (acquisition). Given that this Catholic health care organisation has clearly accepted the principle that sites can be given away to other organisations it seems to me, in this community that is so secular (and furthermore only 12% Catholic), that the Catholic church should give the site to a secular organisation – likely Island Health – so that an elder care campus free from religious dogma can be built.
The new campus will probably stand for decades. The government of Canada is currently examining “Advance Requests” for MAID. Even if this is not made legal straight away it is very likely to occur in time as about 80% of Canadians support it (Ipsos Reid poll). I am currently asking all of my patients over the age of 75, as a routine part of discussions around their wishes for end-of-life care in the future, whether they would wish me to bring up MAID if I thought it appropriate because of their condition at that time. Over 85% want me to do so and the two main reasons they give are pain and their wish not to die suffering in a long term care facility. A change in the law would certainly see an increase in the proportion of deaths in long term care facilities that occur through MAID when a patient’s health representative is able to request MAID on behalf of their loved one who declared that this is what they wished if they were to develop intolerable suffering after they had lost capacity.
Finally, I am a strong supporter of good palliative care. I have a very elderly practice and provide a lot of palliative care. But palliative care is not a complete answer. There are patients who suffer severe physical pain at the end of life despite the best efforts of their physicians. And there are patients whose pain at the end of life is predominantly psychological or existential and for whom palliative care is not sufficient.
Jonathan Reggler
MAID provider
Jonathan — My figures come from an article in the August 2017 edition of the B.C. Medical Journal, which lists you as a co-author. It’s titled, “Case Review of Medically Assisted Deaths on Vancouver Island.” That’s the most recent publicly available data I could find.
I quote from the article, “Results: In the 6-month study period (Decafnation note: first 6 months of MAiD), 72 assisted deaths (37 male, 35 female) occurred in patients ranging in age from 49 to 96 (74.75) years. Assisted deaths made up approximately 2% of the total deaths in that time and took place at home (64%), in acute care (21%), in hospice (12%), and in residential care (3%).
Also, according to other data I have obtained, since the MAiD law came into effect, more than 119 patients have moved through the St. Joesph’s hospice, and only two have been transferred out.
I always have difficulty crediting a statement like : It is particularly instructive to note that the staff of the hospice are, based on my conversations with as many of them as possible, strongly in favour of MAID and disapproving of the hospital’s stance.
You are speaking for the staff? The staff can speak for themselves.
I too was working in a professional job where an outside consultant stated that about us. Don’t know whom he talked to but he never spoke to me. I stated that fact in the staff room. Four voices chimed in with me.
Please Mr. Reggler, just speak for yourself.
George has this bang on and we better be quick about it as the retired population in the Comox vValley is rapidly expanding!
This from a rapidly aging former Medical Director and Chief of Staff at St Josephs.
Thanks, Don. I agree, and would like to enjoy the freedom of movement that such a facility would offer.
Thanks for your excellent article. I totally agree and support your position re: St. JOE’S
I’ll ask my husband if this is true. I don’t think drip lines have a religious component! I would say that having chaplains and spiritual support for all faiths is an important component of faith-based care. St. Josephs has also done a lot to work with First Nations on their special view of health care provision. There’s more to health than the physical and this is where St. Joseph’s excels: attending to the needs of the whole person. This is why they developed their award-winning transition unit for frail seniors no longer needing acute care and were able to greatly increase the mobility and mental health of this population to the point where fewer need to go into extended care.
I’m curious as to other idiosyncrasies (if that’s the right word) at St. Joe’s. A few years back a family member was hospitalized at St. Joe’s, rigged up with the usual driplines, then transferred to a secular hospital in Victoria. All the lines had to be swapped out because the Catholic system’s equipment is incompatible with that of the secular system. (There’s a joke in there somewhere but I’m not going digging for it right now.) This isn’t of the same moral magnitude as the MAiD issue, obviously, but it begs the question: in what other ways is healthcare in the Catholic system distinctive? Having a more complete view of what’s involved and implied by the continuation of St. Joe’s in this role is probably needed.
All Catholic run health institutions must follow the Health Ethics Guide published by the Catholic Health Alliance of Canada — available for $20 per shipping from http://www.navalis.ca. It’s an interesting read — all 162 pages of it. The index can be seen here http://chac.ca/resources/ethics/ethicsguide_e.php — this gives a good idea of the areas where Roman Catholic healthcare is distinctive.