After hospital transfer, Valley must confront moral issues

After hospital transfer, Valley must confront moral issues

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.