Dr.

Tanja Daws
788 Grant Ave
Courtenay
February 6, 2017

Letter to the Editor

St Josephs General Hospital, MAiD and a community disappointed

As a physician who works at St Josephs, I am reminded of the hospitals pledge Care with
Compassion daily. It is displayed on the walls and the Strategic Goals and Objectives, outlining
compassionate care, are on posters in the elevators, stairwells and halls. The strategy
encompasses four areas: Quality, safety, innovation and people. I read these every now and
again, but have become more perplexed by them over the last few months.

It has been 8 months since patients were legally given the right to end their lives with Medical
Assistance in Dying (MAiD). I am humbled by being part of a patients journey as they face their
end of life. MAiD is the most intense, compassionate and hard work I have ever had to do. It is
ultimate care with compassion. I cannot understand St. Josephs stance on MAiD, even though I
myself am a Christian. We both have to answer to the second commandment Thy shall love thy
neighbour as thyself. Or as it is referred to in philosophy, the Golden Rule, or law of reciprocity.

How does St Josephs define care with compassion? Let us examine the goals and objectives of
Quality: Deliver outstanding care with kindness and compassion to those we serve and
Embed a person centered philosophy of care that brings excellence in care, dignity, meaning
and connectedness to the lives of our residents, patients and their loved ones. Patients can apply
for MAiD in hospital or hospice if their physician refers them and may have conversations with a
provider. They then have to be transferred elsewhere to receive MAiD - usually home, or to
another regional hospital, or nowhere, but we will get to that. It is neither kind, nor
compassionate, nor medically necessary. As doctors we transfer patients all the time. Critically ill
via helicopter or more stable via ambulance. The critical patients are at risk of dying if not
transferred. The more stable patients either need a higher level of care or a speciality not
available on the St. Josephs call roster. All these patients have good medical reasons for transfer
and can be maximally treated to ensure comfort. MAiD patients are different. They have no
medical reasons to be moved - in fact all in-patients requesting MAiD thus far needed to be in
hospital or hospice as their care needs overwhelmed what could be offered at home. The transfer
itself is a source of unfailing distress to patients and their families. They cannot receive the
medications that might be used for comfort in a normal transfer as these might make them so
drowsy that they lose capacity, the legal right to consent, which is mandatory at the time of
MAiD. Sometimes capacity is never regained once lost, so the right to MAiD is lost too. This
may result in their worst fears coming true - suffering more. There is no care other than the
MAiD provider and family after arrival at home. And some patients do not have a home to go to,
or a family. Imagine a death in a reclining chair in a large conference room, after hours, because
there is nothing better available. The transfer being physically and emotionally painful, draining,
stressful and in stark contrast to the peaceful spa-like hospice left behind half an hour ago. Does
St. Josephs care? Only that their assisted death was not at St Josephs. It is not how I would
interpret the second commandment.

Furthermore, Quality goals and strategies also include to Strengthen the continuum of care to
support timely access to services and smooth patient flow for all patients as well as Provide an
exceptional health care experience through development and provision of patient-and-family-
centered care. That is of no comfort to a patient who waited hours for an ambulance as a low
priority, to be sent home for MAiD. Knowing when death is coming, being prepared and then
having to wait hours, is sheer torture - both to the patient and their family.

Examining the goals of Safety, St. Josephs aims to Continue our journey of cultural safety for
all. We may have come a long way in terms of ethnicity, but St. Josephs lacks severely on
recognizing our culture around death. Those we serve is part of the greater BC population
where 87% of the population is in favour of MAiD and this included 81% of Catholics. Being the
only health care facility in the area (and publicly funded), at least until September, makes it clear,
St. Josephs serves doctrine, not the community. And the pressure may be less when the new
hospital opens, but the revamped St. Josephs facility and the Hospice patients will still be
shackled. And why would this be an issue you wonder? We have been in a situation where at one
point 50% of the Hospice patients had requested MAiD. This is not a small issue.

There are two more Goals to examine; Innovation and People. St. Josephs aims to Demonstrate
good stewardship of resources through enhancing our culture of accountability.
I honestly do not know what this really means, but here is what it does not: Suggesting
transferring a patient to Nanaimo or Campbell River hospital to have an IV inserted (and then
come back to the Valley) if the physicians feel they will not be able to do it themselves at home
due to technical difficulties. (Home and Community care nursing in our area do not do IVs). To
be exact we would not provide the instruments for MAiD is the official answer to a formal
request.
The People strategy includes Maximize the individual and collective capacity and talents of our
staff. Staff is not allowed to receive any formal MAiD training as employees, invitations for
education, or to even talk to patients or families about MAiD or prepare for their future jobs at
the new hospital where MAiD will be allowed. This includes nurses, pharmacists and clerks.
Startling as the thought may be at least 80%+ are supportive of MAiD as BC residents. Caring
for MAiD patients during the wait period and not being allowed to talk about it, dealing with
the distressed patient and family waiting for transfer, the patient at risk of losing capacity
overnight how is that compassionate care to the patient and family, or fair towards the staff?

The prognosis is grave. St. Josephs policy leads to the hospital abandoning patients who are
seeking MAiD at the time they most need care and compassion, just before their deaths. People
with already unbearable suffering, whose death is meant to be peaceful and dignified, are the
victims of dogma and one religions interpretation of what compassion is. And for what it is
worth, the patients I see for MAiD are not affected by my religion. What is important is what
they believe and hold on too.
Death and taxes are certain. May your loved ones have access to choice at the end of life and true
compassionate care in all its forms. May the Hospice move to secular ground.