Staff who opposed MAiD faced ‘ethical dilemmas,’ withheld Fraser Health documents show

B.C.’s largest regional health authority has finally taken the wraps off unpublished documents showing the introduction of assisted suicide in Fraser Health Authority hospitals and residences sparked emotional concern and opposition among health-care staff. 

The documents, requested by The B.C. Catholic under a freedom-of-information request, show the implementation of euthanasia became “an emotionally charged issue” for clinical staff and caused “ethical dilemmas” among some care providers.

Assisted suicide in Canada was legalized in 2016 and introduced in hospitals and health-care residences under the term Medical Assistance in Dying. In 2020, The B.C. Catholic filed a freedom-of information request with Fraser Health after learning that some patients felt they were being pestered about the availability of MAiD.

After almost three years of delays, the health authority has finally taken the wraps off withheld documents (see below) showing administrators discussing the resistance that was growing among personnel and raising concerns it would have an impact on palliative care.

The documents don’t indicate, and the health authority hasn’t explained, why the information was kept secret for so long, whether it did anything to address the concerns, or whether staff opposition contributed to B.C.’s current health-care staffing shortages.

The documents relating to staff concerns date back to the years following euthanasia legalization in Canada, before the country’s law became the worlds’ most permissive in 2021 by extending MAiD eligibility to patients whose deaths are not reasonably foreseeable.

Eligibility criteria were scheduled to be loosened again in March with MAiD becoming accessible to those whose sole underlying medical condition is a mental disorder. However, federal Justice Minister David Lametti announced Dec. 15 the Liberal government would delay the extension in response to widespread concern from health-care professionals about the lack of safeguards.

Fraser Health’s release of new portions of heretofore secret documents is its third such disclosure since The B.C. Catholic filed its request for documents in March 2020 seeking information about how the authority developed and implemented its MAiD policies.

The request for information was made after The B.C. Catholic received reports of patients saying they were being persistently reminded about the availability of euthanasia. The authority responded 11 months later by releasing heavily-redacted policy documents showing that its official policy was for  MAiD to be a patient-led process.

Fraser Health released more heavily-redacted documents in November 2021, this time relating to in-camera meetings of its board and board committees. The records showed the board ignoring repeated requests from its own palliative-care team not to require hospices to allow assisted suicides on their premises.

Now The B.C. Catholic has received the latest batch of health authority documents. They comprise the same 131 pages released in 2021, but this time with fewer redactions.

The documents include minutes of the Aug 16, 2016, meeting of the Board Quality Performance Committee and include a summary of comments by then-CEL Michael Marchbank on the implementation of MAiD.

The  meeting, summarizing comments, about MAiD implementation, made by then-CEO Michael Marchbank, referred to as MM. The minutes read that Marchbank “noted that this has become an emotionally charged issue for our clinical staff. Fraser Health has an outstanding palliative care program and we don’t want to impact this. We also have one of the best ethics programs within Fraser Health. He recommended that we need to work through this issue with the assistance of ethics and ensure that everyone has a voice on this issue.”

Minutes of the June 13, 2017, board of directors meeting, which was held in-camera, include sections with updates on MAiD. One section reads, “It was noted that if we move forward with the recommended plan that there will be resistance both within and outside the organization through the transition period; however, we will serve the needs of individual patients who are eligible and entitled to this care choice.”

Minutes of the Oct. 17, 2017, board meeting contain this line: “There continue to be issues with some care providers who are having ethical dilemmas with providing this service [i.e., MAiD].”

The B.C. Catholic followed up on the disclosures by sending a series of question to Fraser Health’s media-relations offices, asking:

*What steps did the FHA take to deal with/respond to the staff discomfort and/or opposition to implementation of MAiD?

*Did this discomfort and/or opposition contribute in any way to the ongoing staff shortages that health facilities are experiencing?

*Why did the FHA not disclose this information last year, when it made its initial release of in-camera documents?

*Are there any new concerns being raised by health-care staff connected to any of the new developments regarding MAiD (including the broadening of access, and the looming broadening for mental disorder)?

Fraser Health had not responded by press time. The authority says on its website that it is the largest of the five regional health authorities in the province and is responsible for the delivery of health services to more than 1.9 million people in 20 communities from Burnaby to Fraser Canyon.

Alex Schadenberg, executive director of the Ontario-based Euthanasia Prevention Coalition, said in an interview he thinks it is obvious that Fraser Health’s delayed release of the documents shows fit wanted to underplay opposition it was receiving to its aggressive pro-MAiD policies.

“They were trying to hide the level of push-back they were experiencing because I think they didn’t want it to be seen as the big problem that it was,” Schadenberg said. “They wanted you to think they had everything under control and to marginalize public opposition, especially coming from the Delta Hospice Society.”

That society lost a protracted legal and political battle with the B.C. government to keep MAiD out of its hospice.

Dr. Kevin Sclater, a family physician who recently resigned over the “moral distress” caused by MAiD availability at the Port Moody hospice he worked in, said Fraser Health’s secrecy results from “the obvious philosophical disconnect” between palliative care and the “woke agenda” of including MAiD as an end-of-life option.

“Fraser Health should be embarrassed,” he said.

Sclater speculated that Fraser Health didn’t want “to air their dirty laundry,” even though it was already public knowledge that experts such as Dr. Neil Hilliard, then-Program Medical Director of the authority’s palliative-care team, opposed MAiD being available in hospices.

Hilliard ended up resigning in 2017 after the board mandated that the authority’s senior leadership had to support its policy of MAiD in hospices.

Release of the new documents comes at a time when Canada is under increasing international scrutiny for its permissive assisted-suicide policies.

On Jan. 8, England’s DailyMail.com published a story saying, “MAiD has now grown so popular that Canada has both anti-suicide hotlines to try and stop people killing themselves, as well as pro-suicide hotlines for people wanting to end their lives.”

The story also repeated the widely reported fact that some Canadians “are now seeking assisted suicide due to poverty and homelessness or mental anguish, as opposed to the traditional method of the terminally-ill seeking a painless death.”

The story also disclosed that two B.C. physicians, Ellen Wiebe and Stefanie Green, have performed a total of about 700 killings.

The website of B.C.’s Medical Services Commission says it pays $283.85 to doctors involved in assessing and carrying out MAiD, describing the service as “MAiD Event Preparation and Procedure.”

Catholics facilities allowed to reject MAiD ... so far

Canada’s leading anti-euthanasia activist says the day may be coming when governments try to force Catholic health-care institutions to provide euthanasia in their facilities.

Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, said in an interview he is worried that “conscience rights” allowing health workers to refuse to participate in assisted suicide are not protected by law. He noted that the House of Commons last October voted down a private-member’s bill aimed at giving health-care workers the right to refuse to participate in assisted killing, even indirectly.

Catholic teaching on the deliberate taking of a human life through euthanasia (mercy killing) or assisted suicide is clear: it is a “a crime against human life” and, therefore, is “intrinsically evil” in every circumstance.

Pope Francis has spoken often on the evils of assisted suicide. Last February, for example, he said at his general audience that society has to be careful not to confuse palliative care, which is properly aimed at helping terminally ill patients, “with unacceptable deviations that lead to killing. We must accompany death, not provoke death or help any kind of suicide."

Last September, the Vatican disclosed that Pope Francis had approved the publication of a formal Letter, by the Congregation for the Doctrine of the Faith, entitled “Samaritanus bonus (The Good Samaritan): On the Care of Persons in the Critical and Terminal Phases of Life”

The Letter states, “The uninfringeable value of life is a fundamental principle of the natural moral law and an essential foundation of the legal order. We cannot directly choose to take the life of another, even if they request it.”

Critics have characterized Canada’s Medical Assistance in Dying law – which since 2021 has allowed patients to access MAiD even if their death is not reasonably foreseeable – as the most permissive in the world.

No law exists, however, to compel health-care workers to participate in a deliberate killing of a patient. As well, nine of the 10 provinces do not compel a doctor, who refuses to assist patients in obtaining an assisted suicide, to refer them to a doctor who will provide the service. Ontario is the exception.

Port Coquitlam physician Dr. Kevin Sclater, who last autumn cited the “moral distress” caused by having to participate in a system that allows MAiD, as a reason for resigning his position at Crossroads Hospice in Port Moody, said in a January interview that a B.C. physician’s only relevant duty is to provide basic information about the availability of the procedure.

Schadenberg, who is Catholic, said, “I think there’s a big question of what’s going to happen to faith-based facilities in the near future. I get the feeling that it’s just a matter of time before they try to foist [MAiD] on faith-based facilities.”

The B.C. Catholic reported in May that the B.C. branch of Dying with Dignity had launched a campaign aimed at forcing Catholic and other faith-based health-care facilities to do just that—allow patients to undergo MAiD without being transferred to a secular facility.

Archbishop J. Michael Miller said at the time he did not think the campaign posed an immediate threat. “It’s only ideologues who push this and they don’t have the upper hand at the moment,” he said. “What’s going to happen in the long run is harder for me to discern.”

Schadenberg said he fears government authorities have already revealed their intentions by “forcing Catholic institutions to send [patients] for death.” He explained, that in B.C. and Ontario, for example, faith-based institutions, while not required to execute a MAiD request, must facilitate a patient’s transfer to an institution that will carry out an assisted suicide.

Providence Health Care, which operates 17 facilities, confirmed that is does facilitate such transfers.

Asked to provide details of its policy for patient-requested euthanasia, Providence’s media-relations office provided a link to the Fraser Health Authority’s policy on the matter.

The policy states that patients requesting MAiD should be “provided support in a non-judgmental way to ensure they are aware of all care options available to them, and they are provided with the wanted and appropriate physical, psychological, and spiritual supports to help address needs (suffering) that may underlie their expressed request and impact their quality of life.”

Facilities must ensure “inquiries or requests for MAiD are actively engaged in a timely manner and access to the lawful MAiD request process is not impeded.”

As well, “formal assessments for MAiD eligibility [are permitted to] take place at PHC sites if wanted by the patient.” Such assessments can be carried out by health-care workers provided by Vancouver Coastal Health’s Assisted Dying Program, or another health authority’s “MAiD Care Coordination Service” before the patient is transferred.

Timeline of The B.C. Catholic’s MAiD investigation

The B.C. Catholic launched its investigation into the development and implementation of Fraser Health Authority’s Medical Assistance in Dying policies after hearing from a woman in December 2019 that while she was receiving treatment for a serious illness at a Fraser Health facility she was pestered by staff about assisted suicide.

The woman said she repeatedly told nurses and doctors she was not interested in killing herself, but they persistently told her about the option, which became legal in Canada in 2016 and was further expanded in 2021 to include persons whose deaths were not reasonably foreseeable and to remove the requirement to offer palliative care.

The B.C. Catholic subsequently learned of other cases similar to that of the original complaint.

Here is a timeline of ensuing developments:

March 2020: Frustrated in its attempts to learn whether Fraser Health staff had been specifically instructed to urge sick and elderly patients to agree to assisted suicide, The B.C. Catholic files a freedom-of-information application asking for all records related to the development and implementation of its MAiD policies.

February 2021: In a pandemic-delayed response to the FOI application, the health authority releases 115 pages of broad policy documents, all of which indicate that MAiD is supposed to be a patient-led process. Fraser Health withholds reports, agendas, and minutes of board meetings dealing with MAiD policy on the grounds the meetings were held “in camera” and thus were closed to the public.

March 2021:  The B.C. Catholic publishes a package of stories under the heading, “Whose Dying Wish?” The main story, headlined “Patients being offered euthanasia contrary to Fraser Health policy, B.C. Catholic investigation finds,” said evidence showed the authority’s official policy of MAiD being a “patient-led process” was not being followed.

March 2021:  The B.C. Catholic files an appeal with the Office of the Information and Privacy Commissioner of B.C. seeking the release of the in-camera documents.

November 2021:  Before the hearing on the appeal is held, Fraser Health releases 131 pages of new, heavily redacted in-camera documents showing how the board ignored, dismissed, and downplayed concerns raised by senior palliative-care staff about a policy to provide MAiD in all its facilities, including hospices.

November 2021: The B.C. Catholic publishes a story based on those new documents headlined, “Secret talks, dismissed experts: documents show Fraser Health’s grim push of MAiD on hospices.” At the same time, the B.C. Catholic launches a further appeal with the provincial office, seeking to uncover more of the redacted in-camera documents.

May 2022: The Canadian Christian Communicators Association awards The B.C. Catholic a second-place prize for newswriting and an A.C. Forrest Memorial Award honourable mention for its March 2021 MAiD coverage.

June: 2022: The Catholic Media Association, representing Catholic media in North America, awards the B.C. Catholic first prizes in both the investigative-news and local/regional-news categories for its March 2021 stories.

November 2022: The B.C. Catholic publishes a story about plans of the Delta Hospice Society (which lost a fight with Fraser Health to keep MAiD out of its hospice) to establish a MAiD-free hospice.

December 2022: The B.C. Catholic publishes a story on the “moral distress” associated with the delivery of MAiD in a Fraser-Health-funded hospice and how it contributed to Dr. Kevin Sclater’s resignation from the facility.

December 2022: Fraser Health re-releases the 131 pages it made public in November 2021, but this time with fewer redacted parts. The new information (see main story) shows that in 2016 and 2017 Fraser Health was aware of continuing staff discomfort and opposition to the implementation of MAiD in regional facilities.

January 2023: The B.C. Catholic informs the freedom-of-information office it intends to continue its appeal to uncover still-redacted sections of the in-camera documents. A “written inquiry” under the Freedom of Information and Protection of Privacy Act is scheduled for Feb. 9.

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