The Nipissing Serenity Hospice is in the middle of an ethical battle with a small group of doctors within the city of North Bay.
Dr.Mike Leckie is part of a four-doctor team that provides Medical Assistance in Dying, or MAiD within the city of North Bay.
However, the new local hospice has decided that assisted deaths within its walls are not part of its mandate.
"It does not fall within our position," said Vivian Papaiz, Chair of the Board of Directors at the Nipissing Serenity Hospice.
"Palliative Care sees dying as a normal part of life and we want to help people to die well and I think we say that in our statement. They do not want to hasten death, that is not what we are about. That is what MAiD is about, but that's not what we are about."
Papaiz says the board looked long and hard at the situation. They also looked for guidance on the subject matter from both the Canadian Hospice Palliative Care Association (their national association) and the Canadian Society of Palliative Care physicians.
"They feel MAiD is not part of the tools that we need in a hospice," she said about the two organizations.
Leckie along with local physicians Dr.Paul Prestion, Dr.Renee Gauthier and Dr.John Seguin who make up the local MAiD group, recently sent a letter to the hospice expressing their disappointment over the decision.
(See the letter below)
Leckie says since 2016, they have done more than 100 assisted death services in the region.
"We have done them very quietly, very efficiently and with no issues," Leckie told BayToday.
He says all they are doing is advocating for their patients.
"This is a very philosophical, moral and ethical question," said Leckie.
"I don't want to change peoples morals or ethics, I just want them to look at this as to why this cannot be an option in our hospice."
Leckie says he is only speaking for the MAiD doctors on this subject and not the entire medical community.
"We are all for palliative care, we do palliative care but it does not always work and if somebody is in that hospice and the palliative care that they are receiving is not working or they decide they do not want to proceed anymore with this, we hate to have them have to be moved back home or back to the hospital to access a medically assisted death," he said.
He believes MAiD services will also help families at the hospice during this stressful time.
"More often than not we are treating the families of these patients just as much as we are treating the patient," he said.
"So the stress and anxiety it would cause somebody to be in our hospice and not be able to access an assisted death and have to be moved we really like to use the word 'unconscionable' to think we would have to treat a patient like that."
However, Papaiz notes that a majority of hospices in Ontario do not allow assisted deaths either.
She noted that MAiD services are accessible in the area but not at this hospice.
"There is lots of opportunity in our community for citizens to access MAiD," said Papaiz.
"They certainly can get it at the hospital, they can take advantage of it in their homes and certainly long term care. There are minimal barriers for that."
Papaiz says that she will share the MAiD letter with the board at the upcoming meeting.
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On January 24th we sent in the letter below to the Board of Directors at Nipissing Serenity Hospice, as well as major stakeholders.
The four of us are speaking out to advocate for people who cannot speak up for themselves.
Bottom line: even if you don’t believe in MAiD, everyone should have the right to chose this option if they want, regardless of what building they are in.
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January 24th, 2020
To: Nipissing Serenity Hospice Board of Directors
Re: Forced Transfers for Medical Assistance in Dying (MAiD) Provisions from the Hospice
Dear Board of Directors,
We would like to congratulate you and the Nipissing area on the opening of the Nipissing Serenity Hospice. It was a long time coming for a well-needed service for our community.
As the MAiD Providers in this area, we must inform you that we are very disappointed to read your position to not allow MAiD provisions to be performed at the Hospice. We absolutely disagree with you that MAiD “is not one of the tools in the palliative care basket”. It is in fact a tool - a very special, humane tool that thousands of Canadians have accessed and the Canadian government, under law, has permitted. We have worked exceptionally hard to standardize the referral, assessment of the individual patient, and the provision of MAiD to allow it to be done professionally and respectfully in all environments of our community (private residences, retirement homes, long-term care facilities, and the hospital). We have followed the rules and guidelines to the letter, as would agree the chief coroner in Toronto, whom we report to after every case. We are all local family physicians that have over 100 years of clinical experience between us. We have provided palliative care to our own patients for many years, will continue to do so, and are pleased to know we now have the Hospice to help in that regard. The four of us pride ourselves on being compassionate physicians that understand, respect, and try our absolute professional and personal best to provide compassionate end of life care to our own and other physicians’ patients in our community.
We want to prevent the inevitable experience this will cause for patients and families such as a patient who has cancer with metastatic skeletal disease and is in horrible pain despite excellent palliative care. They request MAiD and they are referred to us (as all physicians and nurse practitioners are required to by law). We would assume that based on your decision to prevent MAiD in the Hospice, that the patient who is already in excruciating pain, would then have to be transferred out of the Hospice for the actual MAiD provision. Imagine both the mental and physical suffering of heaving this patient from their bed to an ambulance stretcher, to then be jostled down the roads to the hospital or their home, to then be unloaded and rolled into another building. All the while those pathological fractures would cause excruciating pain from all the movement from the transfer. What a disrespectful and horrible end to someone’s life. The amount of pain and stress for the patient and their family to go through such a transfer would be incomprehensible, barbaric and unethical. Your Mission and Vision use words like “peaceful setting, and timely manner”. There is nothing peaceful, or timely when you are forcing a dying patient to leave your facility to access something every Canadian has a legal right to have, especially when the building in question is publically funded. We believe this to be unconscionable. We can only imagine any patient and their family would also agree.
The Nipissing Serenity Hospice supports the Canadian Hospice Palliative Care Association (CHPCA) and the Canadian Society of Palliative Care Physicians (CSPCP) joint statement in their clarification of the relationship of hospice palliative care and MAiD. Allow us to suggest you not think about the CHPCA and CSPCP and think for yourselves. Think about the people of Nipissing area. We are a relatively small community that supports each other, respects each other, and would do anything to help each other, especially with end of life care. We also suggest that the community be engaged and see what their position is on a publically funded facility that denies MAiD to patients in Hospice Care.
Please note we have absolutely no intention of taking over the Hospice and making it a “MAiD centre”. We suspect there will be very few Hospice Patients that will end up requesting MAiD. In fact, the statistics show that many patients that request MAiD end up dying before the provision. We can all confirm that the most comforting feeling a patient has after signing their consent, even if they don’t reach assisted death, is a sense of peace knowing that they are in control and can choose a dignified, painless death.
Make no mistake; MAiD is a very special, rarely used tool in that palliative tool basket you mention. We are the four physicians trained to use that tool and we know we can work with you in the most troublesome times, to make sure every person (and their loved ones), in every scenario has the most professional, peaceful, and least stressful end of life. In the end, we are all working towards the same goal: Advocating for our patients to have access to dignified and peaceful deaths.
Given that North Bay is the most active pro-MAiD community in the province of Ontario and the people overwhelmingly support MAiD as an option, we respectfully request that you immediately reverse your policy to respect the patients’ right to access MAiD in our community’s publicly funded Hospice.
We have copied our letter to our physician colleagues, the Hospital Board, the Mayor of North Bay, our MP, our MPP and the news to inform all stakeholders in our community exactly our (the MAiD provider’s) opinion of your current position of not allowing MAiD at your facility.
We look forward to your reply and more importantly, meeting with you to come up with a better resolution to advocate for our patients.
Yours Truly,
Drs. Mike Leckie, Paul Preston, Renée Gauthier, and John Seguin
