Alberta legislation needed to address Covenant Health assisted-dying policy, says advocacy group

The Alberta government must enact legislation to ensure patients have equitable access to medical assistance in dying, including at religious-based health institutions that currently refuse to provide those services, the Friends of Medicare says.

“There has to be a clear position being taken by the government”: Friends of Medicare

Sandra Azocar, executive director of Friends of Medicare, says the Alberta government must ensure patients at all publicly funded health institutions — even faith-based ones — get fair access to assisted-dying services. (Rick Bremness/CBC)

The Alberta government must enact legislation to ensure patients have equitable access to medical assistance in dying, including at faith-based health institutions that currently refuse to provide those services, the Friends of Medicare says.

Last month, CBC News reported 66-year-old ALS patient Doreen Nowicki was forced to have her medical-assistance-in-dying (MAID) assessment on an Edmonton sidewalk in May 2017, after Covenant Health abruptly revoked permission for her to have it by her palliative bed. Nowicki's health was so poor she could no longer walk or speak.

The publicly funded Catholic health provider refuses to facilitate assisted deaths, saying doing so would violate the faith that underpins its medical care. Its default position is that patients cannot even sign the form requesting an assisted death, or receive MAID assessments by Alberta Health Services (AHS) staff, on its property.

When the federal government legalized assisted dying in 2016, the Alberta government, under Health Minister Sarah Hoffman, exempted Covenant Health from having to provide those services.

"Now we are seeing some of the areas that need to be addressed going forward in terms of ensuring that people have equal access to a perfectly legal medical service," Friends of Medicare executive director Sandra Azocar said.

"That is what the legislation needs to address, is whether or not institutions themselves have a right to basically trump patients' rights," she said.

Patient access to services "impeded"

Last week, CBC News revealed that in 2016 another patient, 72-year-old Bob Hergott, had to sign his form requesting an assisted death in a bus shelter.

Covenant Health, which operates the hospital where he had been a patient for five years, would not allow him to complete the document on its property. Hergott also had to leave the hospital for his assessments and for his medically assisted death.

The Catholic health provider can — and has — allowed on-site assessments by AHS staff in "exceptional circumstances" that take into account the medical fragility of the patient.

Its policy, however, is equivocal: Even if a patient is medically fragile and is unable to stop treatment or be transferred without risk of harm, Covenant Health still only "might" allow the patient to be assessed on its property. Ethics and legal experts have said Covenant's policy is inhumane and infringes on patients' rights.

Following the publishing of CBC News reports, Covenant Health said it is reviewing the language in its policy. The organization said since April 2018, all of its patients requesting MAID were allowed to sign their forms, and have their assessments, on site.

Alberta Health Minister Sarah Hoffman said she will be monitoring the review and will enact her own policy if she is not happy with Covenant Health's new policy. She did not commit to a further review by her ministry on patients' access to assisted dying services in religious facilities, including the procedures themselves.

But Azocar said Hoffman must take a clear stance on this issue, arguing Covenant Health cannot be trusted to properly address the problems with its policy.

Assisted dying decision 'very difficult'

"Institutions are deciding whether or not people can even use their facilities for services," she said.

The decision to access MAID services "is a very difficult, private time for people," Azocar said.

"And putting that onus on them to go somewhere else to even get an assessment, I think is a little bit inhumane and it needs to be addressed."

She said individual clinicians, like nurse practitioners and doctors, cannot be legally forced to provide MAID services, "but that shouldn't be the case around the institutions," which are publicly funded.

Azocar said a solution could be that Covenant Health allow non-objecting clinicians to provide those services on its property, so patients do not need to be transferred.

"Faith based institutions should not be able to interpret the law to the point where those Albertans who are seeking a perfectly legal public medical service are impeded from having equitable access," she said in a news release.

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