CBC Investigates

New Covenant Health policy on assisted dying still 'unacceptable,' critics say

Covenant Health’s revised policy on medical assistance in dying will still allow patient suffering, critics say.

Critics call for Health Minister Sarah Hoffman to impose policy on Catholic health provider

Sandra Azocar, executive director of Friends of Medicare, says the revised policy on medically assisted death from Covenant Health contains ambiguous language. (Rick Bremness/CBC)

Covenant Health's revised policy on medical assistance in dying doesn't go far enough to ensure terminally ill patients will not suffer, critics say

"They are still allowing barriers to be there when it comes to accessing a legal service," Friends of Medicare executive director Sandra Azocar said Monday after reviewing the policy.

The Catholic health provider undertook a review and revision of its policy after CBC News revealed the story of 66-year-old ALS patient Doreen Nowicki.

In May 2017, Nowicki was forced to have her assisted-dying assessment on the sidewalk after Covenant Health abruptly withdrew permission for her to have it by her palliative bed. Nowicki was so ill she could no longer walk or speak.

66-year-old Doreen Nowicki had to have her assisted-dying assessment on the sidewalk in May 2017 because of Covenant Health's actions. (Nowicki family)

CBC News continued to report on other patients who also suffered under Covenant's policy on medical assistance in dying (MAID):

Ethics and legal experts called Covenant's previous policy "inhumane" and said it infringed on patients' rights. 

Under Covenant's policy, the default position was that assisted-dying patients could not undergo assessments by Alberta Health Services (AHS), or even sign the form requesting an assisted death, in Covenant's publicly funded facilities. 

Due to its religious beliefs, the Catholic health provider has never, and will never, allow assisted dying in one of its facilities; patients now must be transferred out of a Covenant facility for that procedure. 

Its revised policy, released Monday, eliminates Covenant's previous position that categorically barred on-site form signings and assessments.

"The new Covenant Health policy confirms that [assisted-dying] assessments will take place onsite at Covenant facilities, but it also honours patient's wishes related to how and where they wish the steps to be completed," the Catholic health provider said in an emailed statement.

Covenant Health's revised policy on assisted dying says patients may sign the request form, and undergo assessments, on its property. (Sam Martin/CBC)

Under its old policy, Covenant could — and sometimes did — make exceptions if a patient was medically fragile, but it always reserved the right to force them off the property to access medical-assistance-in-dying (MAID) services.

Covenant's new position states "it is understood that such activities may occur on Covenant Health sites but will not be arranged by Covenant staff."

But Azocar said that ambiguous language, specifically the use of the word 'may,' again leaves leaves the policy "open for their interpretation." That is unacceptable for a publicly-funded health provider, she said.

"It doesn't ensure that people in Alberta will have equitable access to a legal service," Azocar said, adding that patients in rural communities, where Covenant operates the only health facility, will likely be most impacted by the policy's ambiguity.

Under the revised policy, arrangements for assessments by AHS staff will be made directly between patients and the AHS team. There will be no Covenant participation, "other than ensuring AHS access to the site and an appropriate location or means (e.g. Telehealth) for conversations to take place and/or education materials to be left."

Minister must deliver on promise: Swann

Covenant said it received input from more than 100 stakeholders, including family members, in its policy revision process. 

"Their input provided invaluable perspectives into the needs and wishes of patients and their families and helped ensure the policy is patient-focussed and more reflective of our current experience," Covenant said in a statement.

Health Minister Sarah Hoffman oversaw Covenant's policy review, as did Alberta Health Services. Last month, Hoffman told the legislature she expected the new policy would allow all patients to undergo MAID assessments without leaving their Covenant beds.

"I have asked (Covenant Health) to make sure that they update their policy to reflect that that will be the expectation moving forward," she said. "And if it doesn't do so, I will act myself."

Hoffman did not immediately respond to an interview request from CBC News.

Liberal MLA Dr. David Swann says Health Minister Sarah Hoffman must force Covenant to provide all assisted-dying services in its facilities. (Tim Propp/CBC)

Liberal MLA Dr. David Swann said Hoffman must now honour her promise and enact her own policy.

"She has given them the opportunity to provide a policy that should provide clarity, and certainty, and a commitment to following the law of the land," said Swann, a former medical officer of health. "This does not do that."

Swann said Hoffman must force Covenant to provide all assisted-dying services in its facilities, even an assisted death.

"This is unacceptable; to provide this sort of discretion and uncertainty to patients who are in such difficult circumstances and want to receive the services of medical assistance in dying," he said.

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