Bioethicist Bob Parke is trying to raise funds for a MAID-free, safe haven hospice in Toronto. Photo by Evan Boudreau

Assisted killing still part of Ontario's palliative care plan

  • July 28, 2017

The agency responsible for expanding Ontario’s network of hospice care wants hospice patients to have the option of assisted suicide, even if most hospices and the majority of doctors oppose it.

“The OPCN (Ontario Palliative Care Network) promotes early and equitable access to hospice palliative care for all patients with a life-limiting illness, including individuals who have requested medical assistance in dying,” a spokesperson for the Ontario Palliative Care Network told The Catholic Register in an email.

The provincially-funded OPCN, a sub-agency of Cancer Care Ontario, “recognizes that there may be an intersection between palliative care and medical assistance in dying (MAID). Both medical assistance in dying and palliative care are health care services that exist within the health care system,” wrote Cancer Care Ontario communications advisor Jayani Perera. “However, the focus and mandate of the Ontario Palliative Care Network is advancing palliative care in the province.”

A year into legalized killing in Canada, the big question is how palliative care and hospice beds will be expanded, said bioethicist Bob Parke. Will governments fund hospices that refuse to perform or refer for assisted dying?

Parke will be one of the speakers at a half-day symposium on conscience rights and assisted dying sponsored by the deVeber Institute on July 28 at the University of Toronto’s Wycliffe College. Parke is trying to raise up to $4 million to start a safe haven hospice in Toronto that will not provide euthanasia or assisted suicide.

Parke believes the provincial government will not be willing to fund new hospice beds where doctors won’t deliver assisted suicide and where the hospice won’t refer for the service. The Catholic Register asked the Ministry of Health whether provision of assisted dying factors into funding decisions, but has received no answer.

A survey of more than 1,400 doctors by the Canadian Medical Association in 2015 found that 63 per cent would refuse to provide “medical aid in dying.”

The Ontario Palliative Care Network defines palliative care differently from the provincial association which represents hospices and palliative care providers. The association for the hospices says palliative care “neither hastens death or prolongs life,” while the government agency’s definition remains open to medical aid in dying by calling it an “approach that aims to relieve suffering and improve the quality of living and dying.”

Hospice Palliative Care Ontario’s definition is taken from the World Health Organization. The province’s definition is based on 2002 guidelines of the Canadian Hospice Palliative Care Association.

Given political sensitivities and jockeying between pro-and-anti assisted dying organizations, Parke is hoping his hospice can open and operate entirely on private funding about two years from now.

“If we are accepting government funding, can we have institutional conscientious objection?” Parke asks.

Pro-assisted-death bioethicists have argued for a law to prevent hospices from opting out of assisted killing.

“An opt-out policy essentially forces an unfair choice on dying patients,” wrote bioethicist Jonathan Breslin in the June issue of Hospital News. “To access residential hospice you may have to give up your right to access MAID.”

With the majority of hospices, both religious and non-religious, opting out of assisted suicide and euthanasia, Parke expects a Charter challenge aimed at forcing all publicly-funded hospices to provide assisted suicide.

Only three in 10 Canadians have access to a hospice bed in their own community when they need it. A 2014 Ontario Auditor General’s report pointed out the province’s 260 palliative care beds are unevenly distributed in hospitals and hospices across the province. At the time the Auditor General said Ontario needed 1,350 palliative care beds.

The province has earmarked $75 million over three years to improve the situation and plans to fund 20 new hospices and increase funding to existing facilities.

A bed in a hospice costs Ontario $460 per day, compared to $1,100 per day for palliative care in a hospital bed. Palliative care delivered at home costs about $100 per day.

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