Covenant Health in Edmonton. Photo from Grandin Media

Euthanasia case results in apology from Catholic health care provider in Alberta

By  Thandiwe Konguavi, Canadian Catholic News
  • October 29, 2018

EDMONTON – At what point does a health care provider become complicit in the act of medically-assisted death? 

As more patients seek euthanasia or assisted suicide in Alberta, Covenant Health, one of the country’s largest Catholic health care providers, is gaining more experience in making that call, including from a case that made headlines and prompted an apology from the institution. 

As of Sept. 30, there have been 486 assisted suicides in Alberta since so-called Medical Assistance in Dying (MAiD) was legalized in June 2016. Of those, 64 patients were transferred from a faith-based facility that does not provide the service. 

Covenant Health was not able to provide the number of its patients who have been transferred from its sites for assessments, but at least one of those transfers didn’t go smoothly. 

In the spring of 2017, Doreen Nowicki was 66 and terminally ill with amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s disease. She was receiving palliative care at the Edmonton General Continuing Care Centre operated by Covenant Health. CBC News revealed in a report on Oct. 23 that she was forced to have her assessment for assisted suicide on the sidewalk outside the facility after the hospital refused to allow it on their premises, despite having originally approved it. 

The event went against Covenant Health’s mission to provide compassionate care, said CEO Patrick Dumelie. 

“We ultimately concluded that we didn’t do everything we should’ve done to support this patient and family,” he said. “It’s really important for us as a compassionate, caring organization living our mission, that we don’t abandon people when they’re at their highest need. And so if you’re contemplating taking your own life, there’s no time that you’re more vulnerable. Something like this is really an adverse event. This isn’t how the system functions.”

Nowicki’s request for assisted death was eventually met through Alberta Health Services and she died June 5, 2017. For its part, Covenant Health has apologized to the family and learned from the experience, Dumelie said. 

Covenant Health considers health care an “immense responsibility and a calling,” Ed Stelmach, the board chair and former Alberta premier, said at its annual community meeting on Oct. 24. 

“It’s also challenging work and sometimes we don’t get it right, as you might have read in the news,” said Stelmach. “It requires humility and a commitment to learn and improve.”

Dr. Owen Heisler, Covenant Health’s chief medical officer, said the Catholic health care provider has since improved its system of determining who may have medically assisted death assessments done on its premises and who should leave their facility for assessments.

Covenant Health participates in some of Alberta Health Services’ five stages that people go through when they are considering medical assistance in death, including the “Pre-Contemplation” stage, where a patient is seeking information, and the “Contemplation” stage, where they might make an informal or formal request for more information.

“We’re happy to have that discussion with them,” said Heisler. 

Covenant Health does not participate in the third stage, “Determination,” where assessments are done to see if they meet the criteria, or the fourth stage, “Action,” where the patient’s life is ended.

The fifth stage, “Care after Death,” is where grief support and follow-up is provided for the family.

“After that happens, there’s a lot of distress. We’re more than happy to participate in five, talking to the family to make sure the loved one is respected and the family is respected,” said Heisler. 

The assessment stage, where an AHS navigator, or coordinator, meets with the patient and the family to determine whether the patient is a candidate for medical assistance in dying, is not allowed to be done on Covenant Health premises. Exceptions can be made in the case of “an extraordinary need,” said Heisler.

The Covenant Health policy providing exceptions to having assessments done on site is a measure of compassion, Dumelie said. 

“We don’t want to do more harm to the individual. We don’t want to treat them in a way that could even push them toward medical assistance in dying.”

When a patient is considering medical assistance in dying, Covenant Health’s policy is to seek ways of improving their palliative care, Dumelie added. 

(Grandin Media)

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An open letter to Covenant Health,

I saw your statement in regards to the Nowicki family. In your apology you asked for patients, residents, families, and staff members to reach out and share their own experiences. I feel that this incident...

An open letter to Covenant Health,

I saw your statement in regards to the Nowicki family. In your apology you asked for patients, residents, families, and staff members to reach out and share their own experiences. I feel that this incident calls for a time of reflection and, if you are ready to listen, I would like to share my experiences as a patient, a woman, a Canadian citizen, and a Registered Nurse in Alberta.

As a patient.

I chose a Covenant Health facility because it was the closest hospital to my house. That’s how we should pick a hospital, right? I delivered my baby girl as a crucified Jesus stared down from his front row seat to my wide open legs. I didn’t remember inviting him. Compared to the birth of my son at an Alberta Health Services facility, this all seemed so presumptuous. Crosses in every room, prayers over the intercom, it was all a reminder that I was clearly an outsider.
This was my personal experience as a patient in a Covenant Health Hospital. I must also mention that my experience provided a safe delivery, appropriate medical interventions, and a clean and quiet environment to recover in. I left the hospital with a beautiful baby girl and no bill. I am very thankful for all of those things.

As a woman.

In my limited personal experience with Covenant Health, I was lucky that the closest hospital to my house was able to meet my medical needs. Unfortunately, for many rural and Indigenous women across this province, Covenant Health emergency rooms often serve as the only point of access to emergency contraception. Denying access to federally approved treatments such as the morning after pill and pregnancy termination for medically isolated Albertans is a violation of their right to access these treatments.

Providing emergency contraception to those seeking it in an emergency department is your job. People in rural centers do not choose to go to your facilities, it is a forced geographic decision. Failing to provide services that women need based on religious objections is not an option in the year 2018. It is my right as a women to have access to these treatments. You are a publically funded hospital and evaluating what treatments are morally pleasing enough to administer is not a decision to be made by Covenant Health.

As a citizen of Canada.

When I read stories such as that of the Nowicki family I am outraged. The Supreme Court of Canada granted assisted death as a right to Canadian citizens in 2016. The solutions that you have provided in an attempt to serve this population are unacceptable. Forced transferring of a palliative patient to another facility is not a solution. Requiring assessments for assisted death to be conducted offsite is not a solution. Your policies regarding end of life care are not patient informed and only exist to protect the values of the Catholic Church. You are failing palliative patients in your care every single day.
Providing assisted death to those who qualify for it during end of life care is your job. Citizens of Edmonton do not choose what palliative care unit we end up on. We get sick and we are treated where there is space. It is not the place of a publically funded hospital to evaluate whether government approved treatments meet your moral standards. As an organization who operates the vast majority of palliative care and end of life beds in Edmonton, your failure to provide all approved treatments in regards to end of life care should not be tolerated by our government.

As a Registered Nurse in Alberta.

I chose this profession because I care. I care about the outcomes of my individual patients. I care about how Albertans access health care. I care about reducing barriers to appropriate treatments and I care about improving the health of our province. Most importantly, I care about providing treatment to those in need regardless of gender, age, health status, lifestyle, sexual orientation, beliefs, and health practices.
As a health care organization, you should care too. Why don’t you care about the pain your policies have caused to those trying to exercise their right to assisted death across Alberta? Why don’t you care that by limiting access to emergency contraception you are also limiting a woman’s right to make an informed decision? You should care about putting the medical needs of Albertans first.

As an organization, Covenant Health has demonstrated that adhering to Catholic informed policies is more important than providing adequate services to the people that they serve. Covenant Health should not be allowed to operate any emergency department, palliative care unit, hospice, or end of life care center in Canada. Your policies regarding birth control, pregnancy termination and end-of-life care are not in alignment with the services that are required by Canadians who access these departments. By allowing these policies to shape the practice in your facilities you are failing to provide Albertans with appropriate access to care.

I am a Registered Nurse because I am a fighter. Fighting to protect vulnerable populations is critical work and a part of my professional obligation. Covenant Health, who are you professionally obligated to? Are you answering to the Catholic Church or to the people who are putting their health and tax dollars in your hands?

In solidarity,

A patient, a woman, a Canadian citizen, and a Registered Nurse in Alberta.

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