The article below shows how petty internal policy can inflict totally unnecessary pain, suffering and loss of dignity to a elderly man for its own convenience. This was even more outrageous because the organisation concerned is running a care facility for seniors. It really was the final insult, as they denied the man his legal right to an assisted death.
This issue must be resolved by all those in the care giving profession long before such situations can occur again.
Roy Summerhayes.
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Despite approval for assisted death, man wasn’t allowed to die at care home
An elderly Victoria man spent some of his final moments on a gruelling trip out of his care home after the facility said it wasn’t ready to host medically assisted deaths.
Fred Salmon, 94, received approval for medical assistance in dying in October, four months after legislation was enacted.
He was living at the Veterans Memorial Lodge at Broadmead, but was asked to wait until Nov. 22, when the care home expected to have a policy in place.
“Fred was beside himself. … He said: ‘No, I’m not waiting, I need to go now,’ ” said Valerie Elliott, Salmon’s close friend who held his power of attorney.
“When there’s a law, you actually have to follow it. And when you have a duty to accommodate someone, you don’t brush them off and say: ‘Can you wait until we have done what we should have done much earlier.’ ”
Elliott offered to host Salmon’s death, which took place in November, in her home — a difficult decision — and arranged the transfer.
Tracking down a hospital bed that could be used in both the ambulance and at her home was unexpectedly difficult, she said. At one point, the bed suddenly dropped several levels, causing Salmon excruciating pain. A young attendant twice asked Salmon if he was excited, before Elliott told her that was an inappropriate question.
Elliott said care homes and facilities that haven’t caught up with the legislation are effectively taking away the right to assisted death from individuals who might not be strong enough for a transfer.
“If we don’t insist these facilities have policies in place, and if you’re not going to think about your death before you enter one of these facilities, you may not have a choice,” she said.
Only about five per cent of assisted deaths on Vancouver Island have occurred in care homes, said Dr. David Robertson, Island Health’s executive lead on medical assistance in dying.
The vast majority — about two-thirds — have happened at private homes, while others have taken place at hospitals and hospices.
One reason is that many residents in care homes have dementia or are otherwise too incapacitated to qualify.
While the 18 care homes owned and operated by Island Health have policies in place, the 41 affiliates — such as Broadmead — develop policies through their own boards.
The legislation might make medical assistance in dying a legal right for those who qualify, but it doesn’t compel any particular facility to provide it. Some patients at St. Joseph’s Hospital in Comox have endured a 1.5-hour transfer to Nanaimo, because the Catholic hospital refuses to assist with deaths on religious grounds.
Jim Oldnall, director of clinical programs at Broadmead, said the facility now has a policy in place in line with those at Island Health facilities. If someone is approved for medical assistance in dying, an approved Island Health physician could come to the care home for the procedure.
“When Mr. Salmon requested this, we were in the midst of getting prepared,” Oldnall said.
There was a lag, in part because the legislation came down just before summer, when many staff and board members are on vacation. Administrators were also under the impression that assisted dying would be concentrated in hospitals and hospices. And Oldnall said he was cautious because of “fuzzy” guidelines from bodies such as the College of Registered Nurses of B.C., which encourages seeking legal advice.
Preparing staff on such a sensitive topic is not necessarily straightforward, even if they wouldn’t directly participate in the death, he said.
“Everybody has their own feelings about this; some say we’ll support it, others had a hard time, thinking: ‘I’ve cared for this person and we’re just going to let this happen.’ So it was more about coming to a place with staff to say: ‘This is OK, this is what he wants.’ ”
He said the facility regrets that it wasn’t prepared in time for Salmon’s death.
“At Broadmead, we try to do the best, and we try to be very proactive in making sure we’re ahead of the game. In this case, we weren’t,” he said.
Salmon’s is the only request that Broadmead has received, he said.
Cory Ruf, spokesman for Dying with Dignity Canada, said there’s no excuse for hospitals, hospices or long-term care facilities not to be prepared. While the law was enacted in June, the Supreme Court of Canada overturned the legal ban on doctor-assisted deaths in February 2015.
“Life, death and intolerable suffering don’t necessarily happen during business hours, and it’s incumbent upon health-care facilities to meet the needs of dying patients, not the other way around.”
“For individuals, for example, who are in their last weeks of life and have made a request, and whose capacity is in the balance — that delay alone could effectively deny them their choice, because they’ll lose capacity and become ineligible,” Ruf said.
“This is not unique to faith-based institutions or those that flat-out deny the provision of assisted death on site. The lack of preparedness itself, the going back and forth, the confusion and additional stress that creates can, in some cases, lead to people not being able to access the choice they sought.”
Written by Amy Smart.
Published in the Times Colonist Sunday February 26th 2017.