Since the decriminalization of Medical Assistance in Dying (MAID) in 2016, there have been 2,281 medically assisted deaths in Alberta, with roughly 30 per cent of the procedures occurring in the province’s rural areas. Exactly none of them have occurred in Covenant Health facilities, Alberta’s Catholic health care provider.
Covenant Health is funded though Alberta Health Services (AHS). They received $760 million in funding in 2021, which accounted for 86 per cent of its total revenue.
However, Covenant Health does not strictly report to the AHS, according to the Cooperation and Services agreement between AHS and Covenant health signed in 2010.
According to the agreement, Covenant Health is “entitled to decline to provide a service which conflicts with its Principles of Faith and Ethics,” and that it is an “independent operator . . . governed by its own boards of directors”. The chairman of the this board is former Alberta Premier Ed Stemach, and they in turn report to the six Catholic Bishops of Alberta.
Covenant health adheres to the values as outlined in the Health Ethics Guide, published by the Catholic Health Alliance of Canada in 2012, and as such refuses to be complicit in matters related to abortions, gender reassignment, in vitro fertilization, contraceptive care, and assisted dying.
Rather, patients who elect to take part in such procedures must instead be moved to another facility, in what is called a “forced transfer”.
“Forced transfers [occurs] when a person who has been assessed and approved for MAID, and if they happen to be in a religious institution that does not allow MAID to be provided in their institution,” said Carl Ulrich, chair of Dying With Dignity Canada’s Edmonton Chapter and former Unitarian-Universalist minister.
“We feel that this is really an unfair imposition to someone who’s on their very last day.”
“I don’t know if everyone’s aware but ambulances are really trucks,” said Ulrich, “They’re not limousines that ride smoothly, and for someone who’s very frail and in pain it can be quite brutal to transfer them.”
From 2016 to 2020, there were a total of 125 patient transfers for MAID in Alberta, with 109 patients being transferred from faith-based facilities as reported by AHS — although that information has since been removed from their website.
Forced transfers have been controversial in relation to MAID laws due to the fundamental nature and condition of those who apply, as a patient must be suffering unbearably from an irreversible illness, a disease, or a disability in order to be deemed eligible for an assisted death.
What this means is that the patients subjected to forced transfers are usually the ones most inconvenienced by it.
In 2022, Scott Harrison of Vancouver shared his story with BC news site The Orca about the forced transfer of his partner, Christina Bates, the morning of her scheduled death. She had been staying at St- Paul’s Hospital, which is operated by Providence Health Care — a Roman Catholic faith-based care provider.
He shared his discontent with the process, writing that “the final hour of Christina’s life was unfairly stressful, and completely avoidable.”
Harrison also expressed his irritation over a public hospital having the ability to “pick and choose” which medical services they would provide.
In 2018, Ian Pope experienced similar inconveniences at the very same hospital, being transferred out of the facility twice in order to be assessed for MAiD. The first transfer resulted in a ruptured catheter bag in-transit, and it wasn’t until his third trip from St-Paul’s hospital that he was administered an assisted death.
Many Albertans will be faced with similar situations.
When questioned about what it would take for Covenant Health to review its policy on providing MAID, communication manager Karen Diaper provided the following statement on behalf of the organization:
“Covenant Health conducts a regular review process of its policies (generally every 3 years) unless changes such as legislation occur that would suggest an earlier review or consideration for revisions is needed.”
264 of all of Alberta’s MAID deaths since 2016 occurred in the province’s area just east of Edmonton — home to five Covenant Health Hospitals.
This corridor encompasses the towns of Bonnyville, Mundare, Vegreville, Camrose, Killam, Sedgewick, Caster — as well as parts of Edmonton.
The Alberta Bible Belt: These are the towns in the area served by Covenant Health hospitals, as well as the distances to the closest AHS hospital.
For many of the people living in these communities, it’s not just about the 30-minute drive out of town that they have spent their whole lives getting accustomed to.
It’s about leaving home.
Lara White is a senior’s outreach nurse with Community Mental Health, in Camrose. She grew up in Camrose, and was born in the original St -Mary’s hospital before it was demolished and rebuilt in 1989.
“I don’t think that it’s right that the facility has a blanket policy of refusing procedures to people,” said White.
“Our tax dollars are funding it, and we can’t access all the services that we should be able to.”
White spoke of the difficulties involved with a forced transfer, considering the closest non-Covenant Health Hospital is in Daysland – 30km outside of the city.
“If they’re in the palliative care home in St. Mary’s Hospital, and they make the decision that they want to die with dignity, they now have to be transferred to another facility,” said White, “And they might be in a really bad physical state, they might have a lot of pain. The move is a big deal — not only for them, but for their families. “
“If they’re already in palliative care, it’s asinine to me that they now have to be moved to another facility.”
White also mentioned the issue of transportation given the current state of ambulatory care in the province. As a nurse and the mother to a paramedic, she has had a first-hand view of Alberta’s current health care crisis.
“We know how difficult it is to get an ambulance even to an emergency nowadays.”
Finally, White spoke of her bond with the city of Camrose.
“If I had a condition that was really going to negatively affect the quality of my life, I can see myself choosing MAID,” said White, “And I’d like to be able to have the choice of dying in the hospital that I was born in.”
“It would be very sad for me that [I would have] to choose to go elsewhere.”
Brenden Leier, a clinical ethicist for the University of Alberta and Stollery Children’s Hospitals, as well as the Mazankowski Alberta Heart Institute, says the issue is overstated in the political sphere.
“Systematically, the pressure from the public often is often pressure to say, in principle, you shouldn’t have the right to refuse these types of things if these institutions are publicly funded,” said Leier, “That’s more of a political issue that frontline people don’t have the opportunity to work out.”
“My preference is always to empower people at the frontlines to solve their own problems,” said Leier, speaking on healthcare in rural communities.
“They’re the best at it,” said Leier, “And because they have a vested interest, it’s not theoretical or political.”
Drawing from his personal observations, Leier believes that difficult circumstances always work out the best when local staff are “challenged or charged and respected enough to solve their own problems” and that those might simply be “ad hoc solutions on a one-by-one basis”.
“Politically, that might not look good, but practically it’s probably ideal,” said Leier.
A bigger concern, according to Leier, is the access to MAiD in long-term care facilities, in particular the nature of the people occupying them.
“People don’t consider them hospitals, they consider them to be their home where they move in to receive assistance,” said Leier.
“Can your landlord tell you, if you live in an apartment building that you can’t have MAID in your apartment?”
A 2019 Alberta Health Services Performance Report commissioned by the UCP government and prepared by Ernst and Young recommended to “end the current Covenant Health Cooperation and Services Agreement and develop a new agreement that enables more effective system coordination by AHS”.
The report also stated that “AHS should be able to set clear expectations for outcomes to Covenant and have the ability to hold Covenant accountable to achieving those outcomes”.
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