A few months after Clint Gossard was diagnosed with terminal cancer, he told his family he was ready to die and wanted a doctor’s help to do it.
His wife, LeeAnne, planned to make arrangements at the Irene Thomas Hospice, a 10-suite facility down the street from the hospital where he was a patient. A former irrigation specialist, Mr. Gossard had worked on the hospice gardens a few years before his sickness left him bedridden, with his weight dropping and fevers so high he could hardly breathe. The pair thought the hospice would be the best place for him to live his last days.
But the option wasn’t available. Even if he had been able to get a room at Irene Thomas – not always the case when people seek hospice care in their home communities – a doctor would not have been able to perform the end-of-life procedure there. Opened in 2010 and run by the non-profit Delta Hospice Society, Irene Thomas has to date refused to allow medical assistance in dying, or MAID, on site – despite the procedure being legal in Canada since 2016.
“I was like, ‘What do you mean? It’s a place where the sick go,’" an emotional Ms. Gossard recalled in an interview. "I thought when it became [legal], that you could go to the hospice and carry out that procedure. I was shocked, but I didn’t have the strength [to argue].”
Ms. Gossard’s anger is part of a debate over MAID in Delta, a city of about 100,000 people south of Vancouver. The debate has divided a community, triggered a power struggle on the hospice board and resulted in a stand-off between hospice management and B.C.’s Ministry of Health, which last month warned of potential consequences if the hospice continued to refuse to allow MAID on its premises.
The controversy highlights debate over whether publicly funded facilities – including faith-based facilities that object to medically assisted dying on religious grounds – should be required to provide MAID as a condition of receiving government funds.
In B.C., faith-based facilities are not required to provide MAID but are expected to provide referrals. Irene Thomas Hospice is not officially a faith-based facility.
Delta Hospice Society, which runs the hospice, receives the lion’s share of its revenue – $1.6-million, or 47 per cent of $3.4-million, for the year ending March 31, 2019 – from the province, according to filings with Canada Revenue Agency.
Asked about the situation at the hospice last month, B.C. Health Minister Adrian Dix said it is obligated to fulfill its contract with the local health authority while it receives public funds.
“Of course, we do live in a free society,” Mr. Dix said. “Delta Hospice Society can decide that it doesn’t want to continue to receive support from the Fraser Health Authority in its mission. They can choose to do that. You can absolutely have it your way. But you can’t have it both ways.”
For now, people who want a medically assisted death and are patients or residents in publicly funded facilities that don’t provide that service can be transferred – a situation critics say results in unnecessary pain and anxiety for patients and their families.
“It is outrageous that people who are in the very last hours of their life, when they are so frail and so ill that they require minute-to-minute care, are required to transfer,” said Ellen Wiebe, a Vancouver doctor and MAID provider.
Fraser Health has given the Delta Hospice Society until Feb. 3 to change its policy but has not said what it would do if the society fails to comply.
Hospice founder and former executive director Nancy Macey has argued that medically assisted deaths contradict the hospice’s constitution and the goals of palliative and hospice care.
In September, 2019, the then-board of the Delta Hospice Society terminated Ms. Macey, saying publicly only that she was no longer with the organization, and subsequently voted to allow MAID at the hospice.
Ms. Macey told the Delta Optimist she had been terminated and that she planned to seek legal advice. She did not respond to multiple requests for comment from The Globe and Mail.
Supporters of Ms. Macey launched a membership drive in which the number of society members surged to more than 600 from fewer than 200. Ms. Macey also had support from local churches, including St. Andrew’s Anglican Church.
Two annual general meetings followed. The first, in October, ended without a conclusive result after a voting issue; more ballots were cast than there were members registered to vote.
The second, in November, was held in a larger venue to accommodate roughly 300 attendees. The meeting was raucous. Several hospice staff who voiced concerns about hospice oversight and operations were booed. When votes were tallied, there was a new slate of directors that within days reversed the previous board’s decision to allow MAID at the hospice, putting the society at odds with Fraser Health.
Danielle Martell, priest in charge at St. Andrew’s, called the ouster of former board members a “vote for decency."
"The balance of power was dynamically changed and this meant a pro-life board was now firmly in place,” she wrote in a Jan. 1 op-ed for The Light Magazine, a Christian lifestyle publication.
Current hospice society president Angelina Ireland, who ran unsuccessfully as a People’s Party candidate in the federal riding of Delta in the October, 2019, election, did not reply to several requests for comment.
The Gossards ultimately stayed at Delta Hospital, where staff found the family a small, private room on the second floor. The family, including two adult children, brought in candles and photos and slept on mats on the floor. Clint Gossard died, with a doctor’s help, on Jan. 11, 2019, at 59.
Ms. Gossard said she is grateful to have had the room, but angry that the hospice would not allow an assisted death for her husband – or for anybody else.
“It really sits with me bad in my stomach," she said. "He deserved to go there and have that setting before he died.”
Canada brought in new laws enabling MAID in 2016 following a Supreme Court of Canada decision that found denying it was unconstitutional. Since 2017, there have been 2,801 MAID cases in B.C., with 124 of those – or about 4.4 per cent – requiring transfers because of non-participating facilities, according to figures from regional health authorities.
The controversy in Delta has implications for other institutions and governments across Canada, says Jocelyn Downie, a professor of law and medicine at Dalhousie University in Halifax.
She cited the example of Nova Scotia, where the provincial health authority in September brought in a policy to require a Catholic hospital to provide access to medically assisted dying on site. The hospital had been under provincial control since 1996, giving local the province more leeway to act.
Delta Hospice Society may be independent but relies on the province for its operation, Prof. Downie said.
“With this [facility], it is not faith-based and it receives public funding. So I don’t see any basis for continuing to fund it if it does not allow a legal service,” Prof. Downie said.
Ms. Gossard echoed the sentiment.
“If it was private, fine,” she said. “It’s not. It’s public. We pay our taxes, we live in this community. It [MAID] should be offered there to anybody who’s going through this horrible thing in life.”