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assisted dying

St. Paul's Hospital in Vancouver is seen in April, 2015.Ben Nelms/The Globe and Mail

A publicly funded Catholic health-care network in British Columbia apologized last spring to a secular hospital after it mismanaged part of the transfer of a frail man seeking a physician-assisted death, documents show.

In his note of apology to Vancouver General Hospital, the director of ethics services for Providence Health Care called the problems that occurred during the patient's move from one hospital to another, "a foreseeable and preventable issue for which I accept full responsibility."

"On behalf of the team managing Medical Assistance in Dying requests, and all of [Providence Health Care], I want to convey my sincere apology for the issues that arose in the transfer of [the patient]," David Unger wrote in an e-mail dated May 18 that was obtained through a freedom-of-information request by the advocacy group Dying with Dignity Canada.

Read more: Assisted dying in religious facilities means tough choices for families

Details of the apology emerged as Dying with Dignity and a national association of medical-aid-in-dying (MAID) providers renewed their calls for all publicly funded hospitals, nursing homes and hospices in Canada to allow physician-assisted death – a practice that has now been legal for more than 18 months.

"This is about publicly funded institutions," said Stefanie Green, a Vancouver Island doctor and the president of the Canadian Association of MAID Assessors and Providers. "Any publicly funded institution, I think, has the obligation to provide legal, sanctioned, covered medical services in Canada."

But supporters of faith-based facilities have been pushing back against that demand, saying that allowing doctors to hasten patients' deaths on their premises would violate the institutions' beliefs.

Individual doctors have the right to refuse to provide assisted deaths, but it's unclear whether religious facilities have the same rights, because the question has not been tested in court.

The Providence apology letter does not describe exactly what went wrong when the man was sent from St. Paul's Hospital, the largest of Providence's 10 sites, to Vancouver General, but partly redacted internal e-mails say he was so ill that his caregivers worried he would lose the capacity to consent to an assisted death if he was not quickly moved out of St. Paul's, where assisted dying is prohibited.

When the man arrived at Vancouver General's emergency department, there was no bed set aside for him. He waited half an hour to be transferred to a bed that was deemed inappropriate, then another hour to be sent to the right bed, the documents show.

An apparent miscommunication on the part of St. Paul's resulted in the "delivery method for a commonly used palliative care medication" not being ready for the patient when he reached Vancouver General, according to a spokeswoman for Providence Health Care, who said privacy rules prevented her from being more specific.

Christopher De Bono, Providence's vice-president of mission, ethics, spirituality and Indigenous wellness, said the apology was part of the network's efforts to be as responsible and transparent as possible with the health-care organizations that take in their assisted-dying patients.

"Most of our transfers, we're pleased to say, have actually been uneventful," he said. "In the cases where we could have done better, we've implemented important changes."

Robert Breen, the executive director of the Denominational Health Association of B.C., said the 44 faith-based facilities his group represents are, "doing everything they can" to make assisted dying transfers go smoothly.

"We will not abandon you, we will not treat you in any different way," he said. "We just can't do that final procedure on this site."

One of the nursing homes in the DHA fold was the site of a clandestine assisted death earlier this year.

The Globe and Mail recently told the story of 83-year-old Barry Hyman, a Vancouver man who wanted to die in a Jewish long-term care home that refused to allow medical aid in dying.

Rather than move him out of the objecting facility, his daughter sneaked in a doctor to help him die in his own bed, an experience that was stressful for the family and the front-line workers who dealt with the fallout.

The Louis Brier Home and Hospital has filed an official complaint with B.C.'s medical regulator against the doctor, Ellen Wiebe, a well-known advocate of assisted dying.

David Keselman, the home's chief executive officer, told The Globe that the Hyman family's subterfuge was "very traumatic" for staff, and that the facility makes no secret of its opposition to assisted dying.

Dr. Wiebe said she was only doing what was in the best interests of a patient who qualified for a legal assisted death, and wanted that death to happen in his own home.

The case raises troubling questions about how physicians already use the degree of autonomy that Canada's assisted-dying law gives them, according to Trudo Lemmens, a professor of law and bioethics at the University of Toronto, who added it would become a more serious problem if the safeguard of restricting it to end-of-life is abandoned and the law is expanded.

"This confirms the kind of concerns I have about what happens when we start opening up the practice [of MAID] and you have individual doctors being so zealously committed to providing this kind of service that they actually ignore the existing structure and the existing debate," he said.