The first time that Ian Pope was transferred out of a Vancouver Catholic hospital for an assisted-death eligibility assessment, the appointment started badly and ended worse.
On the taxi ride from St. Paul's Hospital to a downtown clinic, a catheter bag affixed to the 64-year-old's electric wheelchair ruptured. A vase had to be placed under it to catch the leaking urine.
As the appointment wore on, Mr. Pope, who had an advanced case of multiple sclerosis, could barely stay awake.
"He closed his eyes for a while," said Ellen Wiebe, the doctor who assessed him. "I could get him to answer questions and he was being totally co-operative, but he was just so exhausted by the end."
Dr. Wiebe, along with Mr. Pope's daughter and a second doctor who also examined him, say the retired police officer suffered unnecessarily when he was twice transferred out of a publicly funded hospital to find out if he met the criteria for a legal assisted death.
Both doctors would have been happy to meet Mr. Pope in his hospital room, but St. Paul's, which is part of a Catholic health network that opposes assisted death, would not allow it.
Mr. Pope was transferred out of the hospital a final time on Dec. 9 to receive an assisted death at the near-empty apartment he had not lived in for months.
"I thought it was ridiculous," Mr. Pope's daughter, Rachael, said, "because it's a publicly funded hospital."
Mr. Pope's experience underlines the challenges that patients across the country still face if they end up near the end of their lives in a hospital, nursing home or hospice that objects to assisted dying – a procedure that has now been legal in Canada for more than 18 months.
The Globe and Mail recently told the story of an 83-year-old Vancouver man who was living in a Jewish nursing home when he requested an assisted death last year.
Rather than move him out of the objecting facility at the end of his life, his daughter sneaked in Dr. Wiebe to help him die, an experience that was stressful for the family and the front-line workers who dealt with the fallout.
The home has filed an official complaint against Dr. Wiebe with the medical regulator in British Columbia.
Every province that has faith-based health care, except Quebec, continues to allow publicly funded facilities to opt out of providing assisted dying within their walls, including B.C., which has one of the highest rates of medically assisted deaths in the country. (Quebec still allows some hospices to opt out.)
Providence Health Care, a 10-site Catholic network that includes St. Paul's Hospital, said it is doing its best to uphold the church's values while respecting the rights of grievously ill patients who want to die with the help of a doctor.
While the hospital would not comment on the particulars of Mr. Pope's case for privacy reasons, a Providence official confirmed the network has tweaked its policy to ensure that patients are examined immediately before being transferred for assisted-dying assessments to see if they are still well enough to make the trip.
"One of the things that might have been missing in this case was an assessment at the time of transfer of just how well or not well that person was," said Christopher De Bono, Providence's vice-president of mission, ethics, spirituality and Indigenous wellness. "What we've done now is we've built into our process to ensure that every time a patient goes off-site that there is a check-in."
The federal assisted-dying legislation requires that patients undergo two independent medical assessments to make sure they meet the law's criteria, including that patients have a "grievous and irremediable" medical condition that makes a natural death, "reasonably foreseeable."
Mr. De Bono said that in October, Providence adopted a new policy, developed in co-operation with major Catholic health-care networks in Alberta and Saskatchewan, that allows assisted-death assessments to be conducted on-site when patients are too medically fragile to be sent away.
"It's one way that I think we've been leading in understanding how to respond to the complex issue of [medical aid in dying] in a faith-based system," he said.
Across all of Providence's facilities, approximately seven patients have been assessed on-site, while about 15 have been transferred out for eligibility assessments, he said. Some exceptions were made before the new policy took effect, he said.
Seventeen patients have been transferred out of Providence facilities to other places to receive an assisted death.
In Mr. Pope's case, hospital staff determined he was well enough to leave for a second assessment, even after Dr. Wiebe sent an e-mail warning against transferring him a second time.
Dr. Wiebe acknowledged that in her message she emphasized the broken catheter bag, not Mr. Pope's exhaustion, which may have led the hospital to think it could solve the problem by sending Mr. Pope in a medical transport vehicle for a second assessment at his old apartment.
But Jyothi Jayaraman, the palliative-care doctor who met him there, said Mr. Pope seemed drained and distressed by the transfer.
"I was so disturbed that this poor man had to be moved that I wrote an e-mail to the group in St. Paul's which is responsible for co-ordinating this kind of transfer," Dr. Jayaraman said. "I said that I was truly shocked … I felt that this was wrong, what we were doing to this man."
Ms. Pope, who was by her father's side for his second assessment on Dec. 7 and his death two days later, said it was especially galling that her father wound up in a Catholic hospital through no choice of his own.
His apartment was four blocks from St. Paul's and he was taken there after calling 911 because he fell in October.
A spokeswoman for BC Emergency Health Services confirmed the policy is to transport patients to the nearest or most appropriate hospital. In general, patients can't ask paramedics to drive them to the hospital of their choice unless there are extenuating circumstances.