A doctor in Vancouver was cleared of wrongdoing by the province’s college of surgeons and physicians, after she snuck into a Jewish nursing home to provide medical assistance in dying (MAID) for an elderly resident, in opposition to the home’s rules.
On June 29, 2017, Dr. Ellen Wiebe provided the service to Barry Hyman, an 83-year-old resident of the Louis Brier Home & Hospital, as he lay in his room surrounded by his family. Hyman had been disabled by a stroke and diagnosed with lung cancer. When Louis Brier found out about Wiebe’s actions, it filed a complaint with the College of Surgeons and Physicians of British Columbia (CSPBC), which ultimately decided not to censure Wiebe.
“Having determined that you had not breached college standards by performing MAID on a resident of Louis Brier, the committee was not critical of your provision of MAID to Mr. Hyman at Louis Brier Home and Hospital. The committee determined that the complaint did not meet the charging standard,” reads a July 5 letter from the CSPBC’s chief legal counsel, Graeme Keirstead, to Weibe.
Louis Brier’s rules, which were formulated in accordance with Orthodox Jewish law, do not allow MAID to be carried out on its premises. David Keselman, the CEO of Louis Brier, said the home makes it clear to prospective residents that it does not permit MAID on site, but will do whatever possible to facilitate it happening elsewhere. That includes permitting MAID eligibility assessments of residents to occur within the facility.
Louis Brier’s issues with Wiebe’s actions are twofold, said Keselman. The first part is that Wiebe ignored the home’s rules.
“Our care delivery is anchored in Jewish traditions and values. And as such, Jewish traditions and values do not support MAID. And we have to follow this. This is the core of our organization. And she disrespected it,” Keselman said.
The second is that she snuck onto the premises to perform the procedure, and did so without the home’s knowledge. Keselman said the combination of the two elements caused distress in many of the residents, as well as some of the staff. He acknowledges that there may be a cost to forbidding MAID on site, but said it’s part of a balancing act between the rights of the individual and the rights of the collective.
“We certainly understand the challenges with it. We have to be respectful of our traditional values and how those play in how we deliver care. So, again, to say that it creates a hardship, it possibly can, but we work with the family and the individual to reduce and eliminate as much hardship as possible. This process did not allow us to do that,” he said.
Lola Hyman, Barry Hyman’s daughter, said it was important to her father that he be able to die on his own terms. That meant in his home, which at that time was his room at Louis Brier. In an emailed statement provided to The CJN by Dying with Dignity Canada, Lola Hyman agreed with the CSPBC’s decision.
“Dr. Wiebe puts the patient first, as well as their family. She would never jeopardize the patient’s care and the safety of their family. The college’s decision reflects Dr. Wiebe’s professionalism and her commitment to putting the patient at the centre of their own care. Because of her, my father realized his deeply held wish to end his life in peace without having to leave his home. For this, I will always be grateful,” she said.
In 2015, the Supreme Court of Canada struck down the prohibition on MAID and, in 2016, the federal government legalized it, while also leaving room for individual doctors to decline providing the service for personal reasons. In B.C., denominational health institutions, including Louis Brier, are allowed to refuse to provide services that are inconsistent with their religious values.
But Wiebe is not an employee of Louis Brier. And because Louis Brier is a long-term care home – “which means, of course, that it was Barry Hyman’s home,” Wiebe said – she does not require privileges to see her patients there, like she would in a hospital. She believes that distinction may have factored into the CSPBC’s decision.
“They are primarily interested in a patient’s well-being. So they are looking at patients, and in this case, were clear that I had taken good care of my patient. They didn’t say this, but I’m assuming that they don’t consider the staff of care homes to be my responsibility, or my highest responsibility. My highest responsibility is to my patient,” Wiebe said.
She said it would have been better if she had been able to perform the procedure with Louis Brier’s knowledge, “but since we couldn’t, then the choice was: do we honour Louis Brier or Barry Hyman?” Her decision was based on her responsibility to her patient, and also the weight of his request.
“When it comes to end-of-life wishes, they have a higher standard in some way. This has been true in our culture and in most cultures, that your dying wish is considered more important than some wish you have at some other point in your life. And when somebody says that they wish to die in their own bed, in their own home, that seems like something so important to be able to honour that wish,” she said.