“Moral distress” of euthanasia helps spur BC doctor’s hospice resignation

Palliative care and family physician Dr. Kevin Sclater will work his last shift at Crossroads Hospice in Port Moody Dec. 31, saying he can no longer tolerate the fact euthanasia is taking place in the facility. (Photos by Terry O’Neill, The B.C. Catholic - CCN)

By Terry O’Neill, The B.C. Catholic

[Vancouver – Canadian Catholic News] – After at least five years of signing petitions and writing about his opposition to doctor-assisted suicide, Port Coquitlam, B.C. family physician Dr. Kevin Sclater finally decided to act.

Just days after Crossroads Hospice in Port Moody announced Nov. 19 that Sclater was ending his part-time work at the hospice to concentrate on his family practice, he told The B.C. Catholic in an interview that another important reason he decided to sever ties with the facility is because he can no longer tolerate the fact euthanasia is taking place there.

“For me, personally, the challenge as a physician working in a hospice – I am obliged to speak to people about MAiD (medical assistance in dying) if they initiate the conversation,” Sclater said. “I can do that so well that people will not know that my personal opinion about MAiD is completely opposed to it.

“And every time I do that, that just takes a little bit out of me.”

He described a relentless process in which he is not only expected to provide details about assisted suicide but is also consistently asked if he will assess patients on their suitability for medically-provided death, something he just as consistently refuses to do.

“It’s just this ongoing – call it moral distress – that occurs with having to be even included in the MAiD approval” process, said Sclater, who has cared for patients at the hospice since it opened 19 years ago. “I don’t want to have any participation in that process.” His last day at the hospice will be Dec. 28.

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Sclater, 57, has practised family medicine for 31 years. He held a diploma from the American Board of Hospice and Palliative Medicine and now is a Certificant of the Canadian College of Family Physicians with an added competency in palliative care.

Sclater has blogged about his opposition to euthanasia, writing that as a physician he has pledged to do no harm and that he adheres to international standards of palliative care, which preclude hastening a patient’s death. “I respect the free choice of others, but I ‘shall not kill,’” he wrote in one post.

In 2017 he was one of hundreds of Canadian doctors who signed a document prepared by the Canadian Physicians for Life, the Canadian Federation of Catholic Physicians, and the Christian Medical and Dental Society of Canada opposing the expansion of euthanasia.

In 2020, he publicly supported the “MAiD to MAD” initiative which opposed legislation broadening the availability of assisted suicide to those who were not near death.

Both campaigns failed to sway the Liberal government, which, as The B.C. Catholic recently reported, is now on track to enact a provision in March 2023 that will permit doctor-assisted suicide on the sole grounds of mental disorder.

Dr. Kevin Sclater

Sclater, an evangelical Christian, said he opposes euthanasia on many levels, including his personal ethics, the palliative care physician relationship, “and even from a social perspective.”

Catholic teaching is unequivocal about assisted suicide. The Canadian Conference of Catholic Bishops said in a brief submitted to Parliament in May that the Church explicitly opposes any form of euthanasia and that any expansion of eligibility for assisted suicide “will only serve to erode the respect for the essential dignity of the human person and the common good of society, which must be committed to protecting and safeguarding vulnerable individuals and those without a voice.”

Once Ottawa legalized MAiD in 2016, the Fraser Health Authority, which funds the Crossroads Hospice, moved quickly to ensure that euthanasia was available in all its funded facilities, except those with a religious charter opposing euthanasia, such as St. Michael’s Centre in Burnaby. The edict led Neil Hilliard to resign his job as head of the region’s palliative-care program, saying medicalized killing is incompatible with palliative and hospice care.

Sclater agrees. “I’ve always accepted and embraced the philosophy of palliative care … about how the goal of palliative care is not to change the path of the natural life, neither to hasten nor to prolong the time to end natural life,” he said.

“So to include Medical Assistance in Dying or, more specifically, physician-assisted suicide into the palliative approach, it really stretches beyond the definition of what palliative care is and what palliative care should be.”

Moreover, he said palliative care tends to attract people of faith because they often do not have the same fear of death as non-religious people; that same faith can also lead them to oppose MAiD. “So to force that into your workplace or your palliative-care program, it’s really not a good fit,” Sclater said.

He notes the sad irony of hospice workers telling new patients that standard medical interventions such as intravenous injections and hydration are not part of the services provided by a hospice. “But the exception is if you choose MAiD we will actually get someone to come in and start an IV so you can receive drugs that will end your life,” Sclater said. “It’s a little bit of a practical disconnect.”

In the hope of keeping hospice, and Crossroads Hospice specifically, a MAiD-free zone, he tried to persuade Fraser Health to set up centralized MAiD-provision centres where health providers who embrace that practice would be concentrated, “rather than forcing it into a hospice environment where there is some significant opposition to that as a part of palliative care.”

(CNS photo by Shaun Best, Reuters)

The Delta Hospice Society waged a years-long but unsuccessful battle with Fraser Health to keep euthanasia out of its hospice. As reported by The B.C. Catholic, the society is now working on opening a euthanasia-free hospice. The society is also circulating a “Do Not Euthanize” directive for patients to inform medical staff about their opposition to assisted dying and is planning to launch a “guardian-angel” program to team volunteer advocates with vulnerable sick and elderly patients.

When Fraser Health ordered that hospices allow euthanasia on site, officials said it was necessary to prevent increased stress on those patients who were already suffering as they neared death. But Sclater said his experience at Crossroads is that the vast majority of patients choosing doctor-assisted suicide do so for “reasons of autonomy and control” and are not suffering intolerable pain. As such, they could easily be moved to a more suitable facility.

He also revealed “some misadventures” have occurred in the ending of patients’ lives at Crossroads. In one troubling scene this fall euthanasia providers were unable to insert an intravenous needle into the patient’s body. The attempt to find a vein went on for several hours until staff finally called a paramedic from a nearby firehall, who managed to insert a “large-bore” IV needle “right into the lower leg … so that the MAiD provider could administer the lethal drugs.”

In circumstances like that, said Sclater, “You just go, ‘Really, is hospice really the area where you want to be doing MAiD provision?’”