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County considers permitting physician-assisted dying in local long-term care homes

Since 2016, Simcoe County policy required residents be off-site if they elected to proceed with medical assistance in dying; There have been two such instances in that time
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When a person living in a long-term care home operated by the County of Simcoe decides to proceed with medically assisted dying, they may no longer be required to move off-site to do so.

During county council’s committee of the whole meeting this morning, councillors considered a policy update to their medical-assistance-in-dying (MAID) rules at their four long-term care homes, which would see residents choosing to proceed with the controversial procedure able to do so within the home.

While very little discussion occurred at the council table Tuesday concerning the proposed policy change, Deputy Warden Lynn Dollin provided context on the issue.

“I wouldn’t want to give anyone the impression who is watching this that we’re taking this lightly,” said Dollin, who is the mayor of Innisfil. “Back in 2016, we had a lengthy debate on this subject. What it boils down to is the federal government making this decision and being cognizant that we have to find a balance between people’s home and respecting people’s rights.

"It’s a delicate balance, but I think it’s well thought out in the report," she added. 

In 2016, each long-term care home in Ontario was required to decide whether or not they would provide assistance in dying after the passing of Bill C-14.

The criteria to receive medical assistance in dying requires a person to be a Canadian citizen, at least 18 years of age, capable of making health-care decisions, be voluntary, provide an informed consent, and have a grievous and irremediable medical condition.

Since 2016, residents who chose to proceed with physician-assisted dying at county-operated long-term care homes were required to be off-site for the procedure.

There are four long-term care homes operated by Simcoe County: Trillium Manor in Orillia, Georgian Manor in Penetanguishene, Simcoe Manor in Beeton, and Sunset Manor in Collingwood.

Since that time, county officials say medically assisted deaths have occurred in two situations off-site across the county’s four locations.

In July 2020, the county received a legal opinion from Paliare Roland barristers on the lawfulness of the county’s policy related to medically assisted deaths.

“As a result of this more recent review, the current legal opinion recommends that our policy be updated to meet the constitutional rights of those we serve and is not deemed discriminatory by prohibiting MAID from taking place within our facilities,” Lisa Garratt, the county's professional standards supervisor, wrote in her report to council.

According to the staff report, the reasoning behind the 2016 policy was the competing rights of the other residents in the home and the potential psycho-social implications.

“The framework developed was in effort to balance the rights of the individual resident requesting MAID with other residents in the home who may have moral, religious or other personal reasons for objecting to this procedure,” noted Garratt.

Through their analysis, Paliare Roland recommended the county set aside a private space within each home to perform MAID to mitigate the impact on other residents.

This recommendation is included in the new proposed policy. Also included is a recommendation that if a resident raises a desire to explore the option of receiving MAID, the staff will inform the resident’s physician and any further discussions or arrangements for MAID will only be between the resident and their physician.

During the committee of the whole meeting, councillors voted in favour of updating the policy. The decision will need to be ratified at the next regular meeting of council.