Eric Mathison is an assistant professor of philosophy at the University of Toronto Scarborough and a clinical ethicist.
Due to history, not good ethics or policy, faith-based health care organizations receive public funding in most parts of Canada. These hospitals and long-term care facilities are most often Catholic, and they’re funded by taxpayer dollars the same way non-Catholic facilities are. In many cases, patients don’t choose the facility they’re sent to or even know that it’s Catholic. They only find out when the facility turns them down for care they could receive at a non-Catholic facility.
That’s what happened to Sam O’Neill, a 34-year-old woman in Vancouver, B.C. Last year, Sam was diagnosed with stage four cervical cancer. She was approved for medical assistance in dying (MAID) earlier this year, then was admitted to St. Paul’s Hospital in Vancouver for palliative care in March.
Since St. Paul’s is run by Providence Health Care, a Catholic organization, it refuses to allow MAID at the hospital, so Sam was forced to go to a nearby hospice facility to receive the publicly funded treatment she consented to and qualified for. To handle the pain of being moved, she had to be sedated. She didn’t wake up to say the goodbye she wanted, so instead of a peaceful death surrounded by her loved ones, Sam’s last hours involved hospital staff rushing to get her transferred. “It was hell, quite frankly. It was a horrible few hours,” Sam’s mother, Gaye O’Neill, told CTV.
Sam’s story isn’t unusual. Across the country, people are denied MAID and other medical interventions opposed by the Catholic Church, including the morning-after pill, abortion, gender-affirming surgery, pharmaceutical contraception, IUDs, in vitro fertilization and tubal ligation.
In cases like Sam’s, forced transfer causes suffering and interferes with bodily autonomy. In other places, transfer isn’t possible since the faith-based hospital is the only option available. Even when patients can go elsewhere, they still have to suffer the indignity of being denied care in the first place.
This is wrong. Sam’s forced transfer violated her autonomy and likely caused her to suffer. She was entitled to better treatment both ethically and legally. Organizations like Providence Health Care, in contrast, don’t have the moral right to deny care while receiving public funding. Although the issue isn’t settled, many legal experts believe that current practices violate the Charter of Rights and Freedoms.
Since her death, Sam’s parents have spoken about her mistreatment. Others, including Dr. Jyothi Jayaraman, a palliative care physician and MAID provider in Vancouver, have been advocating for years for the provincial government to address forced transfers. So have legal experts such as Jocelyn Downie, a professor at Dalhousie University.
The B.C. government might be finally coming around. Health Minister Adrian Dix said recently that the province is in discussions with Providence Health Care to allow outside health care providers to provide MAID at St. Paul’s. “We are starting with St. Paul’s because circumstances in acute care are often different,” he said. “When you’re going to acute care, you’re not choosing at all. So this is the place to address things, and that’s what we are working with Providence on.”
Acute care needs to change, but long-term care, hospice and other facilities also violate patient rights. The time has come for broad change: Provinces and territories should stop granting religious exemptions to health care organizations when they refuse to provide MAID and other medical interventions. If they want to receive public funding, they shouldn’t be allowed to refuse care on religious grounds.
Importantly, this change is possible without affecting the rights of health care providers. Physicians and nurses can refuse to provide MAID and other interventions for reasons of conscience, which is protected by the Charter. Ending faith-based institutional practices won’t force Catholic doctors to violate their religious beliefs, for instance.
But the new approach shouldn’t lean too heavily on outside providers, either. Finding an outside provider takes time and can itself cause suffering. A Walrus article from last year by Wendy Glauser, for example, describes how a survivor of sexual assault had to wait 10 hours for a sexual-assault nurse to come from a different hospital.
Many faith-based hospitals have providers who are willing to give care that goes against the Catholic Health Alliance of Canada’s ethics guide. Just as many patients who end up in Catholic facilities aren’t Catholic themselves, providers get hired by these hospitals only to find that they can’t act on their own beliefs. They should be allowed to do so. Letting health care organizations restrict their own providers is still giving religious leaders too much control.
Ethically speaking, the case for ending institutional faith-based refusals is easy. People shouldn’t have to worry that they’ll end up at the wrong place when they get in an ambulance, or that they’ll be told their request is immoral according to their nearest hospital. Health care in Canada should put the interests of patients first, which means ending faith-based refusals.
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