A Catholic-run health authority in British Columbia that receives millions in public funds and runs major hospitals in the province, including the flagship St. Paul's Hospital in downtown Vancouver, has sent a memo to staff saying doctor-assisted death is not permitted in its institutions, even as a new parliamentary report says the service should be widely available across the country.
Although B.C. Health Minister Terry Lake says the province can accommodate both a pending new law on physician-assisted dying and the boundaries set by Providence Health Care, others say something has to give, underscoring fault lines sure to show up elsewhere across the country as governments and health-care providers grapple with the realities of helping people die.
"We think the government should say to St. Paul's, 'You've got to fall in line,'" Josh Paterson, executive director of the B.C. Civil Liberties Association, said on Thursday after the parliamentary report was released.
"With respect, we don't think you can have it both ways," Mr. Paterson said. "We don't think those kinds of institutions, whether it is Providence [Health Care], whether it is St. Joseph's hospital in Toronto, whether it is St. Mary's in Kitchener-Waterloo … they cannot hold themselves apart from having to respect patients' rights on this."
However, Mr. Lake suggested that patients who seek doctor-assisted deaths could be accommodated by other, non-Providence Health Care facilities, and that the province has to balance patients' rights with those of health-care professionals who have conscientious objections.
"Patients need to have their wishes respected, but we also recognize that providers have deeply held belief systems as well," he said. "And we think our system can accommodate both of those."
Providence Health Care is a Catholic-run agency that falls under the umbrella of the larger, non-denominational Vancouver Coastal Health Authority. That means a "responsible, respectful transfer" could be arranged if someone in a Providence facility desired a doctor-assisted death, Mr. Lake said.
On a personal note, the Health Minister said he watched his mother pray for release and struggle for breath for hours before she died.
"I totally understand, on a very personal level, but I don't think I would have wanted a provider being forced to provide a service against their moral, ethical or religious belief system. I don't think that's what my mom would have wanted," he said.
"This isn't black and white. You can't force someone to provide a sensitive service at a time that is so critical to people when they are diametrically opposed to it."
However, Mr. Paterson said it is not acceptable for Providence to opt out, or for the province to allow one of its contractors to do so.
"People go to St. Paul's to die," he said, referring to the hospital's palliative-care unit. "For someone who has been lodged in the community of care at St. Paul's to then be asked to ship themselves, in the shape that they're in, to somewhere else, we do think that's too much to ask."
The Supreme Court of Canada struck down the ban on doctor-assisted death last year. The federal government is now working on a new law.
A parliamentary committee report released on Thursday set out 21 recommendations, including that the government work with provinces and territories to balance health-care practitioners' freedom of conscience with the needs of patients who seek medical assistance in dying.
In a Feb. 16 memo to its clinical leadership team and medical advisory committee, Providence officials noted the authority operates under Catholic Health Alliance of Canada guidelines.
"Accordingly, as at the most fundamental level, [physician-assisted death] contradicts the basic tenets of Catholic health care – wherein life is held to be sacred from conception to natural death – and not permitted in Catholic health-care institutions such as Providence," the memo states.
The Catholic Health Alliance of Canada, an umbrella group for Catholic health facilities across the country, did not make a spokesperson available for an interview, but it said it is reviewing the committee report.
Providence is also reviewing the report, a spokeswoman said.
B.C.'s system could accommodate transfers of people seeking doctor-assisted death from Providence facilities to others that have agreed to provide the service, said Eike-Henner Kluge, a philosophy professor at the University of Victoria and an expert in medical ethics.
But if those transfers take place, Providence, not the provincial government, should have to foot the bill, Dr. Kluge said.
He added that such discussions are not likely to be limited to B.C. "Similar things will happen in all provinces where there are health-care institutions that are religiously based – and they are going to be subject to the same kind of consideration," he said.