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Institutions do not have a conscience. Institutions do not have rights.

People do.

Yet, as provinces fashion regulations to conform to Canada's new federal law on assisted death, they are consistently putting the concerns of hospitals (and other institutions) ahead of those of providers and patients.

Faith-based institutions are routinely opting out of providing assisted death and, in many jurisdictions, there is a disturbing level of secrecy about which institutions provide assisted death and even how many patients have opted for hastened death.

These approaches may well be outright unconstitutional; at best, they offend the spirit of the law and the principles of medicare.

On Feb. 6, 2015, the Supreme Court of Canada struck down the Criminal Code prohibitions against assisted dying, saying competent adults with a "grievous and irremediable medical condition" have the legal right to request assisted death.

After much dithering, Parliament adopted Bill C-14, on June 17, 2016. The law has far more restrictive criteria than in the Supreme Court ruling, saying death must be "reasonably foreseeable" for a person to be eligible for assisted death.

Since then, there have been approximately 600 assisted deaths in Canada – or about 20 a week.

But good data are hard to come by because the federal government has yet to adopt regulations on how it will monitor compliance with the law, and provincial disclosure policies are all over the map.

While Ottawa has passed a law making assisted death legal, it is the provinces that are responsible for delivery of health care, and they have to adopt legislation and regulations to ensure the federal law is respected. (Provincial regulatory bodies for physicians, nurses and pharmacists have also adopted new guidelines and procedures.)

That's where things are getting thorny.

A fundamental problem with Canada's decentralized health-care system is that 14 jurisdictions – 10 provinces, three territories and a federal government (which is responsible for care delivery for indigenous peoples, the Canadian Forces, veterans, RCMP, prisoners and refugees) – can have differing rules for provision of care. This is glaringly obvious in the case of assisted dying, where a real patchwork of inequitable access is arising. (To their credit, however, provinces and territories are trying to co-ordinate their efforts, at least on the data collection part of the puzzle.)

In the past week alone, the laws in two provinces have been in the media spotlight. In Saskatchewan – as in many provinces – faith-based institutions are allowed to opt out of the provision of services "not consistent with the fundamental principles of their faith."

In the Saskatoon region alone, 12 institutions, including St. Paul's Hospital, which has the area's only palliative care unit, have declared a "conscientious objection" to the law. Under the rules, patients who request an assisted death will be transferred to a "non-objecting" site. This is a perversity.

It is reasonable for individual physicians and nurses to declare a conscientious objection and not participate in assisted death. But a hospital or nursing home has no such right. Publicly funded institutions cannot arbitrarily decide what services they will provide, nor should they be able to shunt dying patients around like sacks of rice.

In Ontario, institutions can not only opt out of assisted dying, but they can now refuse to say publicly if they provide the service or not. This too is preposterous.

It is reasonable for individual practitioners to not say publicly if they perform assisted death; sadly, it's even necessary because they can be targets of so-called pro-life zealots, as has happened with abortion providers. But, again, privacy is not an institutional right. On the contrary, public institutions have an obligation to be transparent.

What kind of twisted thinking has led our legislators to think that patients and their families should have to jump through hoops to find out where they can get the health services they want and need? In what kind of topsy-turvy world does the discomfort of an institution trump the rights of providers and patients?

Provincial rules are resulting in delays and denial of care for Canadians who are suffering at end of life. There is no excuse for this kind of cruelty. If an institution refuses to offer a service it is qualified to provide, it should be denied public funding.


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