The entrance to the intensive care unit at St. Paul's hospital in downtown Vancouver on April 21, 2020.JONATHAN HAYWARD/The Canadian Press
Brian Bird is a lecturer at the Peter A. Allard School of Law at the University of British Columbia.
The recent news story of a patient who was denied medically assisted death (MAID) at St. Paul’s Hospital in Vancouver, owing to the Catholic belief that intentional termination of human life is killing and not health care, has reignited the debate over whether faith-based hospitals should be allowed to make these refusals.
British Columbia’s Health Minister has said that the Catholic health organization that runs the hospital, Providence Health Care, should provide assisted death at its facilities. Some observers have suggested that the current approach of transferring patients to other facilities makes a mockery of legal MAID in Canada.
But if governments want to force all hospitals to provide MAID, they might as well outlaw the involvement of faith-based and other conscientiously dissenting organizations in health care and assume direct responsibility for these facilities. This approach would be draconian and constitutionally problematic, but it would be less Orwellian than trying to coerce these organizations into betraying their core convictions on life and death, all while purporting to respect their affiliation to a faith tradition that rejects the termination of human life.
Provision of assisted dying across the health care system indeed appears to be what many governments and advocates want, and some seem willing to obscure important considerations and resort to intimidation and shaming to achieve that. It is not surprising that many dismiss protocols adopted by faith-based hospitals to balance their convictions with the wishes of patients, such as transferring patients who desire euthanasia to facilities that are willing to provide it.
But the Charter of Rights and Freedoms paves a two-way street for rights in this context. The Supreme Court has itself noted, in the ruling that legalized assisted dying, that “a physician’s decision to participate in assisted dying is a matter of conscience” and that “the Charter rights of patients and physicians will need to be reconciled.” What remains to be reconciled if all health care facilities that treat patients at the end of life are required to provide assisted death? What effect does this proposal have on patients who do not wish to be treated in health care facilities that offer MAID as a “solution” for their condition?
At times, MAID advocates also look past the growing concerns over how this project has evolved since it became legal across Canada in 2016: first to persons whose deaths were reasonably foreseeable, next to those whose deaths are not foreseeable, and as of March, 2024, to those whose sole underlying condition is a mental illness. This social experiment seems like an emerging disaster destined for a broad entitlement to death on demand. For some Canadians, MAID has even become perceived as an answer to their socioeconomic plight or inability to access support for living with a disability.
Some critics have offered up the simplistic argument that faith-based hospitals should provide MAID because these hospitals receive public funds. But this glosses over the fact that our taxes support many things that, as individuals, we oppose on principle. Pacifists may dislike public spending on national defence, for instance; environmentalists might criticize state subsidies for oil and gas production. The use of our tax dollars in ways that we do not prefer – or even in ways that we abhor – is an inescapable reality of membership in a free, pluralistic, and democratic society. Lawmaking and public policy would come to a screeching halt if every single person had to agree on the use of public funds before they are spent.
The fact is that faith-based health care offers vital services, including palliative care at the end of life, that Canada is in dire need of. In the case of Catholic hospitals, the same Catholic belief that prevents these hospitals from terminating the lives of their patients also compels them to treat patients with life-affirming care that other facilities are often unable to provide. Faith-based health care institutions have long provided excellent care to Canadians from the start of their lives to their last breath. That remains true even without providing MAID.
Tolerance around serious issues on which reasonable people genuinely disagree forms part of the bedrock of the Canadian public square. Bulldozing that diversity because of a tilted vision of rights and the clamour of popular opinion is tempting; it may even feel principled. But indulging in this temptation on sensitive issues of public interest will only erode the foundation of Canada’s free and democratic society.
If our civil society and legal order denies faith-based health care facilities the freedom to pass on giving lethal injections based on the conscientious view that MAID is killing, we will have bought into not just a fundamental misunderstanding of how Canada is meant to function, but a dangerous one.