Dr. David Amies: Publicly funded institutions must be driven by compassion, not righteousness

The debate over conscientious objection has intensified, following the release of a parliamentary report on February 25, which included a call to make physician-assisted dying available in publicly funded healthcare institutions. In his latest Dying With Dignity Canada blog post, Dr. David Amies weighs in on the ongoing debate over whether faith-based but publicly funded institutions have the ethical right to refuse physician-assisted dying.

The recently released joint parliamentary committee report on physician-assisted dying (PAD) suggests that publicly funded institutions will not be able to avoid providing the service on conscientious grounds. Of course, this has the Catholic hierarchy hissing with rage. I just listened to an episode of CBC’s The Current, which outlined the Catholic position and invited a medical ethicist to point out the errors in the argument.

Poking holes in the argument

There are more than 100 Catholic-run medical facilities across the country. They maintain that the people working in them are entitled to decide what services they offer on conscientious grounds. They also maintain that the very organizations themselves possess conscience. Shanaaz Gokool, the new executive director of Dying with Dignity Canada, is on record as saying that facilities are bricks and mortar and cannot be said to possess a conscience!

The presenter of the podcast asked David Nash, chair of the Catholic Association of Health Institutions in Ontario, several very direct questions. He bucked and hedged and offered one equivocal answer after another. Shakespeare's Hotspur threatened to “cavil on the ninth part of a hair” when faced with a particular issue. Nash has nothing to learn from Hotspur. When asked if Catholic hospitals' management would refuse to obey the law of the land, he spoke at length about the need for greater emphasis toward palliative care. No sensible person would disagree. He claimed that governments already consider that hospitals can have conscience. He pointed out that religiously-run organizations have managed to avoid performing abortions by not possessing suitable facilities in which they could be carried out. That argument hardly holds water as far as physician-assisted dying is concerned because all that is needed in those cases is a supply of medication and a means of administration: syringes and needles, beakers and water.

Nash claimed that all patients with terminal illnesses can self-refer themselves to other institutions more sympathetic to their wishes. He was vague about how easy this might be and vaguer still about what might happen to those in remote locations, where a Catholic-run hospital might be the only option in town. Perhaps, his most remarkable claim was that polls on PAD carried out across the country were not to be believed. He felt that if one delved a little more deeply, the true feelings of Canadians would be revealed.

The ethicist who spoke on the broadcast was sympathetic toward the plight of Catholic institutions, but maintained that if they were publicly funded, in whole or in part, they must follow the rule of the land. Moreover he claimed that Section 15 of the Charter, which outlaws discrimination against individuals on the basis of their race, national or ethnic origin, colour, religion, sex, age or mental or physical disability, mandates that no public policy can be based on religious grounds. He claimed that Pope Pius XII actually said in 1956 that keeping someone alive at all costs was unnecessary and undesirable. These views were endorsed 30 years later by the Church.

Compassion trumps righteousness

It looks then as if we are faced with an immovable rock and an irresistible force. A Catholic hospital would do its public relations no good by refusing to admit terminally ill patients because they fear requests for PAD. Imagine what hay the media would make of the sight  of grandma, in extremis, being turned away from their doors. If she did make it in and then put in her request, the hospital management would be faced with the choice of agreeing or transferring her elsewhere. If such a hospital received public funds, it would have to bear all of the costs of the transfer, which could be very considerable.

Catholic institutions from the Vatican down are very tender where their purses are involved. Could it be that mere mammon might trump their consciences? It is probably remiss of me to teach the Church to suck eggs, but I recall the parable of the Good Samaritan in which the righteous passed by the dying man, fearing contamination on religious grounds, while the Samaritan was moved only by his plight. 

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.

(Header photo credit: G. Conti/Wikimedia)

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