In his latest blog post, Dr. David Amies takes another look at the troubling trend of publicly funded healthcare institutions refusing to provide assisted dying on site. By preventing suffering and competent individuals from exercising their right to a peaceful death, Dr. Amies says these institutions are turning their backs on the mandate to do no harm.
Medical aid in dying (MAID) is becoming more common in Canada. Although exact statistics are hard to come by, it looks as if there have been more than 200 cases carried out so far this year. More and more physicians are prepared to provide the service, or at least, refer patients to other colleagues who will. Those of us who consider this to be helping an unfortunate person escape from intolerable and irremediable suffering regard these events as good news. There is, however, a large blight across the country making access to medical aid in dying unnecessarily difficult. I refer, of course, to the attitude of various faith-based healthcare facilities with their doctrinal refusal to be in any way associated with the process.
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The national press has reported a series of instances in which a terminally ill patient is obliged to leave the institution in which he or she has been receiving treatment in order to seek relief through MAID. An especially egregious example concerns the experience of Ian Shearer, aged 84 years, who was obliged to leave St Paul's Hospital in Vancouver because he wanted access to MAID. The grisly details surrounding his last few days of life were reported in the National Post on September 27.
There are other reports of some faith-based hospitals even refusing to allow patients desirous of MAID to be assessed on their premises. That seems to be quite unjustified and unnecessarily callous. If the regular staff will not carry out the prescribed assessments, are there any good reasons why qualified health practitioners from other institutions cannot be allowed in to perform them? These visitors would require no assistance from the hospital staff. (By the way, a well-known B.C. doctor has taken to making assessment visits to Catholic hospitals in disguise! She appears carrying a large bouquet of flowers and is taken to be an innocent visitor.) Remember that the assessment for MAID requires assessments from two independent physicians over a minimum of 10 days. Imagine, therefore, the unnecessary disturbance to the suffering patient that will be occasioned by a faith-based hospital not allowing the necessary assessments to take place on its property. And this doesn’t even include the necessity for transfer to another institution for the actual final procedure.
'A thorny issue'
Faith-based hospitals and other health care institutions think they can be exempted from providing any care that goes against their religious beliefs. Apart from the obvious anomaly of an institution having a conscience, one must point out that almost all such places receive public funding. In return, they are contracted to provide legal medical services.
This is a thorny issue that is dealt with in some detail by Daphne Gilbert, an associate professor of law at the University of Ottawa, in a Globe and Mail article published Friday, October 7. She writes that Catholic hospitals consider that they have religious rights under the Charter of Rights and Freedoms. They base their arguments on a 2015 Supreme Court of Canada case known as Loyola High School v Québec. Three of the judges that heard the case ruled that a religious institution acting as a collective could claim a right to freedom of religion but only if the institution had been set up primarily for religious purposes. It is obvious that hospitals are set up to provide healthcare and not instruction on religious matters. Hospitals of all stripes employ chaplains to provide religious comfort to patients that ask for it.
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There is nothing in the Loyola High School case that relates either positively or negatively to the religious rights of employees of institutions. As the law stands at present, the members of staff of a faith-based hospital are entitled to refuse to take part in procedures which they deem to be contrary to their religious beliefs. Professor Gilbert says, “Hospitals have no conscience, only the people who work in them do.”
However, I am personally made very uncomfortable by people and institutions that claim that the law of the land does not apply to them because of their religious beliefs. I am not at all certain that healthcare practitioners can just flat out refuse to provide legitimate medical services. I concede that no one can be forced to carry out a procedure that they find distasteful, but they cannot escape the obligation to make a timely and effective referral to someone who will. Such is the case in Sweden and Finland.
According to Professor Gilbert, managements of hospitals and similar institutions do not have the right to refuse to provide treatments that are legal and considered ethical, and I find her arguments compelling. Hospitals that are largely funded from the public purse to provide medical care cannot be allowed to get away with sitting on their high horse. It is widely said and believed that the healthcare industry as a whole should, “First, do no harm.” Carting the very sick backwards and forwards for assessments, or worse still, keeping them alive against their well-considered wishes, hardly accords with that dictum.
Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.
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