A B.C. courtroom is the latest battleground in the debate about religious freedom in public life. This time, the questions are about Catholic hospitals’ objections to medical assistance in dying (MAID).
Hearings began Jan. 12 in a case that asks whether religious hospitals violate patients’ constitutional rights when they transfer patients elsewhere to receive MAID.
Dying With Dignity Canada, a charity that advocates for MAID access, launched the case, along with the family of Sam O’Neill, a woman who was required to leave a Catholic hospital to receive MAID.
The transfer “caused and exacerbated Ms. O’Neill’s egregious physical and psychological suffering, and denied her a dignified death, including the ability to say goodbye to her family and loved ones,” the organization’s lawsuit says.
The lawsuit further says the transfer violated O’Neill’s freedom of religion by forcing her to act in accordance with another’s religious beliefs.
Experts say the case is a reminder of how Catholic teaching can directly impact Canadian health care, even if most Canadians think religion has no impact on public policy.
“[Being Catholic] actually means a lot,” said Amélie Barras, a professor at York University in Toronto who is studying Canada’s Catholic hospitals. “It’s not only the [hospital’s] name.”
Forced transfer
At a press conference, Gaye O’Neill, Sam’s mother, described her daughter as a woman who was dedicated to her friends and community. Sam was “enjoying the best life,” Gaye said, until April 2022, when she was diagnosed with advanced cervical cancer at age 33.
In February 2023, O’Neill was approved for MAID. In March, she was admitted to St. Paul’s Hospital, a Catholic hospital in Vancouver where she often received treatment. Doctors told her the cancer had spread to her spine and no treatments were available.
She began receiving palliative care and made plans to say goodbye to her family privately before her death.
But her MAID death on April 4 did not happen how she or her parents wanted, her parents say.
As a religious hospital, St. Paul’s is not required to provide MAID, so O’Neill needed to be transferred elsewhere. Before she left the hospital, O’Neill was moved onto a small toilet; this is where her parents last saw their daughter conscious.
During the 25-minute transfer and afterwards, O’Neill was heavily sedated and never regained consciousness. Her MAID death occurred at the hospice with both parents present.
“The circumstances surrounding the forced transfer … denied her a dignified death, including the ability to say goodbye to her family and loved ones,” the family’s lawsuit says.
Conflicts
Researchers say there are 129 Catholic hospitals and long-term care facilities in Canada. These facilities are publicly funded and accountable to the Catholic Church.
The religious names and decor in these hospitals are not just relics of a bygone era. Catholicism is an active part of these hospitals’ policies.
Catholic health care is “marked by service to and advocacy for the sick and those most vulnerable in our communities,” Providence Health Care Society, the Catholic health-care agency that operates St. Paul’s, wrote in its response to the court.
In their research, Barras and University of Guelph professor Andrea Paras spoke to non-Catholic doctors who said they specifically worked at Catholic hospitals because these hospitals emphasized caring for vulnerable people.
Where conflicts can arise is when patients request care that goes against Catholic teaching, such as MAID or abortion.
Some hospitals allow doctors from outside the hospital to do MAID assessments. A small number have constructed separate buildings next to their hospitals for MAID to be administered. In November 2023, the B.C. government ordered St. Paul’s to construct such a building.
Some research suggests many Canadians support faith-based hospitals transferring MAID patients elsewhere.
Polling from the Angus Reid Institute in September 2024 showed 55 per cent of Canadians supported faith-based hospitals transferring MAID patients, while 28 per cent said they should be required to provide it on-site.
The polling also showed that nearly one-third of Canadians supported having health-care institutions that do not provide MAID.
“It is important to create spaces that are safe for many Canadians who not only do not want to receive MAID, but do not want to be offered MAID or be anxious about the possibility that MAID might be raised,” said Rebecca Vochon, health program director of Cardus, a Christian think tank that commissioned the Angus Reid polling.
“Trust in health care is really important, not only in the patient-doctor relationship, but in terms of the institution as a whole.”
‘A real test case’
In statements to Canadian Affairs, both Unity Health, which operates Catholic hospitals in Toronto, and Covenant Health, which runs Catholic hospitals in Alberta, reiterated their commitment to providing compassionate care to all, regardless of religious beliefs or choices about MAID. But patients are transferred elsewhere for MAID, they said.
Catholic hospices have similar policies. Janet Groen, executive director of St. Joseph’s Hospice in London, Ont., says her organization focuses on providing dying people and their families with spiritual and emotional support as well as medical care.
“[We make] sure that we’re not just looking at physical needs, but that we’re providing psychological, social and spiritual care,” said Groen.
Some wonder if the O’Neill case will force hospitals, and possibly other Catholic organizations such as hospices, to change their policies.
“It could be a real test case about the future viability of the ability of Catholic institutions to not provide certain services, or even about the future viability of having religiously identified, publicly funded hospitals,” said Paras.
Some suggest provinces should stop funding Catholic hospitals altogether. But Barras says that is more complicated than it sounds. The Catholic Church may own the hospital’s land, even after a hospital is made secular.
“It would be a very complex question to deal with, because [Catholic health care] is so entrenched [in health-care systems],” she said.
Kerry Bowman, a bioethicist and professor at the University of Toronto, says he is glad questions about institutions’ religious objections to MAID are being tested in court.
Doctors and nurses can always refuse to participate in procedures they object to for religious reasons, says Bowman.
But it is unclear whether hospitals have a similar institutional ability to be conscientious objectors. Conflict can arise if hospitals are asked to do something that violates their religious principles, or if staff do not share the religious values of the hospital where they work.
“I think there’s a lot of tension on this, and it makes a lot of people very nervous and uncomfortable.”
Ethical framework
Catholic doctors are not the only ones watching the case.
Dr. Obaidullah Khan, who works at non-Catholic hospitals in Kitchener, Ont., says that hospitals’ religious objections to MAID should be respected.
As a Muslim, he disagrees with MAID because it goes against Islamic teachings about the dignity of human life and prohibitions in the Qur’an forbiding suicide and murder.
“I do think the implications of conscientious objection are an important thing to clarify,” said Khan, a board member of the Muslim Medical Association of Canada.
“[Health-care institutions that object to MAID] have done so within a certain ethical framework. If that ethical framework is not taken as a whole, I do think that can cause difficulty in terms of every organization’s mission and vision.”
More broadly, Khan says the high numbers of MAID are worrisome in a country where many struggle to find a family doctor.
“If primary care is not being prioritized, then I don’t know how we can be defending access to MAID.”
