(Image Credit : Emw via Wikimedia Commons; the image is at this link. Used without modification under Creative Commons Licence)
Can a religious institution be compelled to act in contravention of the tenets of the religion it belongs to? A recent article in the Globe & Mail has set this ball rolling, in respect of Medical Assistance in Dying (MAiD).
Recently, the Globe & Mail published an article with the title “Canadian health care should put patients first by ending faith-based refusals” by one Eric Mathison. In the article, the author narrates the case of a patient, 34-year-old Sam O’Neill of Vancouver, B.C., who was admitted to St. Paul’s Hospital in Vancouver for palliative care in March, following a diagnosis of stage four cervical cancer. The hospital is run by Providence Health Care, a Catholic organization. After her admission, Sam had consented to receive Medical Assistance in Dying (MAiD), however, as a Catholic institution, the hospital wouldn’t allow this procedure to be carried out on its premises. As a result, she had to be moved to a ‘nearby hospital’, and to handle the pain of the transport, she had to be sedated. This resulted in Sam not being able to “wake up to say the goodbye she wanted, so instead of a peaceful death surrounded by her loved ones, Sam’s last hours involved hospital staff rushing to get her transferred”.
I am sure there are additional details to the case apart from the ones mentioned by the author, but an obvious question is why the administering of MAiD couldn’t have waited until Sam woke up. The person was going to die, so what was the rush? I can understand that as a patient of stage four cancer, she would have been in considerable pain, but this loose end does remain.
In all honesty, the author seems to have a bias against religion. This is not surprising in today’s Canada, but when it begins to impact on the ideas presented to an audience, it matters. For example, the very first words in the article are “Due to history, not good ethics or policy, faith-based health care organizations receive public funding in most parts of Canada” (Emphasis added). This is a breathtakingly sweeping statement. It condemns a whole (perhaps vast) group of people who were involved in this policy without offering a shred of argument to back it up. Therefore, I have to conclude that it stemmed from the author’s anti-religion bias.
TAKING IT UP A NOTCH
The above statement is not the only one lacking in intellectual rigor in the article. Later on, he says “Organizations like Providence Health Care… don’t have a moral right to deny care while receiving public funding. Although the issue isn’t settled, many legal experts believe that current practices violate the Charter of Rights and Freedoms” (Emphasis added).
Consider the internal contradiction here. The author concedes that ‘the issue isn’t settled’, yet he feels confident enough to make an unequivocal claim that the organizations in question ‘don’t have a moral right’ to deny care. I consider this to be an editorial mistake on the part of G & M, in addition to the author. In today’s media climate, one is forced to wonder if this error was inadvertent or not.
That nitpicking apart, the key issue here is that of the Charter Rights of Canadians. Of course, these are the Rights of individuals vis-à-vis the government, but do they also apply to institutions? As a non-lawyer, my answer is ‘No’. Even the government’s webpage states that “The purpose of section 32 is to make it clear that the Charter only applies to governments, and not to private individuals, businesses, or other organizations”. In light of this categorical statement right from the source, I would love to know which ‘legal experts’ that the author mentions ‘believe that current practices violate the Charter’, and why. I am aware that law tends to be complex, and therefore am willing to hear any argument that disproves the statement on the government’s website. But I suspect that the chances of such argument(s) being convincing are fairly close to zero.
As often happens with ideas resulting from myopic vision, the one offered by the author also suffers from the defect of not having considered different circumstances where the same question is likely to occur. For example, back in September 2022, the Ford government in Ontario declared a new policy whereby patients who were waiting for space in long term care homes could be moved to other locations not of their choosing up to 150 kilometers away or be billed $400 per day if they refuse. At the time, there was quite a bit of brouhaha (and very rightly so) about forcing seniors to live so far away where they may lack social supports / network.
However, if you consider the flip side of this equation, even the LTC’s lost control over who moved into their premises as a resident; the government was going to decide which patient was going to be moved to which LTCH. If this LTCH happened to have a policy – whether stemming from religious beliefs or otherwise – not to allow MAiD to be administered on their premises, then we would be facing the same situation as that of Sam of Vancouver, B.C., in case the resident opted for MAiD later on. Unfortunately, this is not a hypothetical scenario; in January 2018, CBC reported exactly this type of a situation having occurred at a Jewish nursing home in British Columbia (the MAiD provider, Dr. Ellen Wiebe, went ahead anyway and administered MAiD to 83 year old Barry Hyman).
Since long-term care homes also receive public funding (see this link of AdvantAge Ontario), the argument that the author of the article in G&M makes regarding faith-based hospitals applies equally to faith-based LTC’s. Sure, the patient would have consented to receiving MAiD, and most likely at that particular location. But the unexplored issue here is how the exercise of one’s legal rights impacts on others. In particular, the psychological impact on the people working at the institution, and other residents / patients, needs to be taken into consideration. In November 2022, Christopher Lyon wrote about his father’s decision to opt for MAiD, and raised a highly pertinent question: What if a patient’s choice of MAiD is motivated by inflicting pain / suffering on others? Sadly, we don’t delve into such important questions in Canada. Had we done so, we would have some clue as to how to go about factoring in the impact of a patient’s / resident’s choice to access MAiD at the hospital / LTC premises.
ONE MORE DISAPPOINTMENT
According to the G&M article, B.C. Health Minster Adrian Dix has said that “the province is in discussions with Providence Health Care to allow outside health care providers to provide MAID at St. Paul’s”. This is, of course, reactive and resolutely inside-the-box thinking. As a politician, Mr. Dix is not expected to go into the really important (or even relevant) aspects of an existing policy – although we would absolutely love it if some of our elected politicians started doing that.
My disappointment here is with the author of this half-baked article. On G&M’s page, he is introduced as ‘an assistant professor of philosophy at the University of Toronto Scarborough and a clinical ethicist’. I don’t know what ‘clinical ethicist’ means; it seemed to me to be a combination of two familiar words that, presented together, create a void in my understanding. So I looked him up on Google. On the home page of his website ericmathison.ca, he says, “I teach and research bioethics, and I work with health organizations to promote ethical outcomes in healthcare”. Given this claim, his neglect of the psychological impact (on the staff & residents) of forcing religious-owned or -affiliated health facilities to contravene the tenets of their religion, and that too in a matter as serious as bringing about someone’s death, strikes me as particularly odd.
Usually, in my articles and podcasts, I am railing against the mainstream media in our country. However, if you have been following me on Twitter, you will know that I have often expressed dismay at what I see as unmoored takes by members of the academia. This is the first article where I have taken exception to the expressed views of one such member.
Why was this article written & published? As the first Prime Minister of India Jawaharlal Nehru had said, “Nothing is as inevitable as an idea whose time has come”. In the Canada of our times, MAiD is one such idea. From small beginnings in the Carter case in 2015, where assisted dying was made available to those suffering unbearable pain due to terminal illness, and whose death was also imminent, the MAiD regime has expanded the way it has because it is an idea whose time has come. So far, this expansion has taken place in relation to the demographics of MAiD recipients. Despite much public consternation, the plan to make MAiD available to people whose death is not reasonably foreseeable, to the mentally ill, to ‘mature minors’ and even infants is proceeding full steam ahead. Opinion polls show robust support for extending MAiD to the homeless, and for enabling advance consent for MAiD when the person has NOT been diagnosed with any irremediable illness. A lot of people started saying a while ago that we are witnessing the birth of a death cult in Canada. At the time, I didn’t agree – at least not fully – but now I think we may be getting there. However, the morbidly catchy summation ‘Death on demand’ only seemed to be in relation to who can avail MAiD.
Now, it seems, the ground is being prepared to expand it to venues where it was not possible to administer MAiD hitherto. As chance would have it, the first entity in the crosshairs of this next move is religion. I have said earlier that after initial resistance to the idea of MAiD circa 2015-2016, religious institutions threw in the towel and allowed the expansion of MAiD to proceed unhindered. It will be interesting to observe if they put up a fight this time around. If they don’t, ANOTHER dangerous precedent will have been set: organizations can be forced to offer a service as dictated by the government. As I have said earlier, Statism has been growing in Canada. And we will be closer to the threshold where Statism tips over into full-on authoritarianism.
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