daphne bramham: religious exemptions make mockery of assisted dying law
dying people are suffering because provinces won't force taxpayer-funded, faith-based health facilities to provide medically assisted dying.
6 minute read
samantha o'neill, left, and her cousin taryn bodrug, before o'neill was diagnosed with terminal cervical cancer.
taryn bodrug
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medical assistance in dying is legal in canada. polls show it has the support of an overwhelming percentage of canadians. yet because of anachronistic agreements with faith-based health providers, archbishops, rabbis, pastors and their flocks retain a final say about how a dying person must spend their last hours.
in every province but quebec, governments exempt taxpayer-funded religious institutions from providing services deemed contrary to their beliefs. it’s led to forced transfers of frail and fragile patients hoping for a dignified and peaceful death from hospitals, hospices and long-term care homes.
some institutions even refuse physicians access to assess whether patients qualify for medically assisted dying. that forces furtive physician visits, forced transfers or even abandoning any hope of having maid.
these provincial exemptions date back decades to accommodate faith-based hospitals — primarily catholic-run ones — and their ongoing refusal to provide reproductive health services, including contraception and abortion.
rather than penalizing taxpayer-funded, faith-based facilities for failing to provide legal services, provincial governments expanded the exemptions to cover medical assistance in dying, or maid, after it was legalized in 2016.
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it means that as long as politicians allow these exemptions to persist, it is frail, fragile and dying people who are being punished.
their clear wishes for a legal end-of-life procedure certified by two evaluating physicians — their autonomy — is overridden by the beliefs of others.
meantime, the only choice for patients determined to have maid is to leave care homes where they may have resided for years or comfortable rooms in hospices and palliative care units where even exceptional care isn’t enough to relieve their suffering.
the transfers can be excruciating and anything but dignified.
other patients like 34-year-old samantha o’neill are already in such agony that they need to be further sedated to endure the pain of the transfer from st. paul’s hospital to a so-called “work-around room” for the procedure in order to comply with catholic-run providence health care society’s refusal to allow maid.
the suitability of these rooms is questionable.
o’neill died in april having never fully regained consciousness. she was robbed of a hoped-for peaceful death and the opportunity for a final goodbye to family and friends.
dr. ellen wiebe told me about one of her patients who spent his last hours soaked in urine. his catheter came out during the transfer. she spoke about other patients being furtively wheeled out of care homes to waiting cars and ambulances so as not to upset other residents.
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but it was one of her first cases that sticks with her. the long-time resident of jewish-run louis brier was also transferred out to a room provided by vancouver coastal health.
“it was hideous and awful,” wiebe said. “i was so upset that my patient was stuck in storeroom in a completely unsuitable facility. there was no place for family members to sit. so, they spilled out into hallway. it was a shit show.”
(wiebe later provided maid to a longtime resident at his home in louis brier when he refused to be transferred. the care home’s attempt to have wiebe’s licence revoked was rejected by the b.c. college of physicians and surgeons.)
the situation in ontario is at least as bad.
dr. katie forfar, a family physician in renfrew county, talked about a patient with metastatic cancer of the spine who was transferred sitting up in a car. his pain was so excruciating that forfar said the transfer should never have gone ahead.
“i believe that may be a charter offence — the right to avoid cruel and unusual treatment,” she said. “i wrote to the ontario minister of health, but was told that the hospice has a right to refuse to provide this care. they are not faith based.”
quebec is the only province to insist that every taxpayer-funded facility must allow medically assisted dying. none of the others appear to have any appetite for changing the rules. across the country, there are 129 catholic health-care facilities, according to the catholic health alliance. in saskatchewan and nova scotia, the only hospitals in some towns and cities are affiliated with a catholic health-care association and adhere to catholic ideals.
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why this continues is an open question, especially in b.c. that has an ndp government and a civil libertarian for a premier.
but with only one exception, it appears to be exacerbating the problem by continuing to abide by the master agreement signed in 1995 with the denominational health care facilities association.
the exception was delta hospice. in 2021, the government cancelled its $1.5-million-a-year agreement with the privately owned facility operating on provincial land. it refused the board’s offer to have its funding cut in half, which would have allowed it to refuse to allow maid on site.
but since then, it has increased funding for faith-based long-term, hospice and palliative care beds with providence as one of the biggest beneficiaries.
it operates the city’s largest palliative care unit at st. paul’s hospital. currently, there are 12 beds, but that’s likely to increase when the new $2.2-billion, government-funded st. paul’s opens in 2027.
vancouver general hospital has only nine palliative care beds, a reduction of six since the pandemic when coastal health authority took over the specially built unit for covid patients and since then has used it for bone marrow transplant patients.
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the coastal health region — which encompasses the area served by providence health — is home to a quarter of the province’s population. in the region, faith-based organizations operate 44 per cent of hospice beds. providence has 20; the salvation army has 10.
until recently, dr. jyoti jayaraman provided palliative care at may’s place hospice on the downtown eastside. she resigned when coastal health transferred its operation to providence.
“palliative care is providing relief of suffering according to patients’ wishes,” she said in an interview. “for me, maid is part of the tool box. i will do my best to make my patient comfortable … but if my efforts have failed, i want to be able to provide maid.”
data provided by b.c. health to jayaraman indicates that the number of forced transfers is small. it’s less than two per cent across the province, but 5.62 per cent in vancouver.
but jayaraman asks: “how many patients were maid-approved and chose not to have it because not everybody can face a transfer.”
faith groups also operate nearly one in every five of b.c.’s 27,505 long-term care beds. but that will soon increase because the government has committed $207 million to build a 240-bed, care home that providence will operate at the former st. vincent hospital site. it will be operated by providence.
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physicians and health providers have a right to refuse to assist people who want to die. but regina’s dr. george carson questions the exemptions for any publicly funded faith-based hospice, hospital, care home or retirement residence.
“if it was a totally private club funded by its members, it could do what it wants,” carson said in a telephone interview. “but if it’s funded by taxpayers … conscientious objection for a building — particularly one supported by taxpayers — makes no sense.”
allowing religious organizations to retain the inordinate power to impose their beliefs makes a mockery of the law and of canada as a secular country.
but in the absence of political leadership, it seems that once again the courts may be forced to uphold the right of individuals to have some control over how and when they die.
correction: a previous version of this column misstated the cost of the new st. paul’s hospital and the year of its scheduled opening.
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