The Ontario government recently amended the Patients First Act to add that faith-based hospitals are not required to perform medically assisted death. Faith-based hospitals have indicated that they will not offer medical assistance in dying (MAID), a position that has generated numerous comments in the media, most of them negative.
The most frequent arguments are that publicly funded hospitals should be compelled to offer legal health services and that transferring patients in the last days of their life is inhumane. This debate is very similar to the one on abortion several years ago.
Faith-based hospitals have played a vital role in Canadian health care from the very beginnings of this country. Our universal health care system began less than 50 years ago. Before that, many hospitals were owned and operated by religious orders. Most built and operated the hospitals without government support, providing a free workforce and free services to the poor.
Hospitals in Ontario are private not-for-profit corporations that receive part of their operating funds from government. They may also receive some capital funding to upgrade buildings. But they are not, per se, government services. Governments provide operating grants to numerous organizations, such as universities, NGOs and long term care facilities, including private for profit nursing homes.
It is also important to know that not all publicly funded hospitals offer all services. Even the largest academic institutions do not offer all services. For example, patients requiring liver transplants or children who need complex cardiac surgery have to go to Toronto.
Provincial governments are responsible for ensuring that people have access to needed services. But access does not mean at every hospital. This is true for most specialized services, including abortion and assisted death.
In its planning, government should consider the most appropriate locations for services and define protocols for the assessment of patients on sites that don’t offer them. It should also regulate how patients are transferred from other sites (such as nursing homes, hospitals or hospices) to the institutions that provide MAID. Medical assistance can also be provided in the patients’ home through hospices or family physicians.
Some suggest that transferring patients to another institution at the end of their life is inhumane. It is certainly not ideal. But transfers happen all the time. That is how our health care system is built. People are transferred from home to nursing home to hospital to another hospital to rehabilitation centres to hospices, for tests, specialized procedures, or palliative care.
Several writers to various blogs have suggested that government should reduce or cancel its grants to hospitals that refuse to provide medical assistance in dying. If this happened, faith-based hospitals would likely still not provide MAID, and the lack of funding would force them to reduce their services or close their doors. But who would provide the services to replace them?
And most of all, where?
Some have argued that “bricks and mortar do not have a conscience.” True, but they have an owner. In Ottawa, for example, Bruyere Continuing Care’s buildings are owned by the Sisters of Charity of Ottawa. They rent the buildings to BCC Inc for $1 a year.
The Catholic Health Sponsors of Ontario (CHSO) appoints one representative to each Board of the institutions it is involved with. It must also approve the appointment of board members and of the CEO, and it has the authority to fire board members.
The government does not own hospital buildings any more than it owns private nursing homes. It could try to force faith-based hospitals to perform MAID, or decide to eliminate faith-based ownership of hospitals, in which case the owners would likely decide to end their involvement. But they would still own the buildings.
To be able to use the current space, the government would then have to purchase or expropriate the buildings. Province-wide, the cost would be in the hundreds of millions, if not billions. This would not, in my opinion, be a wise use of health care dollars. And expropriating hospitals without proper compensation could lead to long and costly legal proceedings that the government would likely lose.
However, a real problem occurs when the people living in an area may have no choice because the only hospital is faith-based. The only cases I could find in Ontario are Pembroke, Mattawa and Elliott Lake. In such a situation, ending faith-based ownership and purchasing hospital buildings may be an option. But it is not the only one. MAID does not have to occur in hospitals. It could happen in a medical clinic, in a hospice, in a nursing home, at a community health centre or at the patient’s home.
Whatever the situation, it is up to the government, to ensure that the population has access to MAID. In most areas of the province, there are several options.
The government of Ontario’s decision to protect faith-based institutions makes a lot of sense. It is now up to government to ensure that all those in need have access to medically assisted death.
Jocelyn Downie argues Ontario’s faith-based exemptions allow and mask barriers to medical assistance in dying
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A corporation has no faith or belief system, only that which the people running it decide upon. If we were to extrapolate to other situations, such as would it be acceptable for a Jewish Hospital to deny surgeries in which pork products are needed, such as valves? Would it be acceptable for a Jehovah’s Witness Hospital to deny blood transfusions? In both of those cases the answer would be no, it would be unethical. Institutions receiving tax dollars are required by the Health Act to perform all medically necessary procedures or they risk losing funding.
It is unethical to place the burden on the patient over a corporation. Corporations do not have faiths or beliefs. Unlike the US, Canada needs to place the individual over the corporation.
This is public money. It should be about what patients want, not the values of hospitals. Assisted dying is a charter right. Its time to get rid of publically funded, faith based hospitals.
Canada in general is not ready to embrace death. As evident by the increasing government funds for hospital acute care as compared limited funds for chronic care and/or hospice care. As a society, we welcome birth, life and youth with open arms. Death is still a taboo in Canada and we have people having difficulty even saying the word “death”. In addition to that, here we are struggling to understand the movement of palliative care, end-of-life care and death, and our kind government drops the MAID bomb on us. What should we expect? People are bound to freak out and protect themselves from this idea of death and killing. So, that being said, of course the faith-based hospital has every right to refused MAID. Canada thinks, legalizing MAID is somehow embracing the inevitable truth about death. Is not. The faith-based hospitals themselves are victims of our society, so afraid to embrace death and dying. However, now that MAID bomb is in town, there is an universal responsibility to protect the hospitals, healthcare professionals from not becoming a victim again, of crimes and sins. What I mean by crimes and sins, the need to have rigorous assessment of clients who wants MAID. Looking at their health history if detected depression and possible suicide ideations in the past than dig further into it. We have to be very rigorous, possibly more than what we are doing now. I think if the faith-based hospital are uncomfortable with MAID and wants to protect themselves, than who will protect the hospices or the community care providers? Every institutions in Canada, or every profession or even each person has their values and believes; who will protect them from MAID? What about the Hindu, the Jew and the Buddhist, the non-believer healthcare providers? Who will protect them? Though faith-based hospitals has been a huge part of our Canadian history, than so is, multiculturalism and diversity. MAID is here, and we are not ready, now we have to work together to make this safe and protect all who are uncomfortable or comfortable with this. Our society was not and probably will never be ready to even talk about death and dying so we have to continue to advocate for natural death and that death is part of our life as much as birth. However, if patient just cannot accept or embrace death as it comes naturally, so fearful of uncertainties and suffering they choose MAID. Going forward, we have to think about how faith-based hospitals can possibly create a floor where people have access to MAID and can have care providers who are completely pro MAID and can provide MAID with clear conscience. They can do something along that line, because, I know hospices who will not accept clients who are merely there to get MAID.
From my understanding transfers occur because a hospital does not have expertise, or facilities to perform a service, for example something as specialized as a liver transplant or complex paediatric surgeries, not because they are unwilling. I think there is a fundamental difference between transferring someone because the staff do not possess the requisite skill to provide a service, and an institution not allowing it. Faith-based hospitals have gotten around said distinction with abortion by not having the staff or infrastructure to provide them, an argument that is much more difficult to make with medical assistance in dying.
Transfers typically happen because resources are limited and not all hospitals can provide every service. However, MAID is fully within the capabilities of all Ontario hospitals.
The religious affiliation of an institution should not prevent practitioners at that institution from acting in the best interest of the patient. At least, not on the public dollar.
Patients who want medically assisted death should not have to be transferred to another institution. Doing so puts the rights of an organization above the rights of the patient. I believe that this is morally and ethically wrong.