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