MAID lawsuit shines spotlight on faith-based health organizations
Under 1995 agreement, B.C. allows organizations to withhold services that conflict with beliefs, values
A recent lawsuit over access to medical assistance in dying (MAID) in some hospitals in British Columbia has put the practices of religious health organizations in the spotlight.
Faith-based health organizations in B.C. are allowed to opt out of providing certain services if they conflict with their values and beliefs — including access to abortion, contraception and reproductive health care in Catholic-run, publicly funded hospitals, according to researchers.
Providence Health Care, the Catholic health organization that runs St. Paul's Hospital in Vancouver, and the province of B.C. are now being sued by the family of 34-year-old Samantha O'Neill, who was forced to transfer out of St. Paul's because Providence would not provide her with MAID.
Her family said the forced transfer put O'Neill in excruciating pain and the lawsuit is the only way to prevent a similar situation from happening to anyone else.
"Assisted dying is the focal point for this case. But the case has implications beyond that," said Jocelyn Downie, a professor emeritus in the faculty of law and medicine at the University of Dalhousie, who has spent years researching health delivery at religious-run health networks across Canada.
"Canadians need to recognize that they can be denied care much beyond assisted dying," Downie said.
"There's all kinds of care that they could be denied because governments are allowing faith-based institutions that are publicly funded… to deny care based on their religious beliefs and values."
In an email to CBC News, Providence Health Care spokesperson Ann Gibbon said the organization transfers patients who require MAID to a Vancouver Coastal Health facility.
"Because we are a Catholic health-care provider, there are some services not available at its facilities, particularly those intended to end human life. MAID is one of those services," Gibbon said.
"Providence's approach is based on its long-standing moral tradition of compassionate care that neither prolongs dying nor hastens death."
Opting out is allowed
The ability for religious health organizations to opt out of certain health services in B.C. is outlined in a 1995 master agreement between the province and the Denominational Health Association.
The association represents 12 different religious denominations that oversee a combined 7,800 health-care beds including acute care, long-term care and seniors' homes across B.C.
The agreement states that religious-run health facilities have the right to determine the mission and values of their facilities and to "own, manage, operate and conduct the affairs of their respective facilities and to carry out their respective religious missions."
According to Gibbon, Providence Health Care does not provide abortions, but does offer care for patients who have a miscarriage. As pharmacy restrictions are done provincially, contraceptives are available at pharmacies affiliated with Providence Health Care.
However, according to the Catholic Health Alliance of Canada's health ethics guide, Catholic-run hospitals cannot perform abortions, will not provide contraception and will not perform any type of sterilization to prevent future pregnancies.
That means for example, if a woman delivers a baby through caesarian section in a Catholic-run hospital, she cannot have a tubal ligation to prevent future pregnancies.
Jill Doctoroff, interim executive director at Options for Sexual Health, a Vancouver-based women's clinic, said it's "a huge concern" that health services can be different depending on which hospital you go to, especially since people don't often choose where they're treated.
"I think we all know that there's so many challenges within our health-care system right now, and added barriers like the decision based on faith not to provide these services makes it harder," she said.
"We all expect to be able to get the health care we need, regardless of where we are. And I think that as citizens who pay taxes, we should also expect that the health-care facilities are going to be based on health-care and science and not based on faith beliefs."
Government response
Premier David Eby said last week the government is negotiating with Providence Health Care over what services will be provided at the new $2.1 billion St. Paul's Hospital, which is slated to open in 2027.
The province is kicking in $1.3 billion, Providence Health Care is providing $722 million and $131 million is coming from the St. Paul's Foundation.
Providence Health received $700 million in funding from Vancouver Coastal Health last year, plus another $112 million from other health authorities and the B.C. government.
The B.C. government has in the past shut down a hospice for refusing to provide MAID. It happened in 2021 when Fraser Health pulled $1.5 million in public funding after the Delta Hospice Society stopped offering the service.
However, the Delta Hospice Society was not a religious-run health network.
After Samantha O'Neill's parents, Jim and Gaye O'Neill, went public with their concerns, B.C. Health Minister Adrian Dix announced in November that his ministry would set up a clinical space next to St. Paul's where MAID could be provided with the oversight of Vancouver Coastal Health staff.
"I appreciate that people want to see a sort of legal response but my concern is patients and making sure they have access to the care they need," Dix said during an unrelated news conference in Surrey, B.C., on Tuesday. "And that's the action we're taking at St. Paul's."
However, Dr. Jyothi Jayaraman, a Vancouver-based palliative care doctor and MAID practitioner, said that solution ignores the fact there are at least two dozen religious-run hospices and long-term care facilities across B.C.
"Mr. Dix really needs to openly acknowledge that this is not just a St. Paul's problem. It's the problem of all faith-based facilities," said Jayaraman, a plaintiff in the O'Neill case.
Nineteen people this year have been forced to transfer out of Providence Health Care facilities to access MAID, according to the organization.
Nine of those patients were transferred out of St. Paul's, four each from Mount Saint Joseph Hospital and May's Place Hospice in Vancouver, and two from St. John Hospice on the University of B.C. campus.
Jayaraman quit her job at May's Place Hospice last year after it was taken over by Providence Health Care and subsequently stopped offering MAID.
WATCH | Dr. Jyothi Jayaraman discusses why she quit:
The Quebec government passed legislation last year which requires all palliative care homes, including those run by religious health groups, to provide medical assistance in dying.
That law is being challenged by the office of the Roman Catholic Archbishop of Montreal, arguing it violates religious freedom.
Daphne Gilbert, a University of Ottawa professor who has been helping human-rights charity Dying with Dignity with the lawsuit in B.C., said the Quebec government is taking the opposite approach to B.C., which has so far been reluctant to dictate which services religious health networks must provide.
"There you have the government protecting the rights of all Quebeckers in the face of the church's position," Gilbert said. "Whereas in B.C., the government is protecting the church and we're challenging that protection. But the fundamental question is similar."
Downie said it's "profoundly unfair" that the B.C. government has essentially forced patients to sue over the policy.
"It's an abdication of responsibility by the government to do it this way — which is to sort of say, we've got an agreement, we've got a policy. If you don't like it — you being the patient who is faced with this forced transfer — you have to go to court to advocate for your rights."
Gilbert said she expects both the B.C. and Quebec legal challenges to reach the Supreme Court of Canada.
ABOUT THE AUTHOR
With files from Jon Hernandez