Canadian faith-based healthcare facilities wrestle with euthanasia requirements

Family physician Dr. Kevin Sclater worked at Crossroads Hospice in Port Moody, British Columbia, for 19 years. He resigned from his position in December after years of pushing against the hospice’s policies allowing euthanasia, also known in Canada as medical assistance in dying (MAiD).

The nonreligious hospice is government funded so it is required to provide euthanasia. As an evangelical Christian, Sclater felt uncomfortable giving patients information about assisted suicide. He did not have to perform euthanasia, but he was asked to assess patients’ suitability for medical assistance in dying—which he refused.

“Having my own personal beliefs in opposition both spiritually, emotionally, socially, and professionally, I didn’t enjoy talking to people about MAiD,” he said. “But I would have to speak to them respectfully without them knowing that I had my own bias against it, and I just didn’t really want to do that anymore.”

Canada legalized euthanasia in 2016 with the passing of Bill C-14, which allowed assisted suicide for those with a “reasonably foreseeable” death, regardless of the length of their prognosis. In 2021, lawmakers expanded assisted suicide rules further to include patients experiencing irremediable pain without a reasonably foreseeable natural death. The federal government also extended euthanasia to include those suffering from mental illness but delayed the expansion to March 2024. Canada operates a universal public healthcare system with individual provinces involved in the allocation of funds. In British Columbia, healthcare facilities that provide end-of-life care and receive over 50 percent of funding from the government are required to assess patients for assisted suicide and administer it, but the law makes an exception for faith-based facilities.

In July, the Vancouver Sun reported on the death of Samantha O’Neill, a 34-year-old woman with terminal cancer who requested euthanasia while receiving treatment at St. Paul’s Hospital in Vancouver. The publicly funded Roman Catholic hospital is run by Providence Health Care, which, due to religious beliefs, does not provide euthanasia in its 10 hospitals and care facilities. Instead, the hospital can assess patients who request euthanasia and transfer them to a new facility in order to end their lives intentionally.

Although St. Paul’s Hospital is publicly funded, Providence Health Care operates under the Denominational Health Association (DHA), a group of religious healthcare organizations working to protect faith-based rights in healthcare. In 1995, the DHA created an agreement with the British Columbia government that protected member hospitals from being forced to violate their convictions about abortion and euthanasia.

On April 4, O’Neill was transferred to a facility that designates one room for medical assistance in dying run by a regional health authority. The hospital medicated and sedated O’Neill due to her pain before transferring her, and she did not regain consciousness before receiving life-ending medication while at the hospice. O’Neill’s parents voiced their frustration with the hospital’s religious exemption to administer euthanasia.

After O’Neill’s death, Providence Health Care received pushback from pro-euthanasia groups like Dying with Dignity Canada. “With respect to patient transfers for MAiD, I think that patient-centered care demands that the patient’s wishes come first,” British Columbia’s Minister of Health, Adrian Dix, said at a July 4 news conference. “And I’m working with Providence Health Care and St. Paul’s to see that happen.”

Legislators across Canada continue to present bills in favor of expanding assisted suicide. In June, Quebec passed a bill to legally require all palliative care facilities in the province to provide euthanasia—disregarding any faith-based protections. Quebec saw a 51 percent increase in assisted suicide deaths in a year, from 2,427 in 2021 to 3,663 in 2022.

Angelina Ireland is the president of the Delta Hospice Society, a nonprofit organization in British Columbia that provides end-of-life care and support services but not assisted suicide. The society ran a 10-bed hospice for years. However, in 2020, the local health authority notified the Delta Hospice Society that it would cancel the 35-year lease on its building if it didn’t provide euthanasia.

The society planned a meeting to consider becoming a faith-based organization exempt from euthanasia requirements, but three of its supporters petitioned the courts to stop the meeting. The hospice shut down in early 2021 and has since been taken over by the local health authority.

Ireland says that the government has gone beyond the medical assistance in dying legislation.

“The law never said that you have to put MAiD in every single bed. The law said you need to allow people access. They’ve weaponized the law and taken it to the nth degree possible,” she said. “In doing so, they have destroyed palliative care and now would like to destroy religious choice and religious exemptions.”

Ireland pointed to Dr. Balfour Mount, a Canadian physician credited with pioneering palliative care and promoting its adoption in North America. “Palliative care does not hasten death, it takes care of people and their families,” she said. “Not only their physical, but their social, psychological, and spiritual needs, right?”

While working at Crossroads Hospice, Sclater said that it was quite common to see patients transferred to nearby hospitals if they required extra support not provided by the hospice. Since 2016, 402 patients at Providence Health Care have formally requested assisted suicide, and 131 have subsequently proceeded with transfers to other facilities. Sclater said that most patients who need to transfer to access euthanasia can do so easily, so he believes the government should not legislate major policy changes because of a handful of cases.

“We have to be careful,” Sclater said. “We don’t create policy for the sake of exceptions—that never tends to serve the entire public very well.”