Stephen Smysnuik
Should faith-based hospitals get to block MAID?
Photo by Farts Pfotografy, Shutterstock
The Topline
- A B.C. Supreme Court case is challenging whether faith-based hospitals can refuse to allow medical assistance in dying (MAID) in their facilities, forcing the transfer of terminal patients
- The dispute centres on Vancouver’s St. Paul’s Hospital – run by Providence Health Care (PHC) – which does not permit MAID on-site – and Sam O’Neill, who had to be transferred from the hospital to receive MAID in April 2023
- Plaintiffs in the case argue that forced transfers violate Charter rights at the end of life, while the defence argues that hospitals should be able to make their own decisions based on religious beliefs, even inside a public system
Public money means public rules
In Canada, hospitals are public institutions, not private clubs. They are publicly funded, publicly planned, and often the only option available for people when they need access to healthcare.
Such is the case for St. Paul’s Hospital, the only hospital located in Vancouver’s downtown core. When a patient arrives here, they’re not stopping by out of a theological preference, but because it’s the nearest and/or most appropriate hospital.
This was the case for O’Neill, whose family are the plaintiffs in the case taken to the B.C. Supreme Court. They argue , basically, that humans are the ones with Charter rights, not hospitals. Institutions don’t die, they don’t suffer, they don’t experience pain. So why should a hospital’s rights take precedence over a human’s?
They also argue that a hospital policy that forces a dying person to be transferred – rather than carry out the final stage of their own life, on their own terms, in a country where that choice is legal – imposes a religious rule on someone who may not share it.
The province attempted to rectify this problem after her death by creating a workaround – a non-religious space onsite, operated by Vancouver Coastal Health rather than PHC, where MAID could be accessed.
Across Canada, Catholic and other faith-based organizations like PHC run hospitals, long-term care homes, and hospices that are fully integrated into provincial systems.
In some communities, and especially in rural and remote ones, there are no practical alternatives. What do patients in these hospitals do if they choose to end their life on their own terms? MAID then becomes an option only if you have the privilege of residing in the correct postal code.
Universal healthcare is meant to be universal – and that includes legal procedures, even if they’re controversial.
Institutions have missions, too
Carter v. Canada may have legalized MAID, but it never made participation mandatory.
PHC’s refusal isn’t about blocking access altogether. MAID remains legal, funded, and available elsewhere. The institution is simply declining to participate in a procedure that is against their religious beliefs. They claim to be exercising the same conscientious refusal that individual doctors in this province are allowed under the Charter, as long as they make an effective referral.
There’s a practical problem at the root of all this – if faith-based healthcare organizations are forced to abandon their core mission in order to access public funding, they may exit the system entirely. That would leave provinces scrambling to replace beds, staff, and specialized services at a time when healthcare systems are stretched thin across the country.
This could be why B.C. created its MAID workaround for St. Paul’s in the first place. Patients still gain access to MAID without forcing religious institutions to cross a theological no-go zone.
MAID is a lightning rod issue where legal, moral, and theological questions overlap, which makes this specific case more dramatic. But leave MAID out of it, and it becomes a practical question of how Canada and its provinces should handle moral disagreements inside taxpayer-funded institutions.
If the government can override religious identity in this case, why not in other areas where public funds and doctrine clash?
The Charter protects people to choose their religion, just as it protects others who choose no religion at all. Defenders in this case argue that this protection shouldn’t evaporate at the hospital door.
