Mere legalization of euthanasia is never enough. Eventually, efforts will be made to compel dissenting doctors and institutions to become complicit in the killing of sick patients — even if it violates constitutional guarantees of freedom of religion.
That process is accelerating in Canada. Ontario already requires individual doctors, at the risk of professional discipline, to participate in euthanasia — either by killing a legally qualified patient (a category that keeps expanding) or providing an “effective referral,” which means finding for the patient a doctor who’s known to be willing to kill.
Now, efforts are being mounted to coerce objecting institutions into allowing euthanasia — euphemistically called medical assistance in dying (MAID) — even when it violates the faith precepts of a hospital, nursing home, or hospice. Toward that end, a study newly published in BMC Medical Ethics argues that the government should force dissenting institutions to comply with patients’ requests to die.
How can that be? Legalizing euthanasia turns mind-sets upside down. What was once considered a form of murder is redefined as a beneficent medical treatment and the refusal to provide it a cause of harm. From the study:
A small but growing body of research in Canada and internationally has demonstrated a range of harms to patients caused by institutional objections. Institutions have refused to provide patients with information about MAiD, and have refused to permit assessments and provisions onsite, resulting in some patients being transferred out of a facility These transfers have caused patients to experience additional pain, and psychological, emotional, and psychosocial suffering.
In some circumstances, institutional objections have blocked patients’ access altogether, such as when there was no other entity to receive a transfer of the patient or the transfer was physically unbearable for the patients or otherwise impossible. Some studies have also found more insidious effects of institutional objection, which can adversely affect a patient’s end-of-life experience. In a study of the perceptions of health providers, patients and family members from a Saskatchewan regional health authority, Brown et al. found that participants perceived institutional policies prohibiting MAiD as creating barriers to access and challenges in navigating institutional procedures.
Institutional objection to euthanasia also purportedly harms doctors who want to euthanize patients who ask to die and makes them less willing to kill:
There is also some emerging evidence internationally that institutional objections also cause harms to health professionals, and reduce willingness to participate in MAiD Physicians have described structural and emotional challenges from faith-based institutions refusing to allow entry to undertake MAiD assessments and provisions onsite, practising privileges not being honoured, significant travel needed as assessments cannot be carried out onsite, uncertainty caused by lack of protocols and policies, and onerous reporting requirements. Nurses in Belgium have reported that a lack of professional support constrained their ability to represent the patient’s interests. Health professionals who do not share the institution’s position experience moral distress when compelled to act against their values as a result of an institutional position.
The authors report that some institutional resistance to euthanasia has abated because doctors and institutions have become more accepting of the practice. But not all. Something must be done!
The persistence of institutional objections within faith-based institutions . . . suggests that institutional objections rooted in religious values or ideology may be less amenable to change. This is another factor that suggests a stronger regulatory response may be needed, which reduces the need for bottom-up advocacy by patients, family members and health practitioners. Advocacy by very unwell patients and their families in response to a roadblock caused by institutional objection is a significant burden, and many patients may be simply unable to advocate due to factors including how unwell they are.
The absence of top-down regulation may impose a significant burden on clinicians to undertake advocacy and negotiate patient access. Given that the model of assisted dying in Canada relies on clinician involvement to facilitate patient access, reducing burdens on clinicians is also important in ensuring provider sustainability and, in turn, patient access.
The study suggests that institutions be coerced by the state into violating their faith-based mission when it comes to euthanizing patients:
The wide range of harms identified, both to patients and practitioners, suggest that at least some limits to institutional discretion are warranted and that top-down regulatory involvement may be the best way to facilitate patient access to this lawful end-of-life choice.
What might that look like? Stripping institutions of all health-care-related government funding and/or seizing control of dissenting institutions. Both actions were imposed in 2021 against Delta Hospice in British Columbia after it refused to euthanize patients. Delta was crushed even though it was only a ten-bed institution and was adjacent to a public hospital where doctors would have happily euthanized requesting patients. But, even that tiny institutional objection was deemed beyond the pale by the BC government, whose action was later approved by the courts.
One of the main arguments for legalizing euthanasia, or assisted suicide, has always been that it furthers the great principle of “choice.” But sooner or later, choice becomes a one-way street. Comity is eventually shattered, and the freedom of conscience and religion of medical professionals and faith-based institutions becomes a human-rights violation to be remedied by the government and punished by the courts.
I have little doubt that this study will become the justifier for government legislation in Canada to explicitly compel dissenting religiously affiliated medical institutions to euthanize legally qualified patients regardless of ethical or religious objections. The culture of death brooks no dissent.