BOSCHUNG: Those pesky Catholic hospitals

“We are talking about a fundamental human right.” This is ethicist Arthur Schafer’s conclusion about Doreen Nowicki’s attempt to end her life with physician assistance at a facility operated by Covenant Health, Alberta’s Catholic healthcare provider. In the three years since the Supreme Court’s Carter v. Canada decision, physician-assisted suicide (PAS) has gone from a criminal offence to a broadly accepted practice—even a “fundamental human right,” even though it is legally nothing of the sort. Those pesky Catholics hospitals—the only institutions not yet up in this tide of rapid and unprecedented social change. In telling Mrs. Nowicki’s story, CBC has joined the chorus of media voices that condemn the steadfastness of Catholic healthcare and call for legislation to change it. However, no matter how many journalists share this view, it is misguided. Mrs. Nowicki’s story is a tragedy. I cannot begin to fathom the suffering she endured as a patient with ALS. Compounding this, as Covenant Health’s chief medical officer admitted, she and her children were not treated well. But forcing institutions that form an essential part of our national healthcare infrastructure to act in ways that are fundamentally incompatible with their mission is counterproductive. Bullying Catholic healthcare providers into compliance will not result in expanded access to medical care for all Canadians. If forced to perform procedures which compromise its morals, the Catholic Church may be pressed into withdrawing from the administration of organizations like Covenant Health. Would that be a victory for making PAS available to all? Perhaps, but at what cost? If the Church were forced out of healthcare, where would that leave its hospital buildings and services? Does the government really want to put itself in the position of having to purchase or expropriate these facilities? This would be difficult and would take money out of a healthcare system already stretched thin. If Schafer and those who think like him succeed in forcing objecting institutions to participate in PAS, it will be a be a victory in name only, with detrimental consequences for services that are accessed by a far greater number of Canadians than those requesting assisted suicide. For instance, Covenant Health administers more than one-third of Alberta’s palliative care beds. What might happen to these beds if the government found itself on the hook for purchasing these facilities? It’s very likely they would be reduced in number. Indeed, attempting to push the Catholic Church out of the administration of Covenant Health would reduce, not improve, access to palliative care and other essential services. To push for such an outcome would be a triumph of ideology over practicality. Moreover, if access to palliative care were impeded by a broadened access to PAS—a service that is ideally considered only when palliative care has run its course, ultimately the patients and their families suffer. This issue does not simply affect Catholic healthcare organizations. For example, the Delta Hospice Society, a secular hospice in BC, was embroiled in controversy earlier this year when the local health authority attempted to bully them into making physician-assisted suicide available on their premises, despite strenuous objections by hospice founders and operators. The operators correctly maintained that PAS was incompatible with the philosophy of hospice palliative care, and that to force them to provide this service was incompatible with the mission of the hospice itself. This is not a fringe opinion amongst palliative care practitioners. Both Dame Cicely Saunders, the founder of modern palliative care, and Balfour Mount, considered the father of palliative care in Canada, felt that PAS is incompatible with the philosophy of palliative care. If Mr. Schafer has his way and all publicly funded facilities are forced to provide the so-called “full range of options at the end of life”, what will happen to organizations like Delta Hospice Society? Many people look to such places as a refuge from end-of-life “care” which has been corrupted by the introduction of PAS. Shouldn’t we ensure these people also have a choice? While it is easy to look at a tragic story like Mrs. Nowicki’s and blithely decide that the government must force all publicly funded facilities to provide PAS, this is a short-sighted approach which will cause more harm than good. If we really care about the sick and dying, the last thing we need is an approach that leads to a reduction in the availability and diversity of end-of-life care.