WHEN ASSISTED DYING TAKES A BACK SEAT TO RELIGION …
Last month, Ian Shearer, a former Calgary accountant who’d retired to Vancouver, requested medical aid in dying. The 87-year-old was suffering from severe spinal stenosis, along with heart disease, kidney failure, and finally, sepsis. He was dying in tremendous pain.
Shearer, though, was a patient at a Catholic hospital. The hospital refused to honour his request. He was transferred to another public, secular, hospital. But as National Post reported this week, the transfer was disastrous. The ambulance scheduled to move the dying man was more than three hours late. The discharging hospital had reduced Shearer’s fentanyl dose, so he’d be fully competent to consent to a physician-assisted death. Then the ward ran out of fentanyl. So he waited for the ambulance in increasing agony, screaming as he endured a four-kilometre ambulance ride to a hospital where he was finally granted his right to what his family called a beautiful, peaceful death.
Shearer’s story illustrates, all too bleakly, just how unsustainable Canada’s new physicianassisted dying rules are. We say we’re trying to balance competing human rights, the rights of the Catholic Church and the rights of patients. But there’s little balance, when a hospital’s values trump the best interests of a patient, when a dying man’s dignity is sacrificed on the altar of someone else’s religion.
Our Charter’s protection of religious freedom is sacrosanct. Catholics are entitled to their faith and to lead lives guided by their principles. Not all medical ethicists agree, but I personally believe no doctor or nurse, of whatever faith, should be compelled to participate in a physician-assisted death, if doing so would violate their conscience.
But conscientious objection has limits.
Tim Caulfield is director of the University of Alberta’s Health Law Institute.
“Physicians have a fiduciary duty to their patients,” he says. “Even if you recognize a right to conscientious objection, it can only be exercised in a situation where you are not prejudicing the interests of a patient.”
In this case, it’s hard to imagine Shearer’s rights were ever paramount.
Yet even we respect an individual doctor’s right to refuse treatment, does one particular church have a right to run our public hospitals, which serve everyone, according to the dictates of its particular faith?
In Alberta, the Catholic right to run separate schools is enshrined in our province’s founding legislation. There’s no such constitutional protection for a separate Catholic health-care system. Yet taxpayers maintain and fund Covenant Health, just such a system, with all its duplicate health bureaucracy.
Alberta’s Catholic hospitals are largely a legacy of the missionary nuns who opened Alberta’s first hospitals and clinics more than a century ago, before Alberta was a province. It’s a remarkable legacy of public service, one we should rightly honour. But this isn’t 1874. Today’s Alberta is a multicultural province, with a secular rule of law. The Supreme Court of Canada has ruled that patients in extremis have a constitutional right to medical aid in dying. Parliament has legalized the practice. Alberta has regulated it.
Yet patients in Catholic-run hospitals, palliative-care centres or long-term care facilities cannot exercise that rights. They cannot choose, even if they’re non-Catholic. The rights of the Church stand supreme.
We don’t often choose our hospital. That decision is often based on where an ambulance takes us, or where a specialist has privileges. That’s a particular problem in Alberta, where Covenant Health, and Covenant Care run 23 hospitals and care homes under contract to Alberta Health Services. That includes the Grey Nuns and Misericordia in Edmonton. In some other towns, the only hospital is a Catholic one.
In Edmonton, Covenant also operates 90 per cent of all palliative and hospice beds.
That means many non-Catholic Albertans are subject to Catholic dogma around death and dying that may well clash entirely with their own deeply held personal values.
According to AHS, 29 assisted deaths have taken place in Alberta so far, 14 of them in Edmonton. Another 23 Albertans requested medical aid in dying, and were denied. So far, two patients have been forced to transfer from Catholic facilities, run by Covenant, to receive medical aid in dying.
Owen Heisler is chief medical officer for Covenant Health. Covenant, he says, has been working closely with AHS to ensure respectful care for patients who request medical aid in dying. Covenant’s focus, he says, is on “high-quality patient care and non-abandonment of patients.”
“We need to read stories like the one reported in Vancouver and learn from them in the future,” Heisler says.
If Covenant and AHS really can move patients painlessly and simply from one facility to another, maybe compromise is possible. Maybe.
But with every transfer of a medically compromised patient, we run the risk of a tragedy like Ian Shearer’s.
In 2016, it makes no economic sense to sustain two health-care systems, one Catholic, one secular, with two sets of overlapping administrators.
Still, it’s hard to imagine any Alberta government will have the courage or the political capital to rationalize health-care delivery. So we’re left in limbo, stuck with a model that requires patients to respect a hospital’s religious values — but which doesn’t require a hospital to respect a patient’s.