Cory Peel is a GP-Anesthesiologist who locums throughout British Columbia, Alberta and the Yukon
A couple of months ago I read Mike Hager’s article in the Globe and Mail about Dr. Reggler’s tribulations at St. Joseph’s Hospital in Comox, BC, and I was overcome by a realization that, despite having been a practicing Family Physician for 7 years, I had culpably little understanding of the prejudicial impact of faith-based hospitals in determining patient access to care.
The article detailed the refusal of the “Catholic hospital” in Comox to provide medical aid in dying to its patients despite having a staff physician willing and able to do so, thereby forcing them to be transferred elsewhere. That such a policy could exist stunned me. It is the work of “the bishop [a.k.a. the Diocese of Victoria] and the hospital board,” with the board’s CEO maintaining that “minimizing patient discomfort and pain is always the highest priority,” which seems to me to fly in the face of logic.
It is not, however, an isolated example. Canada contains many hospitals whose delivery of healthcare to its patients is directed by Church doctrine.
Allow that to rest for just a moment at the centre of your awareness. It’s not that the historical religious missionaries – in the case of Comox’s hospital, the Sisters of St. Joseph – don’t deserve credit for, in the medical sense, advancing the line of human prosperity and putting to good use some of the overflow of the largest coffers the world has known. They do. But historical credit is all they are due.
Modern medicine’s use of the scientific method as a route of inquiry has long surpassed in utility: folk tales, superstition, revelation, and decree. In my view, human behaviour in the medical field should bear no more heed to a Christian edict than it should the anguished bottom-line ravings of a secular economist. I hope the reader won’t interpret the latter clause as evidence of a naïve rosiness that fiscal reality shouldn’t determine how we treat illness – it must. What I’m suggesting is that, to the extent humanly possible, the provision of medical services in this country should hold as its lone guiding principle that which it purports to: the alleviation, and failing that, the mitigation, of the totality of human suffering.
The Catholic Church’s directive regarding medical aid in dying would seem to me to fail impressively when it insists that a terminally ill patient, for whom any movement is burdensome mentally and often physically, go from hospital bed to stretcher to jostling ambulance ride and to, perhaps, unfamiliar other hospital. No intellectual gymnastics can make me regard this as anything other than a purposeful and unnecessary infliction of pain; worse onto those at the end of their life; worse still under the pretense of sanctimony. Any doctrinal justification of such injustice should be met with the same reproach and condemnation that decry any other religiously inspired torture, in my view.
Publicly provided medical care, the wellspring of Canadian pride and recognized ideal of civilized nations, has no business parsing harm in faith-specific terms. It seems clear to me that public health care institutions have no business mandating traditions or posturings meant to appease any particular version of the afterlife, much less at the expense of patient autonomy and legally entitled treatment, and that if Catholic hospitals want the right to pick and choose what services they provide there is only one conscionable and acceptable way to proceed: they must join the lobby in pursuit of a two-tiered Canadian health delivery system, one that might allow them to withhold care by scripture, offer that version of care to the inclined, and most importantly, do so unsupported by a single publicly-supplied dollar. This is the only possible milieu in which medical decisions based on providers’ faith alone could rationally be considered.
What should the great numbers of people in places like Comox do, where their only community hospital is held hostage by a board and CEO that replace their legal rights with propitiations to a god that they may not even believe in? What ought we to say to religious ideologues who take public, non-denominational dollars and use them to run their very denominational institutions?
In reply, I offer that the present reality of some Canadian hospitals subjecting our list of medical rights to their religious scissors cannot be tolerated, and the realization that it is occurring should evoke disgust and rage in patients, lawmakers and physicians alike. There are, of course, places where religious doctrine is tolerable, but our hospitals are certainly not among them.
Thanks for your article, I agree. I had this published in Globe and Mail MArch 29th 2016:
As a physician, I have a problem with the concept of religious hospitals (Should Catholic Hospitals Be Forced To Kill People ? Focus, March 26). Religion is one thing, and health care is a different thing.
There are no Catholic diseases, Muslim medications or operations for atheists. Is the purpose of a religious hospital to deny patients (of any, all, or no religion) access to those legal medical treatments which are contrary to the moral beliefs of the health care providers? If so, the hospitals should not be part of the state-run medical system.
There is no plan to create an obligation for hospitals to kill anyone. If a sick patient requests help to die in comfort, physicians will be expected to put aside their own moral judgment and refer the patient to someone who is prepared to contemplate this option.
The most nonsensical of all the nonsense in this tirade is the notion that the legalizing of euthanasia in Canada had anything to do with science. If anything it was a triumph of ideology over medical science as we knew it, specifically over the principles of palliative care.
As one of my colleagues likes to say – it’s not my favourite argument against euthanasia, there are many others that I prefer, but it fits well in this context – there is no scientific data in support of the hypothesis that killing a patient ends his or her suffering. It is based on a belief about what does, or does not, happen after death. What Dr. Peel calls “any particular version of the afterlife”. The belief that a dead person does not suffer has no scientific basis, as we have not up to the present found any way of testing it. And likely never will.
One can prefer one belief system over another but it is dishonest to say, when there is no evidence, that one’s own is more scientific. Or most deserving of taxpayer dollars. People of all stripes pay taxes.
If the treatment principles of medical palliative physicians purport to alter patient care depending on what happens after death, they are in greater need of revision than MAiD alone can provide. Luckily this proposed alternate reality does not exist.
The question, “Does a dead person suffer?” is one of the most scientifically answerable questions one can ask, and neuroscience has a mountain of data at its disposal with which to support its answer: NO.
Many further points raised lend themselves to a debate about the existence of a human soul – an interesting topic to be sure, but not one I was trying to address, nor one our community hospitals should be weighing in on. It is a fact, correctly stated, that people of all religious affiliations pay taxes, but at the present time their tax dollars go into a funding pool without retaining any of their benefactors’ religiosities. It is thus an affront to all for an institution (not an individual) thus funded to actively deny a patient a service by presuming some religious authority.
Dear Dr. Peel,
I would like to respond to two points in your blog post.
First, we (in Canada) transfer patients between facilities all the time, if a desired service is not available at the ‘home’ hospital. Hip surgery, cardiac surgery, specialized geriatric services – these are just three that come to mind in my own community. Any transfer has the potential to cause discomfort and distress the patient, and it is to be hoped that appropriate reassurance and pain control would be offered as needed. We do not insist on hip surgery being available at every hospital to avoid have to transfer patients for this. (As an aside, I know patients who would be reassured to be at a facility that does not offer assisted death. We all know the kind of fiscal pressures out there, and how patients can be sometimes persuaded to follow a treatment avenue that might not be their first choice.)
Second, Canada is a multicultural and pluralistic society. Religious freedom is protected under the Charter. You seem dismayed that someone would actually act on a faith-based belief in a way that might affect someone else. But this happens all the time in our diverse nation. (Consider the Ktunaxa First Nations case now before the Supreme Court.) Surely we can respect and honour a diversity of world views, and work to accommodate each other, instead of insisting that Canadians be non-religious if public funding is involved.
Warmly and sincerely yours,
Dr Sandra Brickell
Thank you Dr. Brickell for your thoughtful response. I hope you don’t mind if I try to clarify my position a bit.
To your first paragraph: I am not suggesting that physicians willing and able to provide MAiD be available everywhere. Where they are not, transfer is the only option. Hospitals that do not have the resources – human or logistical – to provide hip surgery, cardiac catheterization, etc., must outsource care, but they never do this on an ideological basis. In this very important way, the Comox hospital situation is starkly different. At St. Joe’s, there is an MD willing and able to provide the care, but there is an institutional, non-medical, ideological barrier preventing it.
I will avoid thoughts on your bracketed aside, not because I don’t think it’s a talk worth having, but because it’s not central to the points I was trying to raise in my post.
To your second paragraph: the survival of the religious plurality and freedoms that make this country great necessitate their remaining divorced completely from matters of overarching government influence – and in Canada more than any other nation, government is involved in the delivery of health care. As such, my dismay is not that individual medical experts and their patients act in faith-based, morally consistent ways within the context of the relationship they have forged; rather, my reproach is directed at religious policy makers who presume to squeeze their way into that relationship and insert their own moral framework.
Lastly, I think avoiding the use of public funds in support of any religiously directed enterprise is the only way to respect, honour, and promote the freedom of, each individual’s spiritual and cultural practice. Any fund leak to the contrary runs the very real risk (see the US experiment) of having religions at disparate positions of favour, and of religious dogma dangerously influencing the running of a nation.
I sincerely thank you for your comments.
Is this one of those fake news type babble that is hoping for like clicks and shares? 5000 years of medical traditions and ethics are of no value to our new Age of Enlightenment where doctors will terminate patients and then go home for a CabSauv.
I’ve met so many in the health care profession that will have nothing to do with MAID and will leave the profession if needed to avoid participating in willfully killing patients. Thank God for hospitals who have marked a line in the sand. They are safe haven for patients who are in need of doctors and nurses with traditional moral and ethical values.
I’m waiting now for a published list of doctors who state their morals and ethics with regard to MAID.
The pagan traditions and ethics of the Fertile Crescent physicians of 3000 BCE have little to add in this discussion.
The Globe article referenced deals not with a health care professional being forced to kill patients or being strong-armed into complicacy. It, rather, profiles patients who wish to end their own lives having present a physician who is able and consenting, free of influence, to assist them. This is a question of patient and provider autonomy, which as long as it does not contradict Canadian Health Care Law, ought not be influenced by any particular hospital’s religious interference.
A list of physicians providing MAiD is reasonable. A list detailing all physicians’ moral and ethical stances on it is not, and lists of this sort compiled over the last 80 years have led to unnecessary human suffering.