Hey there, time traveller!
This article was published 27/6/2017 (1410 days ago), so information in it may no longer be current.
Much has been written lately about St. Boniface Hospital’s refusal to allow medical assistance in dying (MAID) in its facility. Critics argue that health care is publicly funded, patients have a "right" to receive MAID where they wish and some who want this intervention may be too unstable to transfer.
These arguments misrepresent the way health care is funded in Canada and fail to acknowledge important elements of the Carter Supreme Court decision. They ignore the structural realities of our health-care system, and are not supported by recent data on the provision of MAID.
The Carter judgment, which struck down the laws prohibiting MAID, specifically recognizes limits to a patient’s "right" to access MAID. The judgment states that no physician can be forced to participate and the "right" of a patient to access this service must be balanced with a physician’s "right" to opt out.
Amid the criticism, there has been little acknowledgment of the huge contributions that faith-based organizations (particularly Catholic health and social service organizations) have made historically to health care in Canada and how they continue to "subsidize" health care for many Manitobans.
Many people believe government pays for the vast majority of their health care. In reality, only two-thirds of the total cost of health care is paid by governments and this is heavily weighted toward physician and hospital-based services.
Even in hospitals, there are many aspects of the care experience provided or funded by others. Consider diagnostic imaging equipment purchased by a hospital foundation, treatment rooms funded by a wealthy family, or the thousands of volunteer hours provided by community members.
In any faith-based hospital, the denomination — and its congregations that support (and in many cases own) the hospital — has invested millions of dollars and millions of hours in the care that all patients receive, regardless of the patients’ religious beliefs.
The government pays for health-care services provided at St. Boniface Hospital, but the Catholic Health Corporation of Manitoba and many members of the Catholic Church have made an immense investment in the care that is delivered there.
I have worked at St. Boniface Hospital and have a family member who received cardiac surgery there.
The hospital’s focus on compassion, dignity and excellence are all grounded in Catholic traditions and are aspects of health care at St. Boniface I have experienced first-hand.
Medical regulatory authorities across Canada have procedures in place to balance the rights of patients and of doctors. There has been debate about "institutional conscience" and whether hospitals can express foundational beliefs in this area without affecting patient access. Most provincial governments recognize this can be done and have explicitly allowed institutions to opt out of the provision of MAID.
There are many different health-care services in Manitoba that are not available at all sites. Within the city there are many specialized services available at a single site. Outside the Perimeter there are many health-care services that require co-ordination and transfer.
The Winnipeg Regional Health Authority (WRHA) has been very proactive regarding MAID. Its website provides excellent information regarding the assessment process and how to access physicians willing to perform MAID.
The emerging data on who is requesting MAID, why it is being requested and where it is occurring shows that in the majority of cases, it is a premeditated decision. Most who request it fear a loss of control and wish to exit on their own terms. It is being provided in a well-planned manner, mainly in homes.
The idea that there are many patients in acute care hospitals who suddenly develop intolerable symptoms, make a decision to request MAID, need it provided in an expedited manner, and are too ill or unstable to be moved is not supported by this data.
Given the significant dollars and human resources the Catholic Health Corporation of Manitoba provides to subsidize high-quality health care for all Manitobans, it seems reasonable it request that certain commitments be respected in its facilities.
Its opposition to MAID has been longstanding, transparent and carefully considered. A prohibition on MAID in St. Boniface Hospital will impact the care of a small number of Manitobans and these effects can be minimized. Manitobans should recognize the tremendous added value that organizations such as St. Boniface Hospital bring to their health care and encourage them to continue to contribute to the care of all Manitobans in a manner that is consistent with their deeply held commitments.
Dr. Merril Pauls currently works as a physician at a WRHA facility but does not speak for the WRHA. He is also an associate professor in the department of emergency medicine at the University of Manitoba. He is a member of a Christian (not Catholic) church in Winnipeg. He has worked in the past with members of the Catholic Health Corporation of Manitoba.