Canada’s expanding regime of euthanasia, euphemistically known as Medical Assistance in Dying (MAID) has forced an uncomfortable question into the open: must religious hospitals participate in practices that violate their deepest moral convictions, simply because the law now permits them?
The current legal challenge to a Catholic hospital in British Columbia suggests that the answer, for some, is yes. But that conclusion misunderstands both religious freedom and pluralism, and risks impoverishing Canada’s healthcare system in ways we may later regret.
The recent court case in British Columbia, challenging Catholic hospitals’ refusal to administer Medical Assistance in Dying (MAID), raises profound questions about religious freedom and patient rights. This has sparked a vigorous debate, intersecting with themes I explored in an academic article on religious hospitals’ rights to refuse physician-assisted suicide.
Background of the Case
The case was initiated by Dying With Dignity Canada and the family of Sam O’Neill, who had to endure a transfer from St. Paul’s Hospital, a Catholic institution, to access MAID. Her family claims this transfer violated Sam’s constitutional rights, exacerbating her suffering and denying her a dignified death.
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At stake is not whether MAID should be legal — Parliament and the courts have answered that question — but whether institutions formed around millennia-old moral commitments may continue to operate in accordance with them. In short, does Canada still believe that conscience has a place in public life?
Conscience Does Not End at the Hospital Door
Many Canadians accept that individual physicians should not be compelled to participate in assisted dying against their conscience. That much was acknowledged by the Supreme Court of Canada in Carter v. Canada, which explicitly noted that participation in MAID is a matter of conscience and religious belief.
However, that view was rejected by the Ontario Court of Appeal in the Christian Medical and Dental Society of Canada case where the court warned that physicians who were not willing to go against their conscience in support of euthanasia “may be able to find other practice structures that will insulate them from participation in actions to which they object. If they cannot do so, they will have to seek out other ways in which to use their skills, training and commitment to patient care. I do not underestimate the individual sacrifices this may require.”
What is too often missed is that conscience is not only individual; it is institutional. Religious hospitals are not simply bricks and mortar, nor are they morally neutral service providers. They are expressions of religious communities that have long understood healthcare as a vocation ordered toward preserving life from conception to natural death.
This institutional (as well as individual) conscience predates the Charter. Long before Canada became a modern welfare state, religious communities founded hospitals, motivated by their understanding of human dignity and moral responsibility. These institutions were not created to mirror prevailing social norms but to bear witness to a different moral vision — often one that later came to be widely admired.
To now insist that such hospitals must abandon that identity as a condition of continued operation is to misunderstand their very reason for being.
Public Funding Does Not Erase Religious Identity
Critics argue that because religious hospitals receive public funding, they must provide all legal medical services — including MAiD. But this reasoning collapses the distinction between public service and state control.
Canada has long recognized that publicly funded, faith-based institutions may retain their religious character. Religious schools, charities, and healthcare facilities have flourished precisely because governments respected the idea that funding services is not the same as nationalizing conscience.
Forcing Catholic hospitals to provide MAiD would not create neutrality; it would impose a secular orthodoxy that excludes dissenting moral traditions. True neutrality allows space for differing conceptions of the good — particularly on issues as profound as life and death.
A Pluralistic Society Requires Institutional Diversity
We are often told that Canada is a pluralistic society. But pluralism does not mean uniformity. It means coexistence — including coexistence with institutions that dissent from majority views on fundamental human life issues.
Historically, religious institutions have served as a counterweight to state power, offering what political theorists once called “sober second thought.” When governments or courts dramatically alter longstanding social norms, justice requires that space be left for those who cannot, in conscience, follow.
This is especially important in areas such as assisted dying, where society has moved with remarkable speed. For over two millennia, physicians refused to make the intentional killing of patients part of medical practice. That norm has been abandoned within a single generation. Such a rupture demands humility — and accommodation.
The Supreme Court Has Been Here Before
Ironically, the Supreme Court itself has shown how this can be done.
In the Reference re Same-Sex Marriage, the Court recognized that redefining a fundamental institution required robust protection for religious communities that could not accept the new definition. It held that compelling religious officials to perform same-sex marriages would almost certainly violate freedom of religion and could not be justified.
The same logic applies to MAiD. If sacred spaces could not be compelled to host marriages contrary to religious belief, why should hospitals be compelled to host acts they regard as morally impermissible?
Religious freedom loses coherence if it protects clerics but abandons caregivers.
Closing Religious Hospitals Would Harm Us All
There is also a practical cost. History suggests that when governments force faith-based institutions to violate their core beliefs, those institutions often choose closure over capitulation. This has already happened in other sectors.
If Catholic hospitals were forced to provide euthanasia, many would likely close or relinquish their religious identity. The result would not be expanded care, but fewer hospitals, less trust, and diminished social capital.
Research consistently shows that religiously affiliated hospitals foster unusually high levels of patient trust and community support. They are woven into civil society in ways the state cannot easily replicate. Removing them weakens the network of relationships that makes healthcare work.
In the interview with Deina Warren and Bruce Clemenger, the question explored is whether faith-based organizations can maintain their identity while offering public services? The Constitution must safeguard spaces where religious and secular perspectives can coexist.
This includes recognizing institutional conscience protections as a means of ensuring that these hospitals can remain true to their missions. As Deina Warren argues, acknowledging such protections is crucial for preserving the diversity that underpins Canadian pluralism.
Moral Certainty Is No Substitute for Humility
Legal norms change. What one generation celebrates as progressive, another may condemn as tragic overreach. We need only recall the confident legal justifications for eugenics in the early twentieth century — once defended as enlightened, now regarded with horror.
That sobering history should caution us against coercing dissenting institutions on questions of life and death. Protecting religious hospitals today is not resistance to progress; it is an investment in societal resilience.
Canada does not need every institution to think alike. It needs room for difference, especially on matters that cut so deeply into our understanding of what it means to be human.
Implications of the Court’s Decision
A ruling against St. Paul’s Catholic hospital might compel the institution to act against its religious beliefs or face closure, which would impoverish Canada’s healthcare landscape and diminish institutional diversity. As history indicates, such institutions often prefer closure over compromising their beliefs. Of course, that is not always the case but if it is forced to compromise its beliefs we are all the more poorer.
Enforcing secular norms could erode the social capital—trust and cooperation—that societies rely on, as noted by scholars like Robert Putnam. Religiously affiliated hospitals have been shown to foster unique trust and warmth, drawing patients seeking care aligned with the institutional beliefs and purposes.
Conclusion: The Path Forward
This legal battle beckons Canada to deliberate on accommodating both religious and patient rights. The stakes are high: should the court mandate Catholic hospitals to provide MAiD, we risk homogenizing healthcare standards at the expense of religious freedoms. A decision striking a balance—allowing faith-based institutions to respect their religious convictions while ensuring patient access to MAiD through alternate means—would respect our pluralistic fabric.
This case is not just about MAID; it’s a test of how Canada upholds its values of diversity and religious freedom. By protecting spaces where religious and secular can coexist, we embrace a richer, more inclusive society.
