St. Paul's Hospital CEO addresses criticism of policy prohibiting MAID at facility

As construction of a multimillion-dollar end-of-life hospice continues under the management of St. Paul's Hospital, the president and CEO of the publicly funded facility has addressed criticisms of its faith-based objection to medically assisted dying.

Concerns were raised earlier this month about the potential for COVID-19 to block access to medically-assisted deaths (MAID) for patients at St. Paul's, which does not allow the procedure at its facility in Saskatoon. 

Patients that decide to have MAID are usually transported to other facilities, but that procedure was in question earlier this month due to worries about hospital transfers during the pandemic. Transfers were ultimately allowed to continue. 

CBC received strong reactions to the story from those supportive of St. Paul's stance on MAID and from others who believe the facility should not receive public funding.

On April 17, St. Paul's Hospital president and CEO Jean Morrison provided an interview to explain the facility's conscientious objection to the procedure in more detail. She is also the CEO of Emmanuel Care, which owns the hospital. 

Law allows St. Paul's to refuse some services: CEO

She said the basis for St. Paul's policy on MAID is rooted in the Catholic belief that life is sacred. 

"Catholic health care has a long-standing moral tradition of compassionate care that neither prolongs dying or hastens death," said Morrison, adding that the policy is about "respecting life to natural death."

Earlier this month, families of MAID recipients and a doctor who administers MAID called for St. Paul's to dedicate a room at the facility to the Saskatchewan Health Authority, for the purpose of providing a space where the procedure could be carried out. 

Morrison said it would still go against St. Paul's policy, because the procedure would be on Catholic land. She also said she has not received any formal requests for that to happen.

Morrison added that the law allows St. Paul's to exist within the public health system while choosing not to provide some services. 

"It's not different than many other procedures where there [is] pain, where a facility may have the ability theoretically to provide that care," she said. 

"But we still don't provide it everywhere and there are a number of reasons why we don't including — can we do it providing the quality that needs to be provided? Is it efficient to do those things everywhere? Or, on moral grounds."

She said decisions on conscientious objection lie with the Catholic Bishops of Saskatchewan, who appoint board directors to Emmanuel Care.

Although the hospital does not allow MAID onsite, Morrison said she personally respects the person's right to choose.  

"I will always respect it and always support them to move toward what they're looking for and need," she said. 

"We still have our commitment to the client and to provide compassionate care and part of that is working with and exploring that client's desires and wishes and values ... and to then facilitate transitions to people that can provide them care if we need to do that."

The hospital has also faced criticism for choosing not to provide MAID when it receives public funding. 

I'm so surprised that they have done this, at this time, to give public funding to the Catholic health authority to go to a hospice.- Ailsa Watkinson, Professor Emerita of Social Work at University of Regina

St. Paul's is home to the city's only palliative care unit. Morrison said the unit only exists in Saskatoon because St. Paul's Hospital Foundation worked hard to establish it.

She said a new 15-bed end-of-life hospice set to open at the corner of Hilliard Street E. and Melrose Avenue this fall came about the same way.

"The hospice facility is 100 per cent funded in terms of capital by St. Paul's," Morrison said.

"There was no plan on the books to build a hospice in Saskatoon prior to St. Paul's coming forward and making that a reality."

The provincial government has committed a about $4.8 million in operational funding for the hospice to date. 

Province says it strives for balance

Federal legislation passed in 2016 allows eligible Canadian adults to request medical assistance in dying, but it does not force health care providers to deliver it.

"Not all health care providers will be comfortable with medical assistance in dying," reads the Health Canada website. 

"The federal practice may not be consistent with a provider's beliefs and values."

It adds that provincial and territorial governments hold responsibility for health care and that they may make policies around where MAID can occur as long as it does not conflict with the Criminal Code. 

The Ministry of Health in Saskatchewan last week provided an explanation of its stance on MAID.  

"Our goal is to respond in a balanced way to the Supreme Court ruling and federal legislation," it said in a written response to questions. 

"This includes providing appropriate safeguards for vulnerable individuals, while respecting the wishes and personal convictions of patients, families, providers and health care organizations."

In the statement, the government also said it appreciates that MAID is a "deeply personal matter" and a complex issue with implications for patients, families, health care providers, health policy and programs. 

'Bizarre' location for new hospice: MAID advocate

Ailsa Watkinson is a professor emerita of social work at the University of Regina whose research is focused on human rights.

She is strongly opposed to public funding for faith-based health care and described the decision to build the facility at St. Paul's as "bizarre."

"I'm so surprised that they have done this, at this time, to give public funding to the Catholic health authority to go to a hospice — which we need — but to give it to them," said Watkinson.

"It could have been given to the Saskatchewan Health Authority and it could've been set up through any of the other hospitals here in Saskatoon or Regina, but they gave it to a Catholic hospital." 

Proposed court challenge

Watkinson and a colleague have recently applied for funding through the federal Court Challenges Program to develop a case regarding MAID and conscientious objection. 

"The MAID legislation allows physicians and others working in the health-care system to use conscientious objection as their reason not to do these procedures," said Watkinson. 

"But the question is can an institution claim conscientious objection?"

They argue not allowing a patient to have MAID infringes on a patient's right to freedom of and from religion under Section 2 of the Canadian Charter of Rights and Freedoms. 

The application also argues that it limits their right to life, liberty and security of the person under Section 7. It also argues against conscientious objection on the basis of equality, saying that refusing MAID on the basis of religion is a violation of Charter rights.

Watkinson is still waiting to hear if that application will be approved. 

Morrison said that conscientious objection to MAID is ethical, based on Catholicism. 

"It would not be ethical from a Catholic perspective to perform MAID to cause someone's life to end earlier than it naturally would," she said.

"There's a lot of diversity in society and we're not all ever going to agree on everything."

She said she believes in tolerance

"In my experience you don't always come to the same place of agreement, even when you dig in and peel back the onion to gain greater understanding, because you have to go back to the moral foundation —  the values foundation of individual decisions," she said.

"Those are at the core of someone and you don't change those, but you have to have respect for that diversity."