End-of-Life Choice: What’s Religion Got to Do With It?

Sandra Dunham

In 2015, the Supreme Court of Canada decided that the parts of the criminal code which prohibited Medical Assistance in Dying (MAiD) would have to change. And in June of 2016, federal legislation passed to allow for MAiD. Hospitals, long-term care facilities, primary care providers, and hospices all scrambled to create policies to address this new legislation.

From the beginning, Catholic and other faith-based organizations opted out of providing MAiD and even discussing it with patients, citing “religious reasons.” Hospices, faith-based or not, appear to have opted out of MAiD on a large scale as well — on the surface, for philosophical rather than religious reasons. The Canadian Hospice Palliative Care Association (CHPCA) reports that MAiD is not a part of the practice of hospice palliative care. They go on to indicate that “hospice palliative care and MAiD substantially differ in multiple areas including in philosophy, intention, and approach.”

Dying with Dignity Canada offers an interactive map identifying which healthcare facilities offer MAiD. A quick check of the red facility markers (those disallowing MAiD) shows that many are non-faith-based hospices.

The term ‘hospice’ was introduced in the mid-1800s to describe the care provided to dying patients. The idea of hospice as a place to die was not common until 1967 when the first hospice, St. Christopher’s House, opened. Perhaps the religious background of its founder, Dame Cicely Saunders, has crept into the modern hospice movement, or perhaps there is another reason altogether for the reluctance of hospices to embrace MAiD as an end-of-life alternative for their patients.

Although the hospice movement claims to support an individual’s right to make decisions about the care they receive at the end of life, for many Canadian hospices, MAiD is the exception to the rule. Many hospices refuse to offer MAiD in their facilities. For example, Nipissing Serenity Hospice in Ontario and Delta Hospice in BC both refuse to offer MAiD.

In the fervor to avoid allowing patient choice about MAiD, Delta Hospice in BC has walked away from government funding, is facing mounting criticism from donors, and at least in one case — Irene Thomas Hospice — is laying off staff.

Although Delta Hospice was not incorporated as a faith-based organization, religion appears to play a starring role in the anti-MAiD decision. It seems that while the organization is not overtly Christian, its directors are. The board of Delta Hospice is accused of “stacking the membership” with people supporting their religious viewpoint, including those living outside their service area, in an attempt to change the society’s constitution to become Christian based.

The Supreme Court of Canada identified MAiD as a human right. The refusal of hospices to allow MAiD is harmful to individuals and to families. A decision to pursue MAiD in a hospice that does not provide it leads to the unnecessary transfer of the patient, causing an increase in suffering and trauma for the dying individual and their family members. For patients contemplating MAiD, the refusal of a hospice to permit it may prevent the patient from accessing hospice care at the end of life. This is a clear indication that the government of Canada has prioritized the rights of a religious group over the rights of Canadians seeking the end of life on their own terms.

A special thank you to Martin Frith, President of Humanist Canada, for providing background information to assist with this article.

---

Did you know?

• • Oregon was the first U.S. state to pass legislation permitting assisted deaths.
  • Voters approved Oregon Death with Dignity measure in 1994 by a very slim margin (51.31% to 48.69%).
  • The controversial legislation faced numerous court challenges. The first physician assisted death did not take place until 1998.
  • As of January 2020, 2,518 Oregonians have received prescriptions for a hastened death, 66% of whom ingested the medications.
  • Since 1998, Oregon has released an annual report about the implementation of the Oregon Death with Dignity measure.
  • Although CHPCA argues that MAiD is unnecessary as modern palliative care is well able to manage pain, the issue of pain ranked relatively low (based on data from Oregon) on a list of eight end of life concerns.
  • The top three reasons people choose to end their lives early are:
    1. Less able to engage in activities making life enjoyable
    2. Losing autonomy
    3. Loss of dignity

Canada’s MAiD legislation came into effect in June 2016. Since then, more Canadian lives have ended through MAiD each year.

The First Annual Report on Medical Assistance in Dying in Canada, 2019 was published in July 2020.

• • As of December 31, 2019, a total of 13,946 medically assisted deaths have been reported in Canada, with 5,631 of them taking place in the calendar year 2019.
  • MAiD represented 2% of Canadian deaths in 2019.
  • BC had the highest proportion of MAiD deaths at 3.3%.
  • In Newfoundland and Labrador just 0.3% of deaths were attributed to MAiD.
  • In Canada, the top reasons people gave for requesting MAiD were:
    1. Loss of ability to engage in meaningful life activities (82% of MAiD recipients indicated this was part of their rational for requesting MAiD)
    2. Loss of ability to perform activities of daily living (78%)
    3. Inadequate control of symptoms other than pain (or concern about it; 56%)
    4. Inadequate control of pain (or concern about it; 54%)