Should hospice professionals be forced to assist the suicides of their patients who want to die? Not too long ago, the answer to that question would have been an emphatic “Of course not!” Hospice is not about making people dead. Rather, it seeks to help terminally ill patients live well through intensive medical, spiritual, psychological, and social treatments to alleviate the pain and emotional suffering that dying people and their families may experience.
Don’t tell that to the provincial government of British Columbia. After the Supreme Court of Canada conjured a right for anyone diagnosed with a serious medical condition that causes “irremediable suffering” to receive lethal-injection euthanasia, British Columbia passed a law requiring all medical facilities that receive at least 50 percent of their funding from the government to participate in what north of the 46th parallel is known euphemistically as “medical assistance in dying” (MAiD). When Delta Hospice Society, in Delta, British Columbia, announced that it would adhere to the hospice movement’s founding philosophy by banning euthanasia in its facility, the province’s minister of health threatened to cut off all provincial funding. Delta has until February 3 to yield to the euthanasia imperative or face a catastrophic financial crisis.
The Power of the Purse
The power of the purse can be very persuasive, but Delta has not surrendered. Instead, searching for a compromise, it has offered to cut from its annual budget, of $3 million (Canadian dollars), $750,000 of the $1.4 million that it currently receives from the province. That would reduce the portion of its budget that comes from public funding to a point below the 50 percent legal threshold, allowing Delta to continue serving dying patients while maintaining its philosophical integrity. As of this writing, the authorities have not responded to Delta’s offer.
On the face of it, the government’s heavy-handedness makes no logical sense. Everyone acknowledges that Delta provides a very valuable service to the community. And it’s not as if the small hospice, with a mere ten beds, has the power to materially impede access to euthanasia in British Columbia, a province of nearly 5 million people. Indeed, since euthanasia was legalized in 2016, only three Delta patients have asked to be killed — and they were able to obtain their desired end by simply returning home or transferring to a hospital directly next door to the hospice.
So, What Gives?
Angeline Ireland, president of Delta, perceives a direct connection to socialism. When I asked her in an email interview why she thought the government was trying to force the hospice’s participation, she replied, “I would only be speculating,” but “primarily, I think it is ideological and agenda driven. Our provincial government is currently run by socialists. The Left has never valued human life. In socialized medicine the state controls and is all powerful.” She also believes there is a connection to the costs of health care. “I also wonder how much of it is driven by economics. HPC [hospice palliative care] is far more expensive than euthanasia.”
Delta is a secular facility, so what are its bases for refusing to kill? The administrators merely want the freedom to operate the facility according to the precepts of hospice moral philosophy. “HPC and euthanasia are diametrically opposed,” Ireland tells me. “Our health-care discipline has been practiced for 40 years in Canada and in that time has excelled in providing pain- and symptom-management to people. A patient can be stabilized to live out their life the best way possible. We have seen that people offered Hospice Palliative Care tend not to want euthanasia.”
I asked how Delta’s patients would be affected if the province agreed to cut its support of the hospice by $750,000. She told me that “other programs,” such as “bereavement services” for survivors and “a layer of administration,” would have to be cut until new sources of private or philanthropic funding could be found. But she was adamant that dying patients would not be affected, as Delta will “focus exclusively on our hospice.”
A Bitter Irony
And if the government refuses Delta’s compromise and terminates all financial support? Ireland identified a bitter irony. “Over the last 20 years, we have subsidized the government healthcare system by raising $30 million and giving 750,000 voluntary labor hours directly into community healthcare,” she notes. But she remains adamant: “We will not provide euthanasia. If the government withdraws all its funding, we will try to operate on a privately funded downsized version. We will look for other partners to help us carry on our work.”
Will Delta go to court in that circumstance? Yes. “We have not done anything wrong,” Ireland says. “We have not defaulted on our contract. There is nothing in our contract which obliges us to perform euthanasia or have it provided on our premises.” However, seeking justice is expensive. “We could be on the right side of the law and the right side of history, but it will take $400 an hour to hire a lawyer to seek our remedy. Most not-for-profit organizations don’t have the luxury of standing up against Big Government, who have at their disposal seemingly unlimited legal resources.”
And what if all efforts at obtaining relief fail? While Ireland didn’t say it, one presumes that Delta would close the hospice rather than yield to the government’s orders to kill. Notably, the minister of health seems fine with that prospect.
A Clairon Message
Of course, this controversy isn’t really about Delta. British Columbia is sending a clarion message to all health-care providers: resistance to the euthanasia imperative is futile. Ireland understands the stakes. “We believe the nation is looking at our situation and [that it] will have a profound impact on other hospices. If the government can coerce us into killing our patients, they can force any hospice into doing it.”
The Delta coercion has ramifications far beyond the hospice sector. Canada is in the process of expanding health categories that qualify for doctor-administered death. Quebec just opened the door to allowing those with mental illness that is deemed “incurable” to receive euthanasia. The country also seems on the verge of requiring that a person diagnosed with progressive dementia be able to sign a legally binding written directive that she be killed when she becomes incapacitated. Also being seriously debated is the legalization of pediatric euthanasia, perhaps without parental permission in the case of “mature children.” Meanwhile, euthanasia and organ-harvesting have already been conjoined in the country — a utilitarian plum to society, celebrated and promoted in the media. If Delta can be compelled to board the euthanasia train, so too can psychiatric institutions, pediatric hospitals, nursing homes, memory-support facilities, and organ-transplant centers.
And it isn’t just medical facilities that are feeling the heat. In Ontario, an ethics rule of the provincial medical association requires doctors to participate in euthanasia, by either doing the deed or finding a doctor who will. A court of appeals has ruled that the requirement is binding, even if it violates a doctor’s religious beliefs. If doctors don’t want to be complicit in euthanasia, the court sniffed, they should either find another career or restrict their practices to such fields as podiatry, in which they won’t be asked to administer death.
Lessons for the U.S.
What can the United States learn from all this? First, single-payer health care — socialized medicine — allows the government to control the medical profession with an iron fist and harness the sector into advancing controversial social policies. Second, euthanasia is an aggressive social pathogen that brooks no dissent. Once a society widely accepts the underlying premise that killing is an acceptable answer to suffering, access to euthanasia eventually becomes a right that the government must guarantee at the expense of the freedom of conscience of medical practitioners. Finally, access to euthanasia comes to matter more than the ability to assure quality treatment, with the authorities willing to accept a brain drain from the health-care sector rather than allow conscientious objection.
Canada is our closest cultural cousin: We had better be careful, or the same thing could happen here. If we don’t want that, we should reject assisted suicide and focus our national energies on caring instead of killing.
Cross-posted at National Review.