'Co-operation with evil in Canada'

An eminent American Catholic bio-ethicist associated with the National Catholic Bioethics Center in the U.S. has written an analysis of the Medical-Assistance-in-Dying situation at St. Paul's Hospital in Vancouver. It is my understanding that he wrote this analysis in response to facts that I published on this blog some weeks ago. My publication of the analysis here does not imply either support or disagreement with his analysis. Rather, as a reporter, I feel his voice should be heard.

There are many shocking aspects to the euphemistically termed Medical Assistance in Dying or MAiD euthanasia law in Canada. One is how government forces are coercing Catholic health care in Canada to collaborate with the evil of killing sick and vulnerable people. Church teaching is abundantly clear that euthanasia is a grave violation of the moral law and can never be seen as a form of health care. 

What has come to light recently is coercion by the government of British Columbia to make euthanasia available to patients cared for at a Vancouver Catholic hospital. The arrangement called for the province to take land at the St. Paul's campus on which to create a "clinical space" for MAiD to be performed. The space would be staffed by Vancouver Coastal healthcare professionals and was to be connected by a corridor to St. Paul's Hospital. 

"Patients from St. Paul's Hospital accessing MAiD will be discharged by Providence Health and transferred to the care of Vancouver Coastal Health in this new clinical space," the release said. This is not the first time such “compromise” ideas like this have been proposed. In the USA the main issue was direct surgical sterilization, and some hospitals wanted to create independent entities that were financially and legally separated from the Catholic corporation but nevertheless perform sterilizations on their medical campuses. 

The sixth edition of the Ethical and Religious Directives for Catholic Health Care Services of the US Conference of Catholic Bishops specifically excluded collaborative agreements where other entities are established to “oversee, manage, or perform immoral procedures.” It is a fixed principle of Catholic moral teaching that both formal and immediate material cooperation with intrinsic evils such as abortion, euthanasia, direct sterilization, etc., are never permissible. 

In formal cooperation one approves or agrees with the evil that is being done. Immediate material cooperation happens when one disapproves of the evil act but nevertheless cooperates with it in such a close way as to ensure that it occurs. An example of this is agreeing to give a person the money they need to pay for an abortion. Euthanasia activists in Canada have used lawsuits to argue that it is “cruel and unusual” for Catholic hospitals to refuse to kill patients who request euthanasia and thus violate their “constitutional right” to MAiD. They obtained an “arrangement” whereby patients in Catholic hospitals would be discharged and transferred to a secular entity and euthanized in a space just down a hallway from the St. Paul hospital-operated hospice rooms. 

It is true that competent patients should not be kept in a health care facility against their will, but one must be very careful not to engage in immoral cooperation. Catholic hospitals rightly agree to discharge patients rather than carrying out unethical procedures on them, but it is not morally acceptable to facilitate this to the point of simply moving them down the hall in order to be killed. A very strong ethical line is violated by such practice. 

 This is also a cautionary tale. When health care entities are completely dependent on government funds to survive in a single payer system like the one that exists in Canada, the secular authorities can cynically use this leverage to impose their will. Even hospitals in the USA are heavily reliant on reimbursement for patients covered by the Medicare and Medicaid government programs. Unethical mandates from states or the US federal government, with the threat of losing funding if health care institutions refuse to cooperate, therefore can be quite coercive. 

It remains true, however, that everything must be done to resist attempts to force immediate material cooperation with evil. If legal challenges fail, it may ultimately be necessary for hospitals to close rather than allow the terrible actions to take place with their cooperation. This requires immense courage and moral conviction on the part of the Church and administrators. Here one sees how fundamental it is to have religious liberty and institutional conscience rights respected. One bright side of the picture in the US is that trials to preserve religious liberty have with great consistency been won at the Supreme Court level.

 I do not believe the picture is nearly as positive in Canada. Also, institutional conscience is frequently recognized in US legislation, even though academics and activists hostile to conscience rights have tried in recent years to call into question this right. Although it is true that institutions do not have consciences in the same way that individuals do, they are founded and guided by principles and codes of conduct that represent institutional values and beliefs. Catholic health care could not carry out its mission if institutional conscience rights were not acknowledged and protected. This appears to be a big part of the problem facing Canadian Catholic health care.

 Joseph Meaney, PhD, KM