B.C. Supreme Court to hear Charter challenge over religious limits on assisted dying in hospitals

A trial beginning Monday in the Supreme Court of British Columbia will test whether religious exemptions allowing faith-based hospitals to refuse medical assistance in dying (MAID) violate the Canadian Charter of Rights and Freedoms.

The case has been brought by Dying With Dignity Canada, along with the parents of Samantha O’Neill, a Vancouver woman who was required to leave hospital in order to receive MAID in 2023.

O’Neill was 34 when she was admitted to St. Paul's Hospital in March 2023, suffering extreme pain from Stage 4 cervical cancer that had spread to her bones and lungs. She had already been assessed and approved for MAID.

However, because St. Paul’s is operated by Providence Health Care, which does not allow MAID on religious grounds, O’Neill was transferred to another facility to undergo the procedure.

According to court filings, O’Neill was in severe distress in her final hours and did not want to leave her hospital room. The transfer required full sedation, and she never regained consciousness before her death.

The statement of claim argues the move “caused and exacerbated egregious physical and psychological suffering” and denied O’Neill a dignified death, including the opportunity to say goodbye to loved ones.

Dying With Dignity Canada argues that while individual health-care providers may hold personal conscience rights, institutions themselves do not.

“If a hospital is publicly funded, patients should be able to access the full range of lawful health care,” said the organization’s CEO, Helen Long.

The case is being supported by legal scholars, including Daphne Gilbert, a law professor at the University of Ottawa, who argues governments must remain neutral in matters of religion.

“Allowing a religious authority to dictate care in a publicly funded hospital is incompatible with a secular constitutional framework,” Gilbert said.

The defendants include B.C.’s Ministry of Health, the Vancouver Coastal Health Authority, and Providence Health Care, which operates St. Paul’s Hospital along with numerous hospices, long-term care homes and other health facilities across the province.

Provincial policy currently allows faith-based health organizations to opt out of providing MAID, requiring instead that patients be transferred to another location.

In its legal defence, Providence argues it does not prevent access to MAID but facilitates transfers, sometimes to an adjacent space within the same building. It also maintains that some patients deliberately choose faith-based facilities because they do not offer assisted dying.

Court documents show that since MAID became legal in 2016, thousands of assisted deaths have occurred within Vancouver Coastal Health. Since 2023, more than 120 patients have been transferred out of faith-based facilities in that health region to access MAID.

National data indicates hundreds of Canadians have been required to transfer facilities due to institutional policies against assisted dying.

The plaintiffs argue some patients are effectively denied MAID because they are too frail to be moved or because no alternative facility is available in time.

The case will also examine whether the Charter rights of physicians and MAID providers are infringed when they are required to participate in transfers to accommodate the religious beliefs of institutions.

Providence counters that the Charter protects it from being compelled to act against deeply held beliefs and argues that the Charter applies only to government actions, not to religious organizations operating health facilities.

Several organizations have been granted intervener status, including civil liberties groups, humanist associations and faith-based legal organizations.

Four weeks have been scheduled for the trial, with additional legal arguments expected later in the spring. Observers anticipate the case could ultimately be appealed to the Supreme Court of Canada.

Legal experts say the outcome could have far-reaching implications for access to MAID — and potentially other services such as abortion and contraception — at more than 100 publicly funded faith-based health institutions across the country.