Conscientious objection: Can a hospital refuse to provide treatment?

Canada recently legalized medical assistance in dying (MAiD), which allows patients to receive a lethal drug that they can self-administer, or be administered a lethal drug by an authorized clinician with consent of the patient. As provinces and territories work to create and clarify legal guidelines for providing MAiD, many Catholic hospitals have refused to offer it, citing opposition to physician-assisted suicide and euthanasia in Catholic moral teaching.

This controversy surrounding institutional conscience-based refusals raises an important question: Should a health care institution have the right to refuse to provide a particular treatment for conscience-based reasons?

Conscientious objection, while often debated in bioethics and law, is a right widely recognized among health care providers. Individuals involved in patient care generally have the right to refuse to participate in procedures that violate their personal values, subject to certain restrictions such as availability of the patient to seek treatment elsewhere. But does an institution have the same right to refuse to provide services based on religion or ethics?

Opponents of institutional conscience-based restrictions argue that health care facilities that receive public funds and provide services to the community should not be allowed to refuse to provide care that is otherwise legally available to a patient.

Proponents argue that religiously affiliated hospitals are filling a role that is otherwise not currently filled by a public or government institution, and if they are required to provide health care that is in opposition to their established ethical policies, they may decline to continue to provide health care services at all rather than compromise their religious and ethical tenets.

This would then place a significant burden on the government or other health care systems to fill the void that would be left without such hospitals, further restricting available health care, particularly in rural areas with few, if any, health care facilities.

In the case of institutional objection, two distinct questions arise:

  • Should hospitals be permitted to refuse to allow MAiD to occur in their facilities?
  • If the refusal is allowed, should the physician be obligated to refer the patient elsewhere?

In most cases of conscientious objection, health care providers are professionally obligated to refer patients to other providers. Whether or not the Canadian legal system determines that referrals must be made for MAiD, many have argued that even if a facility is willing to transfer the patient, some patients may be too sick for transfer. This effectively prevents the patient from receiving MAiD at all, leading to accusations of patient abandonment by Catholic institutions.

But is it an all-or-nothing issue? Is refusal to provide MAiD abandonment of the patient? Oversimplification of the debate can leave out important facts.

Whether or not Catholic hospitals retain the right to refuse MAiD in their facilities, they do not simply abandon patients who request it. The other half of the Catholic moral opposition to physician aid-in-dying and euthanasia is the strong commitment to uphold the dignity of every patient and sufficiently alleviate pain.

If transfer is not possible, competent and aggressive palliative care is provided to ensure that the patient is relieved of their suffering. Patients may be denied assistance in dying, but they should not be left in pain.

It is an open question whether palliative care is a sufficient substitute for MAiD for patients who request it, but from a Catholic perspective, it allows physicians to relieve a patient’s pain without intending the patient’s death. While the controversy surrounding institutional conscience-based objections is not likely to be resolved anytime soon, patient-centered care should still be the priority of all institutions.

-By Claire Horner, J.D., M.A., assistant professor in the Center for Medical Ethics and Health Policy at Baylor College of Medicine  

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