Survey on the Parliamentary Committee’s Physician-Assisted Dying recommendations, part 2: what the survey respondents got wrong

In Part 1, I covered the recommendations of the federal Parliament’s Special Joint Committee on Physician-Assisted Dying (PDAM) that the respondents of an Angus Reid Institute survey mostly agreed with. Now I’m going to talk about the main issue they disagreed with, and why the survey respondents are wrong.

PDAM made 21 recommendations for how the federal government should go about implementing a fair and reasonable physician-assisted dying infrastructure. Respondents in the ARI survey agreed with most of them, and on most of those they didn’t, there are extenuating circumstances – either ignorance about the topic, or poorly-worded questions. But there was one recommendation that respondents had a real problem with:

  • All publicly-funded health care institutions should provide medical assistance in dying (recommendation 11).
  • Any health care practitioners that conscientiously object to providing assistance in dying on can do so, but must provide an effective referral (recommendation 10).

It was the first recommendation listed above – recommendation 11 – that the survey respondents objected to.

But let’s get the second recommendation – recommendation 10 – out of the way before we dig into the first. The survey’s question 9 was worded like this:

Q9a. There is debate about how these medical professionals should be required to respond if a patient under their care requests a physician-assisted suicide. In this circumstance, should a medical professional who believes physician-assisted suicide is morally wrong:

  • Be required to refer their patient to a doctor who will assist their death by lethal injection
  • Not be required to make such a referral

[IF DOCTORS SHOULD BE REQUIRED TO REFER:]

Q9b. Instead of requiring doctors to make a referral, would you support the provincial government maintaining a 1-800 call line or website which individuals could access to find doctors who participate in this procedure.

  • Yes, that would be okay instead
  • No, doctors should be required to refer

Now I’m baffled as to why it was necessary to specifically mention lethal injection in the ‘required to refer’ option of the first part. Regardless, 72% said that a doctor should be required to refer. Not bad at all. Those 72% were split roughly half-and-half on whether the reference had to be directly to another doctor, or whether it could simply be to some kind of 1–800 hotline or website (51%-49% in favour of the hotline/website).

Readers of this blog will probably argue that it isn’t really ideal that doctors can refuse at all; if they want to practice medicine, they shouldn’t be allowed to pick and choose what medical treatments they’re going to use – they should follow provincial/federal health practices and standards whether they damn well like it or not. Perhaps, but the reality is that doctors have Charter rights, too, and the right to freedom of conscience and religion is among them. Requiring referral for a procedure a doctor can’t do for religious or conscientious reasons is a reasonable compromise.

So now we come to the problematic questions: questions 10 and 11. Both questions are basically identical, except one refers to hospitals, the other to nursing homes. The order between the two was randomized (so some people got the nursing home question first, others got the hospital one first), but the canonical order (used for the results) was hospitals then nursing homes, so I’ll cover them in that order.

Here was question 10:

Q10. Another issue concerns the position of Catholic hospitals that operate in cities and towns across Canada. Catholic hospitals have stated, on moral and ethical grounds, that they will not allow doctor assisted suicide in their facilities. Which of the following is closest to your opinion:

  • Catholic hospitals should be able to say no on moral grounds and patients who want a doctor assisted death would be moved to another facility; or
  • Catholic hospitals should be required by law to allow these procedures at their facilities

[IF Catholic hospitals should be required:]

Q10b. Would you support withdrawing public funding from Catholic hospitals that refuse to allow doctor assisted suicides on their premises?

  • Yes, support
  • No, oppose

So the results to the first part were:

  • 59% – Catholic hospitals should be able to say no on moral grounds and patients who want a doctor assisted death would be moved to another facility
  • 41% – Catholic hospitals should be required by law to allow these procedures at their facilities

Sigh.

But it gets worse. While results by religion were not included in the published data, results by province, gender, age, education, and household income were… and in every single category, the majority voted for allowing Catholic hospitals to refuse to provide the service. It ranged from as low as 51% for males aged 35–54, to as high as 80% for people in Saskatchewan.

With one exception: Québec.

The population of Québec was the only group in the survey that had a majority that said Catholic hospitals should be required to provide the service. And not by a slight margin, either: 68% of Québécois said Catholic hospitals should act like real hospitals.

But before you Québec fans start cheering… you might want to check the results of the second part of the question.

Those who said Catholic hospitals should be required to provide assisted dying services were then asked what should be done for those Catholic hospitals that refuse to do so. A 64% majority overall supported withdrawing government funding from non-compliant Catholic hospitals, and once again, this was true in every single category. It ranged from 58% for 55+ females up to 89% for Alberta.

And once again, the lone exception was Québec. 51% of Québec would not withdraw government funding from Catholic hospitals that refused to provide assisted dying services.

Angus Reid survey 2016-04-01 chart: Physician-assisted dying regulation and Catholic-hospitals

So generally in Canada, Canadians don’t want to require religious hospitals to provide assisted dying services… but those that do insist on defunding hospitals that refuse to do so. But the situation is completely inverted in Québec: Québécois do want religious hospitals to provide assisted dying services… but they say if those hospitals refuse, they should still get government funding.

The situation is pretty much exactly the same for nursing homes, except this time Québec agreed (58%) that non-compliant nursing homes should be defunded.

So Québec gets it objectively right on the first part – hospitals/nursing homes should not not be allowed to refuse to provide the service on moral grounds – while the rest of Canada gets it objectively wrong. However, the rest of Canada gets it objectively right on the second part – hospitals/nursing homes that put their religious beliefs ahead of what’s best for their patients should lose their public funding – while Québec gets it objectively wrong.

Why do I say that it is objectively wrong to allow hospitals (I’m just going to use hospitals as a shorthand for all health care institutions) to refuse to provide assisted dying services on moral or religious grounds? How can I be so sure that it is objectively wrong – isn’t this a matter of opinion?

No, it’s not a matter of opinion. If it appears so, that’s only because you’re missing a somewhat obvious, but vital point.

Hospitals don’t have religious beliefs.

People have religious beliefs; institutions do not have religious beliefs, and it is absurd to pretend they do. It’s not as if having an abortion in the surgical theatre of a Catholic hospital will prevent that hospital’s soul from ascending to Heaven after it dies. I’ve never heard of a hospital being excommunicated because it allowed abortions. I’d be quite concerned if a hospital managed to uproot itself and fit into the nearest church for mass on Sundays, and I’d be quite fascinated to hear what sins a hospital could confess to.

People who think hospitals should be allowed to claim any moral exemptions are profoundly confused. They are bamboozled by language: a ‘Catholic hospital’ is not ‘Catholic’ in the same way that a ‘Catholic nun’ is. A ‘Catholic hospital’ is just a corporation whose board of directors presumably happens to consist predominantly of Catholic members, who want to impose their theology on the corporation’s employees and customers.

Put that way, it kinda makes the spin of ‘Catholic hospitals refusing service on moral grounds’ far less appealing. It reveals the truth behind such spin: This is not an analogous situation to a religious person being forced to act against their faith… it is a situation where religious people are imposing their faith on others.

If a patient in a Catholic hospital wants assisted dying services, and their attending doctor wants to provide them, then what right does a bunch of religious sots on that hospital’s board of directors have to interfere with the beliefs of that doctor and patient? No one is asking any of the directors to be involved.

If a Catholic doctor at a secular hospital can refuse to provide assisted dying services on moral grounds, and the secular board of that hospital cannot intervene, then it should also be true that the Catholic board of a Catholic hospital cannot intervene when an atheist doctor decides that it’s what’s best for their patient. Giving precedence to the moral concerns of Catholic doctors working for secular institutions, while forcing secular doctors to give precedence to the moral concerns of the directorship of Catholic institutions, is flat-out bullshit.

So the Committee got it exactly right. Doctors and other health care practitioners should have the right to refuse to provide assisted dying services (but they must refer the patient), but health care institutions should not.

Québec got it right, too, but Québec screwed up the second part of the equation: how to handle institutions that thumb their noses at the provincial or federal health care guidelines. I frankly can’t see the logic in not threatening such institutions with a loss of public funding. I’d be curious to hear an argument for why we should insist on Catholic hospitals providing assisted dying services, but continue feeding them public money if they refuse.

By and large, it looks like the Canadian public is in agreement with the Parliamentary Committee’s recommendations for assisted dying. Those few areas of disagreement appear to be entirely based on a lack of education, such as about the medical nature of depression. This seems to be true for the issues raised in this post as well. I suspect if we make an effort to clarify – whenever it comes up – that hospitals are institutions, not people, and institutions do not have religious beliefs, we can chip away at the majority who think hospitals can make moral or conscientious objections. This isn’t just important for physician-assisted dying – it has implications for other health issues that religious groups like to make a ‘moral’ fuss over, such as abortion.

9 thoughts on “Survey on the Parliamentary Committee’s Physician-Assisted Dying recommendations, part 2: what the survey respondents got wrong

  1. Perhaps we should use the phrase “Catholic owned and controlled hospitals” to more accurately communicate these ideas.

    • That might help a bit, but I’m not sure that it would be enough.

      The problem – as I see it – is that as soon as you say “Catholic owned…”, a large subset of people are going to go, “oh, they own it, they can set whatever rules they please for it; it’s theirs”. While that would be true for a *private* institution – like a “Catholic owned and operated church” or “Catholic owned and operated bookstore” – it shouldn’t be true for a publicly-funded institution. But the problem is that we now have to convince people of that – that ownership doesn’t necessarily imply you can make whatever rules you please in all cases; we have to change that short-sighed capitalist attitude you refer to in your other comment. Which means that even if we say “Catholic owned and operated hospital”, we *still* have the same battle to fight, more or less. Only now we’ve raised the hackles of libertarians who will leap to defend the rights that come with ownership, so we have an even tougher battle.

      Besides, most people already understand that “Catholic hospital” really means “Catholic owned and operated hospital”. We’re not really changing their thinking with that substitution.

      That’s why I prefer using the expression “Catholic hospital”, then calling out the absurdity of a hospital being “Catholic” (in the same way that a nun is). *That* shakes people’s thinking – it sticks with them because it’s funny and memorable. It gets directly to the problem of assigning beliefs to an institution in a way that “owned and operated” doesn’t, without calling attention to ownership rights or giving undue attention to the rights of the hospital’s board. It keeps the focus on the patient, doctor, and hospital, while undermining the hospital’s claim to have moral input – we don’t even need to discuss the owners, because they’re totally not involved in that equation.

  2. If a patient in a Catholic hospital wants assisted dying services, and their attending doctor wants to provide them, then what right does a bunch of religious sots on that hospital’s board of directors have to interfere with the beliefs of that doctor and patient? No one is asking any of the directors to be involved.

    This would be unfettered capitalism. In a capitalist society those with the money (capital) own the hospital. It is this ownership that we believe entitles the owners to create hospital policy. But we don’t live in a straight ideologically pure capitalist society. And I’m glad. I’m not a fan of ideology.

    On our mixed economic system and society of rules and regulations, we believe that the private religious convictions of the owners (or anyone else) should not be imposed on employees and customers.

    Well done in making that clear.

  3. Very well reasoned article.

    Ending hospital ownership seems to be the straight forward solution to priest-craft interference in Canadian health services. It’s unlikely our friendly and obedient Prime Minister will get behind a proposal like this.

  4. Your accommodationism is what is tripping you up.

    Of COURSE hospitals have religious beliefs, and those beliefs are those of its founders, or owners, or staff, or the name on the front, or whatever.

    If you allow a publicly-funded doctor to refuse to provide service on the basis of a fairy tale, then you must allow a large collective of publicly-funded doctors the same exception to the normal laws.

    I wouldn’t allow it in any case, whatsoever, and I would not only defund.. I would yank the licence of anyone refusing.

  5. “People have religious beliefs; institutions do not have religious beliefs”

    Good point!

  6. While I was searching the DWDC site for links for my newest post, I happened to notice a couple of recent relevant blog posts.

    In “3 ways the new Angus Reid poll on assisted dying misses the mark“, they bring up some very valid points. First, they note that the survey really didn’t give any context about assisted dying – it just asked opinions about random scenarios more or less out of the blue. Second, they note that the survey didn’t mention anything about advance consent in its write-up… though it *did* ask about it in the poll, and 66% agreed (though, ironically, this appears to be one of the things the proposed Liberal legislation won’t include). And finally, they comment – as I did – on the terribly way that psychological issues were raised.

    In “On balancing ‘institutional conscience’ and patient rights“, Dr. David Amies talks about what I brought up here – the absurdity of “institutional conscience”.

  7. Angus Reid’s a lifelong Roman Catholic who “was also not overly pleased with respondents’ backing of assisted suicide, worrying it will be dangerous when doctors start “handing out suicide pills.” His poll on palliative care also showed how this potential alternative to assisted suicide is offered haphazardly.” http://news.nationalpost.com/news/canada/freedom-to-annoy-at-67-pollster-angus-reid-says-he-is-ready-to-do-some-s-disturbing

    In other words, I’d argue that there’s reason to suspect his polls aren’t motivated entirely by a curiosity into the opinion of Canadians.

    • You know, honestly, mentioning something like that was *right* on the tip of my tongue when writing the posts. ^_^; But I didn’t feel right putting it on record, because I have no evidence he actually had any personal input in the surveys. (I’ve heard he’s (semi-)retired, and most of the stuff is actually signed by Shachi Kurl (who I always confuse with Scaachi Koul).)

      But I suppose it’s a fair enough to bring it up. Especially in light of the problems in the survey.

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