I Like My Hospital Like I Like My Government: A Call for Secular-Only Healthcare in Canada
Shawn Mouro, RN, BScN, CCN(C), MN-LPNP(c)
Graduate Student, Arthur Labatt Family School of Nursing, University of Western Ontario
The Catholic Health Alliance of Canada (CHAC) asserts that the religious affiliation of healthcare in Canada has existed for over 400 years, predating the nation’s confederation (2021). As such, it is my understanding that religion has informed and continues to inform expectations around the delivery of healthcare and has imparted its views on health for centuries. Catholicism is the leading religious denomination in Canada, representing 38.7% of the population, and controlling over 129 healthcare organizations (4.4%) and 19,575 hospital and long-term care beds (6.8%) (Canadian Institute for Health Information, 2021; CHAC, 2021; Statistics Canada, 2011). As a result, I will be maintaining my focus on Catholicism. It is my stance that Catholic-based organizations continue to impart and attempt to indoctrinate those vulnerablized by historical and social systems of inequality through their deliverance of biased-based healthcare, negatively impacting these populations. In my opinion, this is manifested by denying women access to approved care, by the lasting negative impact on the mental health of Indigenous communities, and by silencing the voices of dying patients.
Eve and the Apple: My Body, My Choice
Research on how Catholic-based healthcare impacts the health of women is largely American. However, policies that Catholic hospitals in Canada are mandated to implement are informed by American Catholic organizational bodies (CHAC, 2012). My point of departure is that policy is informed by the same source, on similar populations, justifying the extension of research findings from the U.S. context to the Canadian context. We know that Catholic-based facilities apply restrictions on several factors of women’s health including abortion, fertilization, sterilization, and contraception, severely limiting access for women, particularly those in rural areas (CHAC, 2012; Hoskins, 2017). It has also been demonstrated that restrictions to care around a woman’s reproductive rights cause delays in treatment and impact the standard of care provided (Freedman & Stulberg, 2013). The ability of a Catholic-based health institution to impose care restrictions on a woman’s body requires the organization to have a greater charter right than the patient, which is not the case (Owens & Wiebe, 2016).
Research shows that most women do not consider religious affiliation when selecting a healthcare facility (Guiahi et al., 2019). Some may believe that it is the responsibility of the consumer to understand the restrictions of a healthcare facility before pursuing treatment or to gain access to facilities that do offer these restricted interventions. However, I support the notion that the “expectation that women should be able to anticipate and avoid religious policies that are established by religious authorities for the express purpose of restricting women’s reproductive autonomy” is absurd (Wascher et al., 2020, p. 263). I firmly believe that it is not the responsibility of the oppressed to circumvent their own oppression. Moreover, barriers impact a woman’s ability to identify hospitals with restrictive care, such as health literacy, accessibility, shifting policy, provider transparency, and the ability to decipher Catholic doctrine (Stulberg et al., 2019; Wascher et al., 2020). A woman’s choice of hospital is often outside of their control and is “dictated by physician practice, insurance, geography or need for emergency care” (Wascher et al., 2020, p. 263).
Indigenous Erasure by Savage Hands
Religion’s early interactions with Indigenous communities were focused on “saving the heathen souls of the ‘savages’ by attempts at religious conversion” (Bombay et al., 2009, p. 13). This later evolved into the church-led, government-funded Residential School System, which represents the most contemporary attack on Indigenous people (McNally & Martin, 2017). Impacting more than 4 million Indigenous people, subsequent cultural genocide continues through intergenerational trauma and through loss of language, tradition, and culture (McNally & Martin, 2017). Perhaps what the general population may know less about is the impact of religious affiliation in healthcare, whereby historically, Indigenous people were treated in segregated hospitals, in separate “Indian” buildings, were attempted to be converted, and refused treatment altogether (Lux, 2010). For those admitted to the hospital, treatment remained focused on scrutinizing the soul of the individual (Lux, 2010). This racial segregation to substandard healthcare facilities encouraged Indigenous communities to, prudently, avoid Western medicine, ultimately, leading to the stigmatization of the Indigenous as “carelessly indifferent to their own health and a danger to others” (Lux, 2010 p. 417).
Research suggests that Indigenous communities are disproportionately affected by mental health issues, namely posttraumatic stress disorder (PTSD) (Bombay et al., 2009). When compared to the general population, Indigenous peoples are twice as likely to have PTSD (Bombay et al., 2009). Triggers of PTSD can include previously neutral stimuli such as sights, smells, and sounds that have become linked with trauma (Rosch, 2012). As such, it is my understanding that the sound of prayer or the sight of a crucifix could, very easily, trigger instances of PTSD in those with histories of trauma, especially if forced to seek care at Catholic hospitals due to issues of access, geography, or need of emergency care. I find it reprehensible that a population, with an undue history of trauma, be expected to accept and pursue care from its abuser.
The former president of the Canadian Healthcare Association argues that a call for secular-only hospitals threatens the erasure of religious history (Gagnon, 2003). Sholzberg-Gray posits that “[a] lot of the institutions that we consider community institutions were paid for, funded and developed by particular religious groups” (as cited by Gagnon, 2003, p. 331). It is imperative to emphasize that the erasure of Indigenous history and, significantly, Indigenous peoples are carried out through disease, warfare, genocide, and indoctrination in which Catholicism is complicit. (Bombay et al., 2009). Additionally, we must recognize that colonizers of Canada adopted the knowledge of plant medicine from Indigenous people (Turner, 2006). 400 species of plants used by Canadian Indigenous have been widely incorporated into Western medicine (Turner, 2006). Fundamentally, I believe there is no call for erasure. There is certainly a call for representation, for integration of knowledge and history.
For Heaven’s Sake: The Silencing of Dying Voices
Since the enactment of the legislation, there have been 6,749 individuals who have accessed medical assistance in dying (MAID) (Health Canada, 2019). Although a legal medical treatment, restrictions surrounding its implementation in Catholic-based institutions remain (CHAC, 2021). Professionals providing MAID have expressed that a major barrier to its provision includes “the refusal of faith-based institutions to provide information about MAID to patients, as well as their refusal to allow assessments or deaths to occur on-site” (Shaw et al., 2018, p. e397). Certainly, I understand this to be Catholic hospitals imposing Catholic doctrine on their patients when interventions that have been made legal and accessible by the Canadian government are restricted under the guise of religion. Moreover, research supports the conclusion that a Catholic-based institution’s conscientious objection to MAID is not ethical or constitutional in Canada (Kirby, 2019).
There is clear resistance to the suppression of conscientious objection as a defence to denying medical intervention with its enactment growing globally (Zampas, 2013). The argument is that medical professionals must be able to object to the coercion of providing services against their morals, eliciting moral distress (Zampas, 2013). However, it is my resolute position that medical professionals must put the interests of their patients ahead of their own idiosyncratic objections.
Once procedures are legally part of medical practice, the debate around such topics must take place at a societal level and not at the bedside (Savulescu & Schuklenk, 2016). We know there are many examples of how the imposition of religious beliefs on medical practice has had detrimental consequences. According to Savulescu and Schuklenk (2016), these include the Catholic Church’s refusal “to providing birth control in developing countries…its opposition to the provision of condoms to prevent the spread of HIV…or the suboptimal care provided by religiously motivated healthcare professionals to gay and lesbian patients” (p. 164). Moral distress, as a position for conscientious objection, fails to consider the moral distress faced by providers who are stifled by Catholic doctrine (Freedman & Stulberg, 2013; Stulberg et al., 2014).
Secular countries such as Sweden and Finland have successfully controlled for conscientious objection, and with this, demonstrated no negative impact on medical schools’ applications or their ability to replace medical professionals (Savulescu & Schuklenk, 2016). It is my opinion that society must not uphold the myopic views of conscientious objections. Rather, it must focus on a provider’s “conscientious commitment [in]…giving priority to patient care over adherence to conservative religious doctrines or religious self-interest” (Dickens & Cook, 2011, p. 163).
A Call for Change
Catholic-based organizations continue to indoctrinate those vulnerablized by historical and social systems of inequality. In my opinion, this is evidenced through denying women access to government-approved care, by continuing to negatively impact the mental health of Indigenous peoples, and by actively rejecting the rights of dying patients. Canada’s healthcare landscape is changing with Catholic-based facilities previously delivering 35% of healthcare needs to 5% today (Hoskins, 2017). I find this to be reflective of the clear direction of healthcare that most Canadians anticipate. The allowance of Catholic hospitals to cultivate private interests with largely public funds is, not only, reprehensible, but does not fairly represent the public good (Fardella, 2017). Quebec is the only province to make a conscious effort to dismantle “oppressive clerical meddling over many aspects of social policy” by having no religious affiliated healthcare institutions (Hoskins, 2017, para. 16). The rest of Canada, as a post Christian secular state, must follow suit (Aftab, 2019).
References
Aftab, A. (2019). Religious accommodation in the secular state: The sharia debates in Australia,
Canada, and the United Kingdom. Studies in Law, Politics, and Society, 79, 85–108.
https://doi.org/10.1108/s1059-433720190000079006
Bombay, A., Matheson, K., & Anisman, H. (2009). Intergenerational trauma: Convergence of
multiple processes among First Nations peoples in Canada. Journal of Aboriginal Health,
5(3), 6-46. https://doi.org/10.3138/ijih.v5i3.28987
Canadian Institute for Health Information. (2021, April 26). Access and data reports: CMDB
hospital beds staffed and in operation, 2019-2020.
https://www.cihi.ca/sites/default/files/document/beds-staffed-and-in-operation-2019-
2020-en.xlsx
Catholic Health Alliance of Canada. (2012, September). Health Ethics Guide.
https://www.chac.ca/documents/422/Health_Ethics_Guide_2013.pdf
Catholic Health Alliance of Canada. (2021). Caring for the most vulnerable in our communities.
https://www.chac.ca/en/
Dickens, B. M., & Cook, R. J. (2011). Conscientious commitment to women’s health.
International Journal of Gynecology and Obstetrics, 113(2), 163–166.
https://doi.org/10.1016/j.ijgo.2011.02.002
Fardella, J. A. (2017). Post-secular accommodation and Catholic health care: Corporate identity
and the public good. Ethics and Social Welfare, 11(1), 47–61.
https://doi.org/10.1080/17496535.2016.1234630
Freedman, L. R., & Stulberg, D. B. (2013). Conflicts in care for obstetric complications in
Catholic hospitals. The American Journal of Bioethics, 4(4), 1–10.
https://doi.org/10.1080/21507716.2012.751464
Gagnon, L. (2003). Morgentaler’s call for secular-only hospitals earns tepid response. Canadian
Medical Association Journal, 168(3), 331-331b.
https://www.cmaj.ca/content/168/3/331.3
Guiahi, M., Helbin, P. E., Teal, S. B., Stulberg, D., & Sheeder, J. (2019). Patient views on
religious institutional health care. Journal of the American Medical Association, 2(12),
1-11. https://doi.org/10.1001/jamanetworkopen.2019.17008
Health Canada. (2019, April). Fourth report on medical assistance in dying in Canada.
https://www.canada.ca/en/health-canada/services/publications/health-systemservices/
medical-assistance-dying-interim-report-april-2019.html
Hoskins, R. (2017). Holy healthcare: Our religious hospitals problem. Alberta Views.
https://albertaviews.ca/holy-healthcare/
Kirby, J. (2021). Should institutional conscientious objection to assisted dying be
accommodated? Canadian Journal of Bioethics, 4(1), 15–20.
https://doi.org/10.7202/1077623AR
Lux, M. K. (2010). Care for the “racially careless”: Indian hospitals in the Canadian west, 1920-
1950s. Canadian Historical Review, 91(3), 407–434. https://doi.org/10.3138/chr.91.3.407
McNally, M., & Martin, D. (2017). First Nations, Inuit and Metis health: Considerations for
Canadian health leaders in the wake of the Truth and Reconciliation Commission of
Canada report. Healthcare Management Forum, 30(2), 117–122.
https://doi.org/10.1177/0840470416680445
Owens, R. C., & Wiebe, E. (2016). The religious hospital problem. The National Post.
https://www.pressreader.com/canada/national-post-latestedition/
20161026/281758448832434
Rosch, P. J. (2012). Drug therapy for PTSD: More harm than good. Health and Stress, 24(9),
1-19. https://www.stress.org/wp-content/uploads/2011/11/September-Newsletter.pdf
Savulescu, J., & Schuklenk, U. (2017). Why medical professionals have no moral claim to
conscientious objection accommodation in liberal democracies. Journal of Medical
Ethics, 43(4), 234–240. https://doi.org/10.1136/medethics-2016-103560
Shaw, J., Wiebe, E., Nuhn, A., Holmes, S., Kelly, M., & Just, A. (2018). Providing medical
assistance in dying: Practice perspectives. Canadian Family Physician, 64(9), e394-e399.
https://pubmed.ncbi.nlm.nih.gov/30209113/
Statistics Canada. (2011/2018, July 25). Immigration and ethnocultural diversity in Canada:
Religions in Canada. https://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-010-x/99-010-
x2011001-eng.cfm?wbdisable=true#archived
Stulberg, D. B., Guiahi, M., Hebert, L. E., & Freedman, L. R. (2019). Women’s expectation of
receiving reproductive health care at Catholic and non‐Catholic hospitals. Perspectives
on Sexual and Reproductive Health, 51(3), 135–142. https://doi.org/10.1363/psrh.12118
Stulberg, D. B., Hoffman, Y., Dahlquist, I. H., & Freedman, L. R. (2014). Tubal ligation in
Catholic hospitals: A qualitative study of ob-gyns’ experiences. Contraception, 90(4),
422–428. https://doi.org/10.1016/j.contraception.2014.04.015
Turner, N. J. (2006). Indigenous Peoples' Medicine in Canada. The Canadian Encyclopedia.
Retrieved October 8, 2021, from
https://www.thecanadianencyclopedia.ca/en/article/native-medicines
Wascher, J. M., Stulberg, D. B., & Freedman, L. R. (2020). Restrictions on reproductive care at
Catholic hospitals: A qualitative study of patient experiences and perspectives. The
American Journal of Bioethics, 11(4), 257–267. https://doi.org/10.1080/23294515.2020.1817173
Zampas, C. (2013). Legal and ethical standards for protecting women’s human rights and the
practice of conscientious objection in reproductive healthcare settings. International
Journal of Gynecology and Obstetrics, 123, S63-S65.
https://doi.org/10.1016/S0020-7292(13)60005-3
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