Canada’s bishops allow Catholic hospitals to host consultations for euthanasia

OTTAWA, April 18, 2019 (LifeSiteNews) – Canada’s bishops were consulted on and agreed to secret guidelines by Catholic health sponsors that allow third-party euthanasia assessments of medically frail patients in Catholic health care facilities, LifeSiteNews has learned.

And while the Catholic health sponsors who drafted the guidelines in collaboration with ethicists and bishops concluded such assessments were not formal cooperation with evil, they failed to consider there are instances when material cooperation is gravely wrong, as is the case here, says Catholic moral theologian, Dr. E. Christian Brugger.

Allowing assessments for euthanasia at Catholic institutions is “morally wrongful cooperation” because it is “scandalous and a gross failure to bear witness to the Gospel,” said Brugger, who has a Ph.D. in Christian ethics from Oxford, and Masters degrees in moral theology and moral philosophy from Seton Hall, Harvard and Oxford Universities.

The situation is “very similar” to the German bishops allowing Catholic crisis pregnancy centers to issue counseling certificates required for an abortion, added Brugger, formerly a fellow with the Culture of Life Institute in Washington, D.C., and consultant with the United States Conference of Catholic Bishops.

That’s echoed by Alex Schadenberg, executive director of the Euthanasia Prevention Coalition (EPC).

“I’m not suggesting any ill will on the part of the Catholic sponsors or the Canadian bishops, but they’ve made a terrible mistake,” Schadenberg told LifeSiteNews. 

“They’ve given up ground that they should never have given up.”

Catholic guidelines not published

Canada legalized euthanasia in June 2016, and Catholic health sponsors — the religious orders and administrative boards that run Catholic health facilities — came up with “guiding principles” some two years ago to deal with the situation, according to Michael Shea, president of the Catholic Health Alliance of Canada (CHAC).

These principles have “been accepted by all Sponsors and were developed through the collective input of several ethicists and others,” Shea told LifeSiteNews in an email.

But they were never made public, Shea said in an earlier phone call.

“We have made them available to our sponsor organizations based on the collaborative process in establishing them, but we have not published them as a public document,” Shea said.

Nor would he provide LifeSiteNews a copy of the guidelines when asked. “I’d have to check on that because frankly, the guidelines are not a publication of the CHAC,” he said.

Shea ultimately did not release the document to LifeSiteNews, but sent an email summary in which he emphasized that “under no circumstances” do Catholic health care facilities permit euthanasia onsite.

However, it is “understood that there may be exceptional circumstances under which a third-party coordination service might be allowed to conduct an ‘assessment’ relative to MAID on the site of a Catholic facility,” he wrote.

“These specific circumstances relate to the medical condition of a patient/resident and are dependent on the specific procedures utilized in that jurisdiction,” added Shea.

'Morally wrongful cooperation'

Catholic institutions allowing third-party euthanasia assessments onsite is a “clear example of morally wrongful cooperation,” according to Brugger.

“Catholic hospitals that under any circumstances permit assessments to be performed on premises for the vetting of patients to be killed by euthanasia risk the grave evil of scandal,” he told LifeSiteNews.

Moreover, Catholic institutions are called upon to bear “perspicuous witness to the Gospel,” added Brugger.

“In order to witness to this truth, an institution should refuse under all circumstances to cooperate, even materially, in socially acceptable forms of homicide,” he said. 

“Not to do so makes the Church’s witness to Jesus and his sacred moral teachings lose credibility, appear hypocritical, come across as anemic and uninspiring.”

EPC’s Schadenberg told LifeSiteNews that allowing euthanasia assessment onsite make Catholic institutions “morally complicit” in the euthanasia because “without an assessment, the euthanasia cannot take place.”

The law requires a person requesting euthanasia, or Medical Aid in Dying (MAID), be assessed twice before being euthanized, he said.

A physician or nurse practitioner who knows the patient, or a provincial health ministry “assessor,” can do the consultation.

The first assessment takes place directly with the patient to confirm he or she meets the law’s eligibility criteria, that is: has a serious and incurable illness, disease or disability; is in an advanced state of irreversible decline in capability; is enduring physical or psychological suffering that is intolerable and cannot be relieved under conditions that the patient considers acceptable, and his or her natural death is “reasonably foreseeable,” a restriction not defined in the law.

“How is this now not somehow creating moral culpability in the process who will be killed by lethal injection and who will not?” Schadenberg questioned.

“To suggest that it is only acceptable when the person is too frail to be transferred assumes that cooperating with euthanasia is acceptable in certain circumstances, which is not true,” he said.

Catholic health care facilities under duress: bishop

Archbishop and Jesuit Terrence Prendergast of Ottawa told LifeSiteNews in a lengthy response that an “act of allowing a consultation on site is in effect material cooperation in an intrinsically evil act.” 

However, “we should note this qualification,” he added: “Namely that it is under duress (because the law obliges it and no other options are available).”

Schadenberg countered that euthanasia is not medical treatment and there are alternatives, including physical and psychological pain and symptom management, and palliative sedation. 

“Because someone has asked for euthanasia does not mean we are required to give them euthanasia, or an assessment,” he said. 

“We believe in caring not assessing patients for killing.”

Prendergast also noted that a consultation on site “is only to be granted for medically fragile patients who could die if they are transported.”

“It might be asked why the assessment for someone too ill to travel can be allowed, given that they would need to travel to receive MAID anyway,” he said.

“It is said that the vast majority of people requesting an assessment don’t end up wanting MAID, so this way they can continue to care for the person,” Prendergast told LifeSiteNews.

Such assessments are already being carried out in Catholic hospitals, according to Tessia Verbeek, communication advisor of Covenant Health. 

Covenant Health administers 17 Catholic hospitals and long-term care facilities in Alberta and its euthanasia policy, which is published online, allows for third-party assessments onsite in some circumstances. 

“Patients and residents actively exploring MAID have had their assessment completed in our facilities, based on medical fragility and our responsibility to ensure no harm, with due attention to the patient and resident’s total care needs,” Verbeek told LifeSiteNews.

“Assessment is distinct from the formal process of consent. We have found by experience the majority of patients do not go forward with MAID,” she said. “Our values of compassion and respect for the person and their family, as well as Catholic social teaching, require us not to abandon the patient during the assessment process, but rather continue to provide for their care needs,” Verbeek added.

Schadenberg pointed out, however, that such logic is not justification for allowing an assessment because some patients do choose death by lethal injection and the assessment is essential to this taking place. 

Moreover, allowing assessments because some individuals won’t go through with euthanasia is “pointing to a wrong end: the idea that I can always fall back on asking for MAID if things don’t work out the way I would like,” says Moira McQueen, executive director of the Toronto-based Canadian Catholic Bioethics Institute.

“That seems to me like having the possibility of divorce in my head as I enter marriage: I can always fall back on this if matters don’t work out,” she added.

Further moral quandaries

McQueen opposes eligibility assessments onsite at Catholic hospitals because it is not a good Catholic witness.

And she warns that allowing such assessments will lead to further moral quandaries.

“I do think facilities will have future moral problems with patients who can’t be moved, given that a first assessment has been allowed. On what legal basis can they then refuse to allow the second assessment and then, presumably, the procedure on their premises?” she told LifeSiteNews.

“These are very difficult moral questions and I don't think an acceptable answer has been found yet…apart from not doing a first MAID assessment in the first place. Patients would perhaps have to be turned away  – Catholic hospitals would face funding problems, etc,” McQueen said.

“Once euthanasia is on the scene, we have to expect serious moral problems to emerge, and we have to give reasonable solutions in accordance with Church teaching, which clearly does not allow euthanasia in Catholic facilities any more than it allows abortions.”

Brugger agrees.

This is another reason material cooperation can be wrongful because “it makes it harder to avoid formal cooperation in the future,” he said. “We do not place ourselves in near occasions of sin.”

'Formal cooperation' not the issue

Prendergast also made distinction between formal and material cooperation in euthanizing a patient.

The “moral dilemma raised in this complex health care matter” is the distinction “between formal cooperation in evil (euthanasia), which is forbidden by the moral law because this shares in the evil intention of the actor, and material cooperation,” he told LifeSiteNews.

“If you are helping someone along the path to receiving euthanasia because you want to help them get there, that is formal cooperation with intrinsic evil and never permitted,” he said.

“However, material cooperation can be permitted in certain circumstances, depending on how close (proximate) the cooperation is, how strong of a reason there is for the cooperation, and whether it would cause scandal,” he said.

“Regarding the present situation, I think it depends on what exactly the assessment involves and who does it,” Prendergast said.

But Brugger maintains “no Catholic institution should permit assessments for candidates for PAS/euthanasia to be performed on its premises” in order “to protect souls against scandal and maintain the credibility of the Gospel.”

“There’s a lot of confused things said about 'moral cooperation'. And some Catholics, including not a few theologians, make the mistake of thinking ‘if not formal, then permissible’,” he told LifeSiteNews.

“This is a great error and it leads to spurious ethical reasoning, forcing into the category of formal cooperation things that do not belong there,” he said.

Brugger agreed with Prendergast’s notion of formal cooperation being “forbidden” while shedding light on how material cooperation can also be forbidden in certain circumstances.

“For formal cooperation to take place, as St. Alphonsus Ligouri classically stated, the cooperator must share in the bad willing of the principal evildoer; he must intend the evil along with him. In so doing, the cooperator himself also wills the evil, which is always wrongful,” he said.

“But an essential point of the assessment of moral cooperation that’s regularly overlooked is that an instance of cooperation can be rendered wrongful by factors other than that which makes cooperation formal,” he added.

“In other words, not all material cooperation is morally licit.  And in some instances can be gravely evil.”

Brugger compared the Canadian situation to a German situation in which Catholic crisis pregnancy centers were permitted by Catholic bishops to issue counseling certificates to a woman which she required in order to obtain an abortion.

John Paul II wrote letters to the German bishops in 1998 and 1999, asking them to stop doing so. He also personally intervened in 2002 and the Congregation for the Doctrine of the Faith reportedly issued a further instruction in 2007.

But the pope-saint “never judged the counseling clinics to be engaging in formal cooperation. He said the clinics by issuing the certificates appear to be supporting killing, and this cannot be tolerated,” Brugger said.

“In fact, that situation was very similar to this one: in both cases, the people engaging in the behavior could be intending the evil doing, but they need not necessarily be intending it,” he told LifeSiteNews.

Hospital administrators “may just want to avoid the bad consequences for the hospital that the state threatens if they do not cooperate,” Brugger said.

“Still Catholic institutions shouldn’t be engaging in this sort of behavior because it is scandalous and a gross failure to bear witness to the Gospel. It is morally wrong.”

Role of bishops

LifeSiteNews asked Shea if it could be assumed the bishops were aware of and supported the unpublished guidelines because the Canadian Conference of Catholic Bishops has a representative on the CHAC board — currently, Calgary’s Bishop William McGrattan.

“No — I would not support your assumptions as I cannot speak for anyone else in this regard,” Shea wrote back in an email.

However, Shea told LifeSiteNews on the phone the bishops were consulted.

Moreover, Shea said he knew “for certain” Edmonton’s Archbishop Richard Smith “was involved in the creation of the guidelines that were adopted by the sponsors who are involved with CHAC.”

Moreover, “I can tell you that he is certainly involved with Covenant Health, and would have been, I’m sure, engaged in that process as well, but I would leave that for him to address.”

Schadenberg pointed out that Smith was one of the most active bishops in fighting the legalization of euthanasia in Canada.

Lorraine Turchansky, chief of communications for the Edmonton Archdiocese, told LifeSiteNews that Smith is aware of “practices regarding MAID in Alberta,” and that “the Archbishop will not be offering any comment.”

McGrattan was “unavailable for an interview or statement,” his communication director Nadia Hinds told LifeSiteNews.

However, Covenant Health’s Verbeek confirmed that “as part of the extensive consultations undertaken in the creation” of its euthanasia policy, “we included our Bishops who provided valuable insights and discernment.”

Covenant Health came under intense media scrutiny in October when a woman with ALS had a euthanasia assessment on the sidewalk outside a Catholic facility in Edmonton after initial permission to have the assessment onsite was withdrawn. 

CEO Philip Dumilie apologized at that time and said euthanasia assessments are permitted onsite in Catholic institutions “in extraordinary circumstances,” Canadian Catholic News reported at the time.

Covenant Health’s chief medical officer Dr. Owen Heisler told Canadian Catholic News that Covenant Health subsequently updated its policy on when euthanasia assessments would take place onsite.

St. Boniface in Winnipeg also allows euthanasia assessments onsite, LifeSiteNews reported in June 2017.

Elisabeth Bruyère Hospital in Ottawa, renowned for its palliative care, has a similar policy, says Jesse Cressman-Dickinson, director of communications. This hospital recently came under social media scrutiny for having a euthanasia doctor and lobbyist, James Downar, at its research institute and part of its palliative care team. 

While the preference is to transfer patients out for a euthanasia assessment, “if a patient is considered too frail to undergo multiple transfers, the consultation could be enabled onsite,” Cressman-Dickinson told LifeSiteNews in an email.

“This is in agreement with recommendations from our Catholic sponsors and Canadian bishops,” said Cressman-Dickinson.

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