In a case with implications for religious freedom, institutional autonomy, and health care access across Canada, a British Columbia Supreme Court trial starting Jan. 12 will consider whether faith-based hospitals can be forced to provide euthanasia on site.

The case, Gaye O’Neill et al. v. His Majesty the King in Right of the Province of British Columbia, Vancouver Coastal Health Authority, and Providence Health Care Society, arises from the death of a terminally ill woman who sought medical assistance in dying (MAID) while receiving care at St. Paul’s Hospital in Vancouver. Because St. Paul’s is a Catholic facility that does not provide assisted suicide, the patient was transferred to another health care facility that offered MAID. Her family and co-plaintiffs allege the transfer caused “unnecessary pain and distress” and argue that the policy allowing faith-based facilities to opt out of MAID violates the Canadian Charter of Rights and Freedoms.

The co-defendants in the case are the Providence Health Care Society, the Catholic denominational authority that operates St. Paul’s and 16 other facilities, the B.C. Ministry of Health, and the Vancouver Coastal Health Authority (VCH).

Trial proceedings are scheduled to run from Jan. 12 to Feb. 6. While the legality of MAID itself is not being challenged, the court must decide whether publicly funded, faith-based hospitals can maintain MAID-free spaces or whether the state’s duty to provide access overrides institutional conscience rights.

Central to the defense is a 1995 Master Agreement between the B.C. government and denominational health providers. The agreement formally recognizes the right of faith-based facilities to preserve the spiritual nature of the facility and governs how services incompatible with a facility’s religious identity are handled, typically through transfer rather than on-site provision.

Supporters of the current system argue that this pluralistic model protects the diversity of care available to British Columbians.

The Canadian Conference of Catholic Bishops in 2023 released a statement reiterating its opposition to euthanasia in Catholic hospitals. Vancouver Archbishop J. Michael Miller noted that the bishops had already drawn a line in the sand at their September plenary meeting when they stated unanimously that MAID would not be delivered at Catholic hospitals.

The new statement formalized that stance by saying the bishops “unanimously and unequivocally oppose the performance of either euthanasia or assisted suicide (MAID) within health organizations with a Catholic identity.”

The case has drawn a large number of interveners, reflecting its potential national impact on the future of denominational health care in Canada.

The Christian Legal Fellowship (CLF) will argue for the protection of associational religious freedom, suggesting that institutions, like individuals, possess a right to collective conscience. CLF has said that forcing a religious community to act against its foundational beliefs has dehumanizing consequences and undermines the purpose for which such institutions exist.

The Canadian Physicians for Life and the Evangelical Fellowship of Canada are expected to focus on the sanctity of life and the integrity of the medical profession, arguing that a health care system that mandates the ending of life within all its facilities risks failing to protect the most vulnerable.

Conversely, the B.C. Humanist Association has called for the provincial government to “tear up” the 1995 Master Agreement, arguing that it undermines the government’s duty of religious neutrality. “No one should suffer needlessly at the end of life,” said executive director Ian Bushfield, adding that the state should not put the interests of religious institutions ahead of individual rights.

The Canadian Civil Liberties Association (CCLA), also intervening, plans to challenge whether a publicly funded organization can claim standalone religious protections independent of its staff. The CCLA will argue that ascribing religious rights to an institution whose primary purpose is health delivery poses inevitable difficulties for state neutrality.

The Delta Hospice Society (DHS) has introduced a distinct legal argument, suggesting that section 7 of the Charter, which protects the right to life, liberty, and security of the person, should protect a patient’s right to access a MAID-free environment.

“There are many terminally ill palliative care patients who desire to spend their final days without being asked if they want their life ended by their health care provider,” said constitutional lawyer Allison Pejovic, representing the society. DHS argues that for many patients, a space free of euthanasia is a requirement for psychological security of the person.

The trial comes as construction continues on the new $2.18 billion St. Paul’s Hospital at its new site. The B.C. government has indicated it remains committed to the project’s Catholic identity, despite the ongoing litigation.

Evidence and testimony will be heard through early February, with the court expected to receive final written submissions in the spring.