Abortion accessibility in Canada: The Catholic hospital conflict

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A leaked draft showing that the U.S Supreme Court justices are preparing to overturn the Roe v. Wade abortion-rights ruling has sparked debate in Canada, including whether Catholic hospitals can impede your access to abortion.

While geography, knowledge and equity play important roles in limiting access, one woman from Estevan, Sask., told CTV News that she experienced barriers at a Catholic hospital.

The woman, who asked to remain anonymous, went to St. Joseph’s Hospital, the only hospital in her city, to get an abortion in 2013. The now mother-of-two said she was referred to another hospital in Regina, which was 200 kilometres away and an approximate two-hour drive.

“The reason why I was getting an abortion was because the baby wasn't viable,” she told CTV News in a phone interview.

“I was going through one of the hardest things in my life. Then, you're just shipped off to another city, and I just felt that judgment. It's not that I was denied an abortion exactly, but they sure don't make it easy.

“I was lucky that I had the means and support to travel to get an abortion. But what about the women in my city who can’t?” she added.

The hospital, which is a member of the Catholic Health Association of Saskatchewan (CHASSK), confirmed to CTV News that they currently do not perform abortions or stock emergency contraceptives on-site.

They are one of many health-care providers in the country that does not provide some services due to faith-based exemptions.

Under section two of The Canadian Charter of Rights and Freedoms, Catholic hospitals are allowed to deny certain services to patients under their right to religious freedom – but, unlike those who choose to attend Catholic schools, patients frequently turn up in a Catholic health-care facility simply because it is the closest one.

All Catholic hospitals and health-care providers are part of the official universal health-care system. Tax dollars fund them, but they have their own policies that govern treatment plans for services that include abortion, birth control prescriptions, IUD insertions, emergency contraceptives, and dilation and curettage (D&C) procedures.

There are 129 Catholic health-care facilities across the country, according to the Catholic Health Alliance of Canada (CHAC). In certain regions of Canada, such as Saskatchewan and Nova Scotia, the sole hospitals in towns and cities are affiliated with a Catholic health-care association and adhere to Catholic ideals.

The largest Catholic health-care provider in Canada is in Toronto. Unity Health’s network includes three major hospitals, St. Michael’s, St. Joseph’s and Providence Hospital. According to Unity Health’s spokesperson, abortions are not performed in their hospitals, but emergency contraception and hormonal therapies are stocked on-site.

Catholic establishments in Alberta presently account for 12 per cent of acute-care beds and 27 per cent of palliative-care beds, according to The Walrus. Catholic institutions also control around 15 per cent of health services in Ontario, according to the CHAC.

Federal government’s response to improving access 

The Government of Canada announced more than $3.5 million in funding for projects by Action Canada for Sexual Health and Rights (Action Canada) and by the National Abortion Federation Canada on May 11 to improve access to abortion services and offer accurate reproductive health information to Canadians.

The primary goal of the funding was to improve access for women in rural areas, Marie-France Proulx, the Press Secretary for Health Canada, told CTV News.

However, Frederique Chabot, the director of domestic health promotion at Action Canada, worries that the funding won’t offer a long-term solution, especially for women who only have access to a single hospital in their vicinity.

“Every single case can take up to a week of really intense work …, especially with cases that have complex circumstances that we need to support them with,” she said.

“When you start to add up things like plane tickets, hotels, food, taxis … it can cost $1000 plus per case and so, we're already worried if this incredible influx of resources is going to help real people in real-time.”

Access to abortions isn’t dependent on Catholic hospitals when they only make up less than 5 per cent of hospitals in the country, Moira McQueen, the Executive Director of the Canadian Catholic Bioethics Institute, says.

“There are multiple questions that are problematic in health care … when it comes to abortion services, it is problematic that there is only one hospital available (in many cities), and you can’t blame that on the Catholic Church,” she said.

What does the law say?

According to Kathleen Mahoney, a law professor at The University of Calgary, the law has always been clear that individuals can refuse to do certain procedures based on their religious beliefs.

“But an institution has never been given that right. It’s likely that if a hospital were challenged on ethical guidelines or requirements for their employees to do or not do certain things … then those considerations would likely be struck down,” she said.

However, Mahoney says that patients often don’t want the hassle of issuing a legal challenge or complaint and go to private clinics to receive services; and that has become Catholic Hospitals’ greatest strength.

“They have a legal standing to deny services unless it's challenged. Unless there’s no law out there that says you can't do that," she said.

“If there's no law that says you can't jaywalk, then people will jaywalk. So it's legal unless there's a law that says you can't. And that's what you know; civil liberties are all about.”

Questions around Catholic health institutions’ right to refuse procedures against their faith have come up before but remained unresolved, including Medical Assistance in Dying (MAID).

MAID became legal in Canada in June 2016 but has caused discontent in the medical community, Gilbert says. Patients have had to be transferred out of Catholic-run long-term care homes, hospices, and hospitals and put into ambulances to receive the assisted death they desire.

“MAID has led to what is called forced transfers. So, patients get forced out of the hospital to transfer to somewhere else if they want to get MAID because Catholic institutions will not provide it on-site,” said Daphne Gilbert, a law professor at the University of Ottawa specializing in Advanced Sexual Assault law.

“This has been happening for years for decades with abortion, but it never reached the sort of public imagination as much as it has with MAID because we’ve at least had the option of clinic abortions.”

“The problem is we don't have a protective constitutional right to health care. We do have a publicly funded system, and it has to be administered equally,” said Gilbert.