In a quiet Vancouver courtroom, a constitutional confrontation is unfolding that may redefine the boundaries between religious freedom, state funded healthcare, and the right to die with dignity in Canada. The Supreme Court of British Columbia is hearing a challenge brought by Dying With Dignity Canada against the practice of forcing terminally ill patients to transfer from religious healthcare institutions in order to access medical assistance in dying, known nationally as MAiD. What appears at first glance to be a narrow dispute about hospital policy is, in legal reality, a direct collision between competing Charter rights, public funding obligations, and the secular character of the Canadian state.
The case arises from the death of Sam O’Neill, a young woman dying from aggressive cancer who sought MAiD while receiving care at St Paul’s Hospital in Vancouver, a facility operated by Providence Health Care, a Catholic organisation. Because the hospital refuses to provide MAiD on religious grounds, O’Neill was required to undergo a transfer to another facility while in extreme pain and near death. She never regained consciousness after sedation for the transfer and died without the opportunity for final communication with her family. Her parents, now plaintiffs, allege that the state permitted religious doctrine to override their daughter’s constitutional rights at the most vulnerable moment of her life.
At the centre of the litigation are two pillars of the Canadian Charter of Rights and Freedoms: section 7, which guarantees the right to life, liberty and security of the person, and section 2(a), which protects freedom of conscience and religion. Dying With Dignity Canada argues that forced transfers and effective denial of MAiD access violate both. The legal claim is not abstract. It is anchored in physical suffering, psychological distress, loss of autonomy, and what the plaintiffs describe as the deprivation of a peaceful death.
This case cannot be understood without revisiting the legal architecture of assisted dying in Canada. In Carter v Canada (2015), the Supreme Court of Canada held unanimously that the blanket criminal prohibition on physician assisted dying violated section 7 of the Charter by forcing individuals to endure intolerable suffering or to end their lives prematurely. Parliament responded in 2016 by legalising MAiD for eligible adults through amendments to the Criminal Code. Subsequent reforms in 2021 expanded eligibility beyond those whose death was reasonably foreseeable, though mental illness as a sole underlying condition remains excluded for now.
The legal principle established in Carter is unambiguous: personal autonomy in decisions concerning bodily integrity and the timing and manner of death is constitutionally protected. Yet the present case exposes a structural contradiction. While MAiD is legal, access to it depends heavily on institutional cooperation. In several provinces, including British Columbia, large portions of publicly funded healthcare infrastructure are operated by faith based organisations that refuse to provide MAiD on moral or theological grounds.
This is where the legal tension sharpens. Providence Health Care receives public funds, operates within the provincial healthcare system, and exercises statutory authority delegated by the state. Yet it applies religious doctrine to determine which lawful medical services it will deliver. The plaintiffs argue that this arrangement transforms private belief into public power.
Under Canadian constitutional law, the state has a duty of religious neutrality. In cases such as Mouvement laïque québécois v Saguenay (2015), the Supreme Court affirmed that government actors must neither favour nor hinder any particular belief system. The question before the British Columbia court is whether allowing publicly funded hospitals to deny or obstruct access to MAiD constitutes unconstitutional state endorsement of religious doctrine.
The forced transfer practice is particularly vulnerable to legal attack. Medical evidence shows that transferring terminally ill patients significantly increases the risk of pain, complications, delirium, and death en route. In legal terms, this engages the security of the person component of section 7. The Supreme Court has repeatedly held, in cases such as Chaoulli v Quebec and Canada v PHS Community Services Society, that government policies which foreseeably cause physical suffering or psychological distress violate section 7 unless justified under section 1 of the Charter as reasonable and demonstrably justified in a free and democratic society.
It is difficult to see how forcing a dying patient to endure transport solely to accommodate institutional religious beliefs could satisfy that test.
Equally complex is the competing claim raised by interveners such as the Delta Hospice Society, supported by the Justice Centre for Constitutional Freedoms. They argue that patients seeking palliative care should not be exposed to discussions of MAiD and that facilities should be permitted to offer spaces free from assisted dying. They frame this as protection of their own section 7 rights to dignity and bodily autonomy.
However, this argument faces a major constitutional obstacle: freedom from exposure to a lawful medical option is not a recognised Charter right. The Charter protects individuals from state coercion, not from knowledge that legal choices exist. Moreover, patients are not compelled to receive MAiD; they must request it. The legal asymmetry is stark. One group seeks to avoid discussion, while another seeks access to a legal medical procedure to avoid unbearable suffering and death without dignity.
The broader implications extend far beyond British Columbia. Across Canada, approximately one third of hospital beds in some provinces are operated by faith based institutions. If their policies prevail, access to MAiD becomes geographically and institutionally unequal, creating what constitutional scholars call a two tier rights regime. Charter rights would exist in theory but dissolve in practice depending on postal code and hospital ownership.
Internationally, Canada is being closely watched. The country has been cited by the United Nations Special Rapporteur on the right to health for its advanced assisted dying framework, but also criticised for uneven access. Under the International Covenant on Civil and Political Rights, to which Canada is a party, states must ensure effective access to rights, not merely formal legality. Denial through administrative barriers can constitute constructive violation.
European jurisprudence reinforces this principle. The European Court of Human Rights in cases such as Tysiac v Poland and Gross v Switzerland has ruled that where a state permits certain end of life choices, it must provide a clear and accessible framework for their exercise. Obstruction by publicly funded institutions would likely be considered incompatible with the right to private life under Article 8 of the European Convention on Human Rights.
The Canadian litigation also intersects with healthcare governance. Provincial health authorities contract with organisations like Providence to deliver services on behalf of the state. That contractual relationship creates legal accountability. If a private entity performs a public function, constitutional obligations follow. This doctrine, recognised in Eldridge v British Columbia, prevents governments from outsourcing rights violations to third parties.
From a practical standpoint, the case exposes the operational fragility of the MAiD system. Physicians report delays, institutional resistance, intimidation, and administrative obstruction. Families describe chaotic last days spent arranging transfers rather than farewells. These are not abstract harms. They are systemic.
There is also a political dimension. Religious healthcare providers exert substantial lobbying power. Governments have historically avoided confrontation, fearing backlash from faith communities and institutional disruption. But constitutional law does not permit compromise on fundamental rights for political convenience.
If the British Columbia court rules in favour of Dying With Dignity Canada, the consequences will be profound. Health authorities may be required to ensure MAiD is provided onsite in all publicly funded facilities or to create legally enforceable mechanisms guaranteeing seamless access without transfer. Religious hospitals may be forced to choose between maintaining doctrinal purity and retaining public funding.
If the court rules against the plaintiffs, Canada will face a fragmented rights landscape where legal euthanasia exists in statute but is denied in practice to some of the most vulnerable citizens. Such a result would almost certainly be appealed to the Supreme Court of Canada, where the foundational principles of Carter will be tested again, not against criminal prohibition, but against institutional resistance.
This case is not about promoting death. It is about whether the state can allow ideology to stand between a citizen and a lawful medical choice at the moment of greatest vulnerability. It is about whether constitutional rights are real, or conditional. It is about whether publicly funded healthcare serves patients first, or belief systems.
In modern constitutional democracies, the legitimacy of the state rests on neutrality, equal protection, and the primacy of individual dignity. If Sam O’Neill was denied a peaceful death because her hospital placed theology above law, then Canada must confront a disturbing possibility: that the architecture of its healthcare system has quietly subverted the very rights its Constitution promises to protect.