Résumés
Abstract
The contentious, topical debate about whether faith-based health care organizations should be granted accommodation on the basis of institutional conscientious objection to medical assistance is dying (MAiD) is addressed through a comparative analysis of arguments on both sides of the issue that references such relevant considerations as: claimed ‘moral-authority’, competing rights-based claims, obligations arising from patient welfare principles, formal justice, dissimilarity in consequences, and two illustrative arguments from analogy. The analysis leads to the conclusion that nonconditional accommodation on the basis of institutional conscientious objection to MAiD is not ethically acceptable in Canada. A compromise mechanism, consisting of a suggested set of pragmatic conditions, is proposed that could effectively balance the competing moral responsibilities that arise from this conclusion and a core assumption of the paper, i.e., that some dominant faith-based health institutions can legitimately request, and expect, that provincial/territorial governments pay them a measure of respect in their operational, health-care-delivery decision making because of these institutions’ long history of providing high quality, health care in Canada. It is further suggested that provincial/territorial governments only allow large, publicly funded, faith-based health care organizations to enact a conditional version of accommodation on the basis of institutional conscientious objection to MAiD in circumstances where the organization has entered into a formal agreement with the relevant health department to meet the proposed, compromise conditions (or a relevantly-similar set of conditions).
Keywords:
- institutional conscientious objection,
- medical assistance in dying,
- faith-based health institution,
- accommodation,
- publicly-funded health care
Résumé
Le débat controversé et d’actualité sur la question de savoir si les organisations de soins de santé confessionnelles devraient se voir accorder un accommodement sur la base de l’objection de conscience institutionnelle à l’aide médicale à mourir (AMM) est abordé par le biais d’une analyse comparative des arguments des deux côtés de la question qui fait référence à des considérations pertinentes telles que : la revendication d’une « autorité morale », les revendications concurrentes fondées sur les droits, les obligations découlant des principes du bien-être du patient, la justice formelle, la dissemblance des conséquences, et deux arguments illustratifs tirés de l’analogie. L’analyse conduit à la conclusion que l’accommodement non conditionnel sur la base de l’objection de conscience institutionnelle à l’AMM n’est pas éthiquement acceptable au Canada. Un mécanisme de compromis, consistant en un ensemble de conditions pragmatiques, est proposé pour équilibrer efficacement les responsabilités morales concurrentes qui découlent de cette conclusion et d’une hypothèse centrale de l’article, à savoir que certains établissements de santé confessionnels dominants peuvent légitimement demander et s’attendre à ce que les gouvernements provinciaux/territoriaux leur accordent un certain respect dans leur prise de décision opérationnelle en matière de prestation de soins de santé, en raison de la longue histoire de ces établissements en matière de prestation de soins de santé de haute qualité au Canada. Il est en outre suggéré que les gouvernements provinciaux/territoriaux n’autorisent les grandes organisations de soins de santé financées par l’État et fondées sur la foi à adopter une version conditionnelle de l’accommodement sur la base de l’objection de conscience institutionnelle à l’AMM que dans les cas où l’organisation a conclu un accord officiel avec le ministère de la Santé concerné pour satisfaire aux conditions de compromis proposées (ou à un ensemble de conditions similaires).
Mots-clés :
- objection de conscience institutionnelle,
- aide médicale à mourir,
- établissement de santé confessionnel,
- accommodement,
- soins de santé financés par l’État
Parties annexes
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