How did we end up in a situation where some publicly funded facilities are permitted to refuse to provide healthcare services in BC? To answer this question we need to look at the history of healthcare in BC and how religious hospitals came to play a part in our medical system.
“In British Columbia, the first hospitals were shaped by a context of colonization, urbanization, and population change,” wrote Helen Vandeberg and Geertje Boschma in their 2020 paper The Evolution of Early Hospitals in British Columbia published in BC studies.
Prior to the arrival of the early colonists and settlers, there obviously existed from time immemorial Indigenous healers who provided healthcare both to their own peoples and later to the first Europeans to arrive. The first colonists and settlers were also served by passing physicians and other early western healthcare professionals who began to settle in the province.
Watch our webinar with Dying With Dignity Canada CEO Helen Long
BC’s first hospitals were constructed during the 1850s and 60s – many of these were secular, or at least nondenominational, and often named ‘Royal Hospitals’ in recognition of the support they received from the British government. The first religious hospital in the province was St Joseph’s Catholic hospital in Victoria, which was built in 1876 by the nursing Sisters of St Ann.
Through the 1870s and 80s, Catholic hospitals such as Saint Mary’s in New Westminster and St Luke’s Home in Vancouver continued to be built alongside a growing number of nondenominational facilities, like Vancouver City Hospital, which was originally built by the Canadian Pacific Railway. That would later be renamed Vancouver General Hospital.
According to Vandeberg and Boschma, those early Catholic hospitals were largely funded by Catholic sisterhoods and “set out to pride themselves on accepting any type of patient, regardless of condition, age or race”. Royal Columbian, by contrast, would not accept patients with incurable conditions, nor children or the elderly.
Protestants, notably the Methodists and Presbyterians (later United Church), established hospitals in more remote regions of the province, such as the coastal areas around Bella Bella. These were often run by missionaries with a medical background and because of their status in remote communities, were often also appointed to local government roles.
Chinese and Japanese communities, often facing discrimination in these majority white hospitals, established several of their own facilities, though those were often demeaned in the press and frequently were denied similar financial aid to other hospitals.
In the 20th century, more people began to talk about the need for public medical insurance. St Joseph’s in Victoria ran an insurance program for $1/month that was open to people of all faiths and races, but there was no overarching policy to cover every British Columbian, particularly those who were unemployed.
In 1935, Liberal Premier Duff Patullo passed an initial medicare bill but it was deeply opposed by the medical establishment and was never implemented. Later, some partial social assistance programs would roll out, but it wasn’t until WAC Bennett introduced the BC Medical Services Plan in 1965 that every British Columbian would have access to healthcare. A few years later, BC would join Saskatchewan in being the first two provinces in the federal government’s medicare program in 1968 under Prime Minister Lester B Pearson, whose father was a Methodist minister, with support of the NDP’s Tommy Douglas, a former Baptist preacher.
Under Pierre Elliot Trudeau, abortion was partially decriminalized in 1969 – though it was not fully decriminalized until the Supreme Court of Canada’s Morgentaler decision in 1988. During that period, abortions could only be provided in a hospital with a therapeutic abortion committee, and there were no requirements (at least in BC) that hospitals have those. Rather each hospital board decided for itself whether to provide the service.
This created obvious disparities in access and led to the creation of the Abortion Caravan that departed from Vancouver in 1970.
With the announcement of the Morgentaler decision in 1988, then premier Bill Vander Zalm announced he would refuse coverage for any abortion not sanctioned by a therapeutic abortion committee. He was widely condemned for this, including from within his own caucus – notably by Kim Campbell who would go on to be Canada’s only female prime minister. Vander Zalm ultimately backed down and committed to funding the procedure.
The BCNDP, under Mike Harcourt, ran on expanding access to abortion in 1991. They promised funding for clinics and to take away the right of hospital board to decide whether they will provide abortions. They famously won, ending the Social Credit Party and began delivering on those promises.
In March 1992, the government amended the Hospital Act to designate 33 hospitals that must perform abortions. Today Section 24.1 of the act reads “Each hospital listed in the Schedule to this Act must provide the facilities and services, and be operated and maintained, as necessary to allow a qualified person to receive abortion services at that hospital.” None of the 33 listed hospitals were religious.
According to the Pro-Choice Action Network of BC’s Abortion History, “In 1993, Archbishop Adam Exner said staff at BC’s nine Catholic hospitals must forbid abortion, contraception, euthanasia, and sterilization. John Blatherwick, Vancouver medical health officer noted that Vancouver General Hospital was the only non-religious hospital for adults in Vancouver.”
BC Women’s Hospital was originally opened by the Salvation Army as Grace Maternity Hospital. They operated it until 1994 when the original Shaughnessy site was closed and responsibility for the newer facility on Oak Street (which was opened in 1982) was handed over to the province.
The provincial government would develop a Master Agreement with the denominational health care facilities association that was signed on March 16, 1995. The Master Agreement states that the provinces grants the hospitals that are part of the denominational association the right to “preserve the spiritual nature of the facility”, or in other words to refuse to provide services that they deem would desecrate their holy buildings.
Today, members of the Denominational Health Care include Providence Healthcare who operates St Paul’s in downtown Vancouver, as well as a number of Protestant and Jewish associations that operate long term care homes. Because of that Master Agreement, none of those facilities are required to provide abortion, nor are they required to provide medical assistance in dying.
This has resulted in those stories that we’re all likely familiar with – the forced transfers of 173 patients between 2019-2022 across BC, as well as the requirement that people looking to end their pregnancy, or even access contraceptives, go to a willing facility.
In 2022, just five of these agencies – Providence, Louis Brier, Mount St Mary, St Michael’s and Menno Hospital – were paid over $1.1 billion by the provincial government. Many of the other long term care homes also receive 50% of their funding from the province.
But these agencies aren’t static.
Comox Valley’s main hospital for over 100 years was St Joseph’s General Hospital, founded by the Sisters of St Joseph of Toronto. In 2017, a new North Island Hospital was completed, and operation of that facility was taken over by Vancouver Island Health Authority. Today, the Catholic agency only runs the remaining long-term care facility in the city.
More controversially, was the story of the Delta Hospice Society. They operated the Irene Thomas Hospice in Delta, and the society’s board was taken over by anti-choice religious zealots. Because of their refusal to allow medically assisted deaths on site, in 2021 the province pulled funding from the facility and eventually transferred control to Fraser Health.
These two examples offer a path forward for the province as the redevelopment of St Paul’s Hospital in Vancouver continues, with the province investing over $1.3B into the $2 billion project.
For our part, we’re lobbying the provincial health minister to tear up the Master Agreement and require every publicly funded hospital in the province to provide legal and publicly funded healthcare. We’re asking you to write your MLA to say as much and I’ll put that link in the chat shortly.
Ideally, we’d see the province bring all publicly funded healthcare under secular administration. Institutional objections are but one of the issues at play here, but it is one that has some of the most material impact on patients.