Supporters of “voluntary assisted dying” fought hard to achieve legalisation in various jurisdictions around the world. After legalisation, however, battles still remain to be fought.

As several Canadian scholars argue in BMC Medical Ethics, institutional objections are a road block to a smoothly functioning VAD system. Broadly speaking, based on the Canadian experience, there are two kinds of institutions which refuse to cooperate with VAD: faith-based hospitals (presumably mostly Catholic) and hospices which do not regard VAD as appropriate palliative care.

The authors choose their words carefully, but basically they call upon governments to order the refuseniks to cooperate. “Reform is needed to minimize the negative impacts on patients, their caregivers, and health practitioners involved in MAiD practice.”

The authors contend that refusal to allow legal VAD on the premises of an institution causes suffering for the doctors and the patients.

Suffering due to institutional objection is therefore not only attributable to forced transfers, but also to less visible sources of stress including stigma, logistics, and administrative burdens. Institutional objections also constrained choice about how, when and where MAiD could be accessed, and disrupted existing therapeutic relationships, interfering with key parts of quality care.

Their conclusion will seem ominous for the refuseniks – opposition must be crushed:

The wide range of harms identified, both to patients and practitioners, suggest that at least some limits to institutional discretion are warranted and that top-down regulatory involvement may be the best way to facilitate patient access to this lawful end-of-life choice.