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Samantha O'Neill sought MAID in 2023 while suffering from cervical cancer but couldn't access it at Vancouver's St. Paul's Hospital, so she was sedated and transferred to another hospital in what her mother calls an "unbearably painful" experience at the end of her life.

Providence Health Care's lawyer, Geoffrey Cowper, told Chief Justice Ronald Skolrood that he's been tasked with deciding a case that represents "a collision between a view of the Charter that is irreconcilable with the ongoing operation and delivery of health care by faith-based health-care institutions." 

Cowper says the religious accommodation that allows Providence facilities to not provide assisted death procedures shows the benefits of "pluralistic" health-care delivery. 

He says providing health care to anyone — believers and non-believers alike — aligns with Catholic doctrine, and that Providence is therefore an "essential and integral ministry of the church."

O'Neill's mother, Gaye O'Neill, had said outside court on Monday that the treatment of her daughter in her final moments was "traumatic and unbearably cruel to witness." She said she was fighting "for the rights of all ºÃÉ«tvs."

The family's lawyer, Robin Gage, told the court on Monday that forcing patients who seek MAID to be transferred to satisfy the religious beliefs of others amounts to a "coercive burden" that runs afoul of the Charter.

But Cowper said Thursday that public funding of health-care facilities that adhere to Catholic doctrine does not make them government actors or a government program, and that Providence Health Care should be found to have an "institutional right" to freedom of religion.

The case centres on alleged harms to patients forced to transfer out of Providence facilities if they want medical assistance in dying, and Cowper said there needs to "reconciliation" between harms or risks from transfers with "the need to accommodate faith-based institutions."

"The constitution recognizes Providence's religious rights and interests, and it also reconciles the consideration of harms," he said. "Those harms have to be balanced with the rights of religious institutions."

He said the plaintiffs "trivialize the relationship between Providence and its hospitals," by claiming the provincial government merely "delegated building management powers to Providence." 

"It's our hospital. We own it, we control it, and that's what we're supposed to do," he said. "That's not just what we're lawfully allowed to do, that's what the ministry commands us to do." 

The court heard earlier Thursday from a lawyer for the B.C. government who warned the court against a "sudden and abrupt" ruling in the case. 

Alison Brown said it would be a "tragic irony" in a lawsuit aimed at expanding access to medical assistance in dying if such a decision disrupted or harmed patients instead.

Brown said the province allows faith-based care providers to opt out of services against their religious beliefs, and MAID was a "red line" for Providence Health Care. 

She said the "decision-maker" for Providence is the Archbishop of Vancouver, who "cannot accept potentially ending a human life within a facility" Providence operates. 

Brown said the province had gone beyond what the Constitution required with "carefully crafted" policies to meet patient needs, warning the court against a ruling that would interfere with the government's "legislative objective."

"It would be tragic irony if, in a case that aimed to expand access for patients, a remedy was so sudden and abrupt that patients might actually be harmed, that care might be disrupted," she said. 

Brown said that if any aspect of the claim by O'Neill's family is successful, the judge should "at minimum" suspend any findings of constitutional invalidity to allow time for the parties to come back to court for "targeted submissions" on what remedy the court should grant.

David Bell, a lawyer for Vancouver Coastal Health, said its MAID policy scheme "appropriately balances the rights and interests of patients with those of the organizations that choose not to deliver a service based on their sincerely held religious beliefs."

Bell said so-called "adjacent spaces" set up to offer the procedure outside Providence facilities have been a "success story." 

"Adjacent spaces have been a very good step in the betterment of the system," Bell said.

Closing arguments in the case are scheduled to conclude Friday in Vancouver. 

This report by ºÃÉ«tvwas first published April 16, 2026.