The head of St. Joseph's Healthcare in Hamilton wants his hospital to be able to opt out of providing physician-assisted death services.

Kevin Smith says he's waiting on provincial rules that will clarify whether St. Joe's as a Catholic institution must abide by new federal right-to-die laws when they take effect on June 6.

The province is obligated to create new laws after the Supreme Court of Canada ruled a year ago that doctor-assisted death was allowed. Smith hopes the option of opting out is included in Ontario legislation.

Right-to-die advocates oppose that idea, stressing that assisted death has been established as a charter right.

A joint parliamentary committee already recommended last week that individual doctors be able to opt out, provided they give "an effective referral."

But Smith says physician-assisted death goes against the Catholic beliefs of St. Joseph's as a whole. So his organization will watch closely for any way it can merely refer patients elsewhere and not provide the service itself.

If the provincial legislation doesn't allow that, Smith said, then St. Joe's will look at its next steps.

They would be informed that this is a service they wouldn't make available. - Kevin Smith, St. Joseph's CEO, of what it would tell doctors if it didn't provide physician-assisted death

"We would talk with decision makers to understand our legal and moral position and ultimately consider options," he said.

St. Joe's isn't alone on its reluctance. Providence Health Care in Vancouver, for example, recently circulated a memo saying it wouldn't permit physician-assisted death.

The parliamentary committee released 21 recommendations last week for what laws governing physician-assisted death should include. One of them advised that all publicly funded health care institutions should have to provide medical assistance in dying.

Michael Shea, president of the Catholic Health Alliance of Canada, told CBC News that his organization is "reviewing the report."

Not an easy issue

The subject has been a "complex" one at St. Joe's, where board members have discussed it for more than a year, Smith said. Last month, board members had a retreat dedicated to the issue.

If St. Joe's doesn't provide the service, Smith said, then it would likely revise its health care ethics guide that physicians commit to when they're assigned privileges.

They're asking people to choose between what may be some of the best quality palliative care and physician-assisted death. - Shanaaz Gokool, Dying with Dignity

"They would be informed that this is a service they wouldn't make available," he said. Instead, St. Joseph's would give patients information about getting the service at another facility.

That's not good enough, said Shanaaz Gokool, CEO of Dying with Dignity.

"Physician-assisted dying has been established as a charter right, a human right, and they have to allow assisted dying on their premises," she said.

Choosing between your hospital and assisted dying

There are Catholic health institutions that do "wonderful work," she said. In some cases, it's the best quality palliative care in a city.

"They're asking people to choose between what may be some of the best quality palliative care and physician-assisted death."

Furthermore, Gokool said, changing hospitals requires leaving familiar doctors, nurses, and hospital staff, and is difficult for gravely-ill patients.

With such a stance, "you're being told that you're not welcome here if you are thinking you may want an assisted death," she said.

A spokesperson for Ontario Health Minister Eric Hoskins told CBC News on Wednesday that it was too early to comment on what the province's position will be. The ministry is working closely with the College of Physicians and Surgeons before the law comes into effect.