Only months after the Canadian Parliament approved legal assisted suicide, Catholic hospitals, palliative care centers and individual doctors have been put on the defensive amid calls to require them to help patients kill themselves.

Five doctors have filed a legal challenge against the College of Physicians and Surgeons of Ontario for its policy that requires doctors who refuse to participate in assisted suicide and abortion to refer those patients to other doctors.

"In my view, it's the future of Catholic healthcare that's at stake," said their spokesman, Larry Worthen. "No other jurisdiction outside of Canada where assisted suicide is legal requires referral."

He said the college has been "extremely aggressive" in its handling of their case. The doctors are being cross-examined about their religious beliefs. One is Catholic, while four are evangelical Christians.

The college has authority to regulate the practice of medicine in the Ontario province. Refusal to comply with its policies could cost a doctor his or her medical license.

The doctors have the support of the Christian Medical and Dental Society of Canada, the Canadian Federation of Catholic Physicians' Societies and Canadian Physicians for Life, though they face increasing legal costs, Canadian Catholic News reports.

The Attorney General of Ontario has sided with the college, with a spokesperson deeming its policy "a reasonable balance between the sincerely held religious beliefs of objecting physicians and the important state interest in ensuring vulnerable patients are able to access legally available medical procedures."

The three doctors' groups are part of the new organization called Coalition for HealthCARE and Conscience, which includes the Catholic archdioceses of Toronto and Vancouver.

Bishop Ronald Fabbro of London, who is president of the Assembly of Catholic Bishops of Ontario, said the province's bishops have agreed to make conscience protection a top priority.

The Canadian parliament legalized assisted suicide in June on orders from Canada's Supreme Court.

In British Columbia, a local health authority suggested requiring that all publicly funded institutions provide assisted suicide services, including Catholic hospitals and hospice care.

Archbishop J. Michael Miller of Vancouver wrote in protest of the proposal.

The proposal followed strong criticism of a Catholic hospital in Vancouver that transferred an elderly man in severe pain to another hospital because it would not provide assisted suicide.

Ian Shearer, 84, suffered multiple afflictions, including a spinal condition and sepsis. In late August he requested a doctor-assisted suicide at St. Paul's Hospital in Vancouver, which does not provide assisted suicide because it is Catholic.

Shearer was transferred to a hospital about 2.5 miles away. His daughter Jan Lackie alleged that the trip and inadequate pain control put him in agony.

The ambulance arrived three hours late. In order to ensure he was mentally lucid to give legal consent to assisted suicide, his pain drug dosage had been reduced. According to Lackie, there was also a shortage of the narcotic drug in his ward. She added that she wanted religious-operated facilities, like hospitals, nursing homes and hospices, to be required to allow assisted suicide.

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"We have nine judges who said 'Yes' to medical assistance in dying," she said. "I don't understand how the Vatican has so much power, even here in Canada."

Shaf Hussain, a spokesman for the hospital's parent group Providence Health Care, said the health care group finalized a policy this summer that arranges to transfer patients as comfortably as possible when they voice a desire for assisted suicide.

"We'll be working with our partners in the health care system to ensure the patients' needs do come first … and to minimize the discomfort and pain," he said.

St. Paul's Hospital does not host the medical assessment or the signing of consent forms required by the assisted suicide law.

"Life is sacred and the dignity of the person is important," Michael Shea, president of the Catholic Alliance for Canada, told the National Post. "These organizations neither prolong dying nor hasten death, and that's a pretty fundamental value for them."

Shanaaz Gokool, who heads the pro-assisted suicide group Dying with Dignity, charged that facilities that do not provide assisted suicide cause suffering for transferred patients and deny them a right to a legal procedure in places where faith-based health care organizations are the only provider.

"This is going to be a real issue, and it's going to be a real issue across the country," Gokool said.

The Canadian newspaper the Catholic Register in an Oct. 13 editorial drew a warning from the controversy.

"What is playing out in Vancouver is just the beginning," it said. "Catholic and other faith-based institutions across Canada will face increasing public and political pressure to set aside religious and conscience objections to facilitate assisted suicide."

The editorial noted that organ transplants and other surgeries are routinely referred to other hospitals, and Catholic hospitals are not forced to perform abortions.

"But the assisted-suicide lobby offers no such hint of religious tolerance or accommodation when it comes to their issue," the Catholic Register said.