MAID presentation- Ethics of Euthanasia
First, it is good to define what we are talking about.
MAID stands for Medical Assistance in
Dying. This is the practice of a doctor or nurse practitioner using a medication
taken orally or intravenously to end a persons life. This was made legal in
2016 with the introduction of Bill C-14, then expanded in 2021 by Bill C-7. A
further expansion was delayed in 2024 (Bill C-62) to 2027 which will expand MAID
to include mental illnesses.
MAID is a euphemism, like “euthanasia”
(eu=good, thanatos=death). Instead of using terms like 'suicide,'
'assisted suicide,' or 'ending a person’s life,' which are more explicit but
can sound harsh, the term MAID (Medical Assistance in Dying) is used as it
sounds more gentle. Using this kind of euphemism can be somewhat dangerous,
however. During this talk a chaplain at a long-term care facility mentioned
that they have had people request MAID, but when investigated it turns out that
they thought they were requesting “palliative care”. A doctor who was present
at this talk said that they offer “medical assistance in dying” in their service
at the hospice, but not in the sense of killing their patients in MAID. They
assist the dying through pain control and comfort measures.
It is also
worth mentioning that allowing someone to die by withdrawing life-support is,
ethically, not the same as actively killing a person by injecting them with a
drug that will end their life. One is allowing
a natural process (death) to take place that is being interrupted by technology.
The other is causing death, an act of killing.
Similarly,
medications given to control pain that might shorten a person’s life is not the
same as euthanasia, as the intention is to relieve pain, not cause death. This is the
doctrine of double effect. The primary intension
is to relieve the severe pain of a terminally ill patient (good effect), but
the side effect is that it may shorten the patient’s life (bad effect).
Now that we
have painted the picture a bit, I want to start a bit unusually. And it might
seem a bit backwards.
Let’s say we assume there are cases
where we can justifiably use assisted suicide to end someone’s life. One valid
questions is, would we be able to use that ability responsibly? Would our
system be refined enough to use that ability responsibly?
So, just to paint the picture for us
a bit, one of the arguments against using the death penalty (capital punishment)
is that our legal system isn’t refined enough to not make mistakes. So just to
be clear, this is state-sanctioned execution of criminals who are guilty of particularly
heinous crimes.
Consider the case of Cameron Todd
Willingham. In 1992, he was convicted of arson murder in Texas. He was accused
of intentionally setting a fire that killed his three children. He was executed
in 2004. Later investigations (2009) revealed that the evidence used against
him was misinterpreted, and experts concluded that the fire was accidental.
Or consider the case of Carlos
DeLuna, who was executed in 1989 for the stabbing of a Texas convenience store
clerk. A number of years later, evidence emerged pointing to another man,
Carlos Hernandez, who had a history of similar crimes, and it is likely that he
was the actual perpetrator, and DeLuna was wrongfully executed by the state.
There are other reasons to be against
the Death Penalty, but one reason is that the state can’t be trusted with that
kind of power. They make mistakes, and the risk of killing someone who shouldn’t
have been killed is not really worth exercising that power.
So, I would like to look at MAiD in similar
light.
Anecdotally, I know of a situation
where a friend brought a depressed family member to the emergency room because
they had suicidal ideation. I’m not going to say what city this was in. It was
in Alberta, but not Red Deer. They were handed a stack of brochures and one of
those brochures was for MAiD. …
In Canada, medical staff are not
allowed to suggest MAiD to patients. The legislation emphasizes that any
discussion about MAID must be initiated by the patient themselves. Health care
providers cannot proactively bring up the topic or suggest MAID as an option. The reason for this is to protect the
patient's autonomy, aligning with the ethical principles of informed consent
and non-coercion. … But it seems that this is increasingly being brought up by
medical staff. … And yet, a suicidal person was handed a brochure about how to
request assisted suicide in an Alberta hospital.
How do you think that person feels
about bringing their suicidal family member to the hospital?
There are also reported cases where family
members have to get legal system involved to try to stop the state from giving
MAiD to their family member. For
example, in March 2024 an Alberta judge refused to grant a father an injunction
against his 27-year-old daughter’s MAID application. She was found ineligible by
health care practitioners, but went to multiple health care practitioners until
she found some who would agree to approve her application to receive MAID. She is autistic, has ADHD, and lives with her parents
in Calgary. The father says she doesn’t
have a terminal disease. She’s generally healthy and believes that her physical
symptoms are from undiagnosed psychological conditions. The judge said Alberta
Health services approved her MAID application.[1]
Lawyers said they understood the father loved his daughter, but he had no right
to keep her alive against her wishes.
So where do we draw the line here?
When are we dealing with a father whose daughter is severely suicidal and is
trying desperately to help her? And when are we dealing with an individual who
has a valid claim to end their life?
Another example is the reported case of
a 52 year old BC man with bipolar disorder and chronic back pain, whose family
is suing the federal and provincial governments after he allegedly used a day
pass from hospital to end his life with MAID. While receiving psychiatric
treatment at St. Paul’s hospital for his illness, he left the hospital on a day
pass, and went to a clinic in the afternoon where he died through the administration
of MAID. His family wasn’t informed of his departure from the hospital until
after he had undergone MAID.[2]
So, I would say that if you are concerned
that a family member is suicidal, the decision to call on medical help is
complicated by these stories. … I’m speaking as someone who has volunteered on
a suicide crisis line, and who has also had a family member commit suicide
after multiple visits to the emergency room for suicidal ideation. She was
often discharged feeling like she wasn’t taken very seriously, or told there
was no psychiatrist available to see her and was encouraged to go home.
Back to the original question, for
the sake of argument, if we assume there are times when assisted suicide is
justifiable, can we trust that our health system can be trusted to get that
right? How many mistakes do they have to make to make it not worth practicing?
When it came to the death penalty,
many felt that the risk of putting one innocent person to death made the
practice not worth doing.
I’d like to bring up a few more
examples. … According to reporter Shawn Whatley, in September of 2024 a 51-year-old
Nova Scotia woman with an autoimmune disorder was offered MAID twice during two
separate pre-operative assessments for breast cancer surgery within a 15-month period.
She didn’t bring it up. Medical staff did. … Whatley reports that veterans have been
offered MAID for PTSD. A Paralympian was offered MAID after delays to get a
wheelchair lift installed. A patient was granted MAID with only listing
‘hearing loss’ as the reason. A 41-year-old man received MAID for COVID ‘post-vaccination
syndrome’ which is a debatable diagnosis.[3]
According to a report by Chris Selley,
in London, Ontario, a Western University study found that between June 2016 and
December 2019 the rate of MAID requests among the cities poorest was nearly 3
times higher than in the wealthiest areas. … In 2022 Sophia, age 51, received
MAID for multiple chemical sensitivities because she couldn’t find a suitable
apartment to live in.[4]
The reporter Brian Bird wrote that in
Ontario, uncovered documents revealed that 428 euthanasia-related cases
featured potential violations of the Criminal Code.[5]
City News reported about 54 year old Amir
Faroud, who lives in St. Catharines, Ontario, who applied for MAID, not because
he wants to die buy because social supports are failing him. He has pain from a
back injury which he takes medication for, as well as medication for anxiety
and depression. He said he has a hard time managing the pain, but he says it
isn’t the pain that is making him apply for MAID, he is currently in danger of
losing housing and is afraid of homelessness. He’d rather be dead than
homeless. He says that if he had adequate and affordable housing he wouldn’t be
considering MAID. After a successful Go Fund Me was set up he withdrew his MAID
application. … The UN even sent a letter to the Government of Canada, concerned
that the Expansion of MAID might lead to people with disabilities ending their
lives due to factors like loneliness, isolation, and lack of access to social
services.[6]
Can we trust that we are alleviating
extreme suffering and aren’t instead killing people who are lonely, or don’t
want to be a burden on family members?
Again, for the sake of argument, if
we assume there are times when assisted suicide is justifiable, is this a power
we feel that our health system can be trusted with? How many mistakes do they
have to make in order for it to be not worth practicing?
It would be a reasonable stance for
us, as Christians, to say that the risk to innocent life is too high for us to
participate in or to support MAID. It is a power the state shouldn’t have, especially
given other social realities that are in play- like the need for better mental
health care, low cost housing, etc. Individuals who engage in MAID to end their
own lives may think they have a valid reason, but their support for MAID might
be opening the door to ending the lives of people who are vulnerable.
At the beginning I said that I was
doing this backwards. For the sake of argument, I was starting with the
assumption that there were times when it was justifiable. … Most of what I just said can be said to a
secular audience. There isn’t anything particularly religious or Christian
about any of that. And that’s where I want to go now.
We do need compassion for those who
are suffering. Whatever result we come to, we can’t be cold-hearted. I am grateful
that we live in a time when we have better pain control treatments than any
other time in human history. … Like many of you, I have been with people who
have terrible diseases. I have watched people with ALS slowly lose their
ability to communicate and move their bodies. I have been with people suffering
terrible pain from bone cancer. I have watched people forget their loved ones
due to Alzheimer’s. There are awful diseases that cause tremendous suffering.
As we are diagnosed with these
diseases, we can become fearful. We can fear a lack of control over our body.
We can fear the loss of memory. Many will describe this a loss of “dignity”. We fear pain. We fear the loss of the
enjoyment of life.
We have ideals about how we would
like to die. We would like to die without pain, surrounded by loved ones, and
just go to sleep. And some of us are blessed to have that. But I think we
should be careful about trying to engineer that.
We live in a consumerist society. So,
we are trained to have our desires appeased. We are also taught to think of
ourselves as autonomous selves. We have a high regard for choice,
and for the individual. In these discussions, these things get wrapped
up into talk about “dignity”. My being able to make choices is said to
be connected to my dignity. So, we say, I should be able to decide
my death so that I can die with dignity.
There are a number of other factors
that complicate the value of my autonomous choices. I can’t make choices that cause others to be unreasonably
put in danger. I don’t get to exercise my autonomy by running red lights. Or, drinking
and driving. Or, smoking in a restaurant. …
I don’t even get to risk my own life
by choosing not to wear a seatbelt, or not wearing a helmet while riding a
motorbike. There are limits to the risks I can apply to my own life. … So,
there are times when my autonomy, my freedom of choice, is limited by the need
to protect the lives of others, or my own life. The sanctity of human life overrides my
autonomy in these cases.
Someone choosing to end their own
life is a violation of the sanctity of human life, so their autonomy doesn’t
get to override that sanctity.
MAiD is more complicated in that it
isn’t just an individual ending their own life. MAiD involves health care
professionals in ending a person’s life. Those who request MAiD are also
causing those professionals to become implicit in the act of killing, and if it
is ultimately wrongful killing, then it is murder. Maybe not in the legal
sense, but in the sense of the Moral Law that we live under as God’s creatures.
Legalizing something doesn’t change how
God sees it.
It is also complicated to ask health care
professionals to do this. Doctors and nurses, and other health care professionals
are about care and healing. We should think long and hard about asking these
people to get involved in killing. … The Hypocritic Oath has guided medical
professionals for over 2000 years, and includes the lines- "I will neither
give a deadly drug to anybody if asked for it, nor will I make a suggestion to
this effect." Physicians have an ethical
responsibility to do no harm and to avoid participating in actions that could
intentionally end a patient's life. It's a foundational principle in medical
ethics. … So there has usually been a pretty thick line drawn between alleviating
suffering and actively killing a patient.
The way that the word “dignity” tends
to get used in these discussions tends to get tied to control, choice, and
autonomy. So, to die with dignity is almost synonymous with dying according to
a plan that the person has fashioned for themselves. … But, I think that is
worth challenging. The lives of the martyrs are examples of dying with dignity
and they did not have choice. Often we are moved by the dignity people show as
they face a death that is imposed on them. In those moments, faith, perseverance,
patience, and moral character are tested and revealed.[7]
Death by suicide, or assisted
suicide, is a violation of a person’s inherent dignity- we might even see it as
treating one’s life with contempt, and as a violation of the sacredness of
human life. To refrain from participation
in in a person’s suicide is to support their dignity. That’s why we think it is
important to help people who are suicidal.
In the worldview of the Christian, human
beings are made in the image of God. Genesis 9:6 says, “Whoever sheds human
blood, by humans shall their blood be shed; for in the image of God has God
made mankind.” And we see this direction
to “not murder” also in the 10 Commandments. … It is this idea of the sanctity of human
life (because of being made in the image of God) that caused early Christians
to stand so strongly against gladiatorial games, infanticide, and suicide,
which were often a part of Pagan Rome. This
belief also caused them to stand in support of the vulnerable and magenalized.
There are Christian pacifists,
following Jesus’ teaching to turn the other cheek when struck, who are
unwilling to kill even if lives are threatened. … But the more common stance in Christian history has been
some form of Just War theory that allows killing to protect the innocent. But
even in Just War, the ultimate goal is to protect the innocent, not to kill the
attacker. The death of the attacker is almost an unhappy side effect of
protecting the innocent. So, ending a life in Christian theology is not taken
lightly. And this is because people are made in the image of God.
The image of God is not a set of
attributes (like rationality, creativity, compassion, etc). It isn’t that some
people have more of it and some have less of it. It is part of who we are as
human beings. One can’t make one human life worth more or less than another.
And one doesn’t lose the image of God by becoming disabled in some way. Someone with Down’s Syndrome doesn’t have a
less valuable life. A person who has lost certain abilities as they near the
end of their life doesn’t have a less valuable life.
This is one of the fears that arises
in these discussions. We are talking about what kind of human life is valuable,
and what kind is of human life is not worth living. This can slide into the
topic of Eugenics, which is the attempt to engineer human life, that led to
many disabled people being sterilized or outright killed (as in Nazi Germany),
in the attempt to make the gene pool ‘stronger’. We might think this is in the
past, but this is often happening through the practice of abortion in places
like Iceland where nearly all children are aborted who are identified as having
Downs Syndrome through prenatal screening. This makes it quite obvious that a
child with Downs Syndrome is considered less valuable. So we should be very
careful when we start talking about what kind of a life is worth living.
The life that we have been given, we
are responsible for. It comes with certain duties to treat it a certain way,
and we are taught that we will answer to God for the way we have spent our
lives. The ethicist Nigel Biggar compares the life we have been given with
having been given a family heirloom, or a famous painting. We would have a
sense that it would not be a morally good act to smash the family heirloom with
a hammer, or take a Michelangelo painting out into the back yard and light it
on fire. There is a responsibility to care for it, even though you have some
level of possession of it. … Our lives are not ours to do what we want with. We
have a responsibility under God to spend our lives well, directed by God’s
will. No one is entitled to take my life except God, and that includes myself.
To conclude, I would like to read to
you from our Diocesan document that was written to give direction to the clergy
on how we should respond to MAiD:
“A Good Death [this is a reference to the word ‘euthanasia’ which means ‘good death’]
“If we look to Jesus as the example of what it means to be fully human, to be fully alive, then, since death is the final act of being alive, it makes sense that we look at the death of Jesus to see what makes a “good death.” There are three salient points coming from the death of Jesus.
“First, what makes death “good,” what allows for dignity for the person who is dying, is neither choice of the timing or means of death nor is it a product of the conditions under which death is experienced. Instead, dignity is what the individual brings with them as they face death; it is a factor of how one approaches death.
“Second, Jesus approached death by committing himself to God's will, plan and purpose, and by entrusting himself to God's care.
“Third, when we step back from the actual details of the death of Jesus, we see that death is an occasion for God to work beyond our understanding and wildest expectations. At minimum, there is the response of the Centurion as he witnessed the dignity and personhood of Jesus dying on the cross.
“These three points—1) dignity is found in the person, not in circumstances, 2) the meaning of death is determined by what transcends death (e.g. the will of God) and 3) death can serve a greater good—define a “good death.” This description is in general agreement with a significant testimony of philosophical, theological and religious thought.
“[…] [W]e can add that the response of those who support and journey along side those who are dying is to offer the response of Jesus' companions at the cross—to find the courage to bear witness through our compassionate and engaged presence to the fundamental dignity of this child of God as they approach this significant threshold.”
The
following is the direction given to the clergy of the diocese of Calgary:
Position Paper on MAiD
and Protocols on Pastoral Care for those choosing
MAiD
The Anglican Diocese of Calgary
Introduction
To address any social or ethical issue within our present context in a secular, democratic and pluralistic society requires that we begin with a simple recognition; the foundations, principles and goals with which we work, while at times touching or overlapping with those of secular society, will be other than those employed by governments and secular courts. The work of these bodies is to arbitrate between competing individual and social freedoms and demands, while seeking a balance between individual rights and social good that will be acceptable to the greater part of the population. For the Christian Church, our starting point is the revelation of God in Jesus Christ; our principles are those articulated within the teaching of Jesus as received and understood within the Church, and our goal is to “not be conformed to this world, but be transformed by the renewing of your (our) minds” (Romans 12:1-2); to “to let this mind be in you that was in Christ Jesus” (Phil. 2:5); to seek in Christ for God’s will to be done, not our own. This is not to deny, of course, the role of reason in addressing questions before us, but to recognize that all reasoning begins with and rests upon a starting point and the particular data with which it is presented, (for us, the Gospel of Jesus Christ) and to understand that natural reason is perfected only by the grace of God and the guidance of the Holy Spirit. Of course, this basic stance is one which is not meant to and cannot be imposed upon others, but is received when we turn to Christ in faith and allow it to grow in us as we grow in faith; it is, however, one which guides the life and practice of faith within the Church.
When we address issues relating to death, our starting point is an understanding of life. As Christians that means we begin with the received understanding that life arises from God’s creative action. While our cultural context usually inclines us to think of life mechanistically (the product of naturally occurring processes), our faith affirms that life is both created and continuously sustained by the grace and love of God. God is inextricably involved in creation and never absent from any part of it. The gift of life is not once given, but continually being given by the source of all life; in a manner analogous to the sun being the source of light in our solar system. While we are culturally conditioned to think of “our” life as being a sort of “possession” (it is ours, it belongs to us and we have the right to do with what is ours as we might choose) our faith affirms that while life is indeed a gift, all life continues to belong to God. We do not possess it uniquely in the manner that we think about possession within the legal and material framework of the world. Certainly, we have rights with respect to “our life”, both in conjunction with and over against the rights of others, but the political framework within which this is understood in western, secular society is, as hinted above, a way to adjudicate competing concerns between autonomous individuals, not how Christian faith understands our dependence on, our relationship with and our created duty to the source of all life.
The issue of suffering stands at the heart of this attempt to live with God, others and our-self.[8] The presuppositions of our culture (and increasingly our own) underlie and inform our understanding of suffering and the central role it plays in the dialog around death and dying. First, the person is defined irreducibly and almost exclusively as a Self: understood as an autonomous individual. Consequently, the rights of the individual become a focal point and ensuring individual rights the highest good. The state, further, exists to provide and safeguard these rights.
Current presuppositions about God, if they factor at all, seem to consign Him to the role of a doting and indulgent Grandparent who will, of course, want for us what we want for ourselves.
A third set of presuppositions includes community and our duty to others, which are relegated to a secondary or peripheral role. This accentuates both the current poverty of the church and the newly found “salvific” role of the state—as the guarantor of the individual's rights, the provider of the highest good.
The state has supplanted the church. Perhaps the church has become too weak to be a community which can “absorb suffering” and provide the narrative in which Christian people live, (including a narrative about suffering and death), and provide bonds deep enough to sustain people as they face suffering and death.
As a church, the fault may be our own, and science, medicine & the state merely stepped into this vacuum; the state, however, doesn’t generate community. Increasingly it seems the state absolves and frees the individual from community: from responsibility to others. In effect this erodes community. The individual, the Self, is increasingly thrust upon itself and its own resources to determine its own good, to create meaning, to craft a narrative that grounds and orients it. The state dutifully responds by safeguarding and legitimating these various self-determinations, these “rights” of the individual.
These presuppositions and their outworking in our current context underlie the issue regarding the question of suffering (even posing suffering as a problem to be solved indicates the influence of these presuppositions) and they predetermine how one can respond to suffering. Suffering becomes a problem that the state offers to solve
Our presuppositions from a faith perspective, however, lead to a different understanding and response. When we as Christians seek to understand most fully what it means to be fully human with respect to any aspect of life, including our relationship to death, we look to Jesus as the one who has fully shown us what it means to live our lives as God intends and as God created us to. “Not my will, but yours” is the ground on which we stand in faith as we seek to address the question of the death of all human beings – including our own.
A Good Death
If we look to Jesus as the example of what it means to be fully human, to be fully alive, then, since death is the final act of being alive, it makes sense that we look at the death of Jesus to see what makes a “good death.” There are three salient points coming from the death of Jesus.
First, what makes death “good,” what allows for dignity for the person who is dying, is neither choice of the timing or means of death nor is it a product of the conditions under which death is experienced. Instead, dignity is what the individual brings with them as they face death; it is a factor of how one approaches death.
Second, Jesus approached death by committing himself to God's will, plan and purpose, and by entrusting himself to God's care.
Third, when we step back from the actual details of the death of Jesus, we see that death is an occasion for God to work beyond our understanding and wildest expectations. At minimum, there is the response of the Centurion as he witnessed the dignity and personhood of Jesus dying on the cross.
These three points—1) dignity is found in the person, not in circumstances, 2) the meaning of death is determined by what transcends death (e.g. the will of God) and 3) death can serve a greater good—define a “good death.” This description is in general agreement with a significant testimony of philosophical, theological and religious thought.
As we begin to think pastorally about death, we can add that the response of those who support and journey along side those who are dying is to offer the response of Jesus' companions at the cross—to find the courage to bear witness through our compassionate and engaged presence to the fundamental dignity of this child of God as they approach this significant threshold.
Pastoral
Care
When it comes to pastoral care it is important to define what it is we are doing. For instance, while there is overlap between the care given by a Christian priest and a psychologist, it is important to note that the end goal of each encounter is not the same.
The Christian view of a fully healthy human being is a human being whose vision is so flooded with Jesus Christ that they reflect Jesus Christ from the deepest parts of their being. Pastoral care has this as its goal. We see this idea in St. Paul’s words to the church in Galatia- “My little children, for whom I am again in the pain of childbirth until Christ is formed in you” (Gal 4:19). This is stated in many different ways in scripture. For example, the death of the works of the flesh and the expression of the fruit of the Spirit (Gal 5:16-26); The embodiment of love (1 Cor 13); The striving for the perfection of God (Matt 5:48); etc..
From a Christian point of view, health looks like a human being continuously shaped into the image of Christ by being continuously drawn into our Lord’s presence, teaching, and example. The practices of the church lead us in this direction as a part of the primary goal of the church, which is to glorify God. We call on Christ to be Lord of our lives, whatever our circumstances—even when our circumstances are perplexing. As we provide pastoral care, we keep this goal in mind, even if it is not made explicit to the person we are caring for. Whatever help we offer people is to be in line with God’s goal for the person. While God’s will is not always clear in the details of one’s life (e.g. should I become an engineer or a biologist), the overall biblical principles are much more easily discerned (e.g. our central motivations are love of God and neighbour).
There are times when God’s desire to shape us into the image of Jesus will mean not immediately rescuing us from discomfort (see 2 Corinthians 12:7-10). Christ himself endured the cross following God’s will. It surely seemed to be pointless suffering to observers—perhaps it even seemed to be suffering that glorified the power of the Roman Empire, but not God. Jesus is our model when it comes to suffering:Jesus wept (John 11:35); Jesus seems to have felt forsaken by God on the cross (Mk 15:34; Ps 22); Jesus seems to have prayed an unanswered prayer to be saved from suffering (Mk 14:34-36). As hard as this is to hear in a society that is obsessed with immediate comfort and personal autonomy, God’s primary goal in our lives is not our immediate comfort. God’s goal for human beings is long-term joy in the presence of the Trinity and the saints, which is attained by being “in Christ”. This does not mean that God is insensitive to our suffering, rather, God does not want to grant us immediate relief from discomfort if it means sacrificing a greater good (our being shaped into the image of Christ).
As the Christian pastor serves those who are suffering, their task is to help the Christian trust in Christ, who loves them, who suffered for them, and who is constantly interceding for them. As St. Paul says, “I consider that the sufferings of this present time are not worth comparing with the glory about to be revealed to us. … We know that all things work together for good for those who love God, who are called according to his purpose. For those whom he foreknew he also predestined to be conformed to the image of his Son, in order that he might be the firstborn within a large family” (Rom 8:18, 28-29). With the letter to the Colossians, we encourage followers of Christ, “if you have been raised with Christ, seek the things that are above, where Christ is seated at the right hand of God. Set your minds on things that are above, not on things that are on earth, for you have died, and your life is hidden with Christ in God” (Col 3:1-3). In order to respond pastorally to others, we have a great need to rediscover meaning in the midst of suffering.
Suffering is not, however an end in-itself . So while it is not permitted for a Christian to engage in the purposeful killing of a human life (apart from situations of defense of self or others) we are able to help Christians advocate with the health system for improved palliative care, pain control, and withdrawal of active care. Many people are not aware of the range of options, or how to navigate the health system. Clergy are sometimes more aware of these matters due to their experience in these settings.
It may be the case that the use of a drug like morphine will shorten the life of someone who is suffering. This is not to be equated with killing. In just war theory, harm may be done to an attacker, but the motivation is to defend the vulnerable. In a similar sense, the use of drugs is motivated by the desire to control intense pain. A side-effect of the use of that drug may be the shortening of the life of the patient, but the death of the patient is not the primary intent.
It follows, theologically and pastorally, that should someone choose to die by the active involvement of the health system (”assisted suicide”, “euthanasia”, “M.A.I.D”, “mercy killing”, or “legal medical homicide”) we are not to cooperate with this decision. We must resist the temptation to create a liturgy around the moment of killing. It may be tempting for the individual and the priest to sacralize this event, to have the priest hold their hand and pray over them as they slip into eternity. It may be tempting for the individual to have this kind of control over the end of their life, or to romanticize the event. But, we must not lose sight of the fact that this is the active killing of a life—a temple of the Holy Spirit (1 Cor 6:19); a bearer of the image of God (Gen 1:27). This does not mean we give up hope or give up care for the person. It is a delicate situation that requires the wisdom to care for the person without supporting their decision to be killed. This is likely to create a complicated pastoral situation with the person’s family, and perhaps with health care workers as well.
Compassion means to “suffer with” someone. Job’s friends “made an appointment together to come to show him sympathy and comfort him. And when they saw him from a distance, they did not recognize him. And they raised their voices and wept, and they tore their robes and sprinkled dust on their heads towards heaven. And they sat with him on the ground seven days and seven nights, and no one spoke a word to him, for they saw that his suffering was very great.” (Job 2:11-13) This was the best thing Job’s friends did. It is no small thing to be compassionately engaged and present to another who is suffering. Nor is it an easy thing, it requires incredible courage and humility. As pastoral caregivers we need to hold onto hope, and, to provide that hope to others, who may be struggling with hope. God will not let suffering have the last word in His good creation. Life does not end with a cross. It ends with resurrection and new life.
Conclusion
Current cultural and societal values and assumptions about the nature of humanity, the purpose of life and the role of science and medicine have led to a widespread acceptance of Assisted Dying as one choice for those who are facing the end of life. Our biblical, historical and theological norms and values lead to a different conclusion. This brief overview of our Christian position, while not being exhaustive, clearly points to the response we, as Christ's vicars, must give to those who are seeking MAiD. We are grateful for all that clergy do to support and give pastoral care to those in many situations. We hope this guideline gives some parameters to the many who have requested them.
Medical Assistance in Death – PROTOCOL
INTRODUCTION
Christian pastoral care has always had ministry to the sick and dying as one core piece of its activity. Pastors have sat with the dying and their families, offering presence, counsel, and prayer as expressions of our faith and hope in Jesus Christ. We offer our ministry “in sure and certain hope of the resurrection to eternal life through our Lord Jesus Christ.” (Committal, Funeral Rite, BAS p.587) We are present, not as judges, but as pastors. Love for God and for our brothers and sisters in Christ, while holding true to the faith that we have received, is the context for the following protocol, based on the above theological framework. Out of necessity, a protocol is general and meant to give guidance under usual circumstances. There are often “what if’s, and perceived exceptions that might arise. However, exceptions are not a basis for establishing norms, and it is not wise to create a protocol that attempts to deal with every conceivable circumstance.
Parameters for clergy in the Anglican Diocese of Calgary.
BEFORE the death
We fully expect for clergy to provide Pastoral Care before and after the death.
This would include visits to the patient, family or friends as is deemed appropriate by the clergy person. It includes a posture of listening and prayer, not judgment or criticism.
DURING the death
We will not provide liturgies during the event. We strongly advise that clergy not attend the event in order to avoid any confusion or assumption that clergy is blessing the event.
Although clergy are not present at the moment of death; prayers said in advance of and after that moment are as appropriate and fulfill the pastoral call.
Not Permitted:
1. Providing a liturgical framework for the moment of death which in any way celebrates, honours or condones the taking of life or the choice to end life.
a. This includes providing communion, anointing or prayers of blessing at the time of death. Please note:It is appropriate to provide pastoral care to the sick at earlier stages in this process. To avoid the appearance of sacralizing the act of killing, these formal acts of priestly ministration should be concluded at least 24 hours before the event of dying by MAiD
2. Commentary with family or patient which creates guilt or shame around the choice.
AFTER the death
We encourage clergy to be involved in pastoral care with the family after the death of the loved one. Providing ongoing spiritual counseling and conversation for both family and those involved in performing the Medically Assisted Death is appropriate. Alongside of the normal grief experienced at the death of a loved one, there also may be feelings of regret, shame or rejection among surviving family members which should be addressed pastorally. Providing a funeral for the deceased is also an appropriate pastoral act for the family.
Resources
“Guidelines for the Celebration of the Sacraments with Persons & Families Considering or Opting for Death by Assisted Suicide or Euthanasia.” From the Catholic Church bishops of Alberta and the Northwest Territories
https://www.cccb.ca/wp-content/uploads/2020/05/2016-09-14_SacramentalPracticeinSituationsofEuthanasia.pdf
[1] Sorry, there footnotes are a bit messy as this was an oral presentation rather than an academic paper-
CBC
News- "Father of Calgary woman starving herself to death abandons court fight
against her MAID approval" (June 12 / 24)
The Globe and Mail- “Vancouver doctor under scrutiny after
court stays assisted dying request”
[2] CBC
News- "Family sues after man allegedly
got medically assisted death during day pass from hospital" (Dec. 18 / 24)
[3] National
Post- Shawn Whatley: "We’re way beyond the slippery slope. We need new criteria
for MAID" (Oct. 30 / 24)
[4] National Post- Chris
Selley: "More alarming statistics bout ‘medical assistance in dying’" (Nov. 12 /24)
[5] National
Post- Brian Bird: "Euthanasia is a national tragedy – and it’s only getting
worse" (Dec. 19 / 24)
[6] City
News- "Ontario man applying for medically-assisted death as alternative to being
homeless" (Oct. 13/ 22)
[7] A
point made by the ethicist Jeffrey Greenman.
This discussion on suffering
is indebted to Stanley Hauerwas' book: Naming the Silence:God, Medicine, and
the Problem of Suffering T&T Clark, 2001
Very well presented Chris. This has helped me realize how easy it is to be influenced by the secular world. This was another wake-up call for me. Thank you!
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