Excerpts of the interviews conducted by the Anglican Journal about the Supreme Court ruling legalizing doctor-assisted suicide.
Bishop Jane Alexander
Anglican diocese of Edmonton
This is such an enormously complex issue… We’ve got a year it seems to me to grapple with some massive, massive questions. Our hope, of course, is that the discussion is going to be within the context of changes in the health care system because from our perspective, the Anglican Church has a long history… of providing health care and healing and support of the suffering and dying. We’ve supported development of palliative care facilities and pushed for development of hospices and those kinds of things, and so now how are we going to, in what seems like a very new way, bear witness to.. Christ, and [offer] a message of hope in this.
The Anglican Church has been talking about this since about 1975. The first report that came out [was] on “[Considerations Concerning] the Passage from Life to Death,” and so the conversation has been going round as various challenges to the law have come up. One of the key things in our conversations is how do we look at the special risks for people in society…who are already vulnerable by the nature of their illness?
There’s a concern that there might be social or family coercion or dealing with people who have got undiagnosed depression and the pressures of all of those kinds of things for very vulnerable people…We don’t quite know how this picture is going to unfold.
In the church we spend a lot of time with people who are really suffering and facing all kinds of end-of-life decisions… We want to protect… human dignity all the way through and working out how people confront death because we don’t live in a society that has totally always embraced… that sooner or later it happens. And [the question is] how can we support people at those times of their lives when they are in the most difficult situations of trying to make decisions?
I suspect that one of the questions that families might have for chaplains and clergy is, ‘Do you think I am doing the right thing?’ Those kinds of conversations are going to be very difficult to walk alongside because it is for people to make those decisions for themselves. Our job is to be there and provide prayerful and loving support and to proclaim hope even in these darkest of times.
There are Christians who will be on both sides of the discussion that’s going to happen and they’ll begin from the same starting place… from the sovereignty of God. Both groups will want to protect human dignity, preserve the freedom of individual peoples, choose how to confront our frailty, and in the face of death, they’ll all view life as a gift that has been given to us… We do understand that we are called to have hope in suffering and in suffering we find God, but that doesn’t imply that we think people should be having painful deaths, which is why I think, for us, there’s been a real push in terms of palliative care and hospice care.
Bishop Stephen Andrews
Diocese of Algoma
I was disappointed for a couple of reasons. I didn’t think that the judgment was particularly helpful or insightful. [It] was lacking in definition, so it uses the term “a competent adult person,” but it doesn’t define what competence is. It talks about the need for them give consent, but it doesn’t describe what consent is. I’ve just been in too many situations where people are in extremis, where there are a host of psychological and emotional factors involved, which could complicate the decision under the definitions provided by the Supreme Court. For example, if an individual was severely depressed, would they be competent, would they be capable of giving rational consent?
It does talk about the idea that [people have to be] in a grievous or irremediable medical condition, which again isn’t very clearly defined. If you want to take it to absurd extremes, we all have a grievous and irremediable medical condition because our lives will end in death anyway.
The Supreme Court says that intervention is ok in situations where the suffering is intolerable for the individual. Suffering that is intolerable to the individual is my second major concern. It is even greater than the sort of lack of definition in the Supreme Court’s decision. I think that the health of a society is measured by its ability to care for those who are in greatest need, and so there’s a sense in which you can’t talk about individuals without talking about individuals in community. It seems to me that it is the community’s responsibility to [uphold] the dignity of the individual’s life, and it is the case that our medical care today is sophisticated enough that it alleviates a great deal of suffering. It can’t eliminate suffering altogether, but our medical establishment and the Hippocratic Oath obliges them to alleviate as much suffering as possible without- and this is the point of the Dying With Dignity document of the national church- actually taking an initiative to terminate a person’s life. We recognize that life is a divine gift. The granting of life is something that is still the prerogative of God and thinking about it too, in the Christian tradition, we recognize that our life belongs to God, it’s on loan from God, and so it is not ours to shorten.
I’m afraid that some of the implications of this decision are that there could be a weakening of the doctor-patient relationship, especially for elderly patients who are approaching the end of life and are just not confident now that the legal system is such that their doctors have a duty under our laws or however legislatures enshrine the Supreme Court’s decision to preserve life as long as possible.
I think people with disabilities are worried about this. That there may come a point where somebody has an illness that will certainly result in their death before the sort of mean age of dying… so at what point will they be regarded as a drain on the public coffer and not a priority in terms of health care?
One of the other things that comes to mind, and this comes out of a personal experience because I know people relate to these things at the experiential level, and that is that my dad died in October. He had a massive stroke and my brother and I were able to fly down to be with him and he lingered for a little less than a week. We talked to the doctors about not taking any heroic efforts; he had signed a life directive saying that he didn’t want any heroic measures, and so it was a real question for us, as to the degree to which his suffering was something we should seek to shorten… And just as we were discussing this, I saw him with his own family -two sisters – and people from the community rallying around him…a sense in which, in his need and suffering, he was contributing to the depth of human community around him. He gave us the opportunity to care for him. I saw my aunts minister to my dad in a way that has completely changed my relationship with them, and so there’s a sense in which it is not just about the individual. And just because a person may not have, let’s say, a cognitive function, or may be on some kind of life support system, it doesn’t mean that they are not making a contribution to the integrity of our humanity and the integrity of our community.
I think that when we diminish the value of life in this fashion, then we are devaluing all of our humanity and the value of human community.
We did have a discussion about this at our last House of Bishops meeting, and I think it is certainly something we need to discuss more because I am not convinced that the church, as with many of the issues that we are dealing with in our culture, I’m not sure that we are thinking about them from a theological perspective. I think we need to talk a lot more about the nature of life and the difference between the intention to shorten life and the intention not to prolong the dying process. It’s a fine distinction.
Bishop John Chapman
Diocese of Ottawa
I’m ecstatic…Current practice, prior to the new legislation, has been so black and white that it has been unhelpful for those people who are living with unbearable suffering. This new legislation actually now puts the decision back into the hands of the individual, medical professionals, and drawing upon the strength of their faith to make a determination about what action they should take. It’s a compassionate decision.
The freedom comes with enormous responsibility that will need to be exercised with prayerful caution and integrity – integrity that respects the dignity of human beings. It’s a huge challenge before us.
I think our role is that we will need to speak to it – I expect that the people will be looking to the church to provide compassionate, helpful and insightful guidance in how they will understand the legislation. So I think a challenge now rests before every diocese in the country to do whatever they can to help people to understand this new legislation, understand the implications of this new legislation.
Bishop Linda Nicholls
Diocese of Toronto, Trent-Durham
Public opinion has been moving in this direction for some time, but I still am concerned that not enough in-depth conversation has happened for Canadians around the fact that no one is required to seek treatment. So this idea of intolerable suffering, there may be occasions where medical assistance cannot relieve that suffering. In the case of terminal illness, there’s no reason to continue treatment, that’s always been an option. Patients always have the right to decide whether to seek treatment or not to seek treatment and to refuse treatment. I just am concerned that that’s not been sufficiently understood, although I’m sure the courts have considered it.
I am concerned about the court’s lack of definition of what would constitute intolerable suffering…It is not just terminally ill patients. It does require that it be competent persons [who will] make the request. I also have…some concerns for those in the medical profession who disagree with this…. Already on public radio there have been conversations with health professionals about what this will mean for them because they are not all in agreement with this.
I think it was Matt Galloway on CBC interviewing someone who was involved with ethics in hospitals, and his comment was that despite the fact that Europe has had this kind of legislation for some time, less than two per cent of people access it. And he said he thought it had more to do with people’s desire to know they have a choice even if they don’t choose to exercise that choice, and that that fit with his sense of a Canadian ethic of individual freedom. I thought that was a very interesting observation, which might lead you to feel a little more comfortable that this would not be accessed unduly.
But it does raise the question again of what role does the whole community play in supporting individuals, in supporting families, in supporting people who are faced with these tough decisions. It is certainly something that we, as a church, need to have a conversation about…. I don’t know what the task force is working on, but I would hope that they would create some kind of an educational resource that will help people to reflect on this kind of decision and reflect on it theologically.
Just because people have the legal right to it doesn’t mean that that is a decision or a choice that they will make and that’s where chaplains will need to sit with people -and particularly chaplains in hospitals…where they are dealing with people of all faiths and no faith – their role will be to listen very carefully to how human life is understood by the individual. And, where they are specifically acting in the capacity of an Anglican Christian chaplain, to help the person to think about how the church has understood this. That doesn’t mean that they are giving them an answer or insisting that they act in a particular way because, at every level, a person’s conscience is the final judge. But it, I hope, will push us as communities to ask how do we better support people who are facing suffering that is chronic or terminal or intolerable. What are we doing to address those needs of an individual and to support them and their families if they choose to make a decision that we disagree with?
Anglicans do theological reflection on issues such as this, and we believe strongly in the sanctity of life and the gift of life. But we also respect that, in the face of very difficult decisions, individuals may choose in a way that is not in the direction that church policy would take. That’s not to, in any way, say that that person is unacceptable to the church. We all recognize that there are times when we make decisions that seem to be the best or only one we can make in that moment for us and those aren’t always shared by others.
There was a young couple in one of my parishes where a parent was on life-support and had to make the decision to cease life-support…People have made choices to cease life-extending treatments like artificial ventilation, where there is no medical probability of recovery and where the person was known to have not wanted extraordinary intervention. I’ve certainly had conversations with people about what kind of intervention do they want at a time that they might be incapacitated because often it is a family member that has to make that decisions, so in one of my parishes we did a lot of work on living wills and conversations about that. Who do you need to have a conversation with?…. You think when you are well that you couldn’t possibly tolerate being incapacitated in some way but when people reach that place, sometimes it is quite different. Life has a different quality, even if one can’t walk or if one can’t do other things.
The Journal asked hospital chaplains about whether the Supreme Court ruling would have a major impact on their work. Their responses:
The Rev. Joanne Davies
Chaplain, diocese of Toronto
Ecumenical chaplain, Mt. Sinai Hospital
For families, …[assisted dying] is one more thing that they could ask for, or one more thing that they could be afraid the doctors are going to suggest to them because everyone approaches this differently. For some people, the question is ?How are you going to keep my loved one alive?,’ which is the same for the patient, ?How am I going to stay alive?’ And for others, it is ?How am I going to be comfortable and have a good passage to death?’ Those are the ones that I always cheer on and am relieved by because they are easier to care for from a chaplain’s point of view. Sometimes that’s harder for the doctor. When people are focused on understanding a good passage towards death, other than palliative care doctors, they struggle because for them often death is a failure, if they haven’t cured them. … Palliative care is very different.
I struggle with the time it takes for us in the hospital to talk to people about dying. I’m not talking about imminent dying, dying in the next month or anything, but over time with their illness and what that might look like and what their life as they move toward death will look like. It takes us ages to do that.
For me, the most wonderful thing that happens because of this court decision, it means that we’re actually going to talk about death and dying and actually name it. I’m hoping that some of those euphemisms – passing away, gone on, left us, lost – are all going to stop, that we will actually say death and dying and that we will do that in the church as well. As I begin to look at it, that’s the best part… that people will actually start to think about it and that passage to death is one form of care.
People write advance directives when they are quite young, and they may change their mind when they are in their 80s. I think it is a process. I think writing about it and talking about it when we are young is great, but to keep doing it and not think all the decision are made because they are not…. Sometimes we can put up with all sorts of things when we are older than we [thought] we could. …
So when people start being afraid of this court decision, it opens up conversation and possibilities, but I would also hope it does is open up [a conversation] about the sacredness of life that includes death and dying.
[Will this ruling raise questions for an ecumenical or interfaith chaplaincy about what various denominations and religions believe about an individual’s right to hasten death?]
Those issues come up constantly already because religions have views on many things, some less clear than others… I find the best thing is if somebody says ?What does my religion’ or as in the case of Christianity, which I know best but is so broad, ?What does my denomination say about this?’ Sometimes they know and ask me what they do about that. That’s a hard one, particularly if they are a faithful committed person to their church and then they suddenly find themselves facing a decision. When someone says that to me I kind of know that the decision that they want to make is quite opposite to what their own church is telling them, so it is a conflict. So as a chaplain, I’m honest with them, [I tell them] this is what it says within your faith group, and then I ask them to talk about where they are with God.
Some people will not accept that because, in the long line of it, one is an institutional rule as such and the other one is you and God, and then you and God and your community. And if we’re lucky, our community will uphold us in prayer even when we disagree and even when in our prayers, we’ve come to another conclusion with God. I believe that our faith is a community faith as well, but that doesn’t always happen, so sometimes people walk alone, and I have to help them make that decision. … One of the things that is clear to me is, apart from whatever my personal decision is, should it come to be that there is a physician that will assist death in the hospital, I would be with that patient, no matter what my opinion was. It does help me when I know that I have a community in prayer upholding me in my work.
I have had patients who were very sure that the comfort for them at dying would be to choose to die now when [they] choose it rather than go through that last piece. And most people don’t even have in mind a time or a moment, but what they do have in mind is when something happens to their brain or to their body and they want to talk about it and there has not been the ability to talk to their doctors about it until now…. Some doctors may feel relieved because they can talk about, and others may ..not want to….. It’s hard for them. They don’t want to ever been seen to be doing something that will harm somebody, and you know what, that’s really good. …. Just like all forms of care, it’s not for everyone.
Dean Iain Luke
St. James Anglican Church, Peace River
Diocese of Athabasca
What I see at the nursing home is mostly not directly with the people themselves, but with their caregivers, their family members. So then it really is about how to support people and be with them as they are dying, and that is really mostly about simply being there. Family members spend a lot of time with the people they love when they are near death, and I think that partly, they need that affirmed –that that is worth doing…When people aren’t responsive, my role is simply to say to family members that it matters that you’re there. People often can hear things that we don’t realize they’re hearing, but even if they can’t hear, there is a sense in which simply being there counts for something.
It’s going to take a lot of getting used to, by a lot of different groups. Certainly the church, and in our community here, we have a palliative care group that is going to have to adapt to that [ruling]. I also was thinking particularly of doctors – there are going to be doctors who are asked to make decisions that they are not familiar with or perhaps comfortable making. So that was my first reaction, that things are really going to have to reshape themselves around this decision. It remains to be seen what is going to happen in terms of legislation, if there are going to be other provisions put in place to narrow and regulate the way this is going to be focused.
We’ve now fully got to the place where the church, and Christian people who might speak on behalf of it, for us this is simply the lay of the land. The world we are in has changed in this decision, and in a public policy sense it doesn’t matter much if we are for it or against it. And actually, from a Gospel sense, I’m not sure that it matters that much either. The question is, how are we going to proclaim the gospel in the world as it is now? Certainly you can’t help but feel for people who are so anxiously looking forward to their own death, or have been through that with somebody who has…I certainly wouldn’t want to take anything away from what they’ve experienced. My question would be in terms of pastoral care and sharing the good news, how do we make sure we are there for people who are in that situation.
The gospel concern I had about the decision was that here we have a statement that dying and suffering around death have no value, and in fact, have a negative value – so much so that it is worth dying first before going through that suffering. The Gospel doesn’t glorify suffering for its own sake, but it does say that there is something to be found there, and that that is not the worst thing that can happen to you. People talk about dying with dignity a lot, and my own experience has been that I’ve never met anyone who died with anything but dignity, and that came from within them; it has nothing to do with the circumstances of the conditions in which they died, it was something that shone out of them. I think we are in a place as pastoral and spiritual caregivers or other people who do that within the church where we’re able to affirm that. And that might change the way people live with that decision even if it doesn’t change the decision.
The church’s involvement in palliative care has certainly grown along with the growing concern for and interest in palliative care in the communities I’ve worked in. In these kinds of places, there is a kind of community care for the system. Everyone has to get behind it in order for things to happen the way that we would want them to happen. In Peace River, there is a significant palliative care association made up of volunteers who advocate for palliative care provision in the hospital and who provide [visitation]…and have a commemoration each year for people who have died as well so they continue to walk with those who grieve.
As with so many good things that happen in our communities, it is not solely Christian people, but there are a lot of them. Some people who are very active in church congregations are very active in palliative care work and see it as ministry, see it as there way of sharing the love and presence of God at a difficult time.
I think part of it was the simple act of connectedness – people who are dying or who are letting go of someone who is dying can feel very disconnected and very alone, and that is a spiritual experience in itself, to be cut off from what you have come to assume is the nature of your existence, which for most people is very social.
The hospital experience often cuts people off from their social network, and the experience of illness –especially if it takes away their faculties of communication – cuts people off from each other, and so that’s a kind of desert experience, spiritually speaking. So there’s that need for support and presence and affirming those who are there for people who need them. I think there is also an element of coming to grips with meaning. It’s not very often that people have the leisure when they’re dying to sit back and say, “What have I done with my life?” You don’t really have a retreat moment like that, but it often comes through in the way people are relating to friends and family members around them. Sometimes where I’ve seen a person surrounded by a large and loving family, I certainly get the impression that that gives them the impression that what they’ve done with their life has had meaning because that’s visible in the response, and the love in return that they’re receiving.
Sometimes if I need to have a role in that, it will be in inviting people to tell – a number of times when I’ve been asked to come and pray for someone there, I’ve gathered the family around to pray with me, and their prayers often express something of what the person has meant to them. Whether or not the person can actually hear that is a different question. But certainly they can get that sense that the meaning of their life is still present in the people surrounding them.
My hope would be – and some of the news coverage I’ve seen indicates that this might be the direction – that it would actually receive more resources, because if people are confronted by the reality that others are going to choose death because they don’t have appropriate care while dying, that may stir people to say that we need to be there for them. Both in terms of financial resources, space in the health system, and personnel that have been trained for that kind of care and that would also volunteer in the ways that are needed – I hope it would enhance that.
I think that the complications are going to come more at the front end, where people who themselves don’t really understand what palliative care might offer might say, ?I won’t really go for that, I want the exit door right now.’ And that would be where doctors would need to be well-equipped to deal with people in that position.
The Rev. Keirsten Wells
Coordinating diocesan health care chaplain
Diocese of Nova Scotia and Prince Edward Island
I’m not sure, I really don’t know. It seems like a really good decision for competent individuals diagnosed with a terminal illness and want to decide how they are going to engage in their own death.
I don’t know how it will impact people in the hospital who hadn’t anticipated their imminent death. There’s a whole bunch of layers underneath the tip of this iceberg. There are people who get up in the morning and think they are going to have a normal day and have a huge stroke and by the end of the week they are in discussions with doctors about whether to continue life support, removal of treatments and so forth. Those patients and their families talk to me a lot about medically assisted death, and I’m not sure how this ruling will apply to those people.
Even among competent individuals that are deemed medically to have capacity to decide, there is a wide variety of decision making styles and influences. You see it all the time with people making healthcare decisions that are going to be least upsetting for their families, for example, and that’s in competition with the decisions they might make if they were only making decisions for themselves.
So there are a multitude of factors that are going into people’s decisions, and illness and diagnosis and mental health are part of it; they’re going to have to have some pretty rigorous structures put around them…What do we consider “intolerable suffering?” Is that part of a group or corporate decision, or is it solely a personal decision? The physicians are going to need to weigh in, the ethicists, the theologians, the chaplains, all the special interest groups… I don’t believe the court’s idea was to just let everybody make the choice lightly. There’s going to be a lot of safeguards, and that is my hope. It won’t be an easy or terribly quick process to enter into, but I hope it will be meaningful and very consultative.
Personally, I think that it is a positive development, and my observation of what patients and families have said to me over the last 15 years of working in healthcare is that this is an option that people want to have available. It’s not an option that they want to have forced on them, and there is concern over the vulnerable and all of the discussion around the “silver tsunami.” This is not a solution to overburdened healthcare systems. And that is a concern, and it’s a worry. But I think that individuals that are going through their illness and their suffering and their death think about this subject in a way that they perhaps never have before, and they want to talk about it, and many of them would like the option. And because of that I think this is a good thing; I think that it represents the majority of popular opinion, and the desire for people to have autonomy over how they engage their death.
As a chaplain, we work with the content that the client presents. If it is important to a person, they will raise it pretty much as quickly as possible. And once it is raised, it is my role not to help them make a decision but to explore their feelings about the circumstance they find themselves in, to explore their hopes and fears about their faith, about the transition from life into death and what happens after death. I hear a lot of frustrations of people coping with the healthcare system. It is my job to listen and reflect and to help as much as I can people work through their distress. At the end of life there is a lot of distress – there is pain, there is anxiety, there are a lot of questions.
When people are approaching their death, palliative care is the best that we have to offer right now. It doesn’t alleviate everyone’s spiritual and physical and emotional suffering. For some, it does a great job, and for others not so much, because we’re all different. So do people in palliative care still suffer in their dying process, and would some of them still choose to end their life earlier? I believe that they would. I don’t think that there is a problem with the palliative care, I think [it] goes way beyond that into more personal choice, and what the individual and family desire for themselves. I don’t think that this is an alternative to palliative care -some people are very happy with palliative care, and some would choose to have more autonomy over their death regardless of palliative care.
This ruling is not black and white – and I don’t think dying is ever going to be black and white, from a legal perspective or a theological perspective or a medical perspective, because people aren’t. I think the church needs to do some thinking about this. We haven’t done a lot of talking about this in awhile, and I think we have a lot of questions we need to ask ourselves about the meaning of death. Is it a failure? Is it harmful? What does God think of our personal autonomy? Is suffering always a good thing? These are questions that we really have to put some weight behind, and some time, because a lot of people really do care about what the church thinks. A lot of people really wouldn’t make a decision that they feel would be contrary to their faith, and they link their faith to the doctrine of the churc