In a nod to changing times, the Anglican Church of Canada’s latest report on physician-assisted dying, rather than opposing the practice, recognizes it as a reality. The report offers reflections and resources around assisted dying and related issues, such as palliative care.
The Supreme Court of Canada struck down last year a ban on physician-assisted death for the “grievously and irremediably ill” as unconstitutional, notes the paper, entitled In Sure and Certain Hope: Resources to Assist Pastoral and Theological Approaches to Physician Assisted Dying, released Thursday, June 9.
In the wake of this decision, the paper states, “public debate concerning the legal ban on physician assisted dying is in some ways over.”
As a result, the authors continue, “our energy is best spent at this time ensuring that this practice is governed in ways that reflect insofar as possible a just expression of care for the dignity of every human being, whatever the circumstances.”
The paper offers to Canadian Anglicans “a framework for effective pastoral support for all concerned (patients, family, loved ones, care providers, and wider communities of support), whatever decisions particular patients ultimately believe themselves called to make.”
“We’re no longer in a debate about whether or not society is going to legalize physician-assisted dying-that’s happening, that train is out of the station,” says Canon Eric Beresford, chair of the church’s task force on physician-assisted death, which produced the report. “So now our question as Anglicans is, ‘How do we provide pastoral care to people…some of whom will choose to avail themselves of physician-assisted dying?’ ”
The paper opens with an introduction to the issue, and moves on to a discussion of related theological concerns and questions. It discusses how palliative and pastoral care ought to be provided to those facing the end of their lives. It includes suggested prayers and litanies and a list of books and other resources. It also includes the submission the task force made in February to the parliamentary committee charged with advising Ottawa on drafting the legislation around the practice, which consists of 16 questions the task force wanted lawmakers to ponder.
Archbishop Fred Hiltz, primate of the Anglican Church of Canada, was not available for comment on the report as of press time. In a statement accompanying its release, however, Hiltz acknowledged that not everyone would like the fact that the report argued neither against nor in favour of physician-assisted dying.
“A report like this is not going to please everybody because it doesn’t give a direct answer, and that will frustrate some people,” Hiltz said. “But…to give a direct answer is, in fact, to alienate people over a very sensitive and complex issue.”
Hiltz stressed the use in the paper of the term “covenant of presence”-the commitment of clergy and loved ones to be with people contemplating assisted dying, whatever their own views on the matter.
This is not the church’s first formal response to the issue. In 1998, it released Care in Dying: A Consideration of the Practices of Euthanasia and Physician Assisted Suicide. This earlier paper voiced a “cautiously negative” view on legalizing physician-assisted dying, Beresford says.
“That document, in the end, couldn’t believe that assisting a person with their dying was an act of care,” he says. “Our society disagrees-it thinks it can be.”
Beresford says some people see the new paper as an argument in favour of physician-assisted dying. These people, he says, have “completely misread” the report.
“At this point, physician-assisted dying is a part of our society,” he says. “Now, some churches are going to continue to argue this is a bad, bad thing, and we must stop it. That’s a decision that some churches have made. I suppose our problem with that is…what do you do with those members of your congregation who say, ‘Yes, but we believe it’s the right thing for us’? Are you really going to abandon them by simply saying, ‘Well, you know, tough luck-it’s not something you should be deciding’?” he says.
“I don’t think that’s the Anglican way. I think the Anglican way has always been one of trying to find methods of pastoral accommodation, trying to find ways of being present to people who are in a diversity of situations making a diversity of decisions.”
The paper includes personal reflections by Anglican priests, including Canon Douglas Graydon, a member of the task force who also specialized in end-of-life care for more than 20 years.
“Within that experience I learned that, for some, assisted dying, if it had been possible, would have been a choice that would uphold the dignity, autonomy and humanity of their lives,” states Graydon in his reflection. “Assisted dying would have been the natural extension of ensuring control within their life and therefore would have maintained a sense of quality of life and a recognition of the sacredness of life.”
In an interview with the Anglican Journal, Graydon, speaking on his own behalf rather than that of the task force, praises the report for not arguing either for or against physician-assisted suicide, but instead focusing on the challenge of how clerics and loved ones can be present and attentive to people struggling with end-of-life questions.
“I think its strength is that it theologically challenges people to think, and reflect, and study on the dimensions of suffering and autonomy and our duty to care for [them], and how one goes about celebrating the sacredness of life within the crucible of a conversation around ‘Help me to die,’ ” he says.
Graydon says he hopes the paper will help Anglicans talk with each other about a subject that can be very divisive.
“My fear is, and my experience to a certain degree has been, that assisted dying is one of those topics that people very quickly retreat into a corner and then they come out boxing…to defend their position,” he says. “So first and foremost, I hope the document stimulates conversation and encourages people to come together, regardless of their personal views, to learn and explore and study the issue.”
The Supreme Court of Canada has given Ottawa until June 6 to enact new legislation allowing the practice. The deadline has passed, with a bill proposed by the government passed in the House of Commons but now held up by debate in the Senate-meaning the issue is now in a kind of legal limbo.
“It is not illegal. The sections of the Criminal Code that would have made it illegal have been struck down and nothing has replaced them,” Beresford says. “You couldn’t break the law in this area because there’s no law to break.”
The parliamentary committee, Beresford says, appeared to have “completely ignored” the Anglican Church of Canada’s submission, which sought to ensure that especially vulnerable people would be protected. Instead, he says, the committee seemed to favour allowing relatively broad access to physician-assisted death-granting access to children and depressed people, for example. The bill as it was actually introduced by the Liberal government, however, was narrower-though amendments have been proposed in the Senate to broaden access once again, he says.
Beresford says he hopes lawmakers’ attempts to open up access to physician-assisted dying won’t include those in the especially vulnerable groups outlined in the task force’s submission.
“If they reopen it to people who don’t have the capacity for consent, I think this is deeply problematic-children, for example,” he says. “Do we really want to have physicians ending the lives of children-on what basis? Are we really going to limit this to like, putting a dog down?”
Also, if Canadians really want those facing end-of-life decisions to be able to decide freely, we need to significantly improve the quality of palliative care, he says.
“Our current levels of palliative care leave a lot of people, to our mind, without a genuine choice?[provision is] spotty at best and in many places quite poor,” he says. “If that’s the situation, I can completely understand why somebody would say, ‘In my current medical situation, this medical system basically abandons me to intolerable suffering or choosing death. And I choose death.’ “?