When I started pastoring in September of 2015, I became acquainted with all the programs and organizations that our church supports. I’ve aways been impressed with how many different fields Christians find they are called to minister in, including healthcare. Our church supports the Bethania group that operates two personal care homes in Winnipeg. These care homes were started by Mennonite churches and seek to cater to those needing extensive care in our church communities as well as our wider city.
During one of our liaison meetings in April of 2016, I was surprised when they handed us a statement in response to a Canadian Supreme Court ruling regarding Medical Assistance in Dying (MAID). They were clear that Bethania wouldn’t endorse MAID in their facilities because it violates their core Christian beliefs about life and care.
It wasn’t their stance that shocked me, but my lack of awareness on the issue in our contemporary culture. Abortion and euthanasia were hot topics growing up, especially because we had the luxury of debating moral ideals without any personal experience. This lack of experience made questions of euthanasia as theoretical as going to war, and so, it was fairly easy for me to take a stance as a teen.
However, now faced with this declaration by a personal care home supported by our church and the possibility of being asked questions about MAID as a pastor, I grappled with the importance of this issue in our Canadian context. I knew it wasn’t something I could treat lightly any longer.
As I began to research theological perspectives about life and death, our Canadian decision to legalize MAID, and equivalent decisions of other countries, it became clear that this topic is more complicated than I first assumed. I have come to understand that most public debates like this are so divided because there are good arguments on both sides.
Although I don’t agree with MAID, I understand how and why our society, and some Christians, have moved in this direction. Arguments can be made about the sanctity of life, autonomy, compassion in suffering, and the slippery slope, to support both sides. I’m at a place where I don’t believe the arguments for MAID are unsound, but that the arguments against it are more in line with the biblical narrative Christianity has subscribed to for most of its history.
It must first be made clear where the conversation about MAID fits into the larger end-of-life debate. There are two dimensions to this issue, creating four basic situations of assistance in dying, in this case, for medical reasons. Although the term euthanasia is used less often in conversations about MAID, it literally means “good death” and is used to define the process by which someone would, with the assistance of others, end their own life because of severe suffering. The first dimension of “passive” and “active” euthanasia defines either the omission or commission of medical treatment that results in the end of life. The second dimension of “voluntary” and “involuntary” euthanasia describes the prior and informed consent of the patient in ending their own life.
For the most part, passive euthanasia has been accepted as an ethical option for patients, where allowing death to happen naturally without medical intervention to unnecessarily prolong it, is considered morally justifiable. Involuntary euthanasia, where end of life is sought by the physician or family without the consent of the patient or by following the wishes and directives of a patient who is unable to give consent, has and is still viewed as ethically wrong and comparable to murder. MAID in Canada deals specifically with active voluntary euthanasia, where a patient requests and consents to medical measures being taken in order to end their life because of their situation. It’s within this criteria that people most strongly disagree with what the ethical action for patients and physicians is.
In February of 2015, the Canadian Supreme Court gave directives to Parliament to amend the Criminal Code, because their ruling that the refusal to allow someone to request MAID goes against our Canadian Charter of Rights and Freedoms. With this decision, MAID has fallen into the realm of personal rights and autonomy, leading the Canadian government to amend the Criminal Code in June of 2016. This amendment allows for physicians, nurse practitioners and pharmacists to prescribe or administer a lethal substance to a patient under strict conditions.
These conditions and restrictions are important to note and are as follows:
- They are eligible for health services funded by a government in Canada;
- They are at least 18 and capable of making decisions with respect to their health;
- They have a grievous and irremediable medical condition;
- They have made a voluntary request for medical assistance in dying that, in particular, was not made as a result of external pressure; and
- They give informed consent to receive MAID after having been informed of the means that are available to relieve their suffering, including palliative care.
Safeguards are written into this amendment that try to diffuse possible abuses of MAID as well as more detail about what constitutes a legitimate irremediable medical condition. Between December 10, 2015 and June 30, 2017, one third of the requests made for MAID were denied because of these safeguards, resulting in 2,149 deaths by medical assistance during this time period. This accounts for less than 1% of the total deaths in Canada, but the percentage has risen since MAID was introduced. Cancer is the most frequent reason for MAID, which has been requested by people in all age groups over 18, with the average age of MAID deaths at 73.
So, Medical Assistance in Dying is here. Now the question is how we might enter into the discussion and debate around this topic. That is the focus of next week’s post.