I was fielding questions at a palliative care conference when the issue arose. “Doug, I hate to ask you this, but what are your feelings on physician-assisted suicide?”
I was not particularly surprised. The matter of what Canadian’s refer to as “medical aid in dying” had been in the news and many medical teams and palliative care workers were wondering how its impending introduction in Canada’s health care system would affect them. A few weeks later, Canada’s Parliament enacted a law making it possible for suffering people whose death is “reasonably foreseeable” to be eligible for medically assisted death.
The topic has long been a politically and emotionally volatile issue, with strongly principled activists of various convictions holding center stage in the public debate. But while it made perfect sense for someone to ask the question, I had not prepared myself to face it, and I eased into the discussion with something of a disclaimer.
“At one level, it doesn’t matter what my feelings are,” I began. “The freedom for qualified patients to choose medical aid in dying—and the responsibility of the system to make it available—is about to become the law of the land.”
Indeed, I work in a major hospital where this option will soon be a recurring reality. It’s coming to my workplace, and I’m certain to encounter it in the weeks, months and years ahead.
I returned to the original question and tried to make a general point. “On the whole,” I said, “I think it will be better if people with palliative care and spiritual care sensitivities are available to patients and families who are making those decisions for themselves.”
Looking ahead, I believe that when I find myself in such situations, it will be important for me to suspend whatever judgments I might be inclined to make in order to offer the best spiritual care I can provide for patients and their families in quite particular circumstances.
Another hand went up. “I’m going to have to disagree with you, Doug. I believe in the sanctity of life from conception until natural death. No life is ours to take. We cannot make those calls. It’s up to God to decide when a life is to end.”
I listened attentively as this woman gave eloquent expression to her deep convictions, eventually concluding with an air of finality. Case closed.
“Yes,” I acknowledged. “And that perspective has very much been a part of the broader public conversation. However, it doesn’t have much bearing on my response as a spiritual health practitioner in a public institution. I feel that it’s better to be present to people in these circumstances, rather than to be absent on principle.”
We were able to leave it there.
But I wasn’t able to leave it there. I had answered the question professionally, yet clearly there was more on which to reflect. As I see it, we all need assistance in both living and dying, and that everyone should be involved in the lives of others. We are interdependent beings. It takes a village for a person to live well—and to die well.
I’m in favor of person-assisted dying (and pastor-assisted dying, and physician-assisted dying, for that matter) when it means that we honestly and empathetically help our fellow human beings to be at peace with themselves and with others when it comes their time to die; and to be unafraid of what awaits beyond the dark veil. This is the neighborly thing to do.
North Americans tend to find this difficult. Modern medicine’s many successes, and our individualistic inclinations, have helped to nurture a culture with unrealistic perspectives about what is, after all, the inescapable material demise of our bodies. We either resist death so fiercely that we flirt with outright denial, or in some cases we rush towards it prematurely. Neither extreme will satisfy.
Our first impulse is to ignore the prospect of death until its looming reality somehow overwhelms us. We typically behave as though we believe we will live forever. On the other hand, we may be inclined to seek death’s oblivion, largely because we can’t stand to stay with the pain of the moment. We’ve become so disenchanted with suffering that its dogged persistence drives us to despair. We look for ways to escape, increasingly favoring the finality of death over the distress of difficult living.
Partly because many formerly deadly diseases have been conquered by pharmaceuticals and countless previously dire conditions have become treatable, patients often assume better outcomes than can realistically be offered—and their care providers are loathe to burst the bubble, serving up hopes unlikely to be realized.
Facts of death
Ultimately, we need to face the facts of death. For some that means letting go of the unrealistic expectations that so often hinge on the fixes and cures that medical science strives so hard to deliver. We are mortal beings and our lives are ultimately beyond the reach of even the most sophisticated medicines and techniques.
Medicines and therapies can do much to enhance a person’s quality of life. But we do well to recognize its limits and resist the temptations to chase treatments that merely prolong the process of dying.
The assistance our society most needs, I believe, are strong communities of care where death is neither feared nor denied; where our interdependence is acknowledged and demonstrated; where loneliness is banished; where people have faith that every circumstance in life has potential for purpose and meaning. Certainly churches are called to be exactly those kinds of communities. If that kind of aid in dying were more broadly available, I strongly believe that fewer people would make early plans to facilitate their death.
I’m not one to try to either hasten or forestall the inevitable. Yet there is work to do for spiritual health practitioners—and others—even at the bedside of a person who is deliberately choosing a medically-induced end to their life.
Living or dying, it’s good when we can assist each other in the difficult task of loosening, and eventually releasing, our tenuous grip on the things of this world.