Navigating medical assistance in dying

Our May/June cover story examines how the Church is encountering voluntary euthanasia. Part 1 of a series by Patricia Paddey

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ours before his medically induced death, gerontologist Dr. Ronald Bayne granted a television interview to a news reporter from the comfort of his Victoria, B.C., home.

In the video clip he is seen walking with the help of a walker and sitting upright on a beige loveseat in the tidy apartment. He is thoughtful and articulate, looking both dapper – in a striped shirt and blue V-neck sweater – and younger than his 98 years.

Diagnosed with terminal cancer he is unapologetic about choosing to be put to death that very day. "You would choose death over long-term care, is that essentially …?" asks the reporter before Bayne interjects.

"Oh, yes. Yes, exactly," he says. "That’s certainly what I shall do. I shall not go into long-term care."

When he died early last year, Bayne left behind four daughters, including Lillian, who also spoke on camera.

"For us, looking at you – I mean, you’re sitting here talking to us and you’re still so vital. And we just want to pull," she pauses, choking back tears, "all of those gifts of love and generosity out of you. And we just want to keep having that. So it’s really hard. That’s the dilemma," she says, as if trying to convince her father to change his mind about inviting the premature end of his natural life.

But Bayne appears resolute, seeming not to look at his daughter throughout the 59-second clip, at the end of which she concludes, "We’re reconciled to it. But it’s very, very, very hard."

Reconciled, but it’s very hard

Clergy, chaplains, spiritual care professionals and entire denominations across Canada might say the same thing. When voluntary euthanasia or physician-assisted suicide – popularly known as Medical Assistance in Dying or MAiD – first became legal in June 2016 in this country, much of the public’s attention was focused on those individuals who had won the right to have their lives end at a time of their choosing.

But it takes a community to take a life legally, and some of those who compose the community that surrounds MAiD deaths find the practice ethically immoral and philosophically reprehensible, and experience participation – even from a distance – to be excruciating.

Paul Charbonneau is one of them. Rector at St. Hilda’s Church in Oakville, Ont., a congregation he describes as "life affirming" within the Anglican Network in Canada, he is under the authority of a bishop who has instructed clergy not to participate in MAiD. But caring for someone pastorally can mean being involved, in one way or another, even when you are deeply uncomfortable.

The first time Charbonneau personally encountered MAiD, he was walking into a hospital. Noticing a man in front of him, "I had a feeling he was going to visit someone," he says. "So I walked beside him."

The man told Charbonneau he was going to visit his wife. Then he disclosed something that left Charbonneau speechless. "He said, ‘I was thinking of putting her down, but my kids are uncomfortable with that. Plus, she’s in a state where she can’t make a decision.’ "

The brief exchange was evidence, Charbonneau says, that "Culture swings very quickly." With permissibility has come popularity. MAiD has become "more and more normalized," he believes. "And once a door opens, it never closes again."

Not long after that experience, someone he knew chose MAiD. The man, having recently lost his wife, was diagnosed with cancer and wound up in hospital where, Charbonneau learned, he discussed MAiD with his physician. "He was sick. He was vulnerable. He was depressed. He’d just sold his house. There was huge change coming in his life. But more could have been done."

With permissibility has come popularity. MAiD has become "more and more normalized."

Throughout the two weeks it took for the MAiD team to arrive to end the man’s life, Charbonneau visited him on several occasions. "I was trying to talk him out of it," he says.

The last time he saw the man, "We had some time alone. He was determined to go for it."

Three days later Charbonneau received a text message from the man, which concluded with, "Thank you for everything you’ve done for us. Love you." It was his final goodbye. The cause of death listed on the death certificate was not the lethal drug overdose he had been given, but cancer. "I did the funeral," Charbonneau says, "but it was a private ceremony. I was glad of that."

Appalling

"I think it’s appalling that things have gotten to this point," says Jo-Anne Hollander, a pastor with The Pentecostal Assemblies of Canada and a spiritual health practitioner in long-term care who works in Winnipeg. While she is personally opposed to MAiD, she also believes it’s important to be present with those who choose it.

She’s not yet been asked to attend a MAiD death, but says she would not turn away from doing so because "People need to know that you won’t just abandon them." Besides, she adds, "Think of the families that will need help to assist them in saying good goodbyes."

The research backs her up. According to a qualitative study published in 2021 in BMC Health Services Research, which cites a review of empirical evidence following the implementation of MAiD in this country, "Caring for families throughout the process and into bereavement has consistently been one of the most challenging aspects of MAiD."

Families are not the only ones who might need help navigating the emotional aftershocks that can come with learning someone chose to have their life ended through MAiD. Beryl Orok is spiritual care program facilitator for day hospice clients, staff and volunteers in a home support palliative care program in Perth, Ont.

Prior to the pandemic, she worked with a hospice day program that gathered weekly, which she says became "a little family group.

"One client, who had newly joined our group, had made a decision to have MAiD. They had not shared this decision with the group members." But when the group questioned that particular member’s absence, "They, of course, were informed."

As the group’s spiritual care provider, Orok was left to pick up the pieces. She remembers the group expressing shock, hurt and anger about the person’s decision. That person had seemed good, she says. They didn’t exhibit visible signs of suffering the way many of the other group members did.

"So there was shock, like, ‘Why? Why would they do that?’ Then anger. A couple of the members just thought that that person was a coward. But at the same time, it led them to think about the reality of their own suffering and certain end of life to come."

Orok says that as she listened, she was left with an unsettled feeling. She hoped that none of the group members would ever ask her to be present if they chose to deliberately end their own life. "My personal turmoil comes from being in the position of caring for and loving these people, but never wanting to bear witness to what I consider wrong in every way," she explains.

"But my heart aches to think that they would interpret my reactions as judgment. I do not walk in their shoes, nor do I pretend to understand their pain and suffering. To leave them alone – and many of these people have no one in their life – at such a time somehow seems unconscionable."

In the valley of the shadow of death

Winnipeg hospital chaplain Doug Koop agrees. "The Church needs to be present," he says. "We need pastorally sensitive people to be there in the valley of the shadow of death alongside people who are suffering. You have to be there genuinely for the people. And be there without an agenda. That’s when real spiritual healing occurs."

Koop has attended MAiD deaths and says he has arrived at a place where he is "at peace both with the emotional discomfort and ethical ambiguity in these situations.

"My role is to be a compassionate presence," he says. Still, he concedes it’s one thing to stand by as someone receives a little nudge "across the finish line," but acknowledges that the issue is becoming more complex now that Canada allows people who have a disability or illness to access MAiD when death is not imminent. Could he stand by – as someone who was not dying – was put to death?

The issue is becoming more complex now that Canada allows people who have a disability or illness to access MAiD when death is not imminent.

"I’ll have to cross that bridge when I get to it, of course," he says. "But I’ll keep reminding myself that unless I’ve had some appropriate means of influence or conversation or perspective that’s going to discourage the loss of a life, then my primary purpose is simply to be a companionable soul to a person who’s dictated their choice."

Murray Coughlan also knows what it means to be a companionable soul. He’s told people who were considering MAiD, "I think this is not a decision you should make. But I respect your right to make it. And I’m not going to abandon you or give up on you at the end."

The senior pastor at Gospel Centre Church in Edmonton, he describes two close encounters with MAiD, including with his daughter-in-law’s brother Uriah.

"Uriah was diagnosed with inoperable cancer," Coughlan says. "He came to church that Sunday with my son and daughter-in-law and made a commitment to Christ. I walked with him over the next six months and we talked about MAiD…. I told him, ‘I would rather you didn’t go this way.’

" But Uriah decided to proceed with physician-assisted suicide and the date was set. "The day before, I visited him. We had a great visit," Coughlan remembers. "I said, ‘Next time I see you, you’ll be in heaven. I’ll meet you there.’ The next afternoon he was to undergo the process.

"In the meantime I had been praying for his mind to change, or for [MAiD] somehow to not go forward."

Coughlan says Uriah had been "alert, fully cognitive," during their visit, but late that afternoon he took a turn for the worse, slipped into unconsciousness, and was unable to provide the required assent for MAiD to proceed. Within a few hours of becoming unconscious, he died a natural death. "I was absolutely thrilled that my prayers were answered."

Moral distress

The moral distress at which Coughlan’s prayers hint is just the tip of the iceberg – not all clergy are comfortable being present with someone who is considering MAiD, especially as the time for the procedure draws close. Some may feel that even being in a pastoral care relationship with a person who has chosen MAiD makes them complicit.

And it’s not only spiritual care providers who experience anguish over this issue. There are lay people sitting in the pews of churches all across this country – doctors, nurses, other medical workers and family members – who live in the conviction that every human being is created in the image of God (Genesis 1:27), that every human life is equally full of value and worth (Malachi 2:10), that suffering can be redemptive (2 Corinthians 4:7–12, 16–18) and that God is sovereign over life (Acts 17:24–26) and death (1 Corinthians 15:20–28).

They too may wrestle with their personal and professional obligations to support people in an act that seems to diminish the sacredness of human life. And as they watch regulations and requirements surrounding MAiD loosen and flex, they may wonder where the embrace of it all is leading us.

So where does that leave the Church? What are we supposed to be and how ought we to respond?

They’re not alone. William Robert Nielsen, a surgeon who wrote last year in the Canadian Journal of Bioethics that quite a few of his patients have "benefitted" from MAiD, predicted, "MAiD will lose the status as a last-ditch intervention for uncontrollable pain in imminently dying patients. Sick people will begin to see themselves as easily erasable and as excess human specimens. The conviction that it is a wonderful and divine thing to exist will be hollowed out by notions of a life that strives for societal convenience."

It is compassionate to want to alleviate suffering. Compassion is good. But the Christian conviction that God can redeem suffering, that there can be sparks of light in the deepest darkness, and that all human beings have an innate dignity is directly at odds with a perspective that considers suffering as only cruel, to be avoided at all costs and as something that erodes human dignity.

So where does that leave the Church? What are we supposed to be and how ought we to respond? As MAiD cases grow in this country, it is inevitable that more and more of us will face that question in the years ahead. Should our focus be on claiming our rights in a liberal democracy and avoiding involvement with certain things that go against our deepest convictions? Or is there another way?

Another way

As assistant professor of marketplace theology and leadership at Regent College, David Robinson sees MAiD as offering an opportunity for the Church to demonstrate a different ethic. "In a previous era the Church had a certain social status and embeddedness in Canadian culture," he reflects. "Back then it was more tempting to say that our ethic is for the country. But now we’re in a pluralist context. Christianity has less social privilege, which actually gives us an immense opportunity. Rather than building Canada, we can renew our focus on building communities that face death in a way that Canada would want to engage with and learn from."

Robinson says our culture is trying to come to terms with death and dying, something that’s always been frightening. "Given our current technological powers it seems like an insult that we have to die.

"Meanwhile, the deep loneliness in our society has been exacerbated by the pandemic. I think it’s important the Church not stand over that experience in judgment, but says, ‘We’re with you.’ That means addressing what it is that is leading people to choose death. If it is despair, isolation – well, that is an invitation for the gospel as a new social reality."

Jo-Anne Hollander agrees. "Maybe we need to look at the Christian community and say, ‘When was the last time we had a conversation on a Sunday morning about who we are and how we treat the subject of suffering in our churches? What’s our theology of suffering?’

"I don’t think that telling the world, ‘You can’t do this,’ is going to help at this point. But getting Christians to rise up and become the people that we’re supposed to be…." She allows her thought to trail off before adding, "We don’t think about the resources we need in this culture. Maybe we should be having Bible studies about these hot topics."

If there was a common theme that emerged from all the people interviewed for this article, it was the urgent and growing need for churches to prioritize education on end-of-life issues.

In the wake of their encounters with MAiD, Anglican rector Paul Charbonneau and Pentecostal pastor Murray Coughlan have both sought out resources and training sessions for their congregations, which were well attended. And they’ve preached on life issues from the pulpit.

Charbonneau has also held several study groups on the topic, and created a video on what the Bible says about the sanctity of life (youtu.be/_eHVyHeANUY).

Email queries to EFC-affiliated denominations revealed that several are in the process of creating resources for their churches. (Article continues after sidebar below.)

It is clear there’s no time to lose. Carefully worded obituaries published in the newspaper testify to our culture’s growing acceptance – even embrace – of MAiD, and the celebration of this final act of self-determination. "Chose a medically assisted death," "Died on her own terms," "Died on the day of his choosing," they report starkly.

More festive accounts delve into greater detail, such as the obituary of the woman who "decided she’d had enough and made plans to seek a medically assisted death on her birthday. As she had throughout her life, she called the shots right to the end." For this woman calling the shots at the end meant "having a laugh with friends, finishing her birthday mimosa and then drifting off in the arms of her family."

With publicity like that, it is not surprising that acceptance of MAiD is growing, and numbers of MAiD deaths are climbing. If we wait until MAiD crosses our personal path, we will be unprepared to respond.

Whether we are pastors or not, being willing to engage in frank conversations about suffering and dying could be an important first step for the Church in helping her people to prepare for – and assist others in making peace with – the inevitable approach of the end of life, confident we have a risen Lord who knows what it is to suffer and die, and who promises to be with us to the very end.

Patricia Paddey is a senior writer for Faith Today. She lives in Mississauga, Ont. Faith Today’s Jul/Aug issue will have Part 2 of this story – dealing with conscience protection for doctors.