Medically Assisted Death in Canada

The View from Rev. Stephen Fetter’s Pulpit

In 2015, the Supreme Court of Canada ruled in Carter v. Canada that a competent adult with a “grievous and irremediable medical condition causing enduring suffering” can consent to the termination of their life with the assistance of a physician.

The court ordered the government of Canada to have a law on the books that codified that right by June 2016. The government did, adding nurse practitioners and to the category of those who may provide assistance as well as pharmacists to dispense the necessary substance.

Village Stories wants to know the views of local clergy on the subject, so we put the following fact situation to them.

You are summoned to the bedside of one of your congregants, A.B. They are bedridden at home. They say they are suffering intolerable pain and distress that cannot be eliminated despite receiving pain medication and other narcotics. They have trouble swallowing and can’t go to the washroom without help.

They are mentally competent and in extreme pain. Their doctor has told them their condition is terminal but it could be six months or more before they would die.

Prescribed treatment only makes them sicker.

You have no reason to doubt them.

You have spoken to them and they are coherent and understands their situation.

They want medically assisted death.

What advice would you give?

Response by Rev. Stephen Fetter

Wow! What a terrible position to be in! I’ve never known someone whose physical pain couldn’t be relieved by medication – but I’ve known many who decided that bearing the pain was better than living with the side effects of narcotics that left them confused and nauseated. For them being clear-thinking and hurting was better than being pain-free but unable to interact with the world.

The toughest ethical issues we face in life

The toughest ethical issues we face in life have nothing to do with choosing between “right” and “wrong.” Those are the easy ones! The toughest choices are when there is no “right” answer, and you have to sift and sort through the available options to figure out which one is “least wrong” under the circumstances.

Medically assisted death can be the least wrong option

Like Gloria Taylor, one of the plaintiffs in the ground-breaking Supreme Court Decision that changed Canadian law on this question, I’m a life-long and faithful member of The United Church of Canada. Like her, I believe that medically assisted death can be the least wrong option under some circumstances, and I’m glad that she and her family fought in the courts for this option to be available.

‘You don’t have to die a horrific death in order to go to Heaven or be with the Lord.’

In 2012, she told The United Church Observer, “You don’t have to die a horrific death in order to go to Heaven or be with the Lord.” I agree with her, and I admire her courage and her faith. She was the first person in Canada to choose a medically assisted death after the law was changed.

But you’ve asked for my advice. That’s a rare thing – these days clergy are seldom asked for advice! And there are lots of different players here; I’d have different advice for each of them.

Spend some time tying up the loose ends

If the patient asked my advice, I’d encourage them to spend some time tying up the loose ends of life first. Lots of us don’t get the chance to say our good-byes and make peace with those we’ve struggled with in life.

My dad died of Alzheimer’s, and so was denied that privilege. I’m always moved by the faithful people I’ve accompanied who have used the time before their death to set things as right as they can; they have each died more easily because of that.

Being a burden to others is not a reason for ending one’s life

I’d encourage people not to make a decision because they felt useless or a burden; those feelings are common, but they cloud the issue, and they complicate grief for the family members that the dying person is trying to spare.

A time for grief, story-telling and celebrating the sacredness of a person’s life

If the family members asked for my advice, I’d encourage them to listen more than talk. This is not a time for debate; it’s a time for grief, and story-telling, and celebrating the meaning and sacredness of a person’s life. We each walk the path between life and death in our own way, but our lives have an impact we may never fully know. Family members can help a dying person celebrate the meaning and impact of their life, and in so doing remind them of their sacred value to us and to God.

Offering a humane presence

If the medical caregivers asked for my advice, I’d remind them of their sacred duty to care for their patients. Care is more than a set of measurable medical services to deliver – it’s offering a humane presence that allows the sacred in the caregiver to touch and connect with the soul of the patient. “Care” is about more than preserving life at all costs; it’s about making the most meaning out of each instance of time. Life without meaning is agony; life with richness is the best gift we can give someone, even if it be short. Death need not be “failure” for a medical care-giver; it can be the final dignified event in a whole series of caring encounters.

If the politicians asked for my advice (and now we’re moving into the territory of flights of fancy), I’d insist that providing the option of medically assisted death only partially solves the problem that really needs to be addressed.

The need for more palliative care options

Only a small percentage of people near death will choose this option; every one near death deserves dignity, respect, caring and presence.

We need more palliative care options; we need more opportunities to maximize the value of each pre-death moment of time.

We need creative, time-consuming and resource-rich ways to address the boredom, and loneliness and sense of feeling useless that pervades our long-term care homes and leads people to fear the dying process.

Enhancing the value and meaning of life

Medically assisted death in an over-stretched medical system won’t lead to dignified endings; but as one tool among many in the hands of caring professionals dedicated to enhancing the value and meaning of life, it’s a valuable and important resource.

Rev. Stephen Fetter is minster of Forest Hill United Church, an intercultural congregation just north of Bathurst and Eglinton, He has been ordained in The United Church of Canada for 30 years, and has served in Forest Hill for almost 15 of those.