Resolving about MAID
In my earlier series of posts about the General Synod of the Anglican Church of Canada, I made reference to a motion that I had proposed about Medical Assistance in Dying (MAID) in Canada. The motion wasn’t considered at Synod but the motion itself continues to lead to interesting conversations with people across the church so I wanted to take a moment to lay out some of the thinking behind the motion in hopes it may be more broadly useful.
Some brief background first, however. This month the province of Quebec released its annual report on MAID that indicates 7% of deaths in the province are via MAID, a number that is far more than any other jurisdiction in the world. The number seems likely to continue to grow and it is becoming clear that MAID is no longer seen as a last resort. Quebec is having to remind doctors of the conditions of MAID to ensure doctors are actually respecting them. Meanwhile, the federal government has delayed but remains committed to moving forward on legislation that will expand MAID to include new categories, including mature minors, in advance directives, and for those for whom psychological conditions are the only underlying medical condition.
I want to be clear about my own views on this. I am opposed to MAID. I do not think it should be legal. I would not advise someone to seek it. The Anglican Church of Canada this fall will be releasing a series of essays with perspectives on MAID. My own contribution makes the case that MAID is the logical but tragic policy result of a society governed by a neoliberal ideology of choice. I’ll let you read that essay when it comes out for more on that.
I respect and understand that not everyone in the church shares my view and I suspect there will be essays in the forthcoming collection with which I disagree. I also recognize that I live in a democratic society in which courts have mandated that MAID be allowed. I may disagree with those decisions but I think that part of my commitment to living in this society is to respecting even those decisions that I disagree with. I wish, however, that my church had been able to speak more clearly in opposition to MAID when it was under consideration.
I further recognize that theological convictions are sometimes tempered by pastoral realities. My dogmatic beliefs underlie my pastoral relationships but sometimes a bedside is not a place for abstract theological principles. This is not to say that theological principles are not important — quite the opposite of course. There is a world of difference between having firm beliefs and knowing when to sit lightly with them and not having firm beliefs at all. (I have more to say on this in the forthcoming essay I just mentioned.)
Late last year, when I first began thinking about what I might like a motion from the General Synod to say about MAID, I began ambitiously, essentially drafting something that made quite clear what I believe is the proper Christian opposition to MAID. I also began consulting with bioethicists, with people who work in health care, and with people with more synodical experience than me and several important questions began to become clear. I’ll name two here.
First, from those with more synodical experience, I was frankly asked, “Do you want to pass a motion or do you want to make a statement?” As I reflected on this, I realized I wanted to craft something that I thought could pass because I do think that many people in the church are looking for guidance on this issue and they should rightly expect their General Synod to provide such guidance. I wasn’t sure that a forthright statement of opposition to MAID could pass General Synod (though it would have been interesting to do a straw poll on this).
Part of crafting something that could pass was, I realized, looking to the future, not the past. Therefore, much as I would like the church to clearly state its opposition to MAID, I was asked the quite legitimate question, “What about the Anglican doctor who has assisted in a death since it has been legal? How will they hear a motion that appears to retrospectively condemn what they’ve done?” I’m not sure what is to be gained by the church as the church weighing in several years too late on what is already established practice. Of course, this shouldn’t stop individual Christians from making their views known in opposition. So—after much editing—the motion my seconder and I put forward was deliberately focused on the future, that is, legislation that is currently under consideration as well as other end-of-life policies that could be considered.
Second, it became clear that a key area of question is how Christians are to relate to those who die via MAID. This debate, I learned, is most pronounced at the moment among Canada’s Roman Catholics but I’ve heard versions of it from some Anglicans as well. Here are some of the questions that are arising to which the church is not providing good (or any) answers.
· From a faithful Anglican: My loved one has chosen to die via MAID. I disagree with their decision but I still love them. Can I be in the room with them when they die?
· A version of this from a clergy person: I disagree with MAID but can I still offer last rites to someone about to die in that fashion? Can I be in the room with them when they die, even if I disagree with the method of their death?
· Also from clergy: How do I handle requests for funerals for those who die via MAID? Should I do them or should I not? If I do, do I mention the manner of death? How do I handle divisions among family members about how their loved one died?
All of this was background to the motion that was actually submitted. Again, I want to be clear that this motion has no authority other than my own (and that of my seconder), but here it is for what it’s worth.
C-002 Medical Assistance in Dying
Be it resolved that this General Synod:
1. Affirm the teaching of Scripture that life is a divine gift, the call of the Baptismal Covenant to “respect the dignity of every human being”, and the teaching of Jesus Christ that he has come so that people may have “abundant life” (John 10:10);
I suspect we could have some good theological debate about whether MAID is respecting the dignity of every human being and the nature of abundant life, but this link seems pretty clear to me.
2. Take note with concern of the federal government’s proposals to expand access to Medical Assistance in Dying to include mature minors, those for whom psychological conditions are the only underlying factor, and in advance directives;
This is entirely forward looking in that these proposals have not yet become law. The language of “concern” comes directly from Primate Linda Nicholls’ article about this earlier this year. At the very least, I think Christians should be concerned about the idea that someone who is 16 years old may decide that the best choice for them is to end their life. The nature of MAID and advance directives raises such significant concerns about how to describe the thresholds in which MAID could be invoked for someone who is, for instance, mentally incapacitated. I could go on (and on) but “concern” is, at the very least, warranted. Had this passed, I think it would have been among the first times the church had expressed a clear view on MAID legislation.
The primate herself has expressed the view that Canadians don’t want to hear what the church has to say about legislation. Perhaps, though that didn’t stop bishops from weighing in a few years back on the need for a universal basic income, and it didn’t stop the primate from pushing a resolution on Israel and Palestine at this General Synod that was clearly directed at influencing policy. But other Canadian Anglicans may wish to know what their church believes on this. Perhaps a statement like this shouldn’t come from the General Synod. Then again, the House of Bishops hasn’t exactly been stepping to plate on this one.
3. Express its support for a robust palliative care system as a more appropriate response to human suffering that respects the dignity of all human beings;
4. Call on the government to enact a national palliative care strategy that is attentive to the inequities and injustices in the current health care system;
Palliative care — of the kind that Christians have been involved in providing for literally millennia — is the obvious and natural place where Christian energy at end-of-life should be directed. It is clearly called for “We Can and Must Do Much Better,” an ecumenical and inter-faith document on MAID from a few years back that, for whatever reason, no Anglican signed. By the by, there is a really good article in the current edition of The Walrus about Canada’s cancer strategy that makes the case that this country spends far too much on mediocre cancer medications that extend life for a few weeks or months when it could be spending that money instead on, say, palliative care. The resources are there. They are just being misallocated. (This article I read in hard copy but the current issue doesn’t seem to be online yet.) There is lots more to say about palliative care, including about whether there is a meaningful difference between palliative sedation (which few Christians seem to mind) and MAID — but at least we can do more to support it. By the way, someone said to me in conversation about this, “You know, Christians have so much experience with end-of-life care that if we thought MAID was a good idea, we would have been calling for it literally centuries ago.” The implication being that we didn’t — and we shouldn’t now.
5. Affirm the call of the church and Christians to pastorally accompany when possible all those who are suffering or approaching the end of life, including those who have chosen Medical Assistance in Dying;
This may be the most challenging part of this whole resolution. It is my view that it is possible to “pastorally accompany” those who have chosen to die via MAID, including being present in the room when they die, even if I disagree with the decision. Not all Christians would agree with this. I want to be clear that “pastorally accompany” is not a synonym for “affirm the decision of.” But as those of us in the clerical profession know well and as many other people know too, end-of-life is a sacred time and I do not think it right to deny pastoral accompaniment in that time. Speaking personally, I would be just as willing to, for instance, hold the hand of and pray for and with a person as they take their last breaths after receiving MAID as I have done for those dying in other circumstances. I think there is room for tremendous and generative theological conversation on this point, however, and this resolution is a teeny step in this necessary direction.
6. Encourage members of the Anglican Church of Canada to contact their Member of Parliament to share a copy of this resolution;
7. Direct the General Secretary of this Synod to cause a copy of this resolution to be sent to the Prime Minister, the Minister of Health, and the Minister of Justice;
If we’re going to comment on legislation, we should let the government know about it, both as individual Christians and as a church — even if they don’t really care what we think.
8. Direct the Faith Worship and Ministry Coordinating Committee to work with other Christian bodies in order to identify, and where needed, produce, current educational resources related to Medical Assistance in Dying for the faithful of The Anglican Church of Canada.
The Anglican Church of Canada’s current document on MAID, In Sure and Certain Hope, is well out of date. The legislation has simply changed too much in the intervening years. I do understand, however, that we have a significant resource deficiency in the church and we need to make choices about where we invest our time and attention. But other churches have been weighing in on this. Our full communion partners, the Evangelical Lutheran Church in Canada, have their own (more recent) teaching document on MAID. There’s the ecumenical statement I mentioned earlier on palliative care. The Roman Catholics in Canada are producing reams of material on this. You don’t have to agree with all of this (I don’t) but it provides thinking and guidance to Anglicans who are asking questions. At the least, I think we can expect our national church structures to be able to gather and curate some of this material.
So there we are. This is not a motion that says everything that could be said about MAID but I thought it was a motion that said something about MAID at a time when something needs to be said. It was not meant to be a final word but a word in via as this topic continues to shift and change and evolve. I thought it could have offered some guidance to people in the church who are looking for it.
As for next steps, I gather that motions that are not considered by the General Synod get referred to the Council of General Synod at its first meeting, which I believe will be in November. I gather as well that it has been the custom to invite the mover of the motion to address CoGS. I would welcome such an invitation as I think that CoGS in the coming two-year period has an opportunity to do some important work on this matter that could be of value to the entire church.
Most of all, I am grateful for the conversations I’ve had as a result of this proposed motion and look forward to more. This issue is not going anywhere and will only become more pressing in coming years.
