Expanded in 2021 to allow eligibility for people whose death is reasonably foreseeable, Ottawa’s MAID program is slated to be expanded again in 2027 to include people suffering solely from mental illness. Photos: Ground Picture and Kinga
Archbishop Linda Nicholls, primate of the Anglican Church of Canada, says she intends to write Ottawa on medical assistance in dying (MAID)—one of a slate of MAID-related actions Council of General Synod (CoGS) approved at a special online session March 9.
The resolution requests that the primate write a letter to federal Minister of Health Mark Holland expressing concerns about recent expansions to Canada’s MAID practices and endorsing an expansion of palliative care services as an alternative. It also directs the church’s Public Witness for Social and Ecological Justice and the department of Faith, Worship and Ministry (FWM) to find ways of educating the church on MAID-related issues by using and promoting existing materials previously produced by the church and FWM.
The resolution was on the agenda at General Synod in July 2023 but General Synod did not have time to debate or vote on it, and so it was forwarded to CoGS for consideration instead.
In March 2021, the Canadian government passed Bill C-7, the latest expansion in MAID policy, which amended the law to no longer require that a patient’s death be “reasonably foreseeable” in order to request that a physician end their life. Instead, anyone may be eligible who has a “grievous and irremediable condition.” On Feb. 1 of this year, the government announced it would delay an additional expansion which would have made assisted death available to people suffering solely from mental illness, until 2027. Holland said the delay was to ensure the system would be ready to handle decision-making on mental-health-related MAID cases.
Bishop of Qu’Appelle Helen Kennedy, who originally introduced the resolution on MAID to General Synod in summer 2023, says she felt it was important that the national church form a clearer position on MAID following work her own diocese has been doing on the topic. While she has declined to make a recommendation for or against the clergy in her diocese endorsing MAID, she says she saw several reasons for concern in the direction the expansions were taking.
Much of the church’s discussion on MAID, including the 2016 study resource In Sure and Certain Hope, has dealt with the question of whether and how clergy should be present at the bedsides of parishioners who have chosen to die, Kennedy says—something she describes as a pastoral need with which she didn’t feel comfortable interfering. But hearing debate about eligibility being expanded to include mental illnesses and, in some forums, minors, Kennedy says she felt it was important for the church to take notice.
“There were just concerns that the program is getting bigger and bigger, and [that] makes it a heck of a lot easier to access death, when there are alternatives,” she says. “So to expand palliative care to alleviate as much suffering as is possible seemed the better solution than to expand [MAID] and shorten life, because life is a gift from God.”
While she has compassion for cases where people choose to end their lives because they see nothing but suffering in their future, Kennedy says, she’s also worried that people may choose MAID simply because they feel there’s no value remaining in their lives. She tells the story of a woman in her 80s who felt she’d outlived her usefulness, to whom Kennedy responded by reminding her there was much God might have planned for someone who could still love, pray and care about her fellow humans.
“We’re all dying,” Kennedy says. “God knows when God’s finished with you.”
As this article was being prepared, Nicholls confirmed to the Anglican Journal she would write the letter, reiterating concerns she had about the expansion of MAID and the availability of palliative care.
Most recently, FWM produced a book of essays on MAID from various perspectives around the church aimed at facilitating theological discussions at the local and diocesan levels. The final version of that collection, Faith Seeking Understanding: Medical Assistance in Dying, has been available online and in print since March 2024.
David Lepofsky is the volunteer chair of disability advocacy group the Accessibility for Ontarians with Disabilities Act (AODA) Alliance, as well as a retired lawyer and part-time professor of legal ethics and public interest advocacy at Osgoode Hall Law School. He says increased access to higher-quality palliative care would be of use mainly to people already facing the end of their lives, rather than those the legislation calls “Track 2” cases—people covered under the expanded eligibility for non-foreseeable deaths.
The greatest need in public policy, Lepofsky argues, is a major expansion in the oversight and accountability procedures accompanying MAID decisions. The current rules used to determine whether a case is appropriate for MAID are highly subjective, he says. The law does not require that patients’ suffering be physical in nature and leaves it up to doctors or nurse practitioners to evaluate whether patients are in possession of their full cognitive and emotional capacity to make the decision—a legal distinction for which he does not believe they have adequate training.
“I’m eligible for MAID because I’m blind,” he says. “I’m living a happy life, but if I went to someone and said ‘I can’t take it anymore and living with blindness is horrible,’ I would meet the definition.”
Currently, he says, a patient in that scenario would be within his rights to insist his MAID request be kept private. A doctor might provide MAID based on his disability, even if his disability was not the real cause for his request; the patient might be, unbeknownst to his doctor, clinically depressed for some other reason, he says.
The line between a person with a disability who is living a happy life and one who is eligible for MAID is therefore concerningly blurry, he says. And since the law does not require an investigation into whether the reported suffering was actually related to his blindness, it might very well allow MAID in this case. That’s just one example, he says, of a scenario that can’t be corrected for without more robust oversight
The March meeting of CoGS dealt with a number of other items left over from the 2023 meeting of General Synod. One of these was a resolution to create a discipleship and evangelism task force dedicated to fulfilling the church’s commitment to “invite and deepen life with Christ.” Under the resolution, also approved by CoGS, the task force, formed by FWM, will create and share print and digital resources to help local leaders in the church share the gospel and the love of Christ in their communities.
CoGS also voted to direct the Governance Working Group (GWG) to review the current process by which CoGS members are elected, which Nicholls said can be arcane and confusing. Kim Chadsey, of the ecclesiastical province of Ontario, said current rules frequently lead dioceses to choose between putting forward an incomplete slate of nominees or else padding their lists with people who do not actually want to serve on CoGS. GWG is to recommend improvements to these rules.