Quandaries’ exist around assisted death ruling, says ethicist

A patient lies in a hospital bed, suffering from a degenerative and incurable disease. Tired of the pain and tired of life, he has just asked his doctor to help him die. His priest sits beside him, and he tells her that this will be the last visit, because he wants the struggle to be over. The priest is uncomfortable. She doesn’t know what to say, but she knows she has to say something.

Following the Supreme Court’s decision to strike down the ban on assisted dying earlier this year, it has become increasingly likely that priests will find themselves in this situation at some point in their ministry. Canon Eric Beresford, the ethicist who heads the Anglican Church of Canada’s task force on physician-assisted dying, would be the first to admit that there is no consensus among Anglicans as to whether or not physician-assisted death is a good thing.

“We are diverse in our views of these issues,” he wryly acknowledged in a presentation to Council of General Synod (CoGS) in November on the work of the task force, “and these issues are not un-nuanced.”

There has been an acknowledgement that no matter what side of the issue they take, clergy will need to get used to providing care and support not just for those coming to grips with death, but for those trying to decide whether or not to take an active role in hastening it.

“It is a difficult decision whether you choose to avail yourself of physician-assisted dying or whether you choose not to—it’s not that one is a difficult choice and the other isn’t,” he stressed. Some clergy will face an additional difficulty: providing pastoral care effectively and appropriately to people “who might be making a decision you don’t much like,” he added.

Having edited the 1999 General Synod report Care in Dying: A Consideration of the Practices of Euthanasia and Physician Assisted Suicide, Beresford is no stranger to end-of-life issues, and while he believes Care in Dying still provides a useful background to the theological issues around euthanasia and assisted dying, he acknowledges it belongs to a different time.

“Clearly it was not compelling, even in our own church,” he said, “and I would suggest that it is now moot, at least from that perspective.” The role of the task force now is to speak to the current Canadian context, a job complicated by the fact that that context is far from clear.

When the Supreme Court of Canada in Carter vs. Canada struck down the ban on physician-assisted dying, it provided few limitations or guidelines, leaving it up to Parliament or the provinces to craft appropriate legislature around how physician-assisted dying should be legally practised in Canada. This leaves a number of what Beresford referred to as “quandaries”—grey areas not yet defined by law—including issues such as: what qualifies as an adult, whether or not a patient’s illness needs to be terminal in order to receive assisted dying, how many physicians need to be involved and what role family will play.

“It is interesting that in the decision of the court, the word ‘family’ is never mentioned,” said Beresford. “That does rather suggest that one of the things that was going on in the mind of the court—and there are other reasons for believing this, too—is an understanding of the autonomy of the individual that is at least un-nuanced.”

But one of the biggest issues is that of palliation. While very much in favour of palliative care, Beresford was skeptical of the argument, sometimes made by the opponents of physician-assisted dying, that palliative care is a better alternative.

“This will only work if the choices for patients are real,” he said, “and those choices are not real where we’re divesting in health care, and they’re not real when, in particular, we are not providing appropriate, adequate and, I would even say, excellent palliative care.”

While he argued that a high level of care is, indeed, what the medical system should strive for, his views on current practice were scathing.

“Palliative care in Canada is spotty at best and is often extraordinarily poor,” he said. “Canada has heavily institutionalized what palliative care it provides, there are still palliative care services provided in a number contexts where, frankly, adequate use of pain management is still deeply problematic and where the personalization of the process of dying is not, in fact, what we have seen.”

Beresford’s task force is in the midst of creating a number of resources, including a theological reflection on the current state of affairs. However, he also asked CoGS members to share their thoughts on what the church’s priorities should be at this time.

Most responded by stressing the importance of developing resources supporting pastoral approaches in line with the diversity of opinions in the church, and the need to advocate for guidelines around assisted dying that will protect the vulnerable, with less of an emphasis on the need for the church to publicly articulate its principles or work through the issue theologically. Beresford said the task force would take these suggestions seriously as it moves forward in its work.

The task force was formed to consider the issue of assisted dying in 2014, before the Carter decision came down, and in addition to Beresford includes Dr. Anne Doig, former president of the Canadian Medical Association; Juliet Guichon, a lawyer from Calgary whose practice involves medical ethics; the Rev. Ian Ritchie, a theologian from the diocese of Ontario; Canon Douglas Graydon, co-ordinator of chaplaincy services for the diocese of Toronto; Louisa Blair, a medical writer and editor from the diocese of Quebec; and Janet Storch, professor emeritus of nursing at the University of Victoria.