The conversation about medical assistance in dying (MAID) in Canada began out of a desire to ease the transition to death for terminally ill people experiencing intractable pain and suffering. After discussion and debate, Canada in 2016 legally permitted access to MAID for adults facing imminent death due to terminal illness, if they were deemed to be suffering intolerably.
In this debate some Anglicans have held an uncomfortable position, recognizing both the sanctity of life as a gift from God to be treasured and protected and the possibility that profound suffering and pain might be considered valid reasons to end one’s life. The church’s 1998 report and study guide Care in Dying stated that support for physician-assisted death constituted a “failure of human community.” The lack of adequate palliative care accessible to all Canadians; lack of strong family and/ or community supports for those facing end-of-life challenges; and a culture that values youth, vitality and independence to the detriment of mutual care and interdependence all contribute, according to the report, to an environment where “being a burden” is to be avoided. Another study, In Sure and Certain Hope, was commended by a task force of the Anglican Church of Canada in 2016 to offer pastoral and theological resources in pastoral care related to physician-assisted death once it was legalized. It included a submission made to the federal government Special Joint Committee on Physician Assisted Dying in February 2016.
Both documents are rooted in the commitment to life as a gift from the Creator that is to be treasured in all its variety and uniqueness. Intentional termination of life ends the opportunity to find the gifts God offers in strength and weakness, in sickness and in health. With sorrow we acknowledge that the decision to end one’s own life is at times taken when mental health has been affected by illness, addiction or profound social disconnections. Such an act may be understood but is not commended.
We also recognize that God has gifted humankind with the capacity to extend life and alleviate suffering through medical intervention including medications and mechanical devices. However, some suffering may be prolonged and profoundly difficult to experience or to accompany. Discerning how to respond involves one’s relationship with God, family and community as well as personal discernment about suffering and consequences. In these final, intractable situations we acknowledge the conscience and autonomy of the individual to discern the way to choose, knowing that in whatever decision is made we must commit ourselves, and those we walk with, to the mercy and compassion of God. There is no condemnation or abandonment, only deep sorrow that such suffering may precede our death—as well as the hope rooted in God’s promise that nothing can separate us from his love (Romans 8:38-39) in this life or the life beyond death.
In 2021, terminal illness was removed as a qualification for MAID in Canada. We now seem likely on the cusp of an additional expansion of eligibility to include those with mental illnesses—an expansion that was expected to take place in March until the federal government’s December announcement of plans to delay it. And further extensions are under discussion. According to the Health Canada website, “Other outstanding important questions related to MAID—such as eligibility of mature minors, advance requests, mental illness, palliative care and the protection of Canadians living with disabilities—will be considered during a Parliamentary review of the MAID legislation.” This review is to conclude by July 2023.
I am concerned about these potential extensions of MAID eligibility and the questions they raise. How do we ensure that every individual and family has what is needed to make an informed and accessible choice? In the face of illnesses or challenging disabilities it may be easy to see MAID as a preferable option, especially as it is less costly than providing the community supports that improve quality of life in its last stages, making access to mental health supports readily available, increasing palliative care accessibility and ensuring a circle of support for those whose lives are challenging physically, emotionally or mentally.
My prayer is that we will be willing to work for all that makes life a gift and blessing so that choices are not limited by fear or lack of support. Honest discussion in parishes about MAID are needed to explore the implications of the current change in legislation and any future ones for individuals, families and communities. Pastoral support is essential in whatever path is chosen. And in all aspects, as we walk in the midst of the realities of suffering, we are called in humility to mercy and compassion in the light of God’s love.