Whether we like it or not, it is now legal in Canada for physicians to terminate the lives of patients under certain circumstances. The time to oppose the legalization of physician-assisted death has passed. The question before us now is how we relate to the new reality.
In February 2015, the Supreme Court of Canada ruled that the laws preventing assisted suicide were “overbroad.” The court said that prohibiting physicians from ever granting the request of patients who wanted to end their lives infringed on the patients' constitutional rights.
One of the two cases on which the court based its decision concerned a woman who had developed ALS (sometimes called Lou Gehrig's disease). The disease would eventually cause her to lose control of her muscles, and, unless something else intervened, she would suffocate when her lungs could no longer inflate. Her body would give way, but not her mind. She found the prospect agonizing.
When she appealed to the court, the disease was not crippling. She did not want to take her own life just then. However, anticipating a future in which she couldn't commit suicide independently, she wanted her physician to be free from criminal prosecution if he later hastened her death.
The Supreme Court agreed. In so doing, they said that others like her should have the same legal protection— others who were suffering “grievously” from “irremediable” medical conditions and for whom any treatment would be “intolerable”; others who, like this woman, are adults able to consent to and refuse medical treatment on the basis of their reasoned assessment of the alternatives. The court said that people who were “vulnerable”—vulnerable to coercion and manipulation—and people who didn't have the capacity to make informed decisions about their own care needed to be protected. No one should be allowed to legally hasten their deaths. But the court judged that Canada was smart enough and well-governed enough to protect those who needed protection, while still allowing physicians to end the lives of people, like the woman with ALS, at their request.
The Supreme Court said they would delay the impact of their ruling, but in June 2016, physician-assisted death will be legally permissible everywhere in the country as a constitutionally protected right.
New Law
Since the court handed down its judgment, federal and provincial legislators and civil servants, colleges of physicians and other health providers, panels of experts, assisted-death advocates and religious leaders—including the leaders of The Salvation Army—have engaged in intense debate and deliberation. Everyone expects there will be new laws and professional regulations in June, but what will they be, and will they be the same everywhere in Canada?
A committee created by the new federal government, comprised of members of Parliament and senators, has said that the conditions articulated by the Supreme Court should be treated as a floor, not a ceiling—recommending that hastened death be allowed for children as well as adults, and for people who are no longer mentally competent, as well as for those still competent. Further, in their view, nurse practitioners and some other professionals, as well as physicians, should be legally permitted to hasten death. Whether the committee's recommendations will be accepted is presently unknown.
Even if they aren't, Canada's laws regarding the hastening of death will be among the most “liberal” in the world. And it will be necessary for those who think they are bad laws to find ways to live with the reality.
If you are a physician you should be protected on two grounds. One is the professional obligation not to practise outside one's area of competence. (Just as not all doctors are trained to perform brain surgery, only certain physicians will have the requisite training to properly hasten death.) The other is the legal right to opt out on the grounds of personal conscience.
Nurses, pharmacists and other health professionals will probably have similar protection.
Right of Conscience
But what about hospitals, hospices and long-term care homes? Will they be granted protection, too? This matters to The Salvation Army because it owns and manages several such institutions across the country.
In late 2014, General André Cox strongly affirmed, “There will be no change in our theological beliefs or in our positional statements. The Salvation Army will always be pro-life. There will be no change in our values and there will be no change in principle.” The Salvation Army has long argued against assisted suicide and euthanasia. Although death is not to be resisted at all costs and although people deserve excellent management of pain and suffering, we should not resort to physician-assisted death. On this basis, The Salvation Army asserts an “institutional right of conscience” that physician-assisted death will not be performed in its health-care facilities.
Some people seem to think that opting out on grounds of conscience is being a bad sport—a power play to try to win something that was lost in the courts. If you are paid from public funds (as doctors and hospices are), you are obligated to go along, the argument goes. The one who pays the piper calls the tune.
This is misguided and false. Conscience is at the heart of identity. Adults know that if they do certain things, they betray themselves. They will have sold out. When we go to our doctors, we want to know whether we can trust them. We want to know whether they really stand for anything. If physicians sway with the winds of opinion or kowtow to wealth, they are not to be trusted.
Commissioner (Dr.) Paul du Plessis is a specialist in palliative medicine. He is married to Commissioner Margaret, who lives with dementia. Last year, Paul shared his “credo” with me. He says, “Relationships should endure even when they are stormy. They should survive loss of cognitive function, social skills and graces, changes of bodily function, behaviour, appearance or hygiene, and when feelings of attraction give way to the reverse, even of revulsion. When we care for another it is to serve Christ (see Matthew 25). With chronic illness and long-term care, this is not a one-off event, but requires ongoing commitment.” These are not only convictions; they are identity statements.
Imagine if this man were to be asked to help terminate someone's life, at their request. I don't think he could do it. If he did, two people would die—the patient and himself.
It's similar for The Salvation Army's presence in hospices and nursing homes. The Salvation Army is not there for the sake of money or prestige, but because of the convictions that define it. To betray those convictions would undermine its very raison d'être. And so it must seek an “institutional conscientious exemption.”
Dignity and Worth
Does this mean that patients and residents of Salvation Army health facilities cannot ask for assisted-death? No. Importantly, no. The professionals in Salvation Army facilities, who are wise and experienced in end-of-life care, have heard these kinds of requests long before the change in law. They know how to explore what lies behind such a request, and they have the skill to address the pain, suffering, loneliness and assaults on dignity that occasion it. Experience shows that few people who ask for their lives to be ended persist in asking when these symptoms are properly attended to.
Winnipeg's Dr. Harvey Chochinov is a world-renowned expert in end-of-life psychology. In a study published in The Lancet, he concluded that “how patients experience themselves to be seen by their health-care providers, is the most ardent predictor of sense of dignity.… Dignity-affirming care refers to the multitude of ways that health-care providers convey appreciation, respect and kindness to their patients … You are a whole person and deserve my time, my respect and my care.”
It is not because of what The Salvation Army is against that it will not provide physician-assisted death, but because of what it is for. It is for the recognition of the worth and dignity of every person. The Salvation Army believes that every person is created in the image of God and loved by God. Even so, as Dr. Chochinov's studies reveal, people can feel their lives are without worth and dignity unless they see in someone else's eyes that they deserve respect, care and attention.
Palliative-care programs are designed to do just that for those with terminal illness. Hospice staff strive to alleviate otherwise irremediable suffering. They create an environment free from the attitude that the dying should die faster. And, in a host of other ways, they show the dying that they still matter.
A Salvationist conscience seeks to provide “dignity-affirming care” to others, too. Those who aren't imminently dying need the holistic embrace of palliative care just as much. Those who, like the woman who brought her case to the Supreme Court, are steadily losing the capacities that mainstream society says make living worthwhile. And those who are poor, disabled, weak or chronically in pain.
It is an outrage that our country is prepared to approve of physician-assisted death as a constitutional right while so many Canadians still lack the assurance that anyone thinks their lives are even worth continuing.
Dr. James Read is the director of The Salvation Army Ethics Centre in Winnipeg.
In February 2015, the Supreme Court of Canada ruled that the laws preventing assisted suicide were “overbroad.” The court said that prohibiting physicians from ever granting the request of patients who wanted to end their lives infringed on the patients' constitutional rights.
One of the two cases on which the court based its decision concerned a woman who had developed ALS (sometimes called Lou Gehrig's disease). The disease would eventually cause her to lose control of her muscles, and, unless something else intervened, she would suffocate when her lungs could no longer inflate. Her body would give way, but not her mind. She found the prospect agonizing.
When she appealed to the court, the disease was not crippling. She did not want to take her own life just then. However, anticipating a future in which she couldn't commit suicide independently, she wanted her physician to be free from criminal prosecution if he later hastened her death.
The Supreme Court agreed. In so doing, they said that others like her should have the same legal protection— others who were suffering “grievously” from “irremediable” medical conditions and for whom any treatment would be “intolerable”; others who, like this woman, are adults able to consent to and refuse medical treatment on the basis of their reasoned assessment of the alternatives. The court said that people who were “vulnerable”—vulnerable to coercion and manipulation—and people who didn't have the capacity to make informed decisions about their own care needed to be protected. No one should be allowed to legally hasten their deaths. But the court judged that Canada was smart enough and well-governed enough to protect those who needed protection, while still allowing physicians to end the lives of people, like the woman with ALS, at their request.
The Supreme Court said they would delay the impact of their ruling, but in June 2016, physician-assisted death will be legally permissible everywhere in the country as a constitutionally protected right.
New Law
Since the court handed down its judgment, federal and provincial legislators and civil servants, colleges of physicians and other health providers, panels of experts, assisted-death advocates and religious leaders—including the leaders of The Salvation Army—have engaged in intense debate and deliberation. Everyone expects there will be new laws and professional regulations in June, but what will they be, and will they be the same everywhere in Canada?
A committee created by the new federal government, comprised of members of Parliament and senators, has said that the conditions articulated by the Supreme Court should be treated as a floor, not a ceiling—recommending that hastened death be allowed for children as well as adults, and for people who are no longer mentally competent, as well as for those still competent. Further, in their view, nurse practitioners and some other professionals, as well as physicians, should be legally permitted to hasten death. Whether the committee's recommendations will be accepted is presently unknown.
Even if they aren't, Canada's laws regarding the hastening of death will be among the most “liberal” in the world. And it will be necessary for those who think they are bad laws to find ways to live with the reality.
If you are a physician you should be protected on two grounds. One is the professional obligation not to practise outside one's area of competence. (Just as not all doctors are trained to perform brain surgery, only certain physicians will have the requisite training to properly hasten death.) The other is the legal right to opt out on the grounds of personal conscience.
Nurses, pharmacists and other health professionals will probably have similar protection.
Right of Conscience
But what about hospitals, hospices and long-term care homes? Will they be granted protection, too? This matters to The Salvation Army because it owns and manages several such institutions across the country.
In late 2014, General André Cox strongly affirmed, “There will be no change in our theological beliefs or in our positional statements. The Salvation Army will always be pro-life. There will be no change in our values and there will be no change in principle.” The Salvation Army has long argued against assisted suicide and euthanasia. Although death is not to be resisted at all costs and although people deserve excellent management of pain and suffering, we should not resort to physician-assisted death. On this basis, The Salvation Army asserts an “institutional right of conscience” that physician-assisted death will not be performed in its health-care facilities.
Some people seem to think that opting out on grounds of conscience is being a bad sport—a power play to try to win something that was lost in the courts. If you are paid from public funds (as doctors and hospices are), you are obligated to go along, the argument goes. The one who pays the piper calls the tune.
This is misguided and false. Conscience is at the heart of identity. Adults know that if they do certain things, they betray themselves. They will have sold out. When we go to our doctors, we want to know whether we can trust them. We want to know whether they really stand for anything. If physicians sway with the winds of opinion or kowtow to wealth, they are not to be trusted.
A Salvationist conscience seeks to provide "dignity-affirming care"
Commissioner (Dr.) Paul du Plessis is a specialist in palliative medicine. He is married to Commissioner Margaret, who lives with dementia. Last year, Paul shared his “credo” with me. He says, “Relationships should endure even when they are stormy. They should survive loss of cognitive function, social skills and graces, changes of bodily function, behaviour, appearance or hygiene, and when feelings of attraction give way to the reverse, even of revulsion. When we care for another it is to serve Christ (see Matthew 25). With chronic illness and long-term care, this is not a one-off event, but requires ongoing commitment.” These are not only convictions; they are identity statements.
Imagine if this man were to be asked to help terminate someone's life, at their request. I don't think he could do it. If he did, two people would die—the patient and himself.
It's similar for The Salvation Army's presence in hospices and nursing homes. The Salvation Army is not there for the sake of money or prestige, but because of the convictions that define it. To betray those convictions would undermine its very raison d'être. And so it must seek an “institutional conscientious exemption.”
Dignity and Worth
Does this mean that patients and residents of Salvation Army health facilities cannot ask for assisted-death? No. Importantly, no. The professionals in Salvation Army facilities, who are wise and experienced in end-of-life care, have heard these kinds of requests long before the change in law. They know how to explore what lies behind such a request, and they have the skill to address the pain, suffering, loneliness and assaults on dignity that occasion it. Experience shows that few people who ask for their lives to be ended persist in asking when these symptoms are properly attended to.
Winnipeg's Dr. Harvey Chochinov is a world-renowned expert in end-of-life psychology. In a study published in The Lancet, he concluded that “how patients experience themselves to be seen by their health-care providers, is the most ardent predictor of sense of dignity.… Dignity-affirming care refers to the multitude of ways that health-care providers convey appreciation, respect and kindness to their patients … You are a whole person and deserve my time, my respect and my care.”
It is not because of what The Salvation Army is against that it will not provide physician-assisted death, but because of what it is for. It is for the recognition of the worth and dignity of every person. The Salvation Army believes that every person is created in the image of God and loved by God. Even so, as Dr. Chochinov's studies reveal, people can feel their lives are without worth and dignity unless they see in someone else's eyes that they deserve respect, care and attention.
Palliative-care programs are designed to do just that for those with terminal illness. Hospice staff strive to alleviate otherwise irremediable suffering. They create an environment free from the attitude that the dying should die faster. And, in a host of other ways, they show the dying that they still matter.
A Salvationist conscience seeks to provide “dignity-affirming care” to others, too. Those who aren't imminently dying need the holistic embrace of palliative care just as much. Those who, like the woman who brought her case to the Supreme Court, are steadily losing the capacities that mainstream society says make living worthwhile. And those who are poor, disabled, weak or chronically in pain.
It is an outrage that our country is prepared to approve of physician-assisted death as a constitutional right while so many Canadians still lack the assurance that anyone thinks their lives are even worth continuing.
Dr. James Read is the director of The Salvation Army Ethics Centre in Winnipeg.
ALS is a cruel disease. My mum is 83 and had great difficulty speaking and swallowing much of anything. Food was getting trapped in her throat and blocking her air way was happening more often. she battled for each breath. The riluzole did very little to help her. The medical team did even less. Her decline was rapid and devastating. The psychological support from the medical centre was non-existent and if it were not for the sensitive care and attention of our primary physician, there she would have died. There has been little if any progress in finding a cure or reliable treatment. Acupuncture eased her anxiety a bit. this year our primary physician started her on Natural Herbs Centre ALS/MND Ayurvedic treatment, 6 months into treatment she improved dramatically. It has been a complete turnaround with her speech, she no longer needs the feeding tube to feed, the treatment is a miracle. She recovered significantly!