Between two worlds
I first met Phil on a sunny Tuesday afternoon in his private room up on the palliative care unit. He was a retired engineer in his late 70s. He had a wonderful family, a beautiful home; he travelled extensively with his loving wife and was very active in his church for a long time.
But now this Christian faith terrified him because of the news he received from his doctor a few months ago: Phil was diagnosed with astrocytoma, an aggressive brain tumor, an inoperable cancer. Radiation and other forms of treatment seemed to be out of the question. And now it seemed like all that was left was the inevitable.
“Pastor, I really can’t bear this anymore,” Phil lamented. “I know it is probably not right but I really feel like asking the doctor for a pill or injection so I can go to sleep and not suffer anymore. Do you understand what I mean?”
What do you say to a man like Phil who has a robust faith in Jesus yet expresses a genuine desire to end his life because the disease burden is too great to bear for him and his family?
New possibilities in dying
Historically, it has been a crime in Canada for one to help a person in ending his/her own life. But in the landmark case of Carter v. Canada, the Supreme Court of Canada (SCC) unanimously determined that the prohibition of medical assistance in dying violated the Charter rights of competent adults who seek medical aid to terminate their lives.
As a result, through Bill C-14, the federal government amended the Criminal Code in June 2016 to allow practitioners to provide medical assistance causing death without any criminal charges. Federal and provincial governments were asked to come up with their own framework and implementation of medical assistance in dying (MAiD).
An interim report released April 2017 indicates that 507 people died in the second half of 2016 by MAiD in Canada. Half of the deaths took place in hospitals or other healthcare facilities.
As the number of people with advanced disease burden grows, so does the desire to push the “ejection button” prematurely. Early and equal access to pain and symptom management, commonly known as palliative care, is proven to alleviate unnecessary disease burdens and sufferings (cf. Gallagher and Baldwin in B.C. Medical Journal), but this is far from commonly available in Canada. Untreated or ignored symptoms lead to a greater degree in “total pain” in the form of existential suffering and spiritual angst.
Journeying with compassion
Christians are not exempt from this. As a matter of fact, people with strong spiritual receptivity sometimes experience greater tension when it comes to making decisions on treatment options and goals of care in end-of-life and/or critical care situations. How do we, as people of God, continue to live and offer “hope and healing, support and counsel” (Article 14, Confession of Faith) in this difficult context?
This goes deeper than ethical and theological dialogues at a cerebral level. The bulk of my work as a clinical chaplain at a medium-sized hospital involves people with irreversible disease trajectories. A good number of them, regardless of their spiritual affiliations, will end up dying in healthcare facilities. Their needs are much deeper than a satisfactory answer to the suffering question. As they bounce through various stages of their illness, it is vital to have someone journeying alongside and supporting them through the compassionate, nonviolent, comfort-focused measures of palliative medicine.
In a context where MAiD is now being seen as a treatment option for the terminally ill, it is essential to uphold the intrinsic value of life as a gift from God. Instead of being a euphemism for medical assistance in dying, “dying with dignity” should be perceived as a biblical mandate in which we advocate for better care in end-of-life situations. We can continue to live well in this dying process because of this great hope of resurrection in Jesus. And as we exemplify this reality, in sickness or wellness, people will query the reason for the hope within us (1 Peter 3:15).
Another contentious issue associated with MAiD concerns availability. As the provinces continue to make MAiD a viable alternative to patients, Christian healthcare workers face the inevitable tension between the observances of their professional standards and the Christian worldview on the sanctity of life.
If a Christian physician with a conscientious objection refers the patient to another doctor, does it mean he/she is indirectly complicit in the act of referral?
How does a Christian nurse respond if s/he faces the requirement to administer the medication in a medically assisted death in order to be hired or maintain employment, even if it is against his/her core spiritual beliefs?
What are our rights as conscientious objectors?
Is a person’s right-to-die equal to another person’s obligation?
The issue of conscientious objection goes beyond individual practitioners. All healthcare institutions including faith-based hospitals, nursing homes and hospice facilities are affected. Many faith-based healthcare providers that are founded on and maintain spiritual and ethical beliefs now face challenges in handling requests for medical assistance in dying.
This is especially tricky when it comes to individuals who have tenancy agreements with their residential care facilities (i.e., it is their home). Transferring the care of people who are terminally ill is also no easy task as staff at a faith-based facility continue to provide care even if they disagree with the resident’s MAiD decision.
How can we respond as Anabaptists?
The provision of MAiD is now legal in Canada and there are no immediate solutions to the current challenges mentioned above. One thing is for sure – as followers of Jesus we will continue to serve and walk alongside those who see MAiD as a legitimate alternative to palliative medicine. The love and salvation of Jesus discriminates against nobody, including people who choose to end their lives. It is our duty to attend them with diligence and love as Jesus modelled for us.
Death is part of our existence, but it must not hijack us with its fear. For we know that “death has been swallowed up” in the victory of Jesus (1 Corinthians 15:54). Nothing will ever separate us from the love of God (Romans 8:38–39) as we acknowledge his grace and mercy, even in the seemingly grim circumstances of imminent death.
We are also called to pray for our fellow brothers and sisters within the medical service (physicians, nurses, pharmacists and other allied health professionals) who are hard-pressed to accommodate this massive shift in care philosophy. There needs to be on-going dialogue in our wrestling with MAiD, both within the realms of theology (through the eyes of our faith) and thanatology (through the academic study of death and dying).
Death is unavoidable, but a death substantiated with the hope in Jesus is definitely achievable.
Yes, Phil died, and his fear was real and overwhelming. At times, he was scared it would destroy him, yet supportive presence and adequate palliative treatment brought him back to himself. In the end, he was able to die a “good death” with much anticipation of the parousia (return).
[Lawrence T. Cheung is a spiritual health practitioner with Providence Health Care in Vancouver, B.C. His ministry focuses are with the patients in palliative care, emergency and nephrology. He and his family are members of Killarney Park MB Church in Vancouver.