Wednesday, March 2, 2016

Coming soon to a hospital near you: physician-assisted dying

Physician-assisted death is coming soon to a health care institution near you. You won’t need to be terminally ill to access this ‘medical intervention’.  In its Carter decision, the Supreme Court of Canada gave Canadians the ‘right to die’, and provided an answer to the perennial problem of pain and suffering.  

Rejecting the belief that suffering can be redemptive

Carter is about more than the "right to die.” It reflects shifting national values about the nature of human suffering. This shift has a lot to do with the rejection of religion in general, but more specifically with the rejection of the Judeo-Christian tradition that shaped our nation.

Some of the values of the tradition conflict with the values Carter expresses. The tradition looks to God’s plan to guide human behavior. Carter relies on personal autonomy and choice.  And whereas, the Judeo-Christian tradition searches for a redemptive value in suffering, Carter rejects suffering.

While people have always struggled with the reality of suffering, throughout history we have recognized and accepted suffering as part of the mystery of being human.  In days past, we were more willing to grapple with suffering and to scrutinize its meaning than we are today. We are much more likely to view suffering in all of its manifestations (summarized in Carter as illness, disability or disease) as an affront to our dignity and a threat to our ‘quality of life’.  

Carter is "an extreme honouring of individual autonomy"

I spoke with Sister Nuala Kenny about the Carter decision and the thorny reality of human suffering. Kenny, of the Sisters of Charity of Halifax, is a pediatrician and the founder of the Department of Bioethics at Dalhousie University. She was a member of the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, which released its recommendations at the end of November 2015. She is a strong opponent of physician-assisted death.

In Kenny’s view, Carter “goes far beyond the media valorization of the person who is in intractable pain and suffering.”  She zones in on two major problems. 

Carter “is an extreme honouring of individual autonomy, but an autonomy that then requires a reciprocal obligation on the part of others.”   It places an obligation on physicians to respond positively to a patient’s request for death. As a physician, Kenny sees this obligation as a betrayal of the Hippocratic tradition.  We have a “huge obligation to provide support for the physical symptoms, that is compassion in itself, and that allows the person who is terminally ill or dying to deal with the spiritual and emotional and psychological challenges.” As a Catholic, the focus on individual autonomy expresses a lack of trust in God’s plan for the individual and the community.

Carter turns suffering, which is a metaphysical reality, into a medical problem. To explain the “medicalization of suffering”, Kenny points to the reasons that lead people to request physician-assisted death. These reasons include a sense of a loss of dignity and of independence, worries about becoming a burden to others, uncertainty about the future, and fears of isolation and a lack of care.  “Those are issues of human suffering. The medicalization of suffering uses death as a treatment for suffering, because there is no prescription for suffering.”

Sharing in the paschal mystery

In the Christian tradition, when a person suffers, he or she metaphorically shares in the Paschal mystery – the suffering, death and resurrection of Jesus. Kenny points out that for Christians the notion that physician-assisted death is a compassionate and merciful response to suffering “repudiates the suffering of Jesus” and “flies in the face of the mystery of suffering.”  While this may appear ludicrous to non-Christians, for those of us who profess the Christian faith, it should inform our attitude to suffering, and shape our response to the Supreme Court decision.

Within Catholicism, Kenny worries that Catholics have capitulated to the contemporary values of independence, choice and control. We are reluctant to accept the mystery of suffering; we have become so inculturated that our deepest values may be unchristian, she said.  “We don’t even know that it (physician-assisted death) is wrong.”

By June 2016, even if no regulations are in place, physician-assisted death will be legal in Canada. And while the time for debating the pros and cons of physician-assisted death has past, it is not too late to minimize the potential harms of Carter’s overly broad and permissive criteria.

A productive response for those of us who have grievous concerns about physician-assisted death centers around palliative care.  Canadians need quality and accessible palliative/hospice care.  This is holistic care that tends to the complex needs of the suffering body and soul, neither hastening death nor prolonging life.

Physician-assisted death is coming soon to your community. Isn’t it time for optimal palliative/hospice care to do the same?

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