Assisted suicide is not the only answer to suffering

"We operate under a false premise when we equate the suffering arising from disease, illness or disability with a loss of dignity."

The Supreme Court of Canada rules in favour of physician assisted suicide

It is eloquent, persuasive and based in law; it almost had me convinced that physician assisted dying is the correct response to suffering.

In the Carter decision, the Supreme Court of Canada ruled that a competent adult who consents to death, and has a “grievous and irremediable medical condition (including illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition” has a right to physician assisted dying.  The ruling does not restrict physician assisted dying to those who are terminally ill.

The Court found that a total ban against physician assisted dying is broader than necessary to achieve its objective of protecting  “vulnerable persons from being induced to commit suicide at a time of weakness”.  In the view of the Court, the consequences of the prohibition impinge on the individual’s right to life, liberty and security of the person.

In the words of the Court, “the prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear they would be incapable of doing so when they reached the point where suffering was intolerable. The rights to liberty and security of the person, which deal with concerns about autonomy and quality of life, are also engaged. An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy. The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person.”

As I read through the lengthy decision, it was difficult not to let the logic of the Court inform my belief on the matter.   It is hard to argue against the individual’s right to autonomy and dignity when I like to make my own decisions, and have no wish to endure suffering, nor watch someone else endure it.

Still, I have issues with physician assisted dying.

A different view of suffering

My attitude towards suffering differs from the negative approach towards suffering implied in the term “dying with dignity”, and endorsed in the Carter decision. In my view, the human person is created in the image and likeness of God. This divine stamp on the individual sanctifies every human life, and gives each of us an innate and inviolable dignity.

We operate under a false premise when we equate the suffering arising from disease, illness or disability with a loss of dignity. I have known people to endure each of these with great dignity, allowing their suffering to transform them, and in the process, their relationships and those who cared for them. Rather than losing their dignity, they grew in graciousness.

Archbishop Antonio Mancini of Halifax-Yarmouth, in a homily I happened to hear while visiting Halifax a few days after the Supreme Court decision, addressed our struggle to make sense of suffering.  “When there is no meaning to suffering, it is only pain, and of course people are afraid… But where there is meaning, where there is love and proper care, where there is community support, suffering can become sacrifice. Sacrifice is not just another word for ‘put up with’. It literally means…to make something “sacred”. To take suffering and to transform it with meaning is to make the reality of suffering a manifestation of the holy and the sacred.”

While this view of the relationship between suffering and dignity differs from that of the majority of Canadians and of the Supreme Court, there is the same desire to act compassionately towards those who suffer. From this standpoint, the compassionate response begins with a willingness to share, not to avoid, the suffering of another, and encompasses support and care.

For those who do not applaud this decision as one giant step forward for Canadians, and who seek an alternate response, the Canadian Conference of Catholic Bishops has issued a statement that may be helpful. The bishops recommend that legislators interpret the decision as narrowly as possible so as not to open the door to euthanasia. They urge governments and professional associations to implement policies that will protect the freedom of conscience of health-care workers who oppose physician assisted dying. And, they renew their call for universal access to quality hospice-palliative care.

Undergirding these action points is an unshakeable belief in the sanctity of human life as a reality that defines the human person, and in the power of love to ease the transition from life to death in even the most difficult of situations.

Let's talk about dying ...just shoot me is not a plan

According to a 2014 Dying with Dignity Ipsos-Reid Survey, 84% of Canadians agree “a doctor should be able to help someone end their life if the person is a competent adult who is terminally ill, suffering unbearably and repeatedly asks for assistance to die”.  While the push to legalize physician-assisted suicide has Canadians passionately debating the right to die and what it means to die with dignity, the debate has had little effect in motivating those who are healthy to prepare for their own eventual date with the Grim Reaper.

We communicate our fear of dying in subconscious ways

Research indicates that most people are fearful of suffering during the dying process. I think we communicate this fear subconsciously through actions that let us believe we can cheat death. These actions are not necessarily bad for us, and may even motivate us to continue living life to our fullest, but they do nothing to ease the way into death or make our dying easier for those we love.

One way we may communicate our fear of dying is to pretend that we are not getting older, obsessing over aging, or jealously guarding our independence, symbolized in our reluctance to surrender our driver’s license, or downsize our home.

We avoid taking practical steps to make our death and dying easier for others. Only 56% of adult Canadians have a signed will, and less than 29% have appointed a power of attorney; fewer have designated a substitute decision-maker for personal care and health matters.  We are highly unlikely to preplan our funeral, even though 75% of us believe doing so would make things easier for our family.

Even our spiritual preparation for death can be limited to our last days when our families seek out the priest to hear our deathbed confession and administer the last rites. 

We think we have lots of time to prepare ourselves to meet our maker and to get our affairs in order, even though death is the one certainty in life and the Grim Reaper lurks in the shadows.

Creating an Advanced Care Plan

The Canadian Hospice Palliative Care Association, partly in response to the public discussion about euthanasia and physician-assisted suicide, wants to shift the public conversation towards the importance of quality hospice palliative care and away from some of the more negative views of death, which, in my view, have played a significant role in shaping Canadian support for physician-assisted suicide. The organization has a suggestion that can help us prepare for our own death and dying.

It recommends that we start talking about end-of-life issues with our family, friends and health-care providers, and suggests that individuals create an Advanced Care Plan (ACP) that will provide direction for our care when the time comes. An ACP can guide us in articulating our personal beliefs and values, and can help us clarify our own attitude about dying and what constitutes a good death. It gets the discussion moving about the types of medical interventions that we would accept or reject if faced with a chronic illness, or a life-threatening illness or injury. And, it provides information on the legal requirements and documents that will enable others to act on our behalf.  An ACP is not a sign-up sheet for physician-assisted suicide or euthanasia; it is a comprehensive plan that can help us live out our life until its natural end.

While the public discourse has Canadians talking about the death and dying of a small minority, most of us skirt around the topic of our own mortality. We avoid planning for that unavoidable dance with the Grim Reaper.

The Grim Reaper can be a motivating image

The Grim Reaper, incidentally, became embedded in the European psyche during the bubonic plague of the 14^th century, when no one could forget the reality of death. It was sometimes depicted in an embrace with a young woman to symbolize that death is an integral part of life. Rather than frighten us, it is an image that can remind us to live well, to never give up on the journey towards wholeness and holiness, and to follow confidently in the footsteps of Jesus who embraced the world from the cross and shows us the way through suffering.

The conversations I have with others about death are largely superficial because the topic can become morbid and depressing. We talk about avoiding suffering, and we would prefer to die in our sleep after a long, healthy and happy life. And, should we become decrepit or senile, we joke about telling our kids to “just shoot me”, which really is not much of a plan when it comes to preparing for death and dying.

Dying with dignity is more than physical

The province of Quebec has responded to the report of its  "Dying with Dignity" commission. The Quebec proposal is recommending that euthanasia/assisted suicide be decriminalized in limited and rare cases. The province is proposing that terminally ill individuals be allowed to request the help of a doctor to end their life. 

Under Quebec's proposal, an individual could make the request providing the individual is:

• suffering from an incurable disease, with no hope of improvement
• experiencing intolerable physical or psychological pain
• receiving palliative care

The proposal places euthanasia/assisted suicide within the realm of medical care; in this context, euthanasia/assisted suicide would be considered an appropriate, and compassionate level of “medical aid in dying”.

Definition

In euthanasia, a third party, such as a doctor, takes the action that ends the individual’s life, while in assisted suicide the dying person takes the final action that causes death.

Those who express support do so from a place of compassion

A recent call in show on CBC Radio debated the issue of euthanasia/assisted suicide. Callers from both sides of the debate shared their experiences.  The callers had journeyed with people they loved through debilitating diseases, and the process of dying. It was evident that this experience had profoundly affected each one of them, and influenced their opinions. Those who expressed support for euthanasia/assisted suicide were responding from a place of compassion and love.

While I do not support euthanasia or assisted suicide, I understand why many people favor the Quebec proposal, and hold the opinion that euthanasia/assisted suicide is a compassionate, and humane response to dying. We do not want to watch someone we love suffer, especially when that person is dying from a painful and debilitating disease that robs the body of its ability to function. We have a collective aversion to pain and suffering. Out of compassion for the dying, we want their suffering to end.

Equating human dignity with a properly functioning body

The discussion of euthanasia/assisted suicide is often framed in terms of human dignity, and we hear frequent references to ‘dying with dignity’.  There is a perception, and a fear that we can lose our dignity in the dying process. As a society, we are developing a vision of dying with dignity that, in my view, relies too heavily on our physical capacities.

We have come to equate human dignity with a properly functioning body. In the euthanasia/assisted suicide debate, when we talk about human dignity, we are most often referring to things like the terminally ill person’s ability to communicate, and to control bodily functions, especially eating and elimination.  A body that is in decline is seen as undignified, and an affront, robbing the individual of ‘quality of life’, and causing unnecessary suffering to the dying and those with them.

Human dignity depends on more than the vigour of the body

Most Canadians would agree that human life is precious. Many of us consider human life to be sacred.  In the Christian worldview, which I share, the human person is more than a physical body. In the teaching of the Catechism of the Catholic Church (# 364), we are animated by a spiritual soul, and we share in the dignity of the image of God. Body and spirit, precious and sacred, the human person has an innate and inviolable dignity.

A view of human dignity that relies solely on the vigour of the body takes into account only one dimension of the human person. It overlooks the psycho-spiritual dimensions of the person.  Human dignity depends on the whole person, and should never be restricted to the physical.  We do not lose our dignity when our body breaks down.

Death may be a moment of exceptional grace

Medical care, especially when caring for the terminally ill, should consider the whole person. Suffering and death, more than any other experience in life, reveals the spiritual dimension of our existence. A comprehensive debate on euthanasia/assisted suicide must include a rigorous discussion on the concept of human dignity. While death is the disintegration of the body, it may also be a moment of exceptional grace, when we discover fully and completely our imperishable dignity, and meet its author face to face.