Some problems with "An Act Respecting End-of-Life Care"

Quebec proposes to enact Bill 52, "An Act Respecting End-of-Life Care", as early as September 2013. The Act will enshrine "medical aid in dying", including assisted suicide, as part of the continuum of medical care at the end-of-life. 

Medical aid in dying will be available according to a set of controlled measures specified in the Act. My understanding from watching an interview with Quebec's Minister of Social Services, Veronique Hivon, is that these measures are intended to limit abuses, while providing a compassionate and caring response to those individuals who seek to hasten their death.

Bill 52 has implications for all of Canada regarding end-of life-care. The arguments are nuanced and require careful analysis.

While I recognize that Bill 52 expresses a deep concern for those who are suffering from an incurable disease at the end-of-life, I am not convinced that legislating a form of assisted suicide is the most compassionate response of a just society.

Autonomy and dying with dignity
In my view, the two most common arguments in favour of assisted suicide - autonomy and dying with dignity - are fundamentally flawed.

We rightly value and want to protect our personal autonomy. Yet, there is very little that we can ever completely control.  Our decisions are never made in a vacuum; our interactions with others, with society, and with events influence our decision-making.  The decisions we make affect not only our own self, but others as well.  

An individualistic determination to control one’s death at the end-of-life exceeds the realm of personal autonomy.  When we are well enough, we want to live; we eschew suicide.  When physical deterioration limits our self-sufficiency, we may want to die.  At that point, we may want another to do the very thing we would not do our self – take our own life. Legislation would frame this desire as an entitlement based on compassion, autonomy and dignity. 

In an earlier post, I expressed my opinion on dying with dignity. To reiterate, dying with dignity is almost always referred to in connection with progressively debilitating diseases; ALS and Alzheimer’s, for example, are frequently mentioned.  There is an underlying presumption that progressive diseases rob the individual of their dignity as suffering increases and the body deteriorates.  There is a perception that physical decline equals a loss of dignity.

The sacredness of the invidivual

We are in danger of developing a view of life that relies too heavily on the vigor of the body and its ability to function. This view limits the sacredness of the individual. It overlooks the emotional, psychological, and spiritual dimensions of the person. It excludes the possibility that the natural process of dying may also serve a metaphysical purpose.

Every individual has an innate and inviolable dignity that disease, suffering and death cannot erase.  The dignity of the individual manifests itself in the totality of body, mind and spirit. End-of-life care must always proceed in a manner that recognizes and reverences the sacredness of life and the dignity of the whole person. 

Experts in palliative care say that pain can be successfully controlled and managed. Yet, depending where we live, less than 30 percent of Canadians who are dying have access to or receive appropriate palliative care. Rather than focusing on assisted suicide, the creation of an accessible and universal palliative care program would help to ensure that the dying receive reverential care appropriate to the dignity of the human person.

Abortion should be safe, legal and rare

"For me, the child developing within the womb is not an exclusive reproductive right, but a gift entrusted to the care of both sexes."

With the recent death of Henry Morgentaler, abortion is again making its way into the public forum. Rationality is often missing from the discussion. The language from both the pro-life and pro-choice camps is frequently highly charged with emotion and vitriol.
In my most recent column, I strive to present an informed and measured approach to abortion.

In the ultrasound images, I thought I recognized the nose

I was excited about being a grandmother from the beginning, but when I saw the ultrasound images of the little one at 19 weeks, I was overcome with emotion.  We could clearly see the little feet, only millimeters long, and in the profile of the face, I thought I recognized the nose.  I stand in awe before the wondrous miracle of life.

Not everyone shares my wonder. There are some who have no compunction about terminating the life of the little person developing in the womb. For them, abortion is a woman’s reproductive right, a simple procedure as benign as removing a wart.  For me, a child developing within the womb is not an exclusive reproductive right, but a gift entrusted to the care of both sexes.

The polls

With the death of Henry Morgentaler, the famous abortion activist whose determination to provide safe abortions for women changed Canada’s abortion law, the highly divisive issue of abortion is once again attracting public attention in both traditional and online media formats.  Despite the public discussion, Prime Minister Stephen Harper refuses to allow any debate on abortion in Parliament, and a January 2013 Angus Reid poll concluded that although “Canadians have continued mixed personal feelings on abortion…the appetite for true legislative action is lacking.”   Two-thirds of Canadians polled are unwilling to re-open the debate on abortion.

The reluctance to formally debate abortion is puzzling given the interest in the topic and the findings of recent polls.  Could a lack of awareness about the absence of abortion laws in Canada explain, in part, our hesitation?

The Angus Reid poll notes “45 percent of respondents mistakenly assume that a woman can have an abortion only during the first three months of her pregnancy”.  Thirty-five percent support no restrictions on abortion, 5 percent would ban abortion, and 60 percent “express a preference to regulate abortion in different ways”: during the first trimester, in cases of rape, when the mother’s life is in danger, or if the fetus has serious defects.

A 2012 Ipsos Reid poll had similar, albeit confusing, findings: 49 percent of respondents said that there should be no restrictions on abortion, while 45 percent felt that abortion should be permitted only in “special circumstances”.  Yet, in the same poll, 60 percent of respondents favored gestational limits on abortion.

Coercion is a factor in many abortions

The Angus Reid poll reported that 43 percent of men and only 27 percent of women favor the status quo. This last finding hints at a problem with abortion that does not often make its way into the public discussion: coercion is a factor in a high percentage of abortions. 

While it is not always men who force a woman to have an abortion, the male partner plays a critical role in the decision.  Others who may exert pressure on a woman to abort include her mother, her father, a doctor or another medical professional. 

A 2004 study, reported in the “Medical Science Monitor”, found that 64 percent of women who had an abortion in the United States did so because of pressure from others. This was despite the woman’s desire to have the child.  Coercion is something to bear in mind when extolling abortion as a woman’s prerogative over her reproductive rights.

Coercion may also play a role in female feticide, which is becoming a cause of concern in Canada. Sex selective abortion is another area where the majority (60 percent of Canadians overall and 66 percent of women) believes there should be laws to “outline whether a woman can have an abortion based solely on the gender of the fetus” (Angus Reid poll on gender based abortion).

Not a rare procedure

Abortion in Canada is not a rare procedure. In 2012, the Canadian Institute for Health Information reported 64, 641 documented abortions in Canada, excluding Quebec.  Since 1979, there have been an estimated 3.5-4 million abortions in Canada.

Still, we remain ambivalent. Harper has read the mood of Canadians correctly. Collectively, we lack the political will to address the legislative vacuum created when the Supreme Court reversed Morgentaler’s conviction and struck down the abortion law in 1988.

Legal, safe and rare: its time to work on the latter

While I would prefer that we treasured and protected the miracle of life at every stage, Canada cannot go back to the days when the criminalization of abortion forced women into back alleys. Abortion, to paraphrase Hilary Clinton, should be legal, safe, and rare. Canada has the first two covered; it’s time to work on the third.

Can Pope Francis bring Catholics home?

People want  leaders who practice what they preach, and Francis seems to be doing just that. Will his charismatic charm and concern for the poor be enough to bring Catholics home?

In my last post, I mentioned that I was on vacation. I had such a relaxing vacation that I completely forgot to post my most recent column. Here it is, with a little preamble not included in print versions.

A few weeks ago, I had a call from a reader, an older gentleman of the Anglican persuasion. He expressed his admiration for Pope Francis, and his hopefulness for change within the Roman Church. We had a lively and interesting conversation, and I was grateful for both his support of my column and for his comments on Catholicism. 

I have been surprised at the amount of interest that people are showing in Francis. He seems to be touching the hearts of people, which brings us to the question of my column: "Will Pope Francis’s charismatic charm and concern for the poor be enough to bring Catholics home?"

Church attendance on the decline

Research surveys support what most people already know.  Church attendance is declining and has been for decades.  In Canada, 28% of Catholics attend Mass at least once a month, compared to 40% in 2004.  In the United States in 2012, 24% of Catholics attended Mass at least once a week compared to 47% in 1974.

While I have no idea what the stats are for Catholics in my little neck of the woods, I can certainly provide anecdotal evidence of declining church attendance.   I have sat through numerous meetings over the years grappling with dwindling finances that correlate with shrinking congregations, and listening to laments about the lack of young people in the pews.  Only a handful of children attend the after school religious education program, and a significant percentage of students enrolled in our Catholic school are non-Catholic.  Sunday after Sunday, the spaces that deceased parishioners formerly occupied remain empty; no one is rushing into fill the gaps. In the last three decades, my family has belonged to three parishes within a ten-mile radius, and our current parish church is next on the local chopping block.

The generalized lack of interest amongst baptized Catholics to practice the faith concerns bishops, priests, religious, pastoral councils, and parents alike.  Dioceses are desperately trying to turn the tide through evangelizing already baptized Catholics.  The Archdiocese of Vancouver, British Columbia, for example, launched a sophisticated advertising campaign called “Catholics Come Home” to entice Catholics back to church.  Other dioceses are offering adult faith formation courses, and promoting youth programs modeled on the hip style of evangelical churches.

Opting out of institutional Catholicism

Catholics are opting out of institutional Catholicism for many reasons. Church teaching on sexuality, the treatment of women, and the clergy sexual abuse scandal are among the most often cited reasons for leaving the Church. 

Pope Francis has begun to address the sexual abuse scandal that so rightly outraged Catholics in North America and Europe. Although it remains to be seen how the Vatican will implement the pope’s directive to  “act decisively” to protect minors, help victims, and deal with the guilty, Francis wasted no time in making his views known.

With regard to women in the Church, Francis shocked some Catholics when he included women in the annual Holy Thursday ritual of the washing of the feet. While washing the feet of a woman in detention is a far cry from the ordination of women, Francis’s action demonstrates an inclusive attitude towards women not previously seen from the Vatican.

On matters of sexuality, Pope Francis upholds the teaching of the Church on gay marriage, birth control, divorce and remarriage. I think all that we can realistically expect from Francis in these areas is a compassionate response to individuals who, in the eyes of the Church, do not measure up to its high standards of sexual morality and holiness.

The place where I believe Francis has a real chance for making inroads with Catholics and others is in his genuine concern for the poor. People see a huge disconnect between the suffering of the poor and the wealth of the Vatican with its ostentatious pomp and ceremony. Even though thousands of religious and lay Catholics are walking with the poor, theological speeches about the poor disappoint when there is no visible action from the Vatican: the credibility of the Church suffers.

Our world needs authentic leaders. Catholic or otherwise, we want leaders who practice what they preach, and Francis seems to be doing just that.  Will it be enough to bring Catholics home? Possibly not, but it may be enough to stop the bleed.

Hallmark is partially right about mothers

...I thought of my mother as springing into the world, fully formed, like Athena from the head of Zeus, ready for the action of being my mother.

This Mother's Day, I am enjoying a vacation in Sooke, BC on the west coast of Vancouver Island.  We are in a modern cottage on an expansive property overlooking the Strait of Juan de Fuca surrounded with beauty and quiet. The place is conducive to reflecting on blessings. My own mother  has been a blessing in my life, and I hope that I am a blessing to my children. I was also blessed in my relationship with my mother-in-law, my grandmother, and several aunts.  

Around Mother's Day, we tend to focus on the traits that we commonly associate with mothers; flowery cards abound extolling mothers for their gentleness, kindness, compassion, and lifetime support. One of the dangers of this Hallmark style of effusiveness is that we may reduce women to the biological role of child bearing and the sociological role of child rearing. While I am privileged to be a mother and am extraordinarily blessed in my children, motherhood is not the sum total of who I am, or of my contribution to the world.  

Springing fully formed, ready for action

I suspect that from an early age we quite naturally think that the primary role of a woman is to be a mother.  We literally begin life attached to our mother’s body, and in our immaturity, we think that our mother is an extension of our own self.

My mother and father 

I’m not sure when I first came to the realization that my mother had her own identity. For a good portion of my life, I thought of my mother as springing into the world, fully formed, like Athena from the head of Zeus, ready for the action of being my mother.  It just did not enter my head that my mother was once a little girl, skipping on the street; or a teenager, breaking loose from her own parents; or a young woman with dreams and aspirations for her future.

My mother's brown coat

If I were to design a Mother’s Day card, it would have two pictures: a mother in a brown, wool coat with the caption, “a generous mother”, and a mother in a navy coat with the caption, “and a talented woman”.

My mother had two such coats.  I remember the brown coat clearly. It had a beautiful fur collar and big round black buttons.  At the same time the brown coat made its way into her closet, a white faux fur coat appeared in mine.  I loved that coat; it was haute couture for a little girl, and I felt special and glamorous when I wore it.  It was a sad day when I outgrew it. I wonder if my mother felt a similar sense of sadness when she said good-bye to the brown coat.  You see, while I wore my coat for one season, my mother wore her coat for years.

The brown coat is fixed in my memory as a symbol of generosity. It never occurred to me that Mom went without so that her daughters could be well turned out.  But, it was even more than that. We enjoyed Mom’s lavish generosity on a daily basis, even if we failed to notice it. Material sacrifices, like wearing the brown coat winter after winter, meant nutritious food on the table, a roof over our heads, swimming and piano lessons, properly fitting clothes, and a university education.  With the gift of her time, she nurtured us and our dreams, while her own took a back seat. 

And her navy coat

Perhaps my mother did feel a touch of nostalgia when she got rid of her brown coat because that coat had seen us grow from children into young women. It had been with Mom through the busy years of raising four daughters and the lean years of building a business.  But more than likely, Mom was ready to put on her new navy coat as a symbolic welcome to the next phase of her life, a phase that gave her the freedom to explore new avenues of service to the community, to discover new talents, and to have some fun of her own along the way.

I have never asked Mom if she minded wearing that brown coat for so many years, but I am confident that she would look at me incredulously and reply, “No, why would I mind?”  And in that reply, lies the lavishness of a mother’s love and the generosity of a woman who graces the world with her particular talents apart from motherhood.

Much Ado About Nothing?

Chicago Blackhawks defenseman, Duncan Keith, made some snide comments to female reporter Karen Thomson following a 3-1 loss to the Vancouver Canucks. Don Cherry went on a rant about women in men's dressing rooms, and his colleague Ron McLean countered with an opinion on the CBC website.  

I have never personally understood why any reporter, male or female, needs to be in the locker room getting an "exclusive" interview with a player. Really, what earth shattering revelation hinges on how a team played or didn't play its game?  It's much ado about nothing. But, this latest sports controversy prompts the question, "What price do we put on respect? How highly do we value the dignity of each person?"

For my thoughts on this, please see "Locker room banter isn't always funny" from Troy Media.