Article by Deacon Larry Worthen
Christian Medical and Dental Association of Canada
[Note: This article is based on a talk Deacon Larry recently gave. It will be updated with a video of the talk sometime in the upcoming weeks.]
Recently, a friend passed away after a long battle with esophageal cancer. He was a man who lived life to the fullest right up to the end. He wrote a weekly blog about his experience of having a terminal illness which helped his readers see that death could be approached calmly and with a sense of hope. He also grew in his relationship with Christ in the months leading up to his death. He was baptised and confirmed and I was honoured to be his sponsor into the church.
When his treatments were discontinued because they were no longer beneficial, he contacted me to have a heart-to-heart talk. He wanted to know that he could reach out to me for encouragement and support if he needed it. I reassured him that he could call me anytime.
He had a few good weeks after that and so I did not hear from him. Eventually, I heard through his son that he was not doing very well. One Friday morning he called me on Zoom and was very distraught. He had gone to the bathroom with the help of his wife earlier that morning and had fallen off the toilet. He lay on the floor helplessly for 30 minutes until the paramedics came to get him back into bed. When he was talking to me, he was sobbing uncontrollably. His primary concern was his wife. He said that he did not want to be a burden to her. I listened as well as I could and asked “Have you discussed your feelings about this with your wife?” He admitted that she had reassured him that she wanted to love him by caring for him during his time of vulnerability.
I said “I have a theory that might explain what you are experiencing. Do you want me to share it with you, to see if it makes sense?” After he answered in the affirmative, I explained that since his diagnosis he had had losses, things he had to give up. Because these losses came gradually, he was able to deal with them one by one – by talking to God, and his wife, family and friends. This week, however, he had experienced a lot of loss, all at once. And it had overwhelmed him emotionally with grief. I assured him that being overwhelmed from time to time is part of the process. He was only human after all. Even though he had felt helpless lying on the floor of the bathroom he experienced his wife’s and God’s unconditional love.
My explanation seemed to give him peace. I said “so many times in your blog your readers talked about your courage in the face of death. But really, it is today’s story that you should write about because today was your most courageous act of all.” Later that day he was transferred to a local hospice.
I saw him in person in the hospice only once after that to pray together. He held my hand and I thanked him for being my friend when we said goodbye. He died peacefully the next day and a few days later I presided at his interment.
As we were talking that Friday morning it dawned on me how vulnerable my friend was in this weakened state. What if I were a physician who believed that MAID was a good thing for patients and had the same interaction with my friend? How would I have responded to his concern about being a burden to his wife? Not wanting to be a burden was the reason given for 35.9 % of the patients who died by MAID in Canada in 2020.
The sad reality is that there is division within the Canadian medical community about how to respond to my friend’s lament. In the original Carter decision, the court held that there was no medical consensus on the ethics of assisted dying. Yet regulators have taken steps to ensure that every physician has an obligation to take action to ensure the patient has access to MAID. This means that as far as the regulators are concerned, death and life are equally valid outcomes for patients under these circumstances provided the criteria for MAID are met. The current Canadian narrative is that we leave that decision up to the patient, because we have no ethical consensus about the rightness or wrongness of intentionally ending the lives of patients. But in my friend’s case he was so vulnerable that any intervention might have pushed him one way or the other. Since there is now no waiting period for MAID when death is reasonably foreseeable, this means that for this type of patient, every interaction can rapidly escalate to MAID.
We can see how the physician’s ethical stance can have a significant impact on communications with the patient and their final decision. The patient is someone’s father, mother, wife or husband. Current legislation and policy does not require that those people be informed if the patient decides to die by MAID. Once the patient signs the forms, their death is justified, regardless of their motivation. Should physicians even have that level of power over their patients?
In Canada, legalizing MAID was a decision taken by one BC judge in the Carter case that was later upheld by the Supreme Court of Canada. A small but very well positioned network of lawyers, academics and media leaders started the initiative that, after a while, appeared to have a life of its own. The use of the courts allowed the advocates to do an end run around politicians who were only too happy to have a politically challenging issue taken off their plates. A positive MAID narrative was established in the media which the majority of people were unable or too afraid to challenge. Physician’s associations were reluctant to stand against this tide as well.
In June 2016, when MAID was legalized, the public had a mental image of Gloria Taylor in mind when they thought of patients who wanted MAID. Gloria Taylor was the BC grandmother who had ALS and was worried about her capacity to end her life because of her disability. She was a plaintiff in the Carter case. There was also Toronto doctor Donald Lowe who appealed to the Canadian public for the legalization of euthanasia via a video that was promoted by the CBC. The public saw articulate, supported, independent people who had time to consider their wishes. This “halo” effect for MAID has resulted in punitive intervention by regulators against practitioners who object to the practice as well as expansion of those who are eligible to include new categories of individuals. Now persons with disabilities, those with chronic illness, people with psychiatric conditions are included. Children and those who have advanced directives are currently being considered by a parliamentary committee.
Despite all of the good press, I am convinced that many people in the medical fraternity continue to be uneasy with the legalization of MAID. We estimate that only 1% of physicians in Ontario participate in MAID, either by doing assessments or performing the procedure. If this was really a good thing for patients, wouldn’t it be embraced by many more physicians?
There have been reported implications for patient care. I would like to share with you some anecdotes that help describe our current situation. Some of the anecdotes come from published accounts while others come from conversations, I have had with well- established prominent palliative care physicians. To protect their privacy, I have not included the names of the sources that have not been already published.
- An article this week in the Globe and Mail [Note: Published May 9th 2022 and paywalled: Assisted dying must not be confused for palliative care.] provided this quote from prominent palliative care physician Dr. Leonie Herx: “Many palliative care services have had to integrate MAID into their programs in order to receive funding. . . . As a result already scarce resources . . . have been diverted to support MAID services. Tragically, too many physicians know of patients who opted for MAID due to lack of adequate palliative-home care resources to remain in their homes or in the community."
- Doctors reported that when patients withdraw their request for MAID after counselling, disappointed family members and medical colleagues can be critical of the physician for “talking the patient out of it”. As most jurisdictions have a requirement that physicians cannot block access of patients to MAID, physicians are worried about generating a College complaint from colleagues or the patient’s family if the patient changes their mind and then claims the doctor was responsible. I have also directly heard stories of third parties being criticized by medical staff when a patient changes their mind after consultation with chaplains and even substitute decision makers. People report that “once the MAID train leaves the station it is difficult to stop it in its tracks.”
- This problem is made even more severe with the challenges to medical care posed by COVID 19. I was told that patients requesting MAID in hospital were being referred for an assessment directly without any counselling because of COVID 19 related strains on the health care system. MAID providers are clear their job is not to provide counselling. Admittedly they are legally required to talk about options, but the concern is that the in-depth counselling to uncover motivations did not occur.
- One physician shared a story about a patient who had requested MAID because she had been assessed and had to move to a nursing home. When the physician found a way to admit her to her former chronic care hospital, she withdrew her request for MAID. The degree of personal autonomy that an individual has depends on their social networks, and the emotional, financial, intellectual and spiritual resources at their disposal. One person encounters a doctor who will advocate for them, while another person in the same situation does not. This does not seem to be fair. It is a matter of life and death.
Six years after the legalization of MAID, the patients who now qualify also include the disabled, the chronically ill and those with mental health concerns. In the view of their advocates, none of these groups, or the terminally ill for that matter, have appropriate or sufficient care to provide suitable alternatives to MAID. We therefore run the risk as a society of promoting MAID by not providing other ways to deal with suffering. In fact, if we are providing insufficient options then how can we argue that MAID is a choice?
One of the pleasant surprises in the 2021 public opinion survey that we funded of Ontario residents was that 55% of respondents were concerned that disabled people would choose MAID because there were insufficient alternatives. This statistic indicates that there are people who are open to a new narrative. Recent news reports about a woman in Ontario who chose MAID because she had environmental sensitivities and could not find proper housing, are gaining traction. A second woman may be following the same path.
In September of this year, we plan to launch our “No options = No choice” campaign which involves the development of a series of short videos highlighting the challenges faced by vulnerable patients to access services and supports that allow them to choose life rather than death. The videos, which will be shared on social media, will invite people to our web site where they can write their provincial and federal politicians about increasing funding for programs for people with disabilities, terminal illness and mental health concerns. We feel that this project is something that our networks of churches and advocacy groups can promote.
It is not controversial, because it simply advocates for patients to be able to make choices. But its implicit message is that the narrative provided by MAID advocates is hiding the reality of a serious abandonment of patients.
As Christians we know that human dignity is a gift from God. It does not depend on human attributes. We also know that our Saviour identified with the vulnerable. We have all experienced the presence of Christ when we reach out to vulnerable people. Because of Jesus Christ we have hope and that hope is something the world really needs right now.
I’d like you to consider helping with this project in one of the following ways:
- Pray for us.
- Send us stories about vulnerable patients and MAID and what you are doing to help.
- Promote the campaign by sending information out to your contacts – professional, personal and church
Our doctors are staying at their posts in a very difficult time for the sake of their vulnerable patients. Their environment is increasingly hostile to their perspectives. Like my friend who was dealing with grief they have lost a lot. We need to pull together to support each other in this difficult time. By doing what you can, you will feel better for trying to protect the vulnerable. These are truly difficult times, but Christ provides us with manifold grace to sustain us in trial. With every challenge there is an opportunity for courage.
God bless you.