Monday, March 7, 2016

Putting the doctor assisted dying option in the spotlight....we vote "yes"

Here we go again!

With 40% of the Canadian population identifying with the Roman Catholic church, two of their leaders, this week, came out swinging against the proposal before the federal government to put forward a piece of legislation that would permit doctors to assist those in extreme circumstances to die. The Cardinal in Toronto, Thomas Collins, had read from every church pulpit in his diocese a letter condemning the proposal. The Bishop in Ottawa, Terry Prendergast, spoke to the National Post indicating that Catholics who chose this path to end their life would not be eligible for the “last rites”.

While the proponents of the legislation, a similar law already having been passed by the Quebec legislature, (historically the most “catholic” province in the country) argue that it is a human right, guaranteed, in their view, by the Charter of Rights and Freedoms. Naturally the Catholic leaders consider it an grave sin because, like abortion, it ‘takes a human life’. The debate in this country will likely heat up between now and June when, by order of the Supreme Court of Canada, the government must bring forward legislation that paves the way for doctor assisted dying.

As a non-Catholic, I can readily see the consistency of the Catholic position, that all life is sacred, and that any overt human action that usurps that life is evil. Contraception, abortion, doctor-assisted dying are all of a piece, under the requirements of their absolute position. And, it is precisely because of the absolute-ness of the Catholic position that it is and can and must be confronted.  

Already, millions of Roman Catholics practice some form of “artificial” birth control, under the supervision of their medical practitioner. Condoms and IUD’s have become common practice, when prospective parents weigh the choice of having more children (some of which they see as unaffordable, others as blocking their path to a career). And whether the church enforces some “liturgical sanction” on those who use contraceptives or not, everyone knows that the practice is ubiquitous. And, as part of the rationale for their position, some Catholics argue that the population of the world, projected to reach 9 billion in this century, will put a significant strain on the ecosystem, and the capacity of the people on the planet to feed, and to clothe and to education and deploy in work with dignity. That argument, however, is not as valid when applied to the debate over doctor assisted dying.

The Right to Life campaign to end a woman’s access to therapeutic abortion continues unabated, on both sides of the 49th parallel, with consider success especially in Texas where over half of the clinics in which the procedure had been performed have now closed, given the strict conditions required by new Texas law, a law that is being challenged in the Supreme Court. Even moderates in the United States agree that abortions must be both legal and therapeutic, particularly in the case of rape, incest or to protect the endangered life of a mother. In Canada, on the other hand, while access may be limited, especially in remote rural areas, and the campaign continues to garner support, the law is unlikely to be overturned any time soon.

Suicide, on the other hand, as a human act, has a history that links it to earlier conceptions of demons, mental illness and “craziness” with which previous historical periods simply could not deal. And anything that involved the taking of a life, whether by an outside agent or by the person inflicting the act on his or her own person, was considered evil. As the locus of the society’s definition of evil, the church’s role, while heavy and serious, was also one of attending to the long-term interests of the institution, the preservation of people of discipline continuing to life the “good life”. Rewards, of a heavenly nature, and sanctions of a, institutional nature were linked in a pattern of classical conditioning, that many considered sacred. Only as recently as 1977, the Canadian government removed the act of suicide from the Criminal Code, giving legal expression to the concept of mental health as a contributing factor in one’s taking one’s life. Since that time, obituaries that read, “suddenly,” are often ‘code’ for a death by suicide. Still, there is a hushed conversation about a possible suicide, and initiatives to prevent suicide have sprung up, helping family members and friends to take note of potential ‘symptoms’ of an impending suicide. Still, however, we hear comments like, “If only I had seen the signs!” from distraught family and friends of the deceased, following a suicide. Whether those individuals who espoused a Roman Catholic faith and committed suicide were given a church funeral is an open question; probably yes in some quarters, and no in others. So the church’s history is nothing if not perfectly clear and consistent, on the issue.

And now, under the pressure of individuals coming forward to seek medical help in ending their own life, a decision taken, for the most part, by those of sound mind who face a terminal illness, and/or the prospect of no end to their extreme suffering, governments whose members consider themselves “enlightened” have passed, or are considering passing laws that would make the intervention of a medical team that includes at least two doctors, and a patient of sound mind, including young people the law considers ‘minors’. One medical doctor, a specialist in disease control, from Mount Sinai Hospital in Toronto, even went so far as to record his own plea for doctor assisted suicide, given the extreme pain his own cancer was inflicting on his person. It is not only one’s body, but also one’s mind and spirit that are overwhelmed by the pain of some illnesses. And the incapacity of the family to alleviate the suffering is also another important feature of such a family situation.

Palliative care, while important and less accessible that everyone would like, does attempt to make those in the end stages of their life comfortable, and as responsive as their condition permits. And everyone would approve of a significant enhancement of that flank of our national health care system. Hospitals, too, have included palliative care sections to their facilities, in addition to the several hospice facilities available in some centres. Nevertheless, there are still people suffering tragically and hopelessly in their own private cave of desperation, who would prefer, and whose families would prefer, that their suffering were brought to a dignified termination.

And, in the broader definition or conception of life, (that sacred concept), there is the life of the individual and the life of the family and the life of the community that has to be taken into account in any ethical consideration of one’s theological belief and practice. And that makes the question’s relevance, and perspective very different from a narrow definition of the biological nature of life. That consideration alone is legitimately considered by many to be a reductionistic approach to the issue.

It is the cookie-cutter rule, applied to circumstances not considered in the application, that renders those adherents to the rule infantilized. Faith, religion, ethics...these are both hard and complex questions, and the mystery of a human being's relationship with a deity is more complex and mysterious than virtually all other relationships. The power of the church, and its leadership, to presume to decide for sentient, mature, thinking and pondering, not to mention praying and reflecting humans on such momentous decisions as whether to conceive a child, or whether or not to end a child's life, or whether or not to choose to access doctor-assisted dying, is overhearing. In fact, setting such a 'bar' as the highest ethical value, is not only presumptuous (presuming to know God's mind) but also demeaning to the human capacity of free will, another of God's gifts to every human. And then to presume to punish those who defy the ecclesiastical edict only adds insult to injury. Taking a position of listening to, of counselling, and even of perhaps providing some mature advice would make much more sense of the relationship between human and God, and bring a different kind of agape to the situation that respects the ambiguity and the mystery and the nuances of every human being going through the decision-making process.

In all aspects of the question of the sacredness of life, contraception, abortion and assisted dying, the narrow definition of the application of the ethical principle is suspect because such an application,  while pure and consistent and absolute, negates the attenuating circumstances. For example, the capacity of the mother/family to give adequate care to an unexpected child, likely to be born out of marriage, to a single mother, in many cases, is a consideration for many women who have to bear the burden of parenthood alone. In the black community alone, in the United States, over 40% of children are born to single parents and as the access to therapeutic abortion atrophies, just today, the New York times writes that the search for back alley, and solo/private abortions will continue to grow. No law is going to prevent or stop men and women from engaging in the act of sexual intimacy, and birth control is not always going to be either available or chosen. No law is going to prevent reasonable and legitimate situations that require a woman to seek a therapeutic abortion. And while there is a reasonable attitude that says the fewer abortions the better for all, nevertheless, access to facilities that are staffed by trained professionals, in sterile atmospheres, with sterile medical equipment are all far more preferable to the former back alley, dark-night abortions of the past.

Similarly, in the case of assisted dying, the church’s absolute position does not fit all situations like a cookie-cutter. In fact, it is the absolute application of a principle to every situation that renders the church’s position untenable. It ignores a significant piece of scriptural evidence: that the relationship between an individual human being and his/her God is a private and personal one, that God does speak to individuals, and that the specific application of the agape love requires more than a single form, frame or approach. Theology, like ethics, is both highly contentious and profoundly impactful. And no one knows the fine details of anyone else’s life, history, belief system, world view, capacity to sustain whatever pressure is imposing itself on any individual. Hence, the argument of a single ecclesiastical law, decree, ethical bar, or gateway to God’s love and acceptance is not sustainable.

I would want any and all members of my family to be able to choose assisted dying should their circumstances make continuing their life unbearable, and should those circumstances be attested to by a panel of medical/ethical/family personnel in support of their decision. Should I become incapacitated, and subject to unbearable pain and suffering without any chance for a return to even a modicum of normal health, I would, along with Dr. Low from Mount Sinai, seek and exercise my right to assisted dying, if for no other reason than those who care about me would be relieved of their own stresses, anxieties and depressions that not only can I not recover, but they cannot, in conjunction with the medical team, improve the situation regarding my “end of life” process.
Of course, enhanced palliative care, including more hospices, would both expand the pathways to a peaceful end of life; nevertheless, the option of assisted dying, without medical professionals who participate having to face criminal charges, seems both ethical and reasonable, not to mention compassionate and ‘healthy’.

In those countries where the option already exists, there is little or no evidence that the option has been abused. The prospect that assisted dying be open to all ages, including the very young who can also suffer deeply from illness or accident, also makes good sense, and we look forward to the day when the Canadian government brings in legislation that considers the human rights of Roman Catholic medical professionals to opt out of having to provide this procedure, that builds in reasonable and responsible checks and balances to prevent both abuse and illegitimate use of the option, for private greed or gain.
And we will be watching, should the first draft presented to parliament not include extension of the option to minors, for that addendum to be added, following a reasonable period, possibly three years, during which the patterns of the applications and the choosing of assisted dying as an ethical option by mature adults, in consultation with their families, their doctors and a team of professionals including ethicists develops.


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