Today, I will attempt
to summarize the document In Sure and Certain Hope issued by the
Anglican Church in 2016. It is an update
of the 1998 Statement on Euthanasia and Assisted Suicide, Care in Dying. The 2016 paper is intended as
a, “Resources to Assist Pastoral and Theological Approaches to Physician
Assisted Dying.” These two documents
provide, I believe, a good perspective on this very complex and challenging issue
for Christians.
The document begins with the affirmation that all people are
created in the image of God and as such have inalienable dignity and should be
treated in ways that reflect this:
Theologically we continue to assert that human persons,
being in the image of God, are the bearers of an inalienable dignity that calls
us to treat each person not merely with respect, but with love, care, and
compassion. This calling, being a reflection of God’s free grace, is in no way
qualified by the circumstances that an individual may face, no matter how
tragic.
Consequently, this places a
duty on society to care for people who require help in appropriate ways:
We need to pay attention to how we are to sustain
communities of care around patients, respecting the decisions of, and
exercising the best possible care first for the patient and then also with care
for the immediate supportive community. In this context the church needs
neither to surrender its basic principles and insights nor propound them in a
way that simply isolates the church from the theologically essential task of
empowering individuals caught up in these situations to make sense of their own
lives, their hopes and fears, their pain and distress.
The document provides framework
for appropriate support which reflects this understanding:
a framework for effective pastoral support for all
concerned (patients, family, loved ones, care providers, and wider communities
of support), whatever decisions particular patients ultimately believe
themselves called to make.
Below are experts from the report
which, I hope summarizes key points. The
report is extensive so it is, of necessity longer than usual.
Suffering
The report
acknowledged that suffering might be meaningful. However, it also noted that
suffering might be devoid of redemptive value in and of itself.
Life as Gift
Already in the case of the withdrawal of treatment we
recognize that life is not an end in itself, and that the approach of death
need not be resisted by all available means.
Care and Community
Understandings of care, and how those understandings shape
and express community, lay at the heart of the reflections in Care in Dying.
Indeed, the trajectory of that document was in many ways set by the way it
answered the question of what constitutes care. In seeking to answer the
question of whether a decision to participate in the ending of life could be
construed as an act of care, the study was in some ways quite tentative.
Vulnerability and Justice
In the area of physician assisted dying there are still
reasons to be concerned about the impact of this change on those in our society
who are most vulnerable…for the churches it is important that we continue to
express concern for those who might be adversely affected. This is not simply a
slippery slope argument. It is rather based in the complexity of how
constitutional protections work and the experience of other jurisdictions where
the initially narrow grounds for physician assisted dying became widened out of
legitimate concern that some who might benefit were excluded under the initial
definitions.
In our society dignity is most commonly linked to the
capacity to be the author of one’s own destiny. However, this is linked with
understandings of human individuality and freedom that are difficult to
maintain.
Perhaps the key point, however, is that the language of
dignity is supposed to remind us that in decisions about the life of a person
it is that person’s life, inherent worth (however that is ascribed), values,
hopes, aspirations, story, etc. that drive the decision-making process and not
the imposition of interpretive frameworks from without, the imposition of what
Zizak and Brueggemann would call ideology
To uphold the intrinsic worth of the human person is to
protect the very vulnerable members of society—those who have (or appear to
have) little if any extrinsic value, because they do not have the capacity for
full authorship or autonomy, and are not able to have the same sorts of
relationships that more “productive” members of society have. This value challenges
the linkage of dignity and worth with autonomy and ability to be in control of
all aspects of one’s life.
Conscience
It will surprise some people that the principle that the
conscience must always be followed (conscientia semper sequenda) is a key element
of Catholic moral theology that has continued if not with greater importance in
the churches of the reformation. The role of conscience grants to the
individual believer the responsibility to be the author of his or her own
decisions.
Hope
As Christians we are called to lives shaped by hope. Hope
involves the commitment that, whatever our circumstances, God is at work for
our good (Ro 8:28 c.f. Mat7:11). It stands opposed to despair. At the same time
hope is not to be confused with a passivity that is unresponsive to our
circumstances. Hope requires that we cooperate with God in the purposes that
God is working out in our lives.
Providing Alternatives
While it is now clear that the provision of such
alternatives cannot function as a bar to patients making decisions to seek
assistance to end their lives we remain of the view that this change will not
reflect the intended affirmation of the dignity of patients unless there are
genuine alternatives amongst which they can discern real and significant choices.
Palliative Care
Although often thought to be synonymous with “terminal” or
“compassionate” care, palliative care is not confined solely to situations in
which curative therapies are no longer possible or desired. Rather, the focus
is on relief of distressing symptoms and maintenance or improvement of the
quality of life of the sufferer regardless of the prognosis or projected
duration of the illness.
Pastoral Care
What matters is that for many, the premium challenge of
end-of-life is to continue to experience meaning, purpose and control over
one’s life.
This presents our church, and those who care for the ill,
with two fundamental challenges. First: pastoral care-providers must discern
honestly through prayer and consultation their personal views and values and
how they affect their capacity to support patients in decision-making in
relation to end-of-life and assisted dying.
Second: pastoral caregivers must assess the strengths and
limitations of available resources that can, or cannot, support the parishioner
who seeks assistance with dying
Pastoral Care and the ministry of presence
Being present to another requires the sacred ability to
listen, to speak and to touch. It is within the sacred conversation of being
present that one can sometimes discern most clearly the needs, questions and
desires of the other.
I acknowledge that we are on Turtle Island, the original
homelands of the many Indigenous Nations who have lived since time immemorial
in Canada or as many First and other Indigenous Nations
All of the lands in Canada are the subject of up to one hundred Treaties signed
by the Crown in the right of Canada with these Nations. I will only mention a few of the Nations:
the Cree, Ojibway, Blackfoot, Blood, Dakota, Mig M'ag, Huron, Inuit and these
lands are also home to the Metis people.
