On May 7, Maclean’s hosts the fourth in a series of town hall meetings, “End-of-Life Care: A National Dialogue.” Held at the Queensbury Convention Centre in Regina in conjunction with the Canadian Medical Association, it will also be live-streamed at Macleans.ca. The conversation will continue at a town hall meeting in Mississsauga, Ont., on May 27.
“Whose body is it anyway?” Sue Rodriguez famously asked two decades ago. Not hers, or yours for that matter, traditional Western thinking has answered for almost two millennia. The answer is rooted in Christianity’s reading of the divine’s will, a reading shared by the other monotheistic faiths, Islam and Judaism. And it’s one reiterated by numerous religious bodies, including the Catholic bishops of Quebec, in their recent collective denunciation of Quebec’s proposed Act Respecting End-of-Life Care, which sets out conditions under which someone can get medical help to die.
But the idea that suicide or mercy killing (as it was once known) are grave sins has long since sunk into the West’s cultural DNA and hence into the law codes that blocked Rodriguez’s claim to ownership of her own life and death. The concept is such a bedrock of Western morality that Mark Miller, a physician, bioethicist and, yes, Roman Catholic priest, can argue passionately against doctor-assisted dying on moral grounds without once mentioning God or Catholic theology. But the bedrock has been crumbling for a long time now—into dust, actually, in the Netherlands, Belgium and some American states where it is no longer a crime, or even morally dubious, for health care professionals to speed dying for those who wish it. And perhaps soon in Canada too, in Quebec and elsewhere, if new federal bills decriminalizing physician assistance in dying become law.
The struggle in this country has numerous factors: whether there is enough palliative and hospice care available to blunt the demand for assisted dying or if an acknowledged right will lead to diminishing palliative funding, and whether potential participants will feel relief at the possibility or pressure. But the outcome will turn, as all great values debates do, on a crisis in authority: which side has the arguments to best capture Canadians’ deepest-held beliefs.
Personal autonomy, choice, control—possibly the highest values in the modern West—are the guiding principles of those who assert a right for us to control our deaths. They are the basis of arguments that frustrate far more than they repel opponents. “Of course there must be respect for individual choice,” says Moira McQueen, a lawyer and theologian at the Canadian Catholic Bioethics Institute, “but not all choices are morally right, and we don’t live in a world just made up of individuals.” We “all live in the shelter of relationships,” echoes chaplain Susan Morgan of St. Elizabeth Health Care, which provides home hospice services in Ontario, B.C. and Quebec. “The experience of the people we care for is that the closer humans come to death, the more autonomy they necessarily lose—it’s up to us to let them make the discovery they are not a burden.”
Priest and physician Mark Miller has been pushing both his profession and his Church for more and better palliative care for 25 years. For those who can get it, “good care means living while you are dying—for some people it’s the richest part of their lives, when they know that the important thing is knowing you are loved and still loving.” Yet too many physicians, he adds, “slough it off as the realm of the death specialists, while the Church tends to get off on moral issues without necessarily doing the practical stuff that needs doing.” It’s a “misuse” of the principle of autonomy to say what individuals do with their lives (or deaths) has no effect on others. “At the end of the day, the very concept will change society; there will be pressure—on the elderly who don’t want to be a burden, on the disabled, on anyone who feels they are living a life that others don’t think a rational person would consider worth living.”
Mainstream moral reasoning has always accepted a patient’s right to refuse or abandon medical care and letting nature take its course. Miller, in fact, thinks too little of that takes place: “Five years on a ventilator in an ICU?” he asks rhetorically. “Rationalize that and properly fund palliative care and much of the demand for death and the fear of it will go away.” On that issue, Wanda Morris, CEO of Dying With Dignity, a group dedicated to allowing end-of-life assistance in dying, couldn’t agree more. “That’s what has been learned in places like Oregon: remove the legal barriers and few take up the prescriptions they can now ask for, fewer of them fill the prescriptions, and fewer still use them.”
It’s the control, Morris avers, the knowledge you can get that assistance if you need it, that is the driving force. “Not everyone is attached to a machine. If those people can refuse medical intervention, why can’t those with chronic conditions like ALS who can foresee painful deaths get help?” Because one action allows death to approach, Miller says, and the other “makes you a killer, and we don’t want to live in a society of killers.” For Morris and others, those physicians are healers, not killers.
The two sides are not so far apart on individual autonomy as it seems to them. Everyone who has staked a position on how we should approach the end of our lives believes, in effect, that dying is a social act with (very serious) individual consequences. Even those who demand the right to make their own call are making one more social demand on the rest of us, the right to ask: help me out of here. In the end, the issue of choice looks to have more traction among Canadians. Few people may take up the option for timing their own deaths, but far more will want to know it’s there for the choosing.
At the Regina town hall, Louis Hugo Francescutti, CMA president, will offer opening remarks. The panel features Dr. Jeff Blackmer, CMA executive director of medical ethics, and Ken Stakiw, co-medical director of palliative services, Saskatoon Health Region. The moderator will be Maclean’s Vancouver Bureau Chief Ken MacQueen.