Physician Assisted Dying In Canada – A Brief Primer
Physician assisted dying, or assisted suicide, has been a much debated topic in North America for the last several years. In a recent article, Collin Hansen referred to it as one of the ten most important theological stories in 2016. With legislation working its way through the courts on both sides of the border, this issue is likely to continue to dominate the headlines for several years to come.
Canada's Bill C-14
On June 17th 2016 the Canadian Parliament passed Bill C-14 into law effectively amending the Criminal Code in order to permit and make legal certain forms of physician assisted dying. According to the amendment a person may receive medical assistance in dying only if they meet ALL of the following criteria:
(a) they are eligible — or, but for any applicable minimum period of residence or waiting period, would be eligible — for health services funded by a government in Canada;
(b) they are at least 18 years of age and capable of making decisions with respect to their health;
(c) they have a grievous and irremediable medical condition;
(d) they have made a voluntary request for medical assistance in dying that, in particular, was not made as a result of external pressure; and
(e) they give informed consent to receive medical assistance in dying after having been informed of the means that are available to relieve their suffering, including palliative care.
(f) their natural death must be reasonably foreseeable.
As a further precaution two medical practioners or nurse practitioners must agree that the patient meets all of the above listed criteria.
In November of 2016 I had the opportunity to sit down with Dr. Diane Haak, Dr. Ben McNaull and pastor and lawyer Josh Tong in order to discuss the legal, pastoral and Gospel implications of this legislation.
Bill C-14 And Religious Liberty
The critical issue with respect to religious liberty has to do with the requirement for effective referral. Effective referral essentially requires a physician to request and to affirm as suitable and necessary a specialized procedure. This is understood in the medical profession as a necessary part of the process and a critical aspect of the assumed cooperation between the family physician and the specialist. Therein lies the problem. Most Christian family physicians do not wish to cooperate in this particular procedure.
To listen to Drs. Haak and McNaull define Physician Assisted Dying and explain why it is a significant religious liberty concern see here. To hear them explain how this legislation will result in employment discrimination see here.
There is also a concern that medical colleges will begin actively screening out candidates that have moral objections to this particular procedure. This suggestion was recently made in print by a professor at Queen’s University in Kingston Ontario. The article in the journal Bioethics went so far as to claim that “Doctors must put patients’ interests ahead of their own integrity”. People of faith may soon be effectively barred from entering the medical profession if this point of view becomes dominant.
To listen to lawyer Josh Tong discuss this particular issue see here.
Is There A Solution To The Current Legal Impasse?
Bruce Ryder, a constitutional specialist at Osgoode Hall has written that in his opinion the best way to balance patients’ and physicians’ rights would be for governments or medical associations to maintain an online registry of physicians willing to provide medical assistance in dying. He is quoted in the Globe And Mail as saying:
“Requiring objecting physicians to inform patients of the existence of such a registry would be a minimal impairment of their conscience rights and would ensure patients receive timely access.”
In essence, patients desiring the procedure could manage their own referral through the on-line registry taking their family physician completely out of the loop. They would still require two doctors or nurse practitioners to certify that they meet the criteria, but there would be no need for their family doctor to be involved in the process.
Most of the physicians I have spoken to, while maintaining their opposition to PAD in the first place, view this option as a potential compromise. This is in fact precisely the solution being pursued in the Province of Alberta, but so far, Ontario has shown little interest in following suit.
Pastoral Care In A Bill C-14 World
All of this greatly complicates issues when it comes to offering effective and ethical end of life counsel to grieving families. Hospitals will now regularly offer options to families and patients that include a mixture of ethical and unethical treatments and procedures. Pastors will be asked for counsel and should be prepared to speak in an informed and Biblical manner.
To listen to the counsel I received from Drs. Haak and McNaull see here.
Bill C-14 And The Gospel
There is a danger in treating this issue as if it were only a religious liberty concern. The Christian church after all was not founded in order to protect the religious liberties of its membership. Indeed, the founders of the Christian church enjoyed very little in the way of religious liberty. However, while this issue presents itself to our attention under the guise of religious liberty it doesn’t take a great deal of discernment to discover the essential Gospel concerns that lie beneath the surface.
On October 31st 2016 the CBC website ran an article about a 27 year old man named Adam Maier Clayton. The article stated that he suffered from anxiety, mood disorder and obsessive compulsive disorder. He has been petitioning the government to broaden the eligibility requirements for physician assisted dying to include mental illness and psychological suffering. The article quotes him as saying:
"Non-existence is better than this. Non-existence is better than having my father go down my banking history to make sure everything is in check”
Read that sentence one more time.
Here we have a mentally ill person asking for Physician Assisted Dying because he struggles to manage his personal finances. He is frustrated, he is hurting, he is in obvious psychological distress but knowing what we know about what the Bible says about life after death for those outside of Christ how can we not understand this as a significant Gospel concern? “Non-existence” for this young man if he does not know Christ will be infinitely and eternally worse. This is a Gospel issue!
Christian physicians occupy a unique position within Canadian culture and require adequate legal protection to function in that position as salt and light. They must be permitted to operate in accordance with their religious convictions which include beliefs about the value and preciousness of human life and the significance of entering eternity without saving faith in Jesus Christ. This is not merely about protecting the employment privileges of physicians and medical practitioners, it is about preserving human life and protecting a strategic Gospel witness.
To help protect this witness and to show your support for the conscience rights of Canadian medical practitioners please visit www.CanadiansforConscience.ca
And may God alone by glorified!