“What does it mean to ‘be present’ to someone who is dying, and to ‘provide care’? What care do I want to experience when I am dying? Can I provide care for somebody who has very different values from mine?”
These are some of the questions posed in a new study guide aimed at helping Anglicans reflect on and respond to Canadian legislation regarding medical assistance in dying.
The Rev. Eileen Scully, director of faith, worship and ministry for the Anglican Church of Canada, who led the creation of the guide, says changes in legislation have helped to open conversations about “how do I envision how I want to be cared for in my death, in my dying?”
In a historic ruling Feb. 6, 2015, the Supreme Court of Canada struck down laws against physician-assisted dying and gave the government a year to produce new legislation.
In the wake of this decision, a task force of the faith, worship and ministry committee produced an Anglican response, called In Sure and Certain Hope.
The new legislation, passed in June 2016, is now in effect, and allows eligible Canadian adults who have a “grievous and irremediable medical condition” to request medical assistance in dying.
According to the government of Canada’s latest interim report, 1,982 medically-assisted deaths were administered in the first year of the practice’s legalization. (An additional 167 medically-assisted deaths took place earlier in Quebec, which passed provincial legislation prior to federal legalization.)
“The changed legal landscape has moved us…to a point where many of us are likely to know, love and care for those who will face difficult decisions and may choose to avail themselves of medically-assisted dying or to reject such an option,” the study guide notes.
Like In Sure and Certain Hope, the study guide does not address “the debate about the moral appropriateness” of medically-assisted dying. Instead it aims to provide what Scully says has been missing from the church’s response—“the ability to really sit with the pastoral, ethical questions and just say, ‘So how now do we live?’ ”
The challenge, Scully says, is nudging people to have those kinds of conversations.
“It’s a cultural, societal generalization I’m going to make here, but generally, people [are] more interested in being able to debate an issue, to talk about a thing that’s ‘out there’ rather than enter into their own feelings, experiences, personally and interpersonally—where it’s about real lives and real people,” she says.
Scully says they had always planned to create an accompanying study guide after In Sure and Certain Hope was released in 2016. The project took longer than expected, and in the interim, members of the task force had the chance to join and lead discussion groups, panel discussions and clergy conferences on the topic. Through these experiences, they discovered the challenge of directing the conversation away from a “yes-no” debate, which helped shape the guide.
The guide includes suggestions of where and how it can best be used, notes to help group leaders prepare to facilitate a discussion on the topic, processes for discussion groups and guidelines for constructive conversations, and two case studies.
In response to the case studies, the guide recommends reading the stories up to three times and imagining a personal response from different perspectives—as oneself, as the principal caregiver and as the dying person—and reflecting on what elements of the story resonate each time.
“Some of the best kind of learning is paying attention to narrative…You’re driven by curiosity to engage with the story,” says Scully.
Archdeacon Douglas Fenton of the diocese of New Westminster, a member of the faith, worship and ministry committee, helped create and approve the study guide. He sees the guide as providing an entry point into the complex topic of end-of-life care. “I don’t think it’s something that we’re going to just naturally fall into unless we have some guidance on how to enter that conversation.”
There are many facets to the conversation about medically-assisted dying, Fenton says. “It’s not only theological; it’s not only medical ethics and moral theology. It’s also individuals’ spiritual lives that we’re talking about.”
The issue affects not only those making an end-of-life decision for themselves, but family, friends, clergy and caregivers around them.
Scully says the committee is hoping to hear feedback from groups that use the discussion guide.
Her next step, she says, is reaching out to Anglican chaplains and spiritual care providers who work on the front lines of end-of-life issues. “What I hear from them is a kind of loneliness, and the need to talk about this stuff,” she says. She hopes to create a network of spiritual care providers and perhaps a national, or several regional, gatherings.
“There’s nothing more that we share in as humans than life and death,” adds Fenton. “I think…we so often take for granted the life we live.” We rarely talk about death, he says, pointing out the many euphemisms our culture has for death. “On Good Friday, Jesus ‘dies’; the rest of us ‘pass away.’ ” The more resources available to facilitate these kinds of conversations, he says, the better.
“We as a church have a duty to care for each other,” adds Scully. “Actually, it starts beyond that—we have a duty to care for the world.”