MAID remains a controversial subject for many, and after welcoming everyone to the session, van der Meer acknowledged that those attending probably had different views and perspectives. “We are not here to persuade you in any direction,” he assured them. “We are here to respect where each other is coming from and to give enough information, so you have some insight about Medical Assistance in Dying,” and to provide a setting where people felt comfortable asking questions.

He introduced the two guest speakers:

• Dr. Justine Amaro, an emergency medicine and MAID physician at the Ottawa Hospital, and assistant professor in the Faculty of Medicine at the University of Ottawa
• Dr. James Downar is the head and professor of the Division of Palliative Care in the Department of Medicine at the University of Ottawa; Clinical Research Chair in Palliative and End of Life Care for the Faculty of Medicine at the University of Ottawa; staff physician, department of Critical Care at the Ottawa Hospital, and investigator for the Bruyere Research Institute.

The discussion provided an overview of MAID, including some of its history and its path to being legalized, who is using it, ethical concerns or legal constraints, as well as practical details about what happens with a MAID procedure, who qualifies and how MAID is accessed.

Downar began the discussion with a brief history of MAID including landmark legal cases such as Sue Rodgriuez’s, when her fight to have a physician help end her life as her condition of ALS advanced lost in a Supreme Court of Canada decision by one vote in 1993. Many cases followed, but none succeeded until a case brought forward by two women — one with ALS, the other with spinal stenosis—won their case in BC Supreme Court, BC Court of Appeal, and ultimately the Supreme Court of Canada in the early 2015. This ruling struck down the law that made medical assistance in dying illegal for people with “a grievous and irremediable medical condition, ..[defined] as serious and incurable, advanced state of irreversible decline in capability, and somebody who’s experiencing intolerable suffering or suffering that was intolerable to them,” he explained.

When the federal government passed Bill C-14, they added the criteria that a natural death must be reasonably foreseeable, but that was soon challenged in court by two people with disabilities but not terminal conditions. Downar explained that the governments of Quebec and Canada amended the law, so there are now two tracks, one if there is a reasonably foreseeable death, and another if the person does not have a terminal condition but they find their suffering intolerable.

He noted that Quebec has gone one step further, passing a bill allowing advanced requests for people who have a condition where they know they will lose their ability to make decisions in the future.

So far, that is not allowed in the rest of the country, and it touches on one of the difficult complications of MAID that Dr. Amaro discussed. A safeguard in the process is that the person who has applied for MAID must be capable of understanding what is happening and giving their consent on the chosen day. “If on the day of the procedure, I arrive and say, ‘Would you still like to go ahead today?’ and the patient is unexpectedly confused, delirious, they don’t know why I’m there, they don’t understand what’s happening, we can’t go ahead,” she explained.

That concern causes some people to ask for MAID sooner than they might otherwise. Although Amaro says that an amendment to the law has been made that allows for a waiver of final consent, a signed agreement with the doctor specifying conditions in which the person wants the procedure to go ahead if they have lost capacity. Nevertheless, Amaro explained that any sign of refusal on the designated day still ends the process entirely. “We can’t ask later. We’re finished,” she said. “Whereas if you have capacity, you always have the right to change your mind…. “If you say, ‘Dr. Amaro, I’m actually feeling pretty good today. I don’t think I do want MAID yet. Can we put this off?’ 100%. No problem. No one’s going to be upset with you. We can put it off till any future date if capacity is maintained.”

Amaro’s description of how patients are assessed highlighted some of the other safeguards in place. As opposed to the time pressures in much of health care these days, Amaro says assessing physicians visit people who have applied for MAID in their homes, which she says gives her the opportunity to listen to people and understand their situations. “Some patients … want to just get the questions answered and go through it in 20, 25 minutes and we’re done. And sometimes I have the pleasure of sitting over a cup of tea for an hour or two.” A second physician does a follow-up visit, going over all of the same questions again.

She added that part of the assessment process is ensuring that patients know that MAID is not their only option. “There’s almost always a long discussion about the fact that palliative care is a spectrum. And it is an expertise in medicine where you can be provided with care to help … optimize and improve your quality of life throughout the trajectory of your disease…. It’s a wide scope, but part of MAID eligibility is you must be made aware that palliative care exists, and you have to demonstrate that you understand that and you can weigh it out.”

Downar also provided some numbers on who is applying for MAID. The majority of people applying for MAID are people who have a terminal condition, mostly cancer or ALS, as well as some heart and lung diseases. People in the second track whose death is not reasonably foreseeable make up about four percent of MAID in Canada, and most commonly they are suffering with neurological conditions such as Parkinson’s.

Some of the questions asked by those who attended related to clergy and the church. One person said a Roman Catholic friend was wondering if she could be buried in a consecrated cemetery if she chose MAID.

Canon van der Meer, who is the diocesan interfaith officer, said: “I can’t speak for all churches, but we have a friendship among our neighbourhood churches: Baptist, Presbyterian, Roman Catholic and Anglican churches. We had a conversation about this leading up to this event. The Catholic Church does have an official teaching about the sanctity of life, which they interpret to mean that MAID is not possible. However, the Catholic priest has said he would not hesitate to pray with people for any reason. He would do a funeral in the church and a person could be buried in the way anyone else would be.”

As an Anglican priest, he added, “Our church also holds to the sanctity of life, but it does not have an official teaching on MAID…. There is a range of comfort level among my clergy colleagues. Clergy are encouraged to bring their conscience into pastoral matters; they may choose to be pastorally available or if they’re not comfortable, they would invite another clergy person to provide pastoral care. I (and most clergy that I know) would all say that ‘I respect the medical profession, and I will accompany any person pastorally.’ …My intention as a pastor is to be supportive and to trust that the person has made a considered and mature decision and offer whatever spiritual support is needed.”

A full transcript of this very informative discussion was posted in a link in one of St. John’s weekly newsletters: https://files.constantcontact.com/3730ca79501/e5ef67a0-6716-41bd-99b1-402f751a334d.pdf

The post Learning more about Medical Assistance in Dying appeared first on Perspective.

As Bishop of Ottawa at the time, Parker noted “Canon Brittain is a respected scholar of our Church, with published research and expertise concerning relations within the global Anglican Communion, theological responses to crises, political theology, and ethics. He is resident in the Diocese of Toronto and has graciously consented to share his wisdom with our diocesan church when we require learned counsel on complex theological matters.”

One of the most complex issues clergy and lay people are wrestling with is the matter of Medical Assistance in Dying (MAiD). Canon Brittain contributed an article to a book published in 2024 by the Anglican Church of Canada Faith Seeking Understanding: Medical Assistance in Dying — Reflections by Canadian Anglicans. In an interview with Perspective this past summer, he shared some of what was discussed when he was asked to speak on the subject at a clergy conference in another diocese.

“In the conversations I had with the diocesan leadership, they really wanted me to know that their clergy were pretty divided on this issue, which I certainly took to heart. And so, the conversation we had was not about whether clergy should be for or against MAiD… particularly since this was not the conversation I was asked to have. Instead, we talked about how difficult it is for clergy to inhabit situations where people are approaching them for advice about MAiD or possibly asking them to accompany them during the procedure, and how bewildering it can be. We talked about the challenges of being a pastoral leader in this situation and then how to help members of the church think about MAiD in a pastoral way as opposed to sort of an ideological way.”

For clergy who are comfortable accompanying people who choose MAiD, they discussed what challenges and concerns that they need to keep in mind, Brittain said.

For clergy who are less comfortable, they discussed the fact that priests and deacons are not obliged to accompany someone choosing MAiD, but they are still obliged to care for them pastorally. “Can you help them find someone who can support them or their family and talk about a range of alternatives rather than only MAiD?” he suggested.

Brittain noted that in discussing alternatives, such as hospice and palliative care, it is important to ask if those services are available and accessible in that area. If not, “and if we think there should be other options for people, which I hope the church does believe, we need to lobby to make sure these options are available,” he said.

“The church must respond pastorally to those who are dying or who have family who are dying and be the best support we can be…. [MAiD is] a legal option. Some people take it for very good reasons even if they might not be our reasons. And so, we need to try to help people navigate the situation they’re in.”

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Initially, eligibility was limited to terminally ill individuals whose natural death was deemed to be reasonably foreseeable, but that requirement was removed in 2021 after a 2019 Superior Court ruling found the “reasonable foreseeability” eligibility criteria as well as the “end-of-life” criterion from Québec’s Act Respecting End-of-Life Care, to be unconstitutional. Eligibility was also to be extended to individuals whose sole medical condition is a mental illness and who otherwise meet all the criteria, but the government has delayed that addition until March 2024 to allow more time to consider the advice from an expert panel and a special parliamentary committee on MAID and mental illness.

In the February 2023 issue of the Anglican Journal, Archbishop Linda Nicholls, Primate of the Anglican Church of Canada, wrote about “The dilemma of MAID.”  Looking back, she cited the church’s 1998 report “Care in Dying,” which described support for physician-assisted death as a “failure of human community,” and expressed concern that lack of adequate palliative care, strong family and community supports, and a culture that values youth and independence contributed to an environment where people want to avoid “being a burden.” Both that report and a 2016 report “In Sure and Certain Hope,” were rooted in the commitment to life as a gift from the Creator that is to be treasured, she said.

But she went on to write about the church’s current view. “God has gifted humankind with the capacity to extend life and alleviate suffering through medical intervention…However, some suffering may be prolonged and profoundly difficult to experience or to accompany. …In these final, intractable situations, we acknowledge the conscience and autonomy of the individual to discern the way to choose, knowing that in whatever decision is made we must commit ourselves, and those we walk with, to the mercy and compassion of God. There is no condemnation or abandonment, only deep sorrow that such suffering may precede our death—as well as hope rooted in God’s promise that nothing can separate us from his love (Romans 8:38-39) in this life or the life beyond death.”

Within this cultural, legal and ecclesiastical landscape are people struggling with illness and suffering who may be considering medically assisted dying and their families who may or may not agree with their choice. The clergy members who serve them may have questions of their own about what to expect and how to navigate pastoral care in this still relatively new situation.

The Rev. Canon Catherine Ascah and the Rev. Rosemary Parker have both had several experiences with MAID and offered some of their insights in interviews with Crosstalk.

When asked about the ways in which the experience is different, they both commented on the fact that a medically assisted death is scheduled.

“That’s a little surreal,” said Ascah. “I have been at the bedside of people who have died, and you know roughly when things are getting close, but you don’t actually know when it’s going to happen. With medical assistance in death, it’s very scheduled, whether it is in a hospital setting or in a home. …It is a different feel because we are all sitting around, and we know what’s going to happen next in a very intentional way.”

“There is something unusual about having this on your calendar,” said Parker, who also described that aspect as surreal.

Asked if people look for reassurance about the church’s view of MAID, Ascah said, not usually at the scheduled time, but that often the person has called her earlier on as they considered the possibility to ask what the church’s position is. “My response has always been, ‘Before we get to that, what’s your family’s position on this? Have you talked with your family?’ In some cases, they have broached the topic and in some cases they hadn’t because they really did want to know what the church thought about it [first].” She said she tells them, “I am called to walk with you regardless of what you decide.”

“So, you’re okay with this?” people sometimes ask. “In some cases, I think people are looking for a certain level of sanction by the church. I am pretty careful how I choose my words around it,” Ascah said.

“I just say ‘I strongly encourage you to discuss this with your family, but if this is the decision that you guys decide to, that you want to go with, you need to know that I am going to be available to support you throughout that journey if that’s what you would like.’”

In one particular case, she said, the person had decided on medical assistance in dying very soon after a diagnosis and not all of the family members were okay with it. “I was able to meet with the individual and their family and say, ‘I hear that you don’t want this to be prolonged, but I strongly encourage you to just take one step at a time,’ so it did give the family a bit of a chance to process. Ultimately, it wasn’t the family that said yes, it was the individual, but I do think that there’s this difficult process.” Families want to support and honour their loved ones wishes, but it can be difficult for them during the process and afterwards, she said.

Parker said that in her experiences with MAID, “The individual is generally very, very sure that it’s what God is calling them to do. And I think their strength and just their trust in everything is pretty profound. It’s their faith that is the greatest in the room…It’s a pretty inconceivable idea of deciding to die, but these individuals clearly trust where they are going, trust that they’re going to be caught on the other side. At birth we are caught by loved ones or nurses, and they trust that in a similar way there are loving hands to gather them there too.”

Parker has sometimes been asked to be part of earlier conversations, with doctors, for instance, but generally the focus is on the day of the appointment, she said. Sometimes she is in the room when the doctor comes for the procedure, but in other cases she spends time with the person and family before the doctor arrives and prays elsewhere during the appointment.

Ascah also observed that a MAID situation is, and has to be, very clinical. “You have to submit the application, that has to be witnessed. There’s an interview with the doctor and the plans all get made, but when the day actually comes, and the doctor comes and before they start administering the drugs, there is a final ask. There’s a certain script that they have to say so that it is very clear and unambiguous,” she explained. “The doctor introduces themselves to everyone in the room and says why they are there and then will ask the individual ‘Do you still wish to proceed with this procedure? The person has to be able to answer clearly and unambiguously.”

Asked if she had practical advice for clergy colleagues who are new to MAID experiences, Parker said to “have a plan. The death is planned, so it is okay for you to come in with a bit of a plan. And the family should have a plan. Sometimes the family knows exactly what they are going to do, and they have things that are meaningful for them.”

Both Ascah and Parker said that their roles on the day of the appointment are not very different from other pallative care cases.

Ascah said arrangements are made ahead of time if the person and their family want to take communion, and then she does Prayers for the Church and Prayers for the Dying.

Parker said she finds it helpful to bring some music. “Sometimes we’ll sing, ‘Amazing Grace,’ that kind of thing, to move a little away from words and the emotion of the moment and try to transcend it a little bit.”

In addition to Prayers for the Dying, Parker also recommended an ancient prayer adapted from A Litany Anticipating Heaven. “Sometimes, we say it together as the final medication is administered,” she said, offering this excerpt:

To the Kingdom of Heaven,

Lead her home.

To the Garden of Delight,

Lead her home.

To Eternal Bliss,

Lead her home. 

To the Land of Rest,

Lead her home.

To the Company of the Saints,

Lead her home. 

To the Safe Harbor,

Lead her home.

“And everybody in the room, including often the doctors, will join in this refrain of ‘Lead them home.’ And at the end of the day, that, as with any death, that’s what we are doing. We are passing the person from this world into the next. We are returning them to God,” Parker said.

The experience of one next-of-kin

In July 2022 Jane Waterston’s husband François Bregha died of ALS, with medical assistance in dying. While not himself a member of any parish, François helped Jane make decisions about his funeral, burial and celebration of life, and was grateful, five days before he died, to spend an hour with the Rev. Colin McFarland. 

“As you can imagine, the last week before François’ death was charged with emotions, memories, conversations and preparations,” Jane remembers. “At that point his mobility and energy were extremely compromised, but his mind was active and heart full. His priority was to say special goodbyes to many friends and relatives, with the phone and computer. He had had the opportunity to think about how best to leave us and he was always one to stick to the plan.

“A formal pastoral visit from Colin just days before MAID was administered helped François pause and reflect,” she reports. They spent 45 minutes chatting quietly on the front porch, “then I joined them, wanting to be together for this as well. Before he left, Colin asked if we could pray together, and François (somewhat to my surprise) said yes. This is one of the happy memories I have of that very complicated time—I could see how the physical connection of holding hands and listening to Colin’s intercession brought peace and dignity to what we were going through.”

 Jane Waterston is a parishioner at St. Margaret’s Vanier and the designer and production manager for Crosstalk

PHOTO: CONTRIBUTED

PHOTO: ARCHDEACON CHRIS DUNN

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