Ethics of Dying Well

St. Peter’s, Winnipeg, is hosting a conference on physician-assisted dying titled “Suffering and Hope.” The keynote speaker is Eric Beresford, the chairperson of the Primate’s Theological Commission on Physician-Assisted Death. Below, three of the workshop presenters tackle two of the many issues surrounding the primary discussion: what it means to be human and providing pastoral care to the person considering such a decision.
Registration closes for the Suffering and Hope conference February 12. Space is limited for the February 26-27 conference, which will bring together a diverse panel of experts to discuss a Christian theological approach to one of the most important ethical issues today. For more information, visit
Preparing for A Physician-Assisted Death
2016 will almost certainly be the year that Canadians suffering from severe medical problems can legally request a physician to assist them in ending their lives. If you are like the majority of Canadians, you will be relieved that this option is available. If you happen to suffer prolonged physical pain or mental anguish that seems to have no end, you may be asking yourself whether this new option is one that you want to use.
If you think that physician assistance in dying is something you may want, you have likely already suffered a lot or fear unbearable suffering in the future. You are most likely to consider phyworship (1)sician-assisted dying when you feel that there is nothing that will relieve your suffering, or that your life has been so diminished by your illness or injury it no longer has value.
If your suffering has become unbearable, physician-assisted death may appear to be a simple solution, offering you a way out when you feel you’ve had enough. A decision to request assistance from a physician in your dying has a ring of personal authority and decisive finality to it. It speaks of courage and of taking charge. You stare death down and face whatever fears you have about dying and death.
A request for assistance from a physician in your dying is not so much an endpoint as a new beginning – the beginning of a very personal journey as you prepare for death. The journey will include emotional, spiritual, and relational challenges. How you meet these challenges may well determine whether your death is the fulfillment and completion of your life, an act of resignation, or an experience of desolation.
The challenges you may meet as you prepare for a physician-assisted death are both similar to and different from the challenges any dying person faces. They include finding companions for the journey, deciding on whether and when to use physician-assistance in your dying, and refocusing your hopes.
Companions for the Journey
Facing death is an awesome and, for many, a sacred experience. It stirs up strong feelings that can rise with surprising force. It unsettles relationships, roles, and routines. It raises questions about the meaning of life and the meaning of your life in particular. It casts doubts on cherished beliefs and sometimes cheats you of the comfort of familiar religious and spiritual practices.
To meet such challenging experiences, you need to reach deep into your spiritual and emotional resources. Sometimes, you may feel so overwhelmed that you panic and wonder what happened to your ability to cope. These are times when you need sensitive and supportive companions who listen respectfully and who reassure you that they will accompany you to the end. It may be a spouse, family member, friend, counsellor, spiritual leader, or a combination of these. Hopefully, they are people you trust and who respect and/or support your decision to use medical assistance in dying if necessary.
A decision to proceed with physician-assisted death will impact many others, particularly family members and close friends. If possible, include them in your decision by sharing the rawness of your suffering and by discussing practical aspects such as medical assistance and the timing and place of your death. You might also want to talk about who you want to be with you and the rituals, blessings, and final goodbyes that you would find meaningful at that time. Such sharing may stir up difficult emotions, but sensitive and respectful sharing and listening will go a long way to ensuring you have the support and care of those who matter most to you.
Jumping the Gun
Explore all the options available to you. Before seeking physician-assisted death, consider the following questions with your physician:

  • Have all options for relieving and controlling pain or other troubling symptoms been tried?
  • Might you benefit from treatment for depression?
  • Are you struggling with social isolation, feelings of loneliness, or a lack of support?
  • Have you explored all palliative care options?

Each of these questions is based on the conviction that life is to be cherished and that even a life burdened by suffering can be meaningful. They are worth considering before opting for a decision that ends your life.
Refocusing Hope
When you seek physician-assisted death, your hopes for cure and restored health have been dashed many times. Your remaining hopes are now focused on the specifics around your death: When? Where? Who will be there? How will it go? However, this is also a time to consider what your big or ultimate hopes are by reflecting on questions such as:

  • What do you consider to be the meaning of your life and death and with whom do you want to share this?
  • Who do you need to say the following to?
    • Thank you
    • Forgive me
    • I forgive you
    • I love you
    • Goodbye
  • What hopes do you have for those you love most? How might you share these?
  • What does it mean for you to trust in the goodness of life as you face the unknowns of death?
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Glen Horst is a spiritual care advisor with the Canadian Virtual Hospice

Conversations with a wise and trusted friend, counsellor, or spiritual leader may be helpful in your reflections.
The goal in preparing for death is to find a hopeful and relevant perspective for affirming your life as meaningful and for accepting your death as a natural fulfillment of your life. Your death does not have to be an expression of despair or defeat; it can be a completion of its meaning and purpose. It can be a final affirmation that whether we live or whether we die, we belong to God (Romans 14:8).

Being Human: Telling the Whole Story

Photo: Mike Eliza
Photo: Mike Eliza

People are healed and become more human as they enter into real relationships with others. They then discover that under all the feelings of stress, rejection and humiliation, that they are someone! Those in need and those who come to help are all being healed, and are all, together, becoming more human.
Jean Vanier, Transforming our Hearts
As Christians, we believe that all human beings are created in the image of God. God’s image is indelible. It cannot be earned through achievement. And it cannot be taken away by ill health or poor quality of life.
To bear the image of a Trinitarian God – a God who is relational to the core – means we want others to see God’s image in us. In turn, we are compelled to see God’s image in all others. Living in healthy communities is essential to life as a healthy human being.
Sadly, isolation and loneliness often partner with disability, illness, decline, and suffering. Imagining myself in such a situation, I dread being forgotten or remembered only as a burden. If I am cut off from mainstream community, I cannot be fully myself. Dignity therapy, a model of care designed by palliative physician Harvey Chochinov, is premised on the idea that mutual recognition is important to one’s understanding of personal value: “The reflection that patients see of themselves in the eye of the care provider must ultimately affirm their sense of dignity. At least in part, it would appear, dignity resides in the eye of the beholder” (“Dignity and the Eye of the Beholder”).
Many characters in biblical narratives are subjected to infirmity and indifference. Many are healed by Jesus, and Jesus’ healing power reaches beyond their minds and bodies. It works to restore relationships, pointing to the significance of community in this matter of being a whole human being.

Aimee-Patterson (1)
Aimee Patterson is a Christian ethics consultant at the Salvation Army Ethics Centre and teaches at Booth University College

Take the Gospel of Mark’s account of Jesus healing a hemorrhaging woman (chapter five). From the writer’s perspective, this woman is a sidetrack to Jesus’ journey to heal a dying child. The woman, who is not named in the text, suffers for 12 years, bankrupting herself with medical consults. Her “unclean” condition isolates her from society. As Jesus passes by, crowds pressing in on him, she touches his garment. The power that goes out from him heals her body. But that’s not the end of the healing. And it’s not the end of her story.
The woman hears Jesus call her out from the crowd. Someone who has been marginalized for o
ver a decade is now the centre of attention. She approaches in fear and trembling, admitting to what she’s done and why. She tells him “the whole truth” – her whole story, a story of illness, poverty, and seclusion.

James Read is the executive director of the Salvation Army Ethics Centre and teaches at Booth University College

Jesus listens. He takes time to welcome her into relationship, making a very public connection with her. The woman now sees herself as a person of worth in the eyes of another. Someone else is affirming that she is a child of God, a human being! Jesus praises her courage and conviction, telling the woman that her faith has healed her. This encounter makes her fully well, able to go in peace.
Every human being is a character in God’s story. We are part of something bigger than ourselves. But to be a whole human being we also need to know that others recognize our value. This is especially true when disability or illness threatens.

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