Illness, suffering and death are existential realities and crucial issues that we Catholics face together with all our brothers and sisters in humanity. In keeping with the Gospel of the compassionate Christ, Christians have always sought to alleviate suffering and support the dying in the final moment of their earthly existence. Caring for those who are suffering, providing medical care for the ill, accompanying those at the end of life with compassion and tenderness and being in solidarity with the most vulnerable members of our society are basic elements of our civil and religious identity. But in Canada, the legalization of euthanasia—so-called medical assistance in dying, or MAID—challenges our common values and shakes the very foundations of our living together.
In 2014, the National Assembly of Quebec adopted Bill 52, which authorizes a physician to provoke the death of a patient who is terminally ill and is seeking aid in dying. In order to override the Canadian Criminal Code, which prohibits aiding another person to commit suicide, the Quebec government established that assisted euthanasia by a physician was an act of medical care and, as such, was under provincial jurisdiction.
Euthanasia reveals a crisis in our society’s understanding of suffering, dying and reasons to live our life to its natural end.
In 2016, following a ruling of the Supreme Court of Canada, the government of Canada passed the first federal bill, C-14, on euthanasia, or the “Medical Assistance in Dying” (MAID) law. Physicians could now perform euthanasia for competent and clearly consenting patients suffering from an incurable illness whose natural death is reasonably foreseeable. Very soon, these provincial and federal laws were challenged by plaintiffs who were not in a terminal phase of an illness and who argued that the laws were too restrictive and violated their rights under the Canadian Charter of Rights and Freedoms. In response, the Quebec government ruled that the eligibility criterion that a patient be near the “end of life”—meaning their death was reasonably foreseeable—was no longer in effect in Quebec as of March 11, 2020.
In March 2021, the government of Canada followed suit. A federal bill (C-7) was passed expanding euthanasia eligibility nationwide to those whose death was not “reasonably foreseeable.” Moreover, the Senate of Canada approved euthanasia for persons with mental illness who sought medical assistance in dying. It gave the government of Canada 24 months to establish rules for MAID for people whose only eligibility criterion was a mental disorder.
In the same month, the government of Quebec created a special commission with the mandate to study the expansion of MAID eligibility to persons with disabilities and those with mental illness. The provincial commission was also asked to reflect on the issue of advance requests, which would allow MAID, based on prior signed consent, even when a person can no longer confirm consent.
In March of this year, the federal government decided to prolong the 24-month deadline set up by the Senate. The government requested another year to reflect and consult more deeply on whether it is pertinent and justified to grant persons living with mental illness access to MAID.
Expanding the eligibility of MAID to persons with mental illness and the possibility of advance requests threatens the dignity of the human person and the common good, while raising many questions that have no easy answer. For instance, do we have tools to measure the suffering of someone living with mental illness? At what stage of mental illness will it be possible to offer MAID, and who will be entitled to determine that moment? While we know that mental illnesses are often impossible to cure, how can we ensure that all treatment options have been offered, and how can we know that all reasonable treatment options have been exhausted?
We also know that mental illnesses can diminish people’s ability to judge and deal with their environment and secure the proper means to care for themselves and their loved ones. This incapacity may also push the person to be more susceptible to desire death and commit suicide. How can we determine that the person in this situation really wants to terminate their life and truly consents to it?
Through the medical and Christian community, Christ walks with us when we experience suffering and the final phase of our earthly life.
There are also compelling reasons that advance requests for euthanasia should be excluded from advance directives. First, the notion of giving advance consent for euthanasia in anticipation of a situation where a person is no longer able to confirm consent attempts to address a situation that remains hypothetical and cannot take into consideration a possible change of attitude. Second, these advance requests do not consider the desire to live and the emotions that a person may experience at the end of life. Each person lives in the present moment, in their own way, with the grace the Lord gives them at that time.
I remember when my sister Ghislaine was diagnosed with Lewy body dementia (a mix of Parkinson’s and dementia). I was afraid she would not wish to continue living because she was a proud and exceptionally autonomous woman. To my surprise, she continued to enjoy life and live to the end with serenity because of her faith and the fact that she was surrounded by love and compassion from her family and health care providers. She is a reminder that the principles of solidarity, benevolence and compassion must continue to guide us in our care of the most vulnerable members of our society.
There is a big difference between advance directives that would include euthanasia and those referring only to the withholding or withdrawal of treatment. When a person decides not to be treated for cancer or not to receive dialysis because the treatment is no longer beneficial or has become too burdensome, it is a personal choice. This choice may be justified, even with the risk that the person’s life may end more rapidly.
In the case of euthanasia, there is no risk. Here is certainty: The person will die immediately. And what about the burden for the person who must carry the proxy or make the decision in that individual’s place? The autonomy of the sick person is not absolute. There are limits to the exercise of freedom when the common good or fundamental values, such as the sanctity of life and the person’s inherent dignity, are jeopardized.
Those in favor of the expansion of euthanasia (legal in seven countries) and physician-assisted suicide (legal in 10 countries and 11 U.S. states) argue that safeguards are implemented to avoid abuses and risks of maleficence. The Canadian experience reveals that the safeguards are not respected. For instance, in Canada, the safeguards of “reasonably foreseeable death,” including a mandatory waiting period, were promptly removed.
There is a big difference between advance directives that would include euthanasia and those referring only to the withholding or withdrawal of treatment.
The rapidity with which the governments of Quebec and Canada opened up the possibility of greater access to MAID also suggests that other factors, including economic ones, are at play. Investing in palliative care costs more than promoting deadly injections. No wonder there are pressures on palliative care hospices to offer MAID and threats that if they do not, they will not receive funding from the government. No wonder some health care providers are putting pressure on patients with chronic diseases to ask for MAID. When long-term care facilities face serious staff shortages and sick people do not receive the care they are entitled to, MAID becomes a solution. We are in dangerous territory when a lack of economic and human resources motivates end-of-life decisions or when opinions and emotions replace fundamental values in enacting laws.
Proponents of legalized euthanasia have developed a strategy for its acceptance and legalization by the public at large. They have created confusion in the language and presented it as a medical treatment and care. Euthanasia is neither a medical treatment nor care. Treatment opens the possibility of healing and forms a therapeutic bond between patients and health care providers; euthanasia deliberately ends the therapeutic bond and the healing process.
Supporters of euthanasia have also created confusion from a moral point of view: The law is a teacher, and many will conclude that if euthanasia is legal, it is moral. But in reality, Canada’s permissive euthanasia regime threatens fundamental societal values, including the sanctity of life and the inherent dignity of the person and the common good, and it should be questioned and challenged. Canadians must not allow the euphemistic language of “medical assistance in dying” blind them to the evil of legalized killing.
What is needed instead is an expansion of services in the community that will help people suffering from serious diseases or mental illness cope with their reality and find meaning in their life. The accompaniment of those suffering and needing support, which is so dear to Pope Francis, must include those at the end of life and those dealing with chronic and lifelong illnesses. For that reason, good, quality palliative care should be offered more often and at an earlier stage of a serious disease. It is also important to create benevolent communities sustaining the sick, their caregivers and health care professionals, whether at home, in hospice or in other circumstances.
We do not need an expansion of laws giving more access to euthanasia. In fact, we do not need MAID because we have an alternative to the problem of suffering and dying. By that, I mean palliative care that offers not only release from pain but also answers the economic, affective, emotional, social and spiritual needs of the sick and dying person. It is necessary to give the sick or dying person the possibility to maintain their dignity and be accompanied with love and compassion until their natural death. What is needed is not medical aid in dying but medical aid to the dying person. What we need is to help people find meaning in life, suffering and death.
The Catholic Church has been a strong voice for human dignity of the sick and suffering in the years since euthanasia was legalized. “Caring is more than giving medication or administering a treatment,” the Assembly of Quebec Bishops wrote in a document titled “Approaching Death in the Company of Christ.” “It means taking the time to be with the suffering person. This time and presence are the obligatory road of real compassion.”
The Canadian Catholic Conference of Bishops commissioned a group to create a toolkit of four modules to promote palliative care in Catholic parishes and other related contexts. The toolkit, “Horizons of Hope,” can be downloaded for free on the C.C.C.B. website.
Euthanasia reveals a crisis in our society’s understanding of suffering, dying and reasons to live our life to its natural end. Our faith in Jesus, who brought meaning to suffering and dying through his life, death and resurrection, brings us light and hope that we are not alone on our journey. Through the medical and Christian community, Christ walks with us when we experience suffering and the final phase of our earthly life. We, too, are promised an eternity of love, peace and happiness.
