Thursday, February 19, 2015

To be or not to that the question?

2 weeks ago the Supreme Court of Canada ruled on the question of Assisted Suicide. One article on that ruling is here.

To boil it down to basics, the SCC unanimously ruled that a blanket prohibition on Physician Assisted Suicide (or Death as the term some are using) contravenes the Charter of Rights and Freedoms.  The Court gave federal and provincial governments 1 year to draft and pass legislation relating to the issue.  And this is a federal election year...

For the last 2 weeks I have been trying to fully wrap my head around what I think of this ruling.
To begin with, it is arguable that we already have the right to die.  Suicide is not a criminal offense.  This ruling is about the right to have a physician (but what about others?) assist when our body has reached the point that we can not do it for/by ourselves.  And so creating a structure for that assistance to be available may in fact extend some lives.

Interestingly the ruling did not limit the "right to die" (for lack of a better term) to those with a terminal illness.  It also included those in irremediable pain/suffering, which could include mental/emotional anguish.  That complicates matters a bit.

It is one thing to say that someone who is dying should have the right to end her/his suffering.  But someone who has a condition that is not terminal?  Then again ALS (which famous right to die activist Sue Rodrigues had) leaves one unable to function.  It might not kill you directly but is it life?  And the inclusion of mental/emotional suffering?  What do we say to the depressed person who refuses treatment?

I do not think this is a terrible decision.  I think it can be troubling.  I think hard discussions lie ahead for our governments, and our community at large.

One of the issues/fears that comes up is that of vulnerable populations.  One of the cornerstones of the legislation that is to come will be consent.  Freely given, non-encouraged, non-coerced consent.  How do we ensure the patient is not being pushed to make the request?  I think that disabled right advocates have an interesting task ahead of them on that count.

Another issue of course is how do we prove the person is making the request from a position of "sound mind".  Currently it is a default assumption that someone asking to die, particularly when they are non-terminal [though let us be honest none of us is truly non-terminal in the long run], is not showing signs of a sound decision making process.  That is why we can have suicidal persons placed in hospital (or other custody) against their will.  What will be the process in this new era?  In particular on the mental/emotional anguish account.

ANd what about the elderly person who is simply tired of life?  Who is alone?Who wonders why they can't die?   Will they be covered under the legislation that is to come?  (not likely unless a really wide definition of "irremediable pain" is used)

What process will there be in the legislation that is to come to ensure every available form of assistance has been offered?  It is pretty much a fact hat in the current reality some people, for a variety of reasons (including lack of resources, inability to advocate for themselves, lack of another to advocate for them, an inability to understand the system) do not now get exposed to the full range of options.  How do we solve that problem?

But from a faith perspective I have to say there are really basic questions that have to be asked.  What is life?  When is life no longer living?  When is death a gift?  When is life a burden?  We have started (and in many places only just started) those discussions when it comes to palliative care.  But are we really ready to explore them in detail?  I think as faith communities we have a responsibility to facilitate those discussions.  I think as faith communities we have a different perspective to bring to them.

It also occurs that maybe these discussions about what makes life life rather than mere survival will help in the larger issue.  Because I am sure there are far graver threats to our understanding of life in abundance for all than the right to die.  Things like the reality of poverty, the reality of an under-effective mental health system, the reality of classism/racism/chauvanism, the reality of inadequate palliative care.  IF we as people of faith are going to call for the right to life we need to push these questions as well.

It would be easy for faith communities to unequivocally condemn the right to die.  Some communities and some individuals will choose that path.  I think that is non-realistic and, more importantly, non-pastoral.  As faith communities we do need to raise the value of life.  As faith communities we do need to take seriously that life is valuable even when it is not easy in a world where many seem to think life is supposed to be easy.  But as faith communities we have to have the hard discussions.

It is easy to dismiss the right to die, the choice to end one's life as "playing God".  Such accusations have been made about refusing life saving treatments as well.  But then again are we playing God when we shock a heart to regain a normal rhythm? When we repair an aneurysm before it bursts? When we do place a premature child in an incubator? Playing God is not the issue.  The issue is trying to understand how God wants us to use the tools we have at our disposal.

Sometimes life IS a burden.  Sometimes death IS a gift.  I am not sure what criteria we use to determine that....

And where is God in all of it?

Interesting discussions lie ahead.