A number of years ago I worked as a spiritual care chaplain in a psychiatric hospital. It was challenging work, in an environment in which there was profound suffering caused by mental illness. I remember the very first patient that I was called to see, a man suffering from depression so profound that he could barely speak. But there was no mistaking what he said to me on that first visit. He asked me if I could help him die. As a newbie on the floor fresh from suicide intervention training, I immediately went to the station to report this. The people there just looked at me and said, “we know.”
It is a common, in fact daily occurrence on these wards for people to ask to be put to death. In my first week, as a newcomer, I received three such requests. All were from people who were depressed, suffering from treatment-resistant depression which was often mixed with multiple forms of mental illness. This was a psychiatric hospital after all. The suffering was profound, and my initial reaction to being in such a place was gloomy. However I soon realized that over the course of weeks, months and in one case a full year, the patients did respond at least in some measure to treatment. Each of the three patients who asked me to assist them to die, eventually became well enough to go home, though none was cured of depression.
In Canada the Supreme Court has recently ruled that people who are experiencing profound suffering from incurable diseases who are mentally competent have the right to receive physician-assisted suicide. I can’t help wondering if the people who asked me to help them die would now have that right. Some would argue that mental illness by its very definition would make them “mentally incompetent”. Others argue that these people are indeed mentally competent, and that their suffering is as profound as the suffering of those with physical illnesses (see for example this article from the National Post, February 13 2015). There is certainly a need for further clarification, and it is now the responsibility of the Parliament of Canada to conduct the necessary hearings and to enact legislation within the twelve month window provided by the Court.
As a Christian and ordained minister with experience caring for the sick and dying, I acknowledge and appreciate that both the Court and advocates for physician assisted suicide are motivated by compassion for those who suffer, a compassion that I share and that is consistent with my theological perspective. There are a number of other theological perspectives that are important as we consider as a society how we will respond to the Court’s ruling.
First, we do not believe that death is the end. We believe in eternal life, a life that extends beyond the apparent boundary of biological death.
Second, we believe that life is a gift of God and lived in relationship with others, and that as such my life does not belong to me to do with as I please. I am the steward of my life, and I am called to care for and use my life in a manner that is responsive to my calling as a child of God who is to love his neighbour as himself.
And third, and I write this tentatively and aware of the risk of misunderstanding, Christians believe that even in the midst of suffering there is the possibility of redemption. We wish suffering on no one, and we are compassionate in response to suffering. But at the same time we acknowledge that God is present in the midst of suffering, and can bring light even in the midst of darkness. We worship a God who himself suffered and whose suffering we believe was redemptive for humankind. (For a helpful perspective see this article from the New York Times Apr 7 2014.)
These theological principles do not, for me at least, give a prescriptive answer to an ethical evaluation of physician-assisted suicide. My own church, the Anglican Church of Canada, has established a Task Force to consider this issue and to determine whether to update the position taken in its 1998 study paper Care in Dying, which I commend. In this paper a number of relevant issues are considered, including the importance of palliative care. In this country, physician-assisted suicide will be legal in twelve months by virtue of the recent Court ruling. What is now required is that the Government of Canada put a legal and procedural framework around this new reality that considers not simply utilitarian principles and individual human rights, but also the theological principles which have been indicated. It is essential that the Government of Canada not abdicate its responsibility to do this and end up leaving us with a judicial ruling which may be too broad in its interpretation and application. This much, at least, we owe to the three patients who asked me to end their lives, but eventually, after much suffering, were well enough to go home.