Bedside perspectives on MAID

“Horrifically peaceful.” That’s how Richard Bodini, pastor at Heritage Fellowship Christian Reformed Church (CRC) in Brampton, Ontario, describes being present with a person passing from life to death through Medical Assistance in Dying (MAID). “Going from having a conversation with the person to praying over their cold body in a matter of moments,” he says, “is emotional and beautiful, and troubling. Heaven is ripped open, and the entrance to earth is there.”

As a pastor of a church serving a large independent-living community for seniors, Bodini has accompanied hundreds through the valley of death. In the decade since June 2016, when MAID became legal in Canada, more than a dozen of his bedside vigils have involved people who chose medically assisted death.

Synod’s emphatic ‘no’

With the tenth anniversary of MAID’s legalization in Canada approaching, Christian Courier (CC) invited chaplains to reflect on what MAID has meant for them. We wanted to hear especially from those with roots in the Christian Reformed Church in the wake of a unanimous vote by synod, its governing body, to “deplore the legalization and practice of medically assisted suicide as well as the efforts to expand it to include minors and those suffering solely from psychological disabilities.”

In Canada and the U.S., 650 CRC pastors and chaplains serve jurisdictions where MAID is legal. Noting this, the report informing synod’s decision advised chaplains to suggest other alternatives to persons considering MAID, and to abstain from referring those individuals to willing providers. Churches should be reminded, the report said, that “the appropriate Christian response to suffering, disability and/or dying people (and their families) is pastoral, including compassionate palliative care instead of acting to cause death.” Synod’s response, as the denominational magazine, The Banner, observed, stands as an “emphatic and unambiguous ‘no!’ to medically assisted suicide.”

Lines in the sand

Seven Canadian chaplains responded to a CC survey in February on the topic of pastoral care and MAID. Four respondents asked not to be quoted by name. All seven of the chaplains share roots in the CRC, though two have left the denomination. All appreciate synod’s call for a compassionate response to individuals contemplating MAID, but most struggle with the assertion that MAID is always wrong.

A chaplain who worked in a cancer centre before retiring recalls designing and leading a ritual of farewell for a man receiving MAID, and for the family encircling him as he passed. Through tears, the man’s wife later observed, “If there can ever be a good death, this is it.” Reflecting on such scenes, the chaplain writes, “Assisting them on their way for compassionate reasons is not what the commandment ‘Thou shall not kill’ was addressing. Compassion should be the church’s first standard, not a moral fine line.”

“These experiences vary greatly, but I do always experience that I’m on sacred ground,” another chaplain reflects. “My role, regardless of people’s spirituality and regardless of my own thoughts about this person’s decision to die with medical assistance, is to embody God’s vast love and compassion for this fellow human being created in God’s image as they take their last breath.”

These chaplains’ responses remind me of a line from the novel Cutting for Stone by Abraham Verghese: “God will judge us, Mr. Harris, by what we did to relieve the suffering of our fellow human beings. I don’t think God cares what doctrine we embrace.”

The respondents’ stories also raise some hard questions, including these: In a time when medicine offers many means of cheating death, is MAID any more unnatural? Can a clear moral distinction be drawn between injecting sedation to render a person unconscious to the end and injecting a drug to end life? Can we assume that those who choose MAID see life as any less sacred?

Compassion in action

All seven survey respondents are emphatic in saying they follow the lead of the people they support. Not doing so, some observe, would contravene MAID protocols, their core convictions and their profession’s ethical responsibility to “refrain from imposing their own values and beliefs on those served.”

Richard Bodini has reservations about MAID, yet fully supports anyone who has chosen that path. “Is life precious? Absolutely,” he says. “Would I advocate for someone to do MAID? No, I would not. I ask a lot of questions. I try to get them to say what they are wrestling with. Then, if asked, I give my position. But I say, ‘Whatever decision you make, I’m there to journey with you.’ Right or wrong, I feel somewhat uneasy looking someone in the eye and saying they should not be doing this. I believe in my position as a chaplain that crosses a line from care to abuse of power.”

Derrick Lee, chaplain at both CFB Cold Lake and the Bonnyville Healthcare Centre in Alberta, makes a point of exploring root causes with patients who are pondering MAID. Some say they no longer want to burden their families with their care; others “sincerely feel done with living with chronic pain,” he writes. “In the former, I often challenge the patient to open dialogue with their family about whether they actually feel burdened. In the latter circumstances, my role is to simply bear witness to and validate their painfully enduring existence.”

Another respondent, a hospital-based spiritual care clinician, says most patients have already made a firm decision by the time she is called in. “At times I have been able to guide them to reconsider, but this is seldom the case,” she writes. Whatever the decision, she offers information, emotional support, prayer and ceremony suiting the person’s faith tradition. “God knows their heart, their pain, their every need. I am not the judge of right and wrong for them.”

Twice this chaplain has been invited into the room as MAID was provided. One patient had no one else to be with; the other patient’s family did not agree with the patient’s choice of MAID, leaving the chaplain to hold her hand as she passed. Seeing someone talking one moment and gone the next was “a surreal experience,” the chaplain says. But for those who died, her presence brought unconditional compassion into a lonely space.

Under a bushel

Turning the CRC synod’s “no” to MAID into a binding doctrine, some respondents predict, would exacerbate the polarization and stigma that already surround MAID. Several chaplains described times when secrecy made a fraught situation worse. Patients hiding assessment forms in drawers, afraid to share their musings about MAID. Staff blindsided by impending deaths. Families whose loss is compounded by anger over not knowing beforehand that their loved one has chosen MAID.

In his walk with families, Lee regularly sees secrecy become “a recipe for complex grief.” When patients dare to discuss questions about MAID with relatives, he adds, often they’re challenged or even condemned, heightening the emotional and spiritual support needed by everyone affected, families included.

Concern about being judged also extends to chaplains involved with MAID, whose “journeying with” may put them out of step with the CRC stance. Most reported looking outside the denomination for theological grounding, advice, debriefing and support. Recalling a CRC chaplaincy conference of years past where a panel of divergent voices discussed MAID, one writes, “I’m grieving that the time for public dialogue and healthy discussion and disagreement is gone.”

Shine a light

From their place on the frontline of MAID, chaplains had much to say about roles the church might helpfully play in this life-and-death matter.

“Personally, as a chaplain, I would like the church to understand that we do work on the fringes, where much of theology is being worked out in individual and messy situations,” Bodini says. “I would like the church to show up in those spaces sometimes, or at least listen to the chaplains who are there in the messiness.”

Take the belief that palliative care is always a better choice than MAID. For some, it can be exactly that. One chaplain recalls a patient who was approved for MAID but agreed to try palliative care – and gained the inner strength to engage life anew. Another works in a care home where comfort measures regularly allow seniors to “die with dignity, surrounded by love.”

On the other hand, Karen Wilk, who pastors a micro church in Edmonton, watched her mother-in-law die in palliative care over 28 agonizing days. “It was horrible for everyone,” she says.

Palliative care and MAID are meant to be integrated, observes a chaplain who worked in a cancer centre where patients regularly moved from one to the other as death neared. “The intent is to provide access to both.”

These chaplains also invite advocacy – not to do away with MAID, but to ensure that it’s always the last possible option. Some point to deficits in regulations, staff training, assessment standards, medical care, living options and other realities that lead to widely disparate, at times questionable, provision of MAID. Recent removal of a reflection period for those approved for MAID whose death is reasonably foreseeable, one chaplain writes, “has MAID so easy to access instantly that patients do not have time to reconsider or consider options properly. We need to ask for a reset of the time frames.” If the church were to facilitate homes that ensure quality of life for younger people who need significant care, another muses, “I think there would be a lot less MAID.”

Respondents also called for opportunities for Christians to hear a range of opinions about MAID, without judgement. “I would love for the church to break the taboo around MAID so that people don’t need to feel ashamed or afraid to bring this up,” one writes. “People are thinking about this anyway, regardless of the church’s stance.”

Others, including Lee, echo that desire: “Invite discussions of death into the church,” he writes. “Don’t condemn those who are contemplating MAID. This is an invitation for dialogue in relationship: What does a good death look like?”