Our theology of suffering
A Nurse Practitioner in Training wrestles with Medical Assistance in Dying.
For 15 years I have been working as a registered nurse both in Canada and abroad as a missionary in Malawi, East Africa. Recently, I began studying to get my master’s degree in nursing as a primary care Nurse Practitioner. This is a growing field in Canada, and I am excited about the potential for increased diagnostic competence, autonomy and ability to walk with patients long-term as their primary health provider. I quickly realized, however, that navigating the increased responsibility of being a Nurse Practitioner means that I can no longer remain a spectator to the challenging spiritual and ethical issues in Canada’s healthcare system. Medical Assistance in Dying (MAiD) and the pending legislative changes in Canada which may change eligibility to include people with mental illnesses as their primary reason for seeking MAiD, present me with immediate questions I need to wrestle with.
‘I had no idea it was so peaceful’
In my grappling with MAiD, I met with a Christian nurse practitioner who works in palliative care. Though her practice does not provide MAiD, she has been there for a few MAiD procedures. “I had no idea. […] They were very peaceful,” the Nurse Practitioner, who prefers to remain anonymous, said. She explained that a lot of people are not afraid of death itself, but the process of dying: “People don’t want to suffer.” One of the reasons her team has not adopted MAiD is because many physicians still don’t understand palliative care, and there is still a resistance to referring patients to palliative services as a “one-way-ticket to death.” Since the government never provided a clear definition of palliative care within MAiD, she sees a need among palliative care providers to focus on educating health practitioners and getting more patients access to the scope of services they can provide.
“Palliative care is about removing the burden from the person, getting to know their values, their past experiences of life and death and how that’s impacting their own present view of their own mortality,” this nurse practitioner said. There are limits to what palliative care can do to alleviate patient suffering; there used to be a belief within palliative care that if a patient is given the full scope of services, there would be no need of MAiD, but her experiences has shown that that is not the case.
When I asked about her Christian life and offering MAiD she didn’t state a clear opinion. However, she did say, “I don’t proselytize – I can’t – I do know that through the way I show compassionate care and show love for people, people can see there’s a difference . . . in my assessment I ask, ‘where do you get your strength?’ It opens a door to talk about faith.” She emphasized the critical need for Christians working in end-of-life-care; “We have to be there in those hard places.”
Finding the fine line
I still have many questions. What is the line between relieving suffering and causing death? For patients choosing MAiD, what role can and should Christian health practitioners play in providing compassionate and loving care? I relate to the dilemma that Christian health care workers like her face, as they desire to reduce suffering in others but wrestle with what is ‘too far.’
Spiritually, I have to remember what my theology of suffering is. What I believe about suffering and what God says about it, determines everything about what I do in response to it. The Bible is clear that we will face varied challenges in this life. Christ suffered, not just physically, and he is not far from those who suffer. Suffering, in the Christian faith, is not meaningless or worthless. Christ can redeem our suffering, purify us, and use it to help us minister to others (Jn. 9:1-7). He can also use it in our lives to develop characteristics like patience and perseverance (James 1:2-4; 5:7-11) and the outcome of that suffering in our lives as we look to God for the strength to endure, will be beautiful and glorious (Rom. 8:18; 2 Cor. 4:16-18). But as a practitioner, what role should I play in reducing my patients’ symptoms of suffering as others around me remove it altogether? Before I wade into this grey and murky world of whether MAiD ought to be available at all, and before I can scrutinize providers of MAiD, I must examine myself.
Examining my own life first
Here’s where I start: I have to ask myself, how have I contributed to our society’s need for these services to begin with? What can I do, in my home and in my community, to include those who are mentally suffering and vulnerable around my own table? What lengths can I go to walk through endless months of depression, chronic pain, or increasing disability with those who suffer from these ills? What strides can I take to make Christ known in the margins of my society? I can make a lot of excuses for lack of time, energy or emotional capacity, but caring for those who are truly suffering will never be convenient or comfortable.
The Bible is clear that we ought to weep with those who weep and rejoice with those who rejoice (Rom. 12:15-16). Beyond bringing meals and showing up in crisis, am I hospitable to those who are long-suffering? Truthfully, I’ve not always been inclusive. The bearing of suffering is hard enough in my workplace, I don’t really want to have my home, my family, my life, rubbing shoulders with that kind of hardship. But, having now lived in Africa as a missionary for the past four years, I’ve learned a lot from my African brothers and sisters about hospitality without grumbling (1 Pet. 4:9). They have an inclusivity that humbles me. My pride needs to get out of the way and allow others into my brokenness so I can share in theirs. Becoming inclusive of those who struggle with different issues than me, will not look perfect, in fact it will be difficult and costly to my own comfort.
I want to love like Christ did and be in the hard spaces with others, even if it is in the shadow of death and disease. He wasn’t just hospitable, he sought people out. He went where they were. Do I seek relationships out with people who are physically and mentally suffering? Christ came close to the outcasts, the suffering, the marginalized; how can I do the same?
What if our radical care for those with mental illnesses, as a Church community, was so compelling, that it reduced the desire for MAiD to begin with? If we, as individuals in the Church, actually took responsibility for all those in pain in our own communities, loved them, and introduced them to our Lord? People will be transformed. Many patients who access MAiD reported feeling loss of dignity, that they are a burden and that they feel isolated, lonely, anxious and afraid. Those are things we can do something about as a body of Christ. We can be restorers of purpose and dignity, we can be supporters of caretakers and we can come near to those who are suffering to offer presence, peace, and comfort.
My best course of action
Personally, I cannot yet reconcile providing MAiD with what I know to be true from Scripture in regards to how God uses suffering and how we ultimately ought not to enact another’s death. But I do know enough from Scripture to know that MAiD exists because I have, in part, failed both in my job in healthcare and in my own home, to care for the broken and the hurting as Christ calls me to. I think my best course of action as a practitioner, and as a Christian in community, is to care for the hurting better, include them more, create a community of grace around them, give them dignity, purpose, and meaning and demonstrate the love of Christ such that MAiD becomes the least appealing option.
This is a longer version of the piece that appeared in our September issue.