A time to die

When Susan Griffiths of Winnipeg went to Switzerland a year ago to die by doctor-assisted suicide, it was headline news and re-ignited the debate around end-of-life issues. Responses to her death revealed that we are living in a time of shifting public sentiment when it comes to end-of-life issues, especially concerning euthanasia and assisted suicide.

Then last fall, at age 75, Henry Rempel of Kitchener, Ont., chose to end his life. His obituary read: “In the end, his suffering was too great due to the harsh progression of the arthritis and due to many other medical ailments, such as a cancer, and he made the brave decision to complete his life in Switzerland with the help of the kind people of an organization called ‘Dignitas: To live with dignity, to die with dignity.’ ”

“He had given it great thought for years,” said his brother John Rempel, director of the Toronto Mennonite Theological Centre. “He was a conflicted person about religion and part of that had to do with his suffering, the worst of which was his rheumatoid arthritis, which in the end crippled him. It was terrible to watch him suffer.”

Changing perspectives

The April 5, 2014, issue of the Winnipeg Free Press states a recent national poll shows a growing number of Canadians—now 68 percent—support the legalization of assisted suicide. An editorial in that same paper states that Canadians have been polled for more than 20 years on their views of assisted suicide and concludes: “Over that time, the focus of the discussion as to who should be allowed such help, and in what circumstances, has shifted—moving from those with terminal illnesses and who will be unable to kill themselves, to include those who are in the painful grips from a mental illness that cannot be relieved, or even those who cannot speak for themselves.”

Just a week before, Conservative Member of Parliament Steven Fletcher introduced two bills that would allow for physician-assisted suicide. He told reporters, “I would have found a lot of comfort in knowing that I had options.” Fletcher was paralyzed from the neck down in 1996 when the car he was driving hit a moose.

The Supreme Court of Canada has announced that it will hear an appeal of a ruling in British Columbia about an assisted-suicide case. If the court should decide the current Criminal Code ban on assisted suicide is unconstitutional, it will be up to Parliament to draft new legislation.

Until the recent election in Quebec, a bill that would have allowed physicians to help patients die under certain circumstances was being considered.

Against this backdrop of shifting laws and public opinion can we find some solid ground to stand on? Dr. Cornelius Woelk, medical director of palliative care for Southern Health in Manitoba, says it is vital that the church get involved in the discussion: “It is happening around us. It is easy to say that euthanasia and assisted suicide should never happen, but that’s like putting your head in the sand. This discussion is happening and we should be part of the solution and talking about these issues.”

In the image of God . . . or baby boomers?

As Mennonites, we believe that we are created in the image of God, and understand that life is a gift from God that is to be lived and nurtured with reverence and respect. But with ever-advancing research, technology and medical interventions, the ways we define the beginning and ending of life have become blurred, or at least more nuanced. We are better able to treat illnesses, but not necessarily cure them. We face a future of a rapidly growing elderly population, one that demands quality of life without pain and suffering, and increasingly the ability to control how and when they die.

David Schroeder, professor emeritus of New Testament and philosophy at Canadian Mennonite University, Winnipeg, says that we fail to recognize that death is always with us and every day we are making life-and-death choices. “Dying sets in from the beginning of life,” he says. “Our body is constantly dying and in need of being renewed.” But such talk goes against the grain of our society that avoids talking about death.

As a young athletic man, Schroeder contracted polio. “When I survived polio, I was conscious of the sportsman in me having passed away,” he says. “I could grieve the loss, but I could not change it. Now I am aware of the relative uselessness of my right arm, and the process of dying continues.” Now approaching 90, he has experienced the deaths of many close friends and family.

Marianne Mellinger, supervisor of applied theological studies and program coordinator of the spirituality and aging program at the University of Waterloo, Ont., says that being able to accept that death is a part of living, but being willing to talk about it is countercultural. “We live in a culture that emphasizes how the baby boomer generation wants to continue living and being active, and then to drop dead,” she says. “The idea of slowing down hasn’t made it into their mindset.”

Ethical decisions in an age of technology

The situations and decisions we face have become increasingly complex and nuanced. “God has given to humans the gift of technology, but it has to be used responsibly,” says Schroeder.

With current technology there are interventions that can extend life beyond that which is natural, says Woelk, noting, “There are no laws against withholding or withdrawing care. We have all these interventions that are not natural. We can keep people alive in an almost artificial state.”

The reality is that we seldom know all the factors that enter into making an ethical decision, and yet we have to make a decision.

“We are always in the process of making ethical decisions without having full or adequate information,” Schroeder acknowledges. “We need to learn to work at those places where we differ. We quickly move to the sports approach, dividing into two factions, each side trying to persuade the other.”

But he believes there is another way. “We could turn that around and say that we are one community, and serve the same faith and the same Lord, and together seek the will of God, even though we know full well that we may not achieve final solutions before we have to act,” Schroeder says. “We should be much more ready to isolate problems and use all the resources we have and together try to find a solution. We should be quicker to implement decisions reached and see if they provide good fruit and, if not, repent and try a second round of discerning.”

John Rempel, whose pacifist faith compels him to resist any form of taking a life, struggles to understand his brother’s death. He has come to see that it is important to “find some way of balancing your own struggle and conviction over and against a capacity to listen without judgment to what an afflicted person is saying.”

“Sometimes our decision-making centres on avoiding pain,” says Woelk. “But I think that we can treat a lot of physical symptoms if we continue to be diligent and work hard to stay on top.”

Rempel wonders if things might have turned out differently if his brother’s pain hadn’t been so extreme and if it had been brought under control sooner. “If that had been the case, I can’t say what he would have done, but it would have changed how he made the decision and maybe would have changed the decision.”

What to say when someone says, ‘Why can’t I die?’

In her work as chaplain, and in talking with other chaplains, Mellinger has encountered situations in which people express the wish to die. “ ‘Why can’t I die?’ is one of the top things seniors will say,” she says, “especially those who are quite elderly or have a terminal or chronic illness, or feel they have nothing to live for. I think, however, the request for assisted suicide is much more unusual.”

“What the research shows is that people who come from a faith perspective tend to express that desire less often than those who do not associate with a faith tradition,” she says.

Canadians are fortunate to have publicly funded healthcare, but there is still a steep cost to medical interventions. When interventions to prolong life are considered, “those interventions place more and more financial demands on the system, and require that we plan and prepare for longer life,” says Schroeder. “That is one of the ethical decisions we sometimes face. This requires that a greater amount of our budget—personally or governmentally—has to be provided for medical purposes. People are living longer and that is another good reason to talk about these things. We are better at treating the acute, but we end up with more chronic things that get us down.”

Maximizing the quality of life

“Palliative care is not about lengthening or shortening life, but maximizing the quality of life,” says Woelk. “Harvey Chochinov, professor of psychiatry at the University of Manitoba and director of the Manitoba Palliative Care Research Unit, found that there was a significant number of those with a terminal diagnosis who, early on, expressed the wish to have euthanasia, but as time went on and as they received good palliative care, they became less likely to want euthanasia.”

“End-of-life decisions will be more complicated as time goes on,” Mellinger cautions. “It will be necessary for the church community to be aware of the complexity of cases and to seek to find appropriate Christian responses to them.”

What can you . . . and the church . . . do?

In addition to investing in good palliative care, advance-care directives give concerned Christians an opportunity to speak out about what they believe is important at the end of their lives. An advance directive informs medical providers and the family about the wishes one has with respect to end-of life-decisions. The directive gives “power of attorney” to those people you trust to make decisions for you, says Schroeder.

Woelk supports their use. “These legal documents can delineate what you would want if you can’t speak for yourself,” he says. “It is important to name a proxy, and they need to know what you would want, what your goals are and what are the burdens you would be willing to put up with. These conversations should happen with your family. People are dying all the time, and you can start a conversation about that. A family meeting is very helpful to get those things sorted through. More conversations should be happening before a crisis sets in.”

“It is important because the medical professions may at times be bound legally to use extreme measures to sustain physical life,” notes Schroeder. “They may be governed by laws and directives that are not in agreement with our faith. A medical directive frees them to honour our wishes with respect to end-of-life actions and allows the family to know our wishes and carry them out.”

He strongly advises having a health advocate and sees a place for the church to play a much more significant role. He has been a long-time advocate for churches to employ a nurse or someone who can help with medical decisions, and do some of the education work. “I think the church would actually grow,” he says. “People would see that the church is a good place to be.”

Mellinger agrees that this kind of education is important for the church to provide. “In Mennonite Church Eastern Canada, our lay leadership training event next year will focus on the difficult conversations that need to happen between adult children and their parents, and how churches and pastors can help facilitate and encourage these kinds of conversations,” she says.

“I can never escape dying, but in Christ there is victory over the fear of death because he has broken its power. There is both death and resurrection. I live now in the power of the resurrection,” Schroeder says, quoting I Corinthians 4:16-18.

By carrying this faith forward; by providing good palliative care, guidance and support in facing pain or illness; by having the uncomfortable and yet necessary conversations about end-of-life concerns, perhaps we will not have to fear death.

For reflection and group discussion, go to the discussion questions related to this article.

For more information:
Canadian Virtual Hospice: www.virtualhospice.ca
Canadian Hospice Palliative Care Association: www.hpcintegration.ca
End of life care and living wills: www.advancecareplanning.ca