August 16, 2017

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The torturous ethics of assisted death

Paul Lachine / Newsart</p>

Paul Lachine / Newsart

My mother’s death was not sudden.

For nearly two years, she had valiantly fought lung cancer. By the time she was diagnosed, the disease had already spread through her whole body. She suffered bone fractures because of her tumours. Her brain was dotted with spots.

The end finally came when her body and her mind succumbed to the cumulative ravages of the disease, the chemicals, the radiation and the medication she had absorbed over her horrific and inspiring battle.

She was finally admitted to St. Joseph’s Hospital in Toronto after suffering a complete cognitive breakdown. She couldn’t recognize her family and had grown agitated. She could not walk or care for herself anymore and was in constant, consuming pain. She was disintegrating right in front of us like a sugar cube left in the rain.

Her medical team almost immediately offered us the option of terminal sedation. This involved sedating my mother just enough to put her into a low-level coma from which she would never again wake. We were asked to sign a do-not-resuscitate order. She would be hydrated but not fed.

The physician calmly told us that, over a period of a few days, she would starve to death.

And that’s just what happened. My mother grew smaller and fainter until one day, her heart just stopped.

I have often thought of that last week of her life, and what my family would have elected to do if physician-assisted death was an option. Would we have hastened the end of my mother’s life? Or, would we have taken comfort in the fact that medical science had obtained for her a compromise — a place that was neither living nor dead where she could slowly fade away?

All things being equal, I think we would have elected to bring an end to my mother’s obvious suffering in a quicker and more decisive fashion.

This experience has made the whole issue of physician-assisted death difficult for me to tackle as a journalist. To be honest, I have worried that some of the unresolved emotions from watching my mother’s final days have drained from me the balance that we must bring to our work. But then, St. Boniface Hospital entered the equation.

On May 29, the hospital’s board of directors narrowly voted to allow physician-assisted death to patients under "rare circumstances." This was a rather progressive decision, given that the hospital was founded by a faith-based organization.

However, the Catholic Health Corp. of Manitoba, the hospital’s governing body, added 10 new directors to the board and forced a second vote on June 16, reversing the decision and banning the provision of physician-assisted death.

The fallout from the CHCM’s actions has been profound. Dr. Markus Blouw, the board’s medical president and a practising physician at the hospital, spoke out against the board’s decision. In doing so, he hit upon the intractable issue that separates supporters and opponents of assisted death.

"I have been told that I cannot understand the implications of this decision because I don’t appreciate the value of redemptive suffering," Blouw told the Free Press.

Most faiths believe that suffering is a virtue that brings us closer to whatever god we worship. For Christians, it’s the belief that our suffering is evidence of our godliness, and will be relieved later when we reach the kingdom of God.

That is not an offensive or cruel philosophy, by any means. But how it is applied in real life can often be both.

It is impossible to escape the fact that banning physician-assisted death in the name of redemptive suffering, while providing other less-direct methods of ending someone’s suffering, is tenuous on both a legal and moral basis. At its extreme, it’s hypocritical.

Legally, publicly funded hospitals such as St. Boniface have no grounds on which to ban the practice. Individual physicians can opt out and claim freedom of religion. The Supreme Court found that institutions are also able to claim the right to freedom of religion, but only if those institutions are "constituted primarily for religious purposes" and that all aspects of their "operation accords with these religious purposes."

A taxpayer-funded hospital that treats people of all faiths, largely in accordance with a government mandate, does not qualify as a religious organization.

How are hospitals allowed to opt out of providing this service? Across Canada, health-care facilities either operated or founded by faith-based organizations have banned assisted death, in some cases refusing to even refer patients to physicians and facilities that will provide the service. In most instances, the provincial governments that fund their operation have turned a blind eye.

Why? No province wants to pick a fight with faith-based organizations on an issue involving the sanctity of life. These organizations may not speak on behalf of a majority of citizens, but they are politically astute and can hit above their weight when elections roll around. Tolerating the decision of some facilities to opt out of an insured health service is purely a reflection of a political reality no government is willing to ignore.

The consequences of this uneasy political compromise can be dire for individual patients. Terminally ill Canadians are routinely forced to relocate from one health-care facility to another to obtain physician-assisted death. Transferring someone in a frail medical condition often results in increased pain and suffering, both for the patient and their family.

Hospitals that force patients to relocate have not disputed the fact that it adds to the patients’ suffering, but neither have they justified it as moral or ethical.

Which brings us back to my mother, whose final days were lived out in St. Joseph’s Health Centre, a facility founded by a faith-based organization that has opted out of the provision of assisted death. St. Joseph’s will, however, continue to offer terminal sedation. That is curious, because, in a legal and medical context, there is very little difference between euthanasia and terminal or palliative sedation.

A 2012 decision in the B.C. Supreme Court noted that euthanasia (medical intervention that brings immediate death) and terminal sedation (an intervention that results ultimately in death) are really, in most instances, the same thing: "The preponderance of the evidence from ethicists is that there is no ethical distinction between physician-assisted death and other end-of-life practices whose outcome is highly likely to be death."

The fact that faith-based organizations continue to see a religious distinction between the two practices is, at its heart, tenuous. It suggests that somehow, religious principle need not be moral or ethical. Or perhaps that God would approve of a slow, painful death brought on by physician-administered sedation that leads to death by starvation, but frowns on a quicker death brought on by a deeper, physician-assisted sedation.

The direct actions of physicians at a faith-based hospital brought my mother’s life to an end. Not as quickly as we would have liked, but the consequence of the end-of-life treatment she received was clear and unambiguous.

Somewhere at the intersection of religion and medical science, it is my hope that secularists and people of faith can agree on one central reality: by the time patients afflicted by terminal illnesses start to think about assisted death, they and their families have probably suffered enough to prove themselves to God. Any god.

dan.lett@freepress.mb.ca

Read more by Dan Lett.

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