“If in a hundred years, Christians are identified as the people who don’t kill their children or kill their elders we will have done well.” —Stanley Hauerwas
“Church should not oppose MAID law, primate says.” So reads a recent headline of the Anglican Journal, the newspaper of the Anglican Church of Canada. In the piece, Archbishop Linda Nicholls calls for the church she leads to avoid publicly opposing the expansion of euthanasia, or medical assistance in dying (MAID), in Canada. “The mood in Canada” is not “to consider what churches have to say about this,” she says, warning against “imposing Christian values.” Far better for the church to “focus on providing pastoral care to people who are considering medical assistance in dying,” the article paraphrases her as saying, “ensuring they have the support they need to make decisions based on the value of their life.”
The value of their lives is just what many fear would not be protected by the widespread adoption of euthanasia, so rapid and sweeping that the United Nations Special Rapporteur on the Rights of Persons with Disabilities has raised concerns. Meanwhile, Archbishop Nicholls, the leader of one of Canada’s largest and historically most influential Christian denominations, is arguing that on an issue of profound moral gravity, the church lacks the capacity and will to say anything to the public as a whole, or indeed even to offer definitive guidance to its own members. The most the church will do is solicit essays for a new collection of theological reflections on MAID and put out an editorial by Archbishop Nicholls expressing “concern” about potential further MAID expansion while emphasizing the church’s role as a nonjudgmental provider of pastoral care. In this refusal to speak plainly, the church in which I serve is sadly not alone.
How did we get here? Euthanasia, which as of 2021 had become the sixth leading cause of death in Canada, was only legalized in 2016, in response to a 2015 Supreme Court of Canada ruling that criminalizing euthanasia violated the Canadian Charter of Rights and Freedoms. The Canadian Parliament complied by passing Bill C-14, a law that allowed euthanasia in a set of carefully delineated circumstances: the person requesting it must have a “grievous and irremediable medical condition” that is incurable, irreversible, and involves unendurable suffering, in which “natural death has become reasonably foreseeable.” Furthermore, consent at the time of the person’s death was required, as was a ten-day waiting period. Children and those whose only diagnosis was mental illness were not eligible.
Disability rights groups and other concerned citizens spoke up in opposition to this law before and after its passage, but for advocates of MAID, within just a few years the existing law was seen as unduly constraining. Once again, the courts led the way: in 2019, the Superior Court of Quebec found that the “reasonably foreseeable” stipulation in the government’s euthanasia law violated the Charter. Parliament passed a new, more expansive MAID law in 2021. Not only did this law, called C-7, remove some of the stipulations for the killing of those whose natural deaths were reasonably foreseeable (“Track 1” euthanasia), but it also allowed people unlikely to die naturally in the near future to seek euthanasia too (“Track 2”). This means that euthanasia, which was initially argued for primarily in terms of terminally ill people for whom MAID would painlessly hasten an inevitable, rapidly approaching death, was now available for those nowhere near dying. The number of euthanasia deaths has grown dramatically each year, from 1,018 in 2016 to 10,064 in 2021. Over 3 percent of deaths in Canada as a whole in 2021 were via MAID.
Euthanasia is logistically distinct from “assisted suicide,” increasingly available in many Western countries including parts of the United States, which requires the individual’s participation in swallowing lethal drugs. With euthanasia, a doctor injects them directly – a procedure that can be performed on individuals who are immobile or even unconscious. While MAID encompasses both methods of hastening death, over 99 percent of Canadian deaths under the law are via euthanasia.
Law C-7 also repealed the exclusion of stand-alone mental illness from the acceptable criteria for seeking MAID, to come into effect in early 2023. That is, supposedly incurable depression and other mental disorders will soon be grounds for a person to be killed by a doctor. (At the time of writing in February, the government has introduced legislation to delay by one year, but not repeal, this part of the expansion.) The government is currently exploring further loosening MAID access, including for so-called “mature minors,” and allowing euthanasia via advance directives, which would allow for individuals to ensure that they were killed via MAID if they were to suffer certain conditions – even if they withheld consent at the time that death would be administered.
Meanwhile, an entire infrastructure has sprung up around MAID, which euphemizes the procedure as gentle and nonthreatening. Thus you can find “death doulas” who work with MAID patients and their families and friends, counseling those about to die to dress warmly and hydrate before their deaths and encouraging the bereaved to process the experience through grounding themselves in their bodies or expressing themselves through dance. What is actually going on – a doctor killing a patient – is cloaked in anesthetizing therapeutic language, presumably to make the experience more pleasant for everyone involved.
In sharp contrast to this gentle language that seeks to make death seem not so very terrible, proponents of MAID expansion use rather grimmer language to talk about the lives of the disabled and dying. They talk about experiences of dependence, diapers, or drooling as evidence of a life lacking in dignity – and thus a life that should be allowed to be ended by doctor-delivered death. It is not a stretch to see why disabled advocates have argued that the expansion of MAID sends the message that “simply having a disability is reason enough for us to want to die,” that life with a disability is necessarily a life unworthy of being lived. Their fears are already coming to pass.
In 2021, the first year the “reasonably foreseeable natural death” criterion was lifted, more than two hundred Canadians who did not have a terminal illness ended their lives with MAID. This group was younger and more likely to use disability services than those with foreseeable deaths. Many reports have emerged of people pursuing MAID because they cannot access the support services they need to live a decent life or because they are pressured to do so by their medical providers. Here are just a few of them.
“Sophia,” a fifty-one-year-old woman who suffered from multiple chemical sensitivities (MCS), could not obtain an apartment that would meet her needs. While MCS is difficult to manage, symptoms can improve significantly with decent housing. “The government sees me as expendable trash, a complainer, useless, and a pain in the ass,” she said in a video a few days before she was killed via MAID in February 2022.
“Denise,” a thirty-one-year-old, was pursuing MAID for similar reasons until a GoFundMe campaign bought her some time. But if she cannot find affordable housing going forward, she may still end up dying by euthanasia.
“Kat,” a woman in her late thirties with a genetic disorder, cannot afford her treatments. “I feel like I’m falling through the cracks so if I’m not able to access health care am I then able to access death care?” she told CTV News. She has been approved for what she calls an “open invitation” to go through with MAID at any time.
Alan, a sixty-one-year-old man, was hospitalized for suicidality and, within a month, applied for MAID. He was killed over the objections of family members and his primary medical provider, who alleged that he did not understand MAID and was coerced into it by hospital staff. The only condition listed on his MAID application was hearing loss.
Sathya, a forty-four-year-old woman who suffered from ALS but for whom natural death was not imminent, was killed via MAID because she could not access home care. “Ultimately, it was not a genetic disease which took me out, it was a system,” she wrote shortly before her death in October 2022.
Some medical professionals even bring up euthanasia unprompted as an option for patients, including as a component of conversations about the costs of hospital stays, and there are regular reports of disabled people, given the insufficient state of disability benefits in Canada, considering MAID because of poverty. The implicit proffer of MAID as a solution to poverty and disability is a grievous betrayal of many of the values Canadians hold dear, of the laudable Canadian commitment to a kinder and gentler society which I have come to so admire as an immigrant here.
Even as these tragic and alarming stories come to light, the trajectory toward more permissive MAID rules seems unlikely to be reversed any time soon. Not only MAID for “mature minors” and via advance directives are on the horizon: a representative of the influential Quebec College of Physicians recently called for parents to be allowed to euthanize infants younger than one year in certain cases, declaring that MAID “is not a moral, political, or religious issue. It is a medical one.” And when the doctors have decided, who are we to judge?
One infamous clash between such “medical” and moral values came to a head in 2019 when Dr. Ellen Wiebe, a prominent MAID provider who has called her more than four hundred euthanasia procedures the most rewarding part of her work as a doctor, sneaked into a Jewish care home to clandestinely kill a resident over the objections of home staff who warned that it might traumatize Holocaust survivors. The home filed a complaint with the province’s College of Physicians and Surgeons, which cleared Wiebe of any wrongdoing – “a decision I was expecting because I trust the College,” she commented. Wiebe has also gained notoriety for telling other MAID providers that she arranged the reassessment of a person judged incompetent to seek MAID and then killed him. Are these actions really the sort of thing over which only the doctors performing them should have the final say?
To their great shame, Canadian mainline Protestants, the historic bastions of public Christianity in Anglophone Canada, have utterly failed to speak prophetically to the broader Canadian society or even coherently to their own members since the passing of MAID legislation in 2016. While many of these church bodies opposed euthanasia before its legalization, since then they have consistently avoided taking strong positions on it, essentially conceding the Quebec doctors’ argument that MAID is at base a medical issue, not a religious one. They have largely embraced a role as providing value-neutral “pastoral care” in whatever end-of-life choices their people may make. But this sort of neutrality proves impossible to maintain. By abandoning their teaching authority, the churches end up supporting MAID advocates’ accounts of human dignity and worth as bound up in choice and independence – accounts that are contrary to Christian teaching and death-dealing to disabled people.
These churches were not always so unwilling to take a stand. In 1996, the Faith and Witness Commission of the Canadian Council of Churches produced a statement critical of moves toward legalizing euthanasia, while admitting that this “convergence” was shared by “many member Churches” but not necessarily all. The Anglican Church of Canada produced a 1998 report called Care in Dying, arguing that “we believe that respect for persons would not be well served by a change in law and practice to enable a physician, family member, or any private citizen to take the life of another or assist in their suicide.” However, despite what appears to be a straightforward judgment, Care in Dying uses some carefully hedged language that anticipates the moves the Anglicans and other mainline denominations would make in years to come: the report describes itself as “a pastoral guideline rather than a policy statement,” inviting “thoughtful and prayerful engagement with the realities that people may face at the end of their lives rather than demanding obedience to closely defined teaching.” It is, unfortunately, precisely this nervousness about the church’s power to teach and expect (or even ask for) obedience that would come to define most later mainline engagement with euthanasia.
Since 2016, the United Church of Canada, the Anglican Church of Canada, and the Evangelical Lutheran Church in Canada (ELCIC) have all accepted MAID with varying degrees of enthusiasm. The United Church, Canada’s largest Protestant denomination, produced a 2017 statement that “we are not opposed in principle to the legislation allowing assistance in dying” and that MAID “may be chosen as a faithful option in certain circumstances.” The ELCIC goes even further, declaring in its 2019 statement, “We affirm that everyone has the human right to assistance in dying,” assistance that explicitly includes euthanasia. Moreover, while the United Church released a follow-up statement in 2020 rejecting the expansion of MAID to those suffering solely from mental illness, as well as the practice of advance directives, the Lutherans instead expressed thanks that “fortunately” the federal government had promised to expand MAID in precisely these ways! After all, the Lutherans affirm that providing access to MAID is a means of “loving your neighbor,” somewhat bizarrely quoting as supporting evidence Luther’s explication of the fifth commandment that Christians must “neither endanger nor harm the lives of our neighbor, but instead help and support them in all of life’s needs.” Euthanasia, the ELCIC declares, is simply part of “a respectful treatment plan developed under difficult circumstances with the best interests and the desires of our neighbor in mind.”
The Anglicans chose silence. To be sure, they had their own report, a 2018 follow-up to Care and Dying called In Sure and Certain Hope – an odd name for a statement so lacking in certainty of any kind. Unlike the United Church and the Lutherans, the Anglicans are unwilling to affirm explicitly that MAID can in some circumstances be a faithful choice. This is not because of any grave moral qualms, but seemingly because even such an affirmation would be too explicit a moral judgment. The church, the report declares, has “become increasingly skeptical of our capacity to understand and interpret the work of God in the life of another person.” Any definitive judgment about the meaning of a person’s life is off limits to the church – rather, the church simply must “listen in the encounter between God and the patient.” The church’s job is to help the dying “continue to experience meaning, purpose and control over one’s life,” facilitating whatever decisions they wish to make and “be[ing] present.” While the report encourages caregivers to seek to “build bridges between the stories told by the parishioner and the stories/teachings of Christ,” certainly any authoritative pronouncement about the nature of life or death seems out of bounds.
In practice, such studied neutrality ends up endorsing the broader Canadian culture’s approach to and understanding of euthanasia, even at the points where such understanding is incompatible with Christian faith. For example, the United Church includes several prayers for use by those planning to end their lives via MAID on the “Death and Dying” section of the church website, co-written by a United Church minister and an executive of Dying with Dignity, the largest pro-euthanasia advocacy group. One of the prayers, designed for a person experiencing fear, includes the following:
I hope they [my family] will be proud of my decision and will understand that MAID is consistent with the love and compassion of Jesus. I have such peace in knowing this is my choice.
Consider too a second prayer, for deciding on the time and place of death:
I do not want to linger in pain, waiting for death to come. I do not want my family and loved ones to watch me suffer to the bitter end. I do not want them to be haunted by memories of a slow, painful death. Daily my dignity is being eroded. I am ready to go through that final door. I give thanks that I have still the ability to choose, but I realize this window of lucid opportunity may very soon be closed [emphasis original].
What these prayers show us is that a supposedly neutral, nonjudgmental approach to accompanying the dying in whatever choice they happen to make actually involves supporting and reinforcing a whole range of judgments about what a good life and a good death consist in. The valorization of choice as the central component of a meaningful life and the suggestion that the suffering of serious illness includes an erosion of dignity are characteristic of pro-MAID language in Canada. It is worth adding explicitly that the association of illness or disability with the loss of human dignity found in the second prayer is precisely what disability advocates have been warning broader Canadian society about: surely one does not lose one’s dignity by being disabled or seriously ill! Churches that choose – in contradiction to the entire history of Christian pastoral care – to forgo any sort of strong moral judgment, failing to teach their people that some choices are right and others are wrong, end up simply parroting the messages of broader Canadian culture.
As the Presbyterian Church of Canada, the only mainline body that has maintained a consistent condemnation of euthanasia, stated in its 2017 statement on the topic, the catechesis about a valuable life from the broader Canadian culture is directly in opposition to Christian teaching. As the Presbyterians note,
We live in a culture enamoured with the closing lines of “Invictus” by William Ernest Henley: “I am the master of my fate: I am the captain of my soul.” “Invictus” is a stirring work of literature, but it decries any trust by God. As Reformed Christians, we profess a different heritage, powerfully stirring to our souls, that proclaims a complete and utter trust in God.
In their refusal to combat the culture’s discipleship of their members, the United Church and the Anglican and Lutheran churches have abandoned both public witness to those outside the church and the exercise of the teaching office to those within it. Instead, in the name of nonjudgmental pastoral presence, the churches are choosing to baptize the same values that have led to MAID’s continued expansion and an ever-rising death count over the continued concerns of disability rights groups who rightly see the dignity and very lives of disabled persons under attack. Perhaps the most vivid image of the mainline churches’ capitulation is a MAID death being carried out in the sanctuary of a United Church in Manitoba, complete with the minister telling journalists that there was a “sense of ‘rightness’” in this woman’s killing.
This, in the end, is where an ethic of sympathy and avoiding judgment absent clear moral commitments leads. For indeed we ought not doubt the deep sympathy with suffering and the humanitarian motives to ease it that drives the popular concern about end-of-life options. One might even say that it is an ethic of sympathy with specifically Christian roots in Jesus’ particular concern for the poor, the suffering, the downtrodden. Yet it is an ethic of sympathy divorced from its original context within a Christian theological and anthropological framework, within a moral universe in which independent self-fashioning is not the highest good. And without this framework, as we have seen in Canada, this ethic of sympathy can go terribly awry. As Flannery O’Connor puts it, “when tenderness is detached from the source of tenderness [the person of Christ], its logical outcome is terror.”
There is much to despair about concerning the current Canadian experiment with euthanasia and the mainline churches’ surrender. But there are also reasons for hope. Roman Catholics, evangelicals, conservative confessional Protestants, and other Christian groups have continued to publicly oppose MAID expansion, joining other religious communities and disability rights advocates standing against an ideology that sees independence as a necessary aspect of human dignity or a good human life. These groups witness in a Canadian context that dependence, far from being an unusual state to be shunned at all costs (even one’s death!), is an inevitable and indeed good part of the human condition.
One of the most visible examples of Christians standing against MAID is in the 2020 open letter “We Can and Must Do Much Better,” in which evangelical, Pentecostal, confessional Protestant, Anabaptist, Roman Catholic, and Orthodox leaders joined Jewish and Muslim leaders in decrying MAID’s expansion. The letter also offered an alternative vision of how Canadians might respond to the situations of profound suffering which may lead people to choose MAID, not least through expanding access to palliative care as an alternative to euthanasia. In short, the letter is a call to solidarity: “Rather than withdrawing from those who are not far from leaving us, we must embrace them even more tightly, helping them to find meaning up to the last moments of life.”
These churches have also worked to find common cause with nonreligious groups that have similarly opposed MAID expansion, especially the disability rights community. The Evangelical Fellowship of Canada’s response focused on the particular harm MAID might do to the disability community and echoed the language of disability advocates in declaring that “in Canada, it shouldn’t be easier to have help in ending your life than to get the support and care you need to live.” Christian and disability rights organizations alike have been weighing in on Canada’s current study about expanding MAID to mature minors and allowing it via advance directive.
But perhaps more important than tactical alliances is the way in which these groups – otherwise quite different – find themselves articulating a similar account of what makes (or does not make) a full and dignified human life. As the Canadian Evangelical magazine Faith Today writes, paraphrasing the physician and professor Dr. Margaret Cottle: “It is not undignified to be cared for. …If we believe every person is created in God’s image, then they deserve such care.” That is, dependence, requiring the assistance of others to live one’s life, does not do anything to detract from one’s basic humanity – pace the United Church of Canada prayer that invites the suffering person to pray, “Daily my dignity is being eroded.” Inclusion Canada, an organization advocating for the rights of Canadians with intellectual disabilities, strikes the same tone in a more secular register, warning against the “wide-scale perception that some persons’ lives are not worth living.” Instead, the organization seeks to promote “positive narratives” about “the quality of life of persons who live with disability, frailty, and suffering.” Similarly, the Canadian Council on Disabilities has articulated its opposition to “negative stereotypes about people with disabilities as suffering individuals in need of state-regulated assistance to end our lives.”
Whatever else they may agree or disagree on, here the traditional Christian account of what makes a good life corresponds very closely with those of disability rights advocates. The notion underlying much MAID advocacy – that a good, dignified life consists above all of independence, absence of suffering, and the proliferation of choices – is contradicted by the experience of disabled persons asserting that their lives have value despite physical pain or the need for care from others, and despite any constraints upon their options. And for the Christian, it is contradicted too by our understanding of the good life as one of acknowledged dependence upon others and above all on God. The Presbyterians make this point powerfully by quoting the beginning of the Heidelberg Catechism in their MAID report:
Q. What is your only comfort in life and in death?
A. That I am not my own, but belong – body and soul, in life and in death – to my faithful Saviour, Jesus Christ.
For the Christian, if indeed Jesus Christ is our model of a fully human life and life in Christ is our goal, independence, freedom from suffering, and the proliferation of choices simply cannot be the necessary requirements for a good life. And Christians can and must agree with secular disability rights advocates that any account of human dignity that places disabled people outside it because they need care is nothing less than evil.
“This is not the end of the road for us,” stated Roxana Jahani Aval, chair of the Canadian Council on Disabilities, at the time of MAID expansion. “This is a fight for our lives.” It is my hope that Christians will continue to accompany them in this struggle, not only Roman Catholics and evangelicals but even within the mainline churches as well. As an Anglican priest serving in the Anglican Church of Canada, I pray that my own church may repent of its silence, its collaboration with a death-dealing euthanasia system that is particularly hostile to the lives of disabled persons. May we stand for the dignity of all people and the goodness of our dependence upon each other – and upon God.