On 'Assisted Dying,' Again

Last Friday, the UK’s House of Commons voted to approve the second reading of a bill to legalize ‘assisted dying’ in England and Wales. This does not guarantee that the bill becomes law; there will be a committee stage and then a third reading. But both proponents and opponents of the bill are treating it as a very big deal indeed.

Now, I’ll largely leave the details of the legislative process to those who know more about it than I; Yuan Yi Zhu’s piece is, I think, a very helpful introduction. But as someone who has written a good deal about MAiD in Canada and the church’s response to it, much of the discourse sounds depressingly familiar. Pro-euthanasia campaigners and MPs seem unable to defend the practice without lying about it (including claiming that eligibility for euthanasia has never been widened after euthanasia laws have been passed — a bizarre claim given what’s happened in Canada). The nigh-unanimous opposition of disability rights groups is passed over in silence. Religious grounds for opposition to euthanasia are treated as somehow inappropriate, even if religious people mount their arguments in the public sphere on viewpoint-neutral grounds (this in a kingdom with an established church, no less!).

But as I said, others can talk about the details of the British situation better than I. There are two things from the Canadian experience that I do think are worth highlighting now, especially for my British readers.

Sustaining Christian opposition to euthanasia post-legalization

I have been heartened to see public opposition to euthanasia from many leaders the Churches of England and of Wales, including the Archbishops of York and Canterbury and many of the bishops in England, and the Archbishop of Wales and all the Welsh bishops.¹ This is good news indeed. But I think the real challenge — a challenge that the Church of England must start preparing for now — is what happens if euthanasia becomes legal in England. In Canada, prior to the legalization of assisted dying, mainline churches generally opposed it. The Faith and Witness Commission of the Canadian Council of Churches put out a statement opposed to legalization in the late 1990s, as did the Anglican Church of Canada. Such opposition was not necessarily particularly loud; evangelicals and Roman Catholics tended then as now to speak more forcefully against it in the public sphere. But it was there.

However, when euthanasia was legalized in 2016, the mainline Canadian churches surrendered to it as a fait accompli. The idea that churches might speak in the public sphere about MAiD was pooh-poohed as unrealistic; thus Linda Nicholls, the recently-retired primate of the Anglican Church of Canada, argued that the Anglican Church should not publicly opposed MAiD expansion, since the broader culture did not care what churches had to say. But mainline Canadian Christians went further than that: the idea that such churches could even authoritatively teach their own members about euthanasia was widely rejected. Rather, given that euthanasia was now a legal option for church members, churches simply had to pastorally accompany their people in whatever choice they made about how their life would end, or so the argument went. The notion that Christianity might in fact have something unique and definitive to say about dying well was largely rejected in favor of an approach to pastoral care as non-judgmental affirmation. It’s a prime example of what I recently called ‘Erastianism without establishment’, a willingness to let the broader culture and ultimately the state set the bounds of acceptable moral behavior for Christians, even as the state or culture in question rejects the basics of Christian belief and practice.

Now, a few Canadian Anglican dioceses have resisted this move and continued to publicly reject euthanasia and regulate how pastoral care is given to those who choose it. For example, I know of a diocese that forbidding ministers from celebrating a liturgy of some sort at the time of death by MAiD, so that it is clear that the church does not sanction the practice. But this is the exception rather than the rule. In general, in the Anglican Church of Canada, the United Church of Canada, and the Evangelical Lutheran Church in Canada, the end result has been churches baptizing views about choice and dignity that are simply incompatible with Christianity in the name of nonjudgmentally accompanying those who choose to have their doctors kill them.

And so the challenge here for the Churches of England and of Wales, a challenge that I think must be prepared for now, is how to stick to their anti-assisted-dying commitments even if the law passes and it is popular with the broader English and Welsh culture.² That is, can these churches call their people to a different way of life than the broader culture around them? Can they do more than just provide a vaguely Jesus-y gloss to whatever the broader culture says is acceptable? I don’t know exactly what this should look like, and it will be a complicated thing to get right — not least because of the Church of England’s legal responsibility (as I understand it) to provide funerals to all who request them. What’s more, from my outsider’s perspective anyway, this seems to be happening at a rather importune time for the English church especially, which is currently wracked by conflict over the place of LGBTQ people in the church and dealing with the fallout from continued failures in safeguarding. But alas, if the Canadian Christian experience about MAiD tells us anything, its that waiting for the politically and organizationally expedient time is a fool’s errand. Because if you’re not careful, you may soon have churches putting out prayer resources that encourage people dying by their doctors’ hands to pray things like this:

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.

Or this:

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].³

I hope and pray that the Churches of England and Wales, and other English and Welsh denominations, will do better than we have done in Canada. I hope and pray that they will have the gumption to call its people to live out a distinction Christian life, even when that life is more restrictive than what the law and broad secular-progressive sentiment require. Unfortunately, it’s something that I expect that all of us will have to learn how to do if our churches will maintain a coherent moral witness in increasingly post-Christian societies.

Is it really true that “no one will die because they feel like a burden”?

One of the arguments often made by pro-euthanasia advocates is that in a well-designed euthanasia program, people won’t die merely because they feel like a burden. The program will simply hasten the death of those terminally ill who would otherwise die in excruciating pain — and who could be opposed to that? Unfortunately, even if you grant that this is an acceptable reason for someone to be killed by their doctor, euthanasia programs have struggled to maintain such strict standards. If indeed the right to euthanasia is grounded in an expansive account of personal autonomy, if you assert that people have the right to leave life in the time and manner of their choosing, it becomes hard to say that only those near to death and suffering physical pain should be able to choose to have their doctors kill them. Indeed, it can even become difficult to rule out factors like the experience of being a burden as being justified grounds for seeking euthanasia.

There was a clear example of exactly this in a New York Times interview last month with Dr Ellen Wiebe, a Canadian doctor who is one of the medical profession’s loudest advocates for and busiest practitioners of MAiD.⁴ The interview was, I think, largely a softball one; the interviewer’s own mother had died by MAiD and he seemed broadly sympathetic to the practice. He was not trying to play ‘gotcha.’ And yet, largely unprompted, Wiebe quite plainly said that she thinks that feeling like a burden to others is a justifiable reason to seek euthanasia — and said that this isn’t merely a thought experiment, but that she killed a man who sought euthanasia for that very reason.

I’ll quote at some length:

As you’re aware, there are all sorts of different criticisms around medical assistance in dying. There’s the slippery slope argument: If we allow people to do this — everybody’s going to want to die.

I think the concern is that more people might feel compelled who otherwise wouldn’t choose to die. That’s the concern, and I was being flippant there, but basically, people want to live unless their life is unbearable.

Another concern could be religious: that MAID devalues the sanctity of life. Another would be that people might end up choosing it for financial reasons or because they’re pressured into it. There’s a long list. Do any of the arguments against MAID hold water for you? It is our job as clinicians who assess people for MAID to determine some of these issues you’ve just brought up. For example, I met a man in a residential hospice, and he was late-stage, confined to bed, and he said, The reason I want MAID is because I don’t want to be a burden to my family. Sorry, that’s not a good enough reason. But of course, he also was very distressed at the fact that he had been a person who’d taken care of his family and now he could have people take care of him, and it was unbearable to him that he was in that state and wasn’t getting better. So I had to determine that his suffering also included that, and not merely that he was doing it to protect his family from having to come to the hospice to see him.

What determination did you make in that instance? Oh, he was most definitely eligible.

My jaw dropped when I read this. But this, Dr Wiebe thinks, is what her commitment to human rights and personal autonomy demands. It strikes me as a perfect encapsulation of where an ethic of individual autonomy above all will get you — and perhaps the morally coarsening effects of having killed over four hundred people, frankly. This is where church and disability advocates alike can offer a fuller, thicker account of what it is to be human and reject the idolatry of a curdled ‘I am the master of my fate’ ideology gone horribly rancid. This is where we can say that being a burden is not a problem but a constitutive part of the human existence — and that dying can be a last opportunity to accept exactly that.

To be sure, Dr Wiebe is extreme, although her extremism has not prevented her from being a prominent voice in Canada on end-of-life issues. But I think this shows starkly what it is that we are up against in Canada, in the UK, in much of the post-Christian West. And I hope that we can respond by offering a genuinely humane ethic of life, death, and suffering to a culture in deep need of it.

1. To the best of my knowledge, I don’t believe any English bishop has publicly supported it although I’m not sure that every English bishop has publicly opposed it, as in Wales. I’ve seen some social media complaints about the Church of England’s silence on euthanasia but I don’t think this is accurate at all.

2. Similar assisted dying legislation is being advanced in Scotland, so the Church of Scotland and the Scottish Episcopal Church will soon face the same question.

3. Both of these prayers are put out by the United Church of Canada.

4. For an introduction to Dr Wiebe, here’s a bit from my Plough piece: “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?”