Feb.7 Open Letter – medical assistance in dying (MAiD)

February 7, 2020 Randy Bushey

This is my open letter to the chair of the board of directors of Nipissing Serenity Hospice. As you may know, the Hospice has been under fire for not permitting medical assistance in death (MAiD) in their facility. Randy Bushey

Much of the published reaction to the decision by Nipissing Serenity Hospice not to permit medical assistance in death (MAiD) in its facility has been negative, angry, and could possibly be characterized as manipulative.

However, although MAiD is legally permitted in our country, intelligent citizens and those who manage our institutions and form our governments must continue to engage in rational and thoughtful dialogue. Without being over-dramatic, I think early evidence suggests our culture is hurtling headlong into a future loaded with uncalculated risk of dreadfully unintended consequence.

For that reason, I recognize and commend the courage of your board to stand your ground and adopt, what in the eyes of some, is a very unpopular position. It is apparent: you are doing what you think is best for residents – current and future – of your fine facility.

Granted, MAiD is the current result of the democratic process. Canada’s Parliament passed MAiD legislation (Bill C-14) in the summer of 2016. However, any rational Canadian must agree that this – from a legal standpoint, at least – is a relatively new issue and continues to evolve in Canadian law and practice. The September 2019 decision by a Quebec judge, striking down the legislated MAiD clause requiring “natural death has become reasonably foreseeable” as a violation of Canadian Charter provisions demonstrates this ongoing evolution.

Canadian values hold that significant human suffering is always a heart-rending, emotional matter. Consequently, MAiD is clearly an issue with abundant complexity requiring that the vigilant weighing of different values must continue.

Some have persuasively argued that assisting in terminating a life should never be a physician’s role. Others have posited that in a culture where significant resources are invested in preventing suicide – including among teenagers and Indigenous peoples – it is incoherent to permit the intentional taking of a life in a publicly-funded facility.

Having sat by the bedside of a member of my own extended family mere days before her chosen date of physician-managed death, I know first-hand that these decisions are grim and arrived at in a context of suffering, uncertainty and angst.

However, legitimate fact-based concerns that this is becoming a societal runaway train, with a horrendous wreck – or multiple wrecks with unspeakable human carnage and loss – being the inevitable and irreversible result, must be carefully measured.

The European experience is instructive. Dr. Theo Boer is a Dutch theologian and health-care ethicist who has lectured in Canada and around the globe. He is also a man who – in the face of disturbing evidence – has changed his mind.

Originally, Dr. Boer stated that the Dutch assisted-dying laws – in place in that country since 2001— were working as intended. In 2007 he wrote, “there doesn’t need to be a slippery slope when it comes to euthanasia. A good euthanasia law, in combination with the euthanasia review procedure, provides the warrants for a stable and relatively low number of euthanasia.”

“But we were wrong – terribly wrong,” he wrote in 2014. His conclusion at that time: “In hindsight, the stabilization in the numbers was just a temporary pause.” Dr. Boer has since seen “orchestrated death” in the Netherlands become “a default way to die”, rather than an option of last resort. The demand in that country – similar to the admittedly small sample size in Canada’s short history of the practice – has grown exponentially.

Toronto-based gerontologist and medical ethicist Tom Koch posits the challenge of a fundamentally rearranged order of priority: “Constitutionally protected ‘life, liberty and security of person’ should not mean just a medical death but, first, the liberty to live one’s life fully, whatever the challenge”.

And what of the spiritual issues? The heavy, existential question that must be inserted into the discussion: what if human death is not the end? What if the Bible’s claim of post-life examination before God for every person is the reality we must all face? Is the person choosing to terminate their life with medical professional and family support, prepared for this ultimate appointment?

If true, this is not simply a religious or spiritual question; it is fundamentally pragmatic. In our Canadian culture, although seldom stated with clarity and volume, the certainty of this post-life appointment with the Almighty is a deeply-held conviction shared by many.

And throughout the Bible, this ethic is evident: suffering can and does have redemptive value.

The final word on this entire issue will be written in future generations; but, in my opinion the Hospice is to be commended for upholding a position, that, while demonstrably not popular with all, is quietly supported by many across the spectrum of Canadian culture.

Your position offers a courageous, measured, protective and dignified response to end-of-life experience; and for that, I am thankful.

Yours respectfully, Randy Bushey

~grapic by Fran Flores, freeimages.com