Open Forum on Assisted Dying:

Discussing Social and Religious Aspects
Emily Bayrachny

On Sunday, March 19, 2017, some fifty community leaders, members of the clergy, and members of the Ukrainian community gathered in the Arbor Room at St. Volodymyr Cultural Centre in Oakville to discuss the Canadian Government’s recent legalization of medically-assisted dying. The titled ‘Open Forum on Assisted Dying’ consisted of a panel of experts:

  • Dr. Moira McQueen, Executive Director of the Canadian Catholic Bioethics Institute at the University of St. Michael’s College, University of Toronto;
  • Dr. George Rewa, Cardiologist;
  • Dr. Merika Skirko, Psychotherapist; and,
  • Fr. Dr. Jaroslaw Buciora, Parish Priest of St. Volodymyr Cathedral.

Moderated by Emily Bayrachny, the panelists each presented their perspective on the new legislation and its ramifications for the Ukrainian Orthodox and Catholic communities, and for Canadian society as a whole.

The idea behind organizing this open forum is grounded in Fr. Dr. Buciora’s belief in a need for informed and open dialogue between the Church and laypersons on issues that affect the daily lives Ukrainian Orthodox community. Many of these issues are symptoms of living in the postmodern age, and often come into conflict with the over 2,000 year old teachings of the Orthodox Church. Nevertheless, Fr. Dr. Buciora advocates an open dialogue that will better help both the Church and faithful understand and navigate various issues that affect them, with the goal of thriving in postmodern society while living a life in accordance to the teachings of the Ukrainian Orthodox faith. This was the first open forum of its kind hosted by the parish and its resounding success raises hopes of future open fora on other topical issues.

Background

Dr. McQueen began her presentation with an overview of the legislation passed by the Canadian Government in June, 2016 legalizing medical assistance in dying (MAID). The culmination of a two-decade debate, Bill C-14 was passed after a ruling from the Supreme Court of Canada that stated that criminalizing medically-assisted dying infringes on the fundamental rights to life, liberty and security of the person as defined by the Canadian Charter of Rights and Freedoms.

Medically-assisted dying is often used to describe a wide range of terms that often do not mean the same thing. ‘Euthanasia’ and ‘Assisted suicide’ are often utilized but require specific definitions: ‘assisted suicide’ refers to the practice of doctors prescribing lethal doses of a drug with the understanding that the patient will take them to end his or her life, while ‘euthanasia’ or ‘medically assisted dying’ requires a medical practitioner to administer the drugs on the patient’s behalf, ending their life. Dr. McQueen highlighted the fundamental difference between these two definitions, with healthcare practitioners taking a more active role in euthanasia. These two definitions also raise their own degrees of agency and moral culpability of medical practitioners and patients themselves.

Restrictions

Canadian law has strict restrictions on eligibility for medically assisted dying as well as the procedure in place to prevent abuse of the practice. The procedure is only available to Canadian citizens or residents eligible for provincial healthcare; in Ontario, only individuals with OHIP may request the procedure. Advance directives are not permitted, meaning the individual cannot arrange for the procedure to be conducted at any point in the future, or specify specific circumstances where they wish the procedure to be conducted.

Only patients with a “grave and irremediable illness” are permitted to request medical assistance in dying. The illness must be terminal or in very advanced stages, cause a great deal of suffering, and there must be reasonable expectation of the individual’s natural death. An individual cannot be euthanized for mental illness and must be over the age of 18. Once a request is made for MAID, the patient must undergo a ten day waiting period, have two independent doctors assess and confirm the severity of their condition and have two independent witnesses sign off on the request. The individual’s consent throughout the process is vital, and the patient can revoke their consent at any point during the process without any legal consequences.

Freedom of Conscience

Dr. McQueen raised the question of freedom of conscience for medical practitioners who feel the practice violates their religious or personal beliefs. Ontario law stipulates that participation in these procedures is not obligatory for all medical practitioners, but if one refuses to conduct the procedure citing religious or personal beliefs, they must refer the requesting patient to another physician who will perform the procedure. Dr. McQueen raised an interesting point in this discussion by suggesting that the mandatory referrals policy also violates the religious and conscience freedoms of medical practitioners. She cited Roman Catholic theological teachings that placed culpability on medical practitioners even for referrals because it created a situation for ‘complicity in evil.’ In this case, Dr. McQueen argued, patient rights trump doctors’ rights and created a major conflict for ethicists and human rights advocates.

The question of mental illness and assisted suicide was brought up by several members of the audience, specifically on the nature of safeguards to protect the mentally ill from being subject to the procedure. A discussion on the Orthodox Church’s stance on suicide due to mental illness and medical assistance in dying highlighted some of the similarities on how the Church views individuals who take their own life, either involuntarily or voluntarily through medical assistance in dying. A wide consensus was reached by those in attendance regarding the subject of sensitivity toward mental illness and suicide. A differentiation must be made between suicide due to mental illness and assisted dying.

Position of the Orthodox Church: Burials and Funerals

In his panel response, the Church’s stance on suicide was discussed at length; officially, both suicide and assisted dying go against the main moral and theological teaching of the Orthodox Church, and the priest is unable to conduct Holy Unction, funerals or be buried for individuals who die by suicide or MAID. There must be a distinction between suicide caused by mental illness and MAID, however both should be reevaluated in terms of personal and religious culpability.

Although, there is an official position of the Church to refuse burial, a more empathetic approach needs to be addressed. It was stated that death is the final aspect of a person’s earthly life, and without a family and priest by the person’s bedside that individual would otherwise be alone. The panelists advocated more emphasis on forgiveness even in the case of MAID, not just for the individual, but for the family of the deceased and the community at large.

The panelists advocated that death in the Orthodox tradition is both a personal and communal event; funerals and burials are just as much for the deceased individual as they are for the grieving family and community. Funerals provide closure and peace for the loved ones left behind and focuses a great deal on the person’s life, rather than the manner in which they died. Following this line of thinking, it would seem futile to deny an individual who chose to die by MAID a Christian burial; it would do very little in the way of comfort and closure for family and community. In advocating this outlook, the panelists put forward a much more compassionate and arguably Christian outlook on the subject of forgiveness and closure.

A final question that was asked concerned the difference between medical assistance in dying and the use of ‘Do Not Resuscitate’ where an individual requests that medical personnel do not keep them alive by artificial means should they sustain life-threatening and critical injuries. This was discussed at length and the consensus of the panelists was that it was not morally wrong due to the passive nature of the request; at the point of DNR, the individual has sustained grave injuries and natural death would have occurred if not for the intervention of artificial means of extending life. Oftentimes, the artificial means of extending life do not guarantee recovery or a life beyond a hospital bed; they often delay imminent natural death rather than buying time for the individual to receive a life-saving medical procedure that will restore or improve their quality of life.

The Open Forum on assisted dying was well-attended and well-received. Attendees expressed a desire to host more open for a on a variety of topics important to the Ukrainian Orthodox community. The next open forum is planned for the fall of 2017, and will be on the subject of mental illness and suicide.