Dr. David Amies: On balancing 'institutional conscience' and patient rights

In his latest offering for the Dying With Dignity Canada blog, Dr. David Amies floats a possible compromise solution that would make it possible for a faith-based but publicly funded hospital to respect patients' right to assisted dying without directly violating its founding religious principles. It's good food for thought as lawmakers try to balance patients' right to a peaceful death with the historical privileges enjoyed by church-affiliated healthcare institutions.

In my last piece, I outlined the progress that is being made in the quest to see sensible, reasonable, accessible law concerning the right to die enacted in Canada. The main impediment appears to lie in the resistance of publicly funded religious institutions threatening not to obey the law on religious and conscientious grounds.

In the past week, much has been written about the eighty-one year-old man's request for assisted death. Superior Court Justice Paul Perell granted his request after a 30-minute, emotional hearing. Justice Perell agreed that the circumstances of the applicant fully met the criteria of the Supreme Court of Canada's recent ruling for an exemption to the still existing criminal code provisions. The man, A.B., had an aggressive form of lymphoma which leaves him with suffering which is an intolerable and unbearable. His statement to the court reads as follows: "My only regret in these last months is that my family and I have had to expend what little energy I have left to fight this court battle. My wish is that our government will see fit to make permanent changes in the law so that no other family will ever have to do this again.”

The judge went further for he said that there would be no need to notify the coroner after the death of A. B. Consequently, his family will be spared the distressing business of an inquest and possible autopsy. Mr. A.B. previously remarked, “I have lived a wonderful and exciting life and have seen so much of the world. I am so lucky to have a beautiful family remain close to me. Although the decision to end my suffering is one that I alone have made, it is important to me to know that I have their support. For all my love of life, I do not fear death and I have a strong wish to die with dignity at the time of my own choosing.”

I am, personally, moved by these statements and completely fail to understand how the management of any religious institution, in which a patient such as A. B. was residing, would not be similarly affected. In my opinion, to force a patient like that to seek alternative accommodation for the last few days of his life, or worse still, to send him home to shift for himself, falls far short of what it means to be a Christian.

A possible way forward

It has been my experience that religious institutions are masters of casuistry. I think then, that I can offer a way out of their conscientious objections to allowing physician-assisted death to take place on their premises. Bear in mind, the great majority of such institutions are in receipt of substantial government funds. Perhaps then, they could quarantine two or three of their rooms so that they would lay outside of the religious domain. Furthermore, they could also strip these rooms of any religious iconography. Their books could be adjusted to reflect  that these rooms were paid for in full by the government portion of their monies. The Bishop of the diocese, in which they were situated, could surely “deconsecrate” them by means of some sort of ceremony. A resident desirous of taking advantage of the likely new law, could be moved from the main body of the institution into one of the quarantined rooms and nursing and medical staff could be brought in from outside to assist the patient on his way during the last day two of his life. Of course, there would be some slight extra expense in such manoeuvres but they would likely be much less than that involved in making a long-distance transfer to another institution.

By this means, all are satisfied. The patient would get his wish. The institution could properly argue that assisted dying was not occurring in its premises and the unfortunate and unsavoury sight of a desperately ill and suffering person being thrown out of the hospital or hospice would not find itself plastered all over the media. Doubtless, there would be a few troubling little details to be overcome but the Roman Catholic Church has not lasted as long as it has through inability to find its way through muddy waters.

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.

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