Eighteen years after the release of Care in Dying, a document produced by the Anglican Church of Canada which sought to provide a theological perspective on physician assisted dying, and 16 months after the Supreme Court of Canada struck down its previous ban on the practice, the church has released a new resource reflecting the changed legal situation in Canada.
Produced by the Faith, Worship, and Ministry Task Force on Physician Assisted Dying, In Sure and Certain Hope: Resources to Assist Pastoral and Theological Approaches to Physician Assisted Dying is available online and offers new perspectives on palliative and pastoral care among others, and provides prayer and liturgical resources.
Unlike Care in Dying, which argued against any change in public policy and recommended that church members “not seek recourse to euthanasia and assisted suicide,” In Sure and Certain Hope does not attempt to argue for or against physician assisted dying.
“Whatever we might think about physician assisted dying, it’s part of the legal landscape in Canada,” said the Rev. Canon Eric Beresford, task force chair.
“The question is no longer simply is this right or wrong,” he added. “The question is, pastorally, how do we care for people in this new situation?”
Archbishop Fred Hiltz, Primate of the Anglican Church of Canada, praised the resource while acknowledging that it did not provide a “yes/no, black-and-white” perspective on physician assisting dying.
“A report like this is not going to please everybody because it doesn’t give a direct answer, and that will frustrate some people,” the Primate said. “But as the report comes out, to give a direct answer is in fact to alienate people over a very sensitive and complex issue.”
He highlighted the use of the term “covenant of presence,” where pastoral caregivers and family members walk with individuals who may be contemplating assisted dying, regardless of their own views.
Following that perspective, the theological section of the resource aims to support what Beresford calls “generous pastoral practice,” going beyond the personal views of clergy on the appropriateness of assisted dying and helping them find a range of responses to whatever decision their parishioners may make, addressing issues such as suffering, intentionality, conscience, dignity, and hope.
The Rev. Dr. Eileen Scully, director of Faith, Worship, and Ministry and principal staff to the task force, said the new resource was designed to raise questions about faith, pastoral presence, and how caregivers can make a difference in society by offering pastoral care to the dying.
“It’s a complex situation … When it comes down to it all, we have a duty to care for each other,” Scully said. “We have a duty to care especially for the vulnerable. We have a duty to care for the dying. We are to accompany people particularly in the dying process.”
One thing that has changed little since the publication of Care in Dying in 1998 is what Beresford calls the “very patchy provision” of palliative care aimed at relieving suffering, which is not always available in Canada and often undertaken in a tertiary care context.
As a result, In Sure and Certain Hope continues to highlight the importance of palliative care that is compassionate and holistic, “facilitative and permissive rather than prescriptive,” and ensures that patients have a real choice.
Potentially the most controversial section pertains to pastoral care, where clergy must be present to bring God’s love and compassion to the dying or terminally ill, in some cases putting their own views aside.
“What the document is saying is that to pass judgement and to refuse to provide care because the person is making a decision we disagree with is, in fact, moral abandonment,” Beresford said. “It’s exactly the opposite of care … Care involves, not denying our views, but living in the tension of our views in relationship to another.
“It involves being present to the other, even when that’s uncomfortable, in the view that ministering the presence of God and the compassion of God is in fact the way that hearts and lives are shaped—not by claiming to pronounce the judgement of God.”
To provide approaches to pastoral care, the task force drew on the experiences of Anglicans such as the Rev. Canon Douglas Graydon, who has provided end-of-life care throughout his vocation.
For 14 years, Canon Graydon served as the chaplain at Casey House Hospice in Toronto during the early years of the HIV/AIDS pandemic, a time when assisted dying was a “constant conversation” among those suffering from AIDS.
“Young men were dying in catastrophic ways, generally abandoned by families, and so they wanted to maintain some kind of control over their lives,” he recalled.
“Of course, [assisted dying] couldn’t happen because it was—is—illegal. But within that culture and all those years of having conversations around it, it certainly helped me come to my own personal views as to where assisted dying rests within the Christian frame of thinking.”
Members of the task force describe In Sure and Certain Hope as adding to Care in Dying, rather than replacing it. They are currently working on two accompanying study pieces: a series of church bulletin inserts dealing with questions on dying and pastoral care, and a Lenten study guide that would provide the framework for a five-week discussion on the issues.
Archbishop Hiltz emphasized the accessibility of In Sure and Certain Hope, which was commended at the last meeting of CoGS in March, to all Anglicans.
“It’s written by theologians and pastoral caregivers, but it’s written in such a way that every person in the Anglican Church of Canada could read this,” the Primate said, adding, “I regard it as a gift to the church at this time.”