A Time to Die: Reflections on Medically-Assisted Dying in Canada

There is “a time to die” says Scripture (Ecclesiastes 3:2). When is that time? And who decides?

I live in Canada, where these questions now seem to have clear answers: you may decide when to die, and whatever you decide is ipso facto the right time.

Over the past few years a sequence of new legislation has been passed by the Canadian government that permit and provide for assisted suicide — or “medical assistance in dying” [MAID]. In 2015, after decades of well-organized campaigns by MAID proponents, Canada’s Supreme Court decriminalized assisted suicide. The next year Parliament passed legislation allowing medically-assisted death for persons whose condition was terminal and for whom death was “reasonably foreseeable.” Recently, Parliament scrapped the requirement of a reasonably foreseeable death (Bill C-7). Now, adults can choose assisted death if their condition is “serious and incurable” and their suffering intolerable. In March 2024, individuals whose suffering is psychiatric, e.g. depression, schizophrenia, or bipolar disorder, shall be able to seek MAID if their condition is deemed “irremediable.” In all likelihood, a parliamentary committee report will very soon recommend MAID be extended to “mature minors.”

These developments in Canada are consistent with changing social attitudes and laws around medically-assisted dying all around the world. Decriminalizing assisted death was a popular move among Canadians (even as questions and concerns have been raised regarding the legal and political processes behind emergent MAID legislation).

A large majority support removing further restrictions on MAID that infringe on a person’s right to choose the time and place of their death.

But the dizzying speed at which these changes are taking place, and the justification given for them beg pause for reflection by Christians. The state of California, which is approximately the same size as Canada (population 40 million), and which also legalized euthanasia in 2016, saw twenty times fewer medically-assisted deaths in 2021 than did Canada. Without intending anything like a full-scale refutation of euthanasia, I wish to pose the question what time is it? in order to drive a spoke in the wheel of MAID’s rapid progress and create space for such reflection.

What time is it?

Let’s put the matter of “a time to die” into the wider context cast by the question: “What time is it?” Christians inclined to think about Christian faith as a kind of worldview will have come across this question in works by N. T. Wright, Craig Bartholomew and Michael Goheen and others. “What time is it?” asks after two things. First, what is the cultural “time”— the Zeitgeist — which shapes how we think about ourselves, our neighbors, and the world at large? Second, what is God’s “time”? In other words, where are we located in the great drama of creation, redemption, and reconciliation that the triune God is writing in human history?

Our Time

Clearly, our “time” in 21st-century Western society valorizes personal choice and autonomy. Much like the Netherland’s trailblazing euthanasia legislation Wet op levensbeëindiging (2001), MAID policy in Canada embodies the dogma of the individual self as autonomous and self-determining. It is “autonomy and freedom of choice” that justified Bill C-7, according to a government briefing. And the same are typically cited as primary reasons for expanding MAID’s scope to people who aren’t dying, to the mentally ill, and even—as recommended by the influential Dying with Dignity lobby—to children “at least 12 years of age and capable of making decisions with respect to their health.”

The risk in defining a person as autonomous and self-determining is to reduce human dignity to possession of these traits. Indeed, the “dying with dignity” movement heavily links dignity with autonomy and choice: to not have free control over your body, mind and destiny due to illness or injury robs you of your dignity. This premise makes it easy to consider people who are not autonomous, but rather must depend on others, as lacking dignity. Should we be surprised, then, at the number of MAID cases involving impoverished Canadians? (This news first broke through the British press and received relatively little attention in Canada until of late.) MAID proponents like Jocelyn Downie at Dalhousie University are quick to defend Canadian protocols: “You have to meet rigorous eligibility criteria. And being poor and not having a home, or a home that is suitable for you, does not make you eligible.” Obviously, poverty is not a formal criterion for MAID! But Prof. Downie is overlooking how our “time” shapes how we think of ourselves. In a society that has idolized autonomy, to become dependent on others financially, medically or otherwise is to forfeit both freedom and self-determination and, therefore, to lose dignity. All this creates a context where poverty as much as disease does make euthanasia credible.

The logic of autonomy and choice is also clear in how Canadians are now thinking about mental illness in reference to MAID. People suffering from depression, PTSD or a psychiatric disorder have (often) lifelong and incurable afflictions from which they are not dying. Rather, their affliction leaves them dependent upon spouses, friends, therapists, nurses, and others. Apart from whatever suffering they experience due to their psychiatric affliction, a major justification for permitting assisted death in these cases appears to be the perception that irremediable dependence has diminished their dignity.

While Christians certainly can use — at least carefully — the language of individual ‘freedom’ and ‘rights,’ we should be critical of how autonomy is defined in our current Zeitgeist and applied in MAID legislation. Drawing upon Scripture and various philosophical traditions, Christian theology has typically insisted that the human person is created to depend upon others in myriad ways. The Lutheran theologian Dietrich Bonhoeffer noted how God creates us as “male and female” (Genesis 1:27) and not as autonomous individuals. “The human being is not alone” Bonhoeffer concludes. In fact, he argues that dependence is the essence of being human — and it’s a good thing to need others and be needed!

Christians should also be wary of how our “time” collapses dignity into autonomy — what makes ‘dying with dignity’ so appealing to many. Dignity is inherent to persons as created by God; it’s not an attribute of our purported autonomy which is lost when we lose our financial independence or control of bodily functions. After all, Christians confess Jesus Christ as the full embodiment of dignity, even as he “takes the form of a slave” (Phil. 2:7) in his incarnation, even though his freedom was taken from him as he was led to the cross, even as he died helpless, poor and utterly dependent.

God’s Time

In Margaret Atwood’s vivid dystopian novel, Oryx and Crake, “Snowman” — one of the few humans left on earth in the aftermath of an engineered bio-pandemic — wakes up from a night of troubled dreams.

Out of habit he looks at his watch — stainless steel case, burnished aluminum band, still shiny although it no longer works. He wears it now as his only talisman. A blank face is what it shows him: zero hour. It causes a jolt of terror to run through him, this absence of official time. Nobody nowhere knows what time it is (5).

On the contrary, Christians claim to know what time it is. We live in the time between the resurrection of Jesus and his coming again. This period of history is often characterized by theologians as having an “already/not yet” dynamic. God’s victory over death and sin has already happened in the death and resurrection of Jesus Christ; the full realization of that victory in history and in our lives has not yet taken place. As a result, joy and peace are present in our lives but so too is grief, pain and suffering. Scripture teaches that through faith we live in hope for what is still to come. As such, in this moment of God’s time we seek to be “patient in suffering” (Romans 12:12) and commit ourselves to bear others’ sufferings through works of justice and mercy.

Enormous pressure is placed upon individuals and a society when we don’t know the time, i.e., where the already/not yet dynamic of God’s time is absent. “It causes a jolt of terror to run through [us].” We become fearfully and frantically impatient. We grow resentful to our aging bodies, and push medicine to overreach in giving us a life free of suffering. Then, when efforts to prolong life without suffering are “no longer the best option” (as a recent op-ed on MAID put it in the Canadian news) we take matters into our own hands. MAID now allows us to remove the ineluctable fact of human suffering by removing the sufferer. And at least some influential Canadians are willing to extend the removal of suffering even beyond the autonomous agent. In the Fall of 2022, Dr. Louis Roy, the head of the College of Physicians in Quebec, recommended that MAID could be applied to infants suffering from “severe deformities” which reduce their likelihood of survival [“qui annihilent toute perspective de survie”].

To be clear, Christian faith doesn’t celebrate suffering or call people to stiff-lipped acceptance of it. The power of medicine to minimize suffering is a great good and should be encouraged, especially through attention to palliative medicine and care.

Yet we should notice what the language of the new MAID legislation in Canada reveals about how our society regards suffering. The law permits assisted death for persons who have a “serious and incurable illness, disease or disability” and who are “enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.” Here, suffering isn’t measured by any standard other than personal feeling. This seems especially significant as MAID extends to people with mental illness: “You can’t see depression on a scan,” bluntly said one medical consultant. Do we grow impatient with suffering not just because of the presence of pain but also — and perhaps foremost — because of the absence of meaning for that suffering? In other words, we lack a narrative in which suffering can be both comprehended and endured. To find that narrative we need to know the time.

Within God’s time, suffering can be comprehended and endured. Faith in what God has already done for us in Jesus Christ gives us hope in what is not yet realized: a world in which “He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away” (Revelation 21:4).

Apparently MAID is backed by very high numbers of Catholics (86%) and Protestants (79%) in Canada. Perhaps the reflections offered here might challenge those many Christians who support MAID in Canada and other countries to think more clearly and more Christianly about our “time to die.” We need churches and religious communities who are compassionate, bearing the sufferings of others through prayer, presence, and works of mercy. We also need prophetic persons and communities to witness to the good limits of a God-made life and rejoice in the many bonds of dependence that connect each one to another and, ultimately, to the triune God.

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