No Last Rites for MAiD

Medical Assistance in Dying is opposed by people of sound conscience for many reasons. Matthew Loftus capably distinguishes between allowing people to die and killing them. Jonathan von Maren notes its especially perilous potential for those who suffer with mental illness. The conference of Canadian Roman Catholic bishops have declared “euthanasia and assisted suicide (MAiD) have always been, and will always be, morally unacceptable because they are affronts to human dignity and violations of natural and divine law.”

An interesting, parallel development has been the searing criticism of Canadian MAiD laws in the pages of Jacobin, hardly a bastion of conservative theological ethics, denouncing on democratic socialist grounds the ways MAiD gives the vulnerable liquidation rather than care, and is being used to systematically euthanize the poor and disabled. 

But despite its diverse critics, MAiD now counts for 1 in 20 deaths in Canada, and since its legalization one decade ago, its toll surpasses the number of Canadian lives lost in World War II. 

Recently, the Anglican Church of Canada approved trial liturgies to be used before and during euthanasia. The introductory pages acknowledge that a variety of support and opposition is held about euthanasia in the denomination, and attempt to describe how heartbreaking and nuanced the circumstances often are surrounding it. 

The animating principle driving its authors is that the church must provide some kind of pastoral support to its people, including those who opt for medical assistance in dying. Because I am an Anglican priest who actively serves every week in pastoral care, I am far from indifferent to or unaware of the complexities of moral reasoning in times of unimaginable pain and dire circumstances. But precisely due to that awareness and experience, it is manifestly obvious to me that these liturgies are not only a catastrophic failure to provide pastoral care that is normed and enlivened by the word of God, but are also a grievous evil. They take the Lord’s name in vain, putting to diabolical use something holy and sacred.

In Fyodor Dostoevsky’s masterpiece The Idiot, Prince Myshkin recounts having nightmares after seeing a public execution by guillotine in nineteenth century Lyons. The valet he spoke with replied “it’s a good thing there’s not so much suffering… when the head flies off.” The prince then hotly responded with a harrowing and insightful reply:

Everybody makes the same observation as you, and this machine, the guillotine, was invented for that. But a thought occurred to me then: what if it’s even worse? To you it seems ridiculous, to you it seems wild, but with some imagination, even a thought like that can pop into your head. Think: if there’s torture, for instance, then there’s suffering, wounds, bodily pain, and it means that all that distracts you from inner torment, so that you only suffer from the wounds until you die. And yet the chief, the strongest pain may not be in the wounds, but in knowing for certain that in an hour, then in ten minutes, then in half a minute, then now, this second—your soul will fly out of your body and you’ll no longer be a man, and it’s for certain—the main thing is that it’s for certain. When you put your head under that knife and hear it come screeching down on you, that one quarter of a second is the most horrible of all.

In these trial liturgies, the certainty that horrified Prince Myshkin is adorned with the blessing of Christ in the liturgical commendation of an Anglican church. It is not terribly surprising that the church’s vocation in this instance has become so determined by meeting the felt-needs of its constituents, of supplying religious goods and services that the customers demand, that the church’s worship and witness has become theologically compromised. 

This is only one of many things downstream of mainline and progressive denominations becoming untethered from, and drifting away from, the authority of Holy Scripture and secondary confessional and historic liturgical norms for ecclesial life. As such, these trial liturgies in Canada are not so much a bellwether portending future problems to come, as a symptom downstream of the prior commitments that J. Gresham Machen so powerfully contrasted with orthodoxy in his powerful and prescient Christianity and Liberalism. The publication of these ghastly trial liturgies forces us to ask: is Christianity in general — and the Anglican pastoral and liturgical expression in particular — an authoritative account of truth and goodness to which we must assimilate ourselves, or a technique that people can use to establish their own sense of meaning derived from other sources?

Today, 103 years after Machen’s book, a range of criticisms have been offered of GAFCON’s call to reset the Global Anglican Communion. I can hardly respond to these wide-ranging criticisms here. But one especially misguided criticism has been aimed at the confidence placed in Scripture where the Abuja Affirmation claims that “The Bible is God’s Word written (Article XX). It was breathed out by him and written for us by faithful messengers. It carries God’s own authority and is its own interpreter – it is clear, sufficient and true for all times. God’s Word is the final authority in the church and in the life of discipleship.” These critics not only neglect how obviously integral Sola scriptura is to the history of the English Reformation and the theology of the historic Anglican formularies, but have also failed to recognize, as Kevin Vanhoozer puts it, that “Sola scriptura is not the answer to the question ‘How many sources should one use in doing theology?’ but instead is about the supremacy of Scripture over doctrinal norms,” namely, that Scripture alone is the norma normans non normata (‘the norming norm that is itself not normed’).

Similarly, one writer critiques the Abuja Affirmation for its confessionalism, for allegedly reducing the basis of the church’s unity to mere assent to propositional truths. Certainly there is more theologically and scripturally to the basis of the church’s unity than that, but arguably there is not less, evident in the authoritative role the Articles have played throughout Anglican history, even American Anglican history, contrary to popular myths. The 2008 Jerusalem Declaration is hardly an innovation; confessional clarity is charity, and guardrails make the highway a better place to drive. The church has long believed there are things worth clearly articulating in order to commend truth and safeguard against error, from the time of the ecumenical councils to the primary author of the classic Anglican Prayer Book and Articles of Religion putting his hand in the flames. 

We need a continuing witness to faithful, historic Anglican worship and witness whose liturgy and pastoral care is answerable ultimately to the word of God as its final judge and animating power. Paul’s epistle to of 1 Corinthians is particularly significant in this regard, that to tolerate or give approval to those who refuse clear calls to repent is to become “arrogant” (1 Cor 5:2), particularly because the church is expressly tasked not with judging the conduct of outsiders but indeed of summoning its own members to repent (1 Cor 5:12–13). If the animating power in the church’s sails is less the living voice of the word of God, but the shifting winds of human whims, especially in an institution committed to little more than institutional continuity detached from meaningful doctrinal guardrails, we will soon drift into the chaotic currents Yeats’ wrote about: “Turning and turning in the widening gyre/The falcon cannot hear the falconer;/Things fall apart; the centre cannot hold;/Mere anarchy is loosed upon the world.”

As Carl Trueman notes in the closing chapters of his incisive The Desecration of Man, there is an extremely rich and deeply scriptural approach to theological anthropology in the historic burial rites of the classic edition of the Anglican Book of Common Prayer, not least the 1662 edition. Those hallowed words solemnly and helpfully acknowledge that life is fragile, death is devastating, God is holy, we are sinners, but Christ is a merciful and comforting Redeemer who gives us hope of sharing in his death and resurrection. That theological anthropology has not only been eclipsed in the modern world’s turn away from traditional Christian funerals to secular ‘celebrations of life,’ but is now perverted in these trial liturgies for MAiD. 

One of the most beautiful liturgical moments I have had the privilege of participating in is at life’s end. In the ACNA’s 2019 Book of Common Prayer, immediately after anointing the dying with holy oil and praying a blessing upon them, a canticle is offered: the Nunc Dimittis, the song of Simeon from Luke 2:29–32. That setting is astonishing in its beauty and power; it has moved me to tears and nearly stunned silence every time I have had the privilege as a priest of leading that rite in those most holy of moments with a dying saint and their gathered loved ones, especially at the lines: “Lord, now lettest thou thy servant depart in peace: according to thy word.”  I often think about those moments every night during Evensong when the Nunc follows the last reading of Holy Scripture and I ask for God’s blessing to depart in peace to rest for the night, that awake we may watch with Christ, and asleep we may rest in peace. 

It is a distortion of this liturgical heritage to superimpose it upon medical assistance in dying; the pastoral care that is needed instead is something altogether different, something that resists a throwaway culture, something that defies rather than deifies the culture of death.

Daunting as it is to imagine, pastoral care in such circumstances might require calling profoundly troubled people at an existential brink to turn back, to change their minds — the root meaning of ‘repentance.’ Raising such a weighty and solemn word, ‘repentance,’ in this context could be horribly misunderstood, as though it were tone-deaf and detached or confrontational towards people who are profoundly suffering in already devastating circumstances.

But if the church’s shepherds are to love precisely such people, we need to be wary that what we conceive of as loving them is actually love and shepherding as it is determined by God through his saving action in Jesus Christ. Left to our own devices and whims as to what love demands or entails, pastoral care in this instance can become distorted into becoming a supportive and reassuring accomplice in a permanent mistake. 

If we are to invite someone in utterly dire straits to ‘choose life’ (Deut 30:19), to decide to continue living, and we help them somehow begin to imagine continuing their life in fellowship with Christ’s sufferings in hope of sharing in his resurrection—even amidst the deepest possible pain—perhaps such mind-changing pastoral care simply consists of being present. Maybe pastoral care could look like persisting in regularly sitting with people who are deeply suffering in a ministry of presence, active listening, prayer, the private ministry of the Word of God, and faithful administration of the sacraments for an unknown length of time—rather than giving not merely a passive approval but an officially pronounced, sacrament-like, holy oil-anointed blessing of the church upon an irreversible decision.

The day this essay was composed, June 24^th, notably is a red-letter feast day for Anglicans: the Nativity of St. John the Baptist. As St. Augustine noted, John declared about Christ that “He must increase, but I must decrease,” and accordingly the daylight lessens from this point onward in the year, while the light increases after the nativity of our Lord Jesus Christ at Christmas. The collect for today in the 1662 Book of Common Prayer reminds the church of its Advent-like vocation to testify to the coming of the Lord, particularly by summoning others to repent, even if that incurs suffering like that of John in his martyrdom. St. John did not serve as Herod’s personal chaplain for having Herodias, pastorally supporting Herod in his moral deliberation and invoking God’s blessing upon it. 

Instead, St. John called the monarch to repent, and he suffered martyrdom for it. All who personally appropriate this collect would do well to contemplate our similar vocation today, even as it might prove costly:

Almighty God, by whose providence thy servant John Baptist was wonderfully born, and sent to prepare the way of thy Son our Saviour, by preaching of repentance: Make us so to follow his doctrine and holy life, that we may truly repent according to his preaching; and after his example constantly speak the truth, boldly rebuke vice, and patiently suffer for the truth's sake; through Jesus Christ our Lord. Amen.