The Bishops of Canada have stated unequivocally that Catholic-sponsored health associations and organization are not to permit “medical assistance in dying/MAiD” in Catholic facilities. What does that mean for individual physicians and other health care providers when treating a patient who is contemplating or requests “MAiD”? The information on this page is intended to help you accompany your patients with compassion and truth.
Click HERE to read the Statement by the Canadian Conference of Catholic Bishops on the Non-Permissibility of Euthanasia and Assisted Suicide within Canadian Health Organizations with a Catholic Identity.
Click HERE to read a column by the Chair of IAHPC (International Association for Hospice & Palliative Care) on The Value of Ambivalence and Procrastination for Patients. The author observes that “patients who procrastinate deciding to stop futile treatments may have an unspoken – but valid and valuable – motive: maintaining hope.”
Answers to Your Questions
Q. How should my Catholic faith influence my professional practice?
Q. Can I provide care to a person who requests “MAiD”?
Q. Is withdrawing treatment the same as euthanasia or assisted suicide?
Q. Can I be present when a patient receives euthanasia or assisted suicide?
The most current magisterial teaching on end of life issues is Samaratianus bonus, a letter promulgated in 2020 by the then Congregation for the Doctrine of the Faith on the care of persons in the critical and terminal phases of life. It states:
Those who spiritually assist these persons should avoid any gesture, such as remaining until the euthanasia is performed, that could be interpreted as approval of this action. Such a presence could imply complicity in this act. This principle applies in a particular way, but is not limited to, chaplains in the healthcare systems where euthanasia is practiced, for they must not give scandal by behaving in a manner that makes them complicit in the termination of human life. (Section V, 11).
This teaching is a guideline, rather than an absolute, but it is firmly grounded in 2000 years of Church teaching. Thus, it should be understood as coming from a place of deep theological, moral and pastoral reflection.
If you have already been present when a patient died by euthanasia or assisted suicide, seek the Sacrament of Penance with a contrite heart. The priest may encourage you to make public your own conversion and rejection of euthanasia and assisted suicide, to pray fervently for the forgiveness and eternal salvation of the deceased, and/or to refuse to participate in any conversation that promotes this moral injustice.Q. Are there any instances where euthanasia or assisted suicide might be permissible?
Q. Can a Catholic facility allow the use of its space by a third party to administer euthanasia or assisted suicide?
Learn More
Accompany with Compassion
Start the conversation
- Don’t automatically say, “I don’t support MAID.” Instead, take the time to think about what you will say and be prepared to listen both to what they say and do not say.
- Let your patient know that you care about him/her and his/her life.
- Keep the conversation as open as possible. It should be a dialogue, not a lecture.
- To start the conversation, you might say:
What I am hearing you say is that you cannot continue living like this in the way you are living now. Would you like to talk more about this? It must be a heavy burden to carry alone
Explore the reasons
Palliative care expert, Dr. Harvey Chochinov, has developed a Model of Dignity and Dignity-Conserving Interventions for Patients Nearing Death (see below). This model includes simple but effective questions you can ask to explore your patient’s sense of their own dignity. For each question, he suggests one or more therapeutic interventions you can use to help you patient regain a sense of control and dignity.
Dr. Kim Adzich, a Canadian physician and member of the International Association for Hospice & Palliative Care, shares some best practices in dignity-conserving care:
Personhood Not Patienthood: 6 Tips on dignity conserving practice in palliative care
| Patient Concern Factors/Subthemes | What to ask… Dignity-Related Questions | What to do… Therapeutic Interventions |
|---|---|---|
| Illness-Related | ||
| Symptom distress Physical distress | How comfortable are you? Is there anything we can do to make you more comfortable? | Vigilance to symptom management Frequent assessment Application of comfort care |
| Psychological distress | How are you coping with what is happening to you? | Assume a supportive stand Empathetic listening Referral to counselling |
| Medical uncertainty | Is there anything further about your illness that you would like to know? Are you getting all the information you feel you need? | Upon request, provide accurate, understandable information and strategies to deal with possible future crises |
| Death anxiety | Are there things about the later stages of your illness that you would like to discuss? | |
| Independence | Has your illness made you more dependent on others? | Have patient participate in decision making, regarding both medical and personal issues |
| Cognitive acuity | Are you have any difficulty with your thinking? | Treat delirium When possible, avoid sedating medication(S) |
| Functional capacity | How much are you able to do for yourself? | Use orthotics, physiotherapy, and occupational therapy |
| Dignity-Conserving Repertoire | ||
| Continuity of self | Are there things about you that this disease does not affect? | Acknowledge and take interest in those aspects of the patient’s live that he or she most values See the patient as worthy of honor, respect, and esteem |
| Role preservation | What things did you do before you were sick that were most important to you? | |
| Maintenance of pride | What about yourself or your life are you most proud of? | |
| Hopefulness | What is still possible? | Encourage and enable the patient to participate in meaningful or purposeful activities |
| Autonomy/control | How in control do you feel? | Involve patient in treatment and care decisions |
| Generativity/legacy | How do you want to be remembered? | Life project (e.g., making audio/video recordings, writing letters, journaling |
| Acceptance | How at peace are you with what is happening to you? | Support the patient in his or her outlook Encourage doing things that enhance his or her sense of well-being (e.g. prayer, meditation, light exercise, listening to music) |
| Resilience/fight spirit | What part of you is strongest right now? | |
| Living in the moment | Are there things that take your mind away from illness and offer you comfort? | Allow the patient to participate in normal routines or take comfort in momentary distractions (e.g. daily outings, light exercise, listening to music) |
| Maintaining normalcy | Are there things you still enjoy doing on a regular basis? | |
| Finding spiritual comfort | Is there a religious or spiritual community that you are, or would like to be, connected with? | Make referrals to chaplain or spiritual leader Enable the patient to participate in particular spiritual and/or culturally-based practices |
| Social Dignity Inventory | ||
| Privacy boundaries | What about your privacy or your body is important to you? | Ask permission to examine patient Proper draping to safeguard and respect privacy |
| Social support | Who are the people that are most important to you? Who is your closest confidante? | Liberal policies about visitation, rooming in Enlist involvement of wide support network |
| Care tenor | Is there anything in the way you are treated that is undermining your sense of dignity? | Treat the patient as worthy of honor, esteem, and respect; adopt a stance conveying this |
| Burden to others | Do you worry about being a burden to others? If so, to whom and in what ways? | Encourage explicitly discussion about these concerns with those they fear they are burdening |
| Aftermath concerns | What are your biggest concerns for the people you will leave behind? | Encourage the settling of affairs, preparation of an advanced directive, making a will, funeral planning |
Despite your best efforts, the patient does not change his or her mind
A Catholic palliative care physician offers this advice:
- If my patient remains adamant in pursuing euthanasia, I will say: “I am not comfortable referring you for MAiD. In Alberta, you can self-refer and facilitate the process yourself.”
- Let your patient see that you are making the effort to care for them in the best way possible. Even if you are not willing to facilitate MAiD, your patient should know that you are still with them and will provide necessary care.