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

 

 

Q. How should my Catholic faith influence my professional practice?  +

As Christians, each one of us has the “noble obligation of working to bring all people throughout the whole world to hear and accept the divine message of salvation” (Decree on the Apostolate of the Lay People, Vatican II, paragraph 3). This obligation does not stop at the doors of the parish church. We are privileged to know the Truth – not just as an idea but in the person of Jesus Christ. St. Peter admonishes us to reverence Christ as Lord in our hearts and to “always be prepared to make a defense to any one who calls you to account for the hope that is in you, yet do it with gentleness and reverence; and keep your conscience clear” (1 Peter 3:15-16). In the same way, St. Paul solemnly urges us to “proclaim the message; be persistent whether the time is favorable or unfavorable; convince, rebuke, and encourage, with the utmost patience in teaching” (2 Timothy 4:2). Take heart. The Catholic Church is not simply opposed to euthanasia. Rather it is FOR LIFE and the salvation of souls. You have Good News to share!

Q. Can I provide care to a person who requests “MAiD”?+

Ultimately, you as the moral agent must discern the answer to this question. Direct participation in “MAiD,” either by direct referral, prescribing a drug that the patient takes him- or herself, or administering a substance that causes death, is formal cooperation in evil and always morally illicit. However, Catholic moral theology has discerned other forms of cooperation that allow one to ask: How far away – how remote – must my actions be from the evil act in order for them to be morally legitimate?
 
Click HERE for a helpful tool to assist you in discerning whether or not you can provide the services requested in good conscience. 

Q. Is withdrawing treatment the same as euthanasia or assisted suicide?+

No. When a person reaches a point where continued intervention is deemed futile or disproportionate (the expected burdens of the treatment are greater than the expected benefits), withdrawing treatment simply allows nature to take its course. However, medically assisted nutrition and hydration must be given until the person can no longer benefit from this care. Withholding or withdrawing nutrition and hydration must never be done to hasten death (Catholic Health Alliance of Canada, Health Ethics Guide, 2012).

Q. Can I be present when a patient receives euthanasia or assisted suicide?+

Even when the state legally permits euthanasia and assisted suicide, as it does Canada, Catholics are not to take part in it. They may not request it as a treatment option, nor may they participate in it with or for another person. As hard as it may be, a Catholic must not be present when another person is killed by euthanasia or takes their own life by 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?+

It is never permissible in Catholic teaching, which draws a firm line in the sand: we respect the sanctity of life as stewards of God’s creation, from conception until natural death. (CCBI News: Catholic Facilities—No to MAID: Church Teaching on Cooperation in Evil, November 3, 2023) 

Q. Can a Catholic facility allow the use of its space by a third party to administer euthanasia or assisted suicide?+

Admitting a third-party entry to Catholic facilities to perform MAID is not an ethical response by Catholic institutions that exist to protect the inherent worth and dignity of life from conception until natural death. Any action that contradicts that principle is wrong, abortion and euthanasia being the most extreme in that both deliberately bring about death to a God-given human life. (CCBI News: Catholic Facilities—No to MAID: Church Teaching on Cooperation in Evil, November 3, 2023) 

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/SubthemesWhat to ask… Dignity-Related QuestionsWhat to do… Therapeutic Interventions
Illness-Related
Symptom distress Physical distressHow 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 distressHow are you coping with what is happening to you?Assume a supportive stand Empathetic listening Referral to counselling
Medical uncertaintyIs 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 anxietyAre there things about the later stages of your illness that you would like to discuss?
IndependenceHas your illness made you more dependent on others?Have patient participate in decision making, regarding both medical and personal issues
Cognitive acuityAre you have any difficulty with your thinking?Treat delirium When possible, avoid sedating medication(S)
Functional capacityHow much are you able to do for yourself?Use orthotics, physiotherapy, and occupational therapy
Dignity-Conserving Repertoire
Continuity of selfAre 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 preservationWhat things did you do before you were sick that were most important to you?
Maintenance of prideWhat about yourself or your life are you most proud of?
HopefulnessWhat is still possible?Encourage and enable the patient to participate in meaningful or purposeful activities
Autonomy/controlHow in control do you feel?Involve patient in treatment and care decisions
Generativity/legacyHow do you want to be remembered?Life project (e.g., making audio/video recordings, writing letters, journaling
AcceptanceHow 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 spiritWhat part of you is strongest right now?
Living in the momentAre 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 normalcyAre there things you still enjoy doing on a regular basis?
Finding spiritual comfortIs 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 boundariesWhat about your privacy or your body is important to you?Ask permission to examine patient Proper draping to safeguard and respect privacy
Social supportWho 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 tenorIs 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 othersDo 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 concernsWhat 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
Source: Harvey Max Chochinov. Dignity Therapy: Final Words for Final Days. Copyright © 2012 by Oxford University Press. Reproduced with permission of The Licensor through PLSclear. Click HERE to download a pdf of the Dignity Therapy table.
 

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.