Going into that Good Night

Just over 18 months ago I sat at my mother’s bedside during her final days. Her decision had been not to pursue further medical treatment, which inevitably meant that her death would be imminent. But she was content, and at peace. The palliative care that she received provided comfort and she left this world as she had lived her life – with dignity.

A dear friend chose a different path as he struggled with health issues over the past few years. He courageously endured numerous rounds of treatments that, at times, tested him mercilessly. But he was a stubborn, determined soul who squeezed as much time as he could from a life that had been well-lived.

Two different people, two different choices, yet their decisions are strikingly similar when you realize that in both cases, when faced with death, they determined they wanted to be the authors of their own destiny.

As a United Church minister, I have often journeyed with people as they grasp onto, sometimes firmly, sometimes not, every last moment of life. It is a privilege to be with people during these times – but it can be a challenge when faced with troubling questions about what constitutes a “good death”, and how does one achieve that when pain or disability can sometimes prevent an individual from living as they would want to during their last weeks, days, or hours on this earth.

The question of being able to die with dignity has been on my mind lately as I listen to renewed public debate over the question of whether assisted suicide and euthanasia should be legalized.

In June, the Quebec government approved legislation that allows doctors in that province to assist terminally ill patients who wish to die. In the months leading up to that decision, voices were heard both for and against what some people consider legalized murder, and others believe is compassionate care. It is a debate that is unlikely to be over soon.

This week, the Supreme Court of Canada is scheduled to once again address the issue of assisted suicide and euthanasia when it hears an appeal by the British Columbia Civil Liberties Association (BCCLA) in the Carter v Canada case. The BCCLA is challenging the laws that criminalize doctors for helping competent, seriously ill individuals who wish to hasten death.

Legal arguments aside, often the most compelling advocates for the right to die are the people who were faced with that fight in their own lives. Sue Rodriguez, Dr. Donald Low, and Gloria Taylor are just a few of the voices that have spoken passionately for the right of Canadians to die in a manner and a time of their own choosing.

For others though, any form of physician-assisted dying is a slippery slope that society must avoid at all costs. Clearly consensus is not something that will be easily achieved.

And so what insight or wisdom might I offer as a religious leader as the Supreme Court listens to arguments on both sides of a question that I believe challenges us as a society to hold in tension not only the legal ramifications of this debate, but also the moral and ethical issues that arise when discussing assisted suicide and euthanasia.

For Christians, life is a sacred gift from God and needs to be valued and protected.  But we also know that both life and death are part of the whole created order. Life itself isn’t absolute. Nor certainly is death. To speak of the sanctity of life is to affirm God’s desire for abundance of life for all of creation. God is love, and the Christian affirmation is that God’s love is the only absolute. “In life, in death, in life beyond death, God is with us” says our creed.

So the United Church’s theological tradition is not to suggest that believing in the sanctity of life means that any attempt to end life must be prevented. Instead, what we are called to do is first listen to the struggles of those who are facing hard decisions and to make sure that they are not alone in those decisions, and second, to trust people with difficult choices about their own lives.

We also live, however, within the legal framework of our society and are bound to honour our laws.  But laws change and this is an area where I think they should change in order to allow physician-assisted dying in circumstances that meet carefully defined criteria.

I came to this conclusion after weighing a persuasive range of moral, ethical, and legal arguments on all sides of this question. In the end, I concluded that as a society we have to talk more about death and dying. Our communities need to be places where no one struggles with life and death decisions without a listening ear and a warm hand. And as individuals we need help with the difficult choices we are called to make in our lives today, choices that all too often involve having to choose between the lesser of evils.

Hastening death should never be a first choice, but sometimes, for some people, when faced with the unbearable suffering of ALS, or a hundred other terminal illnesses, it may be the right choice. We need only listen to the stories of those who are walking and have walked this path, and trust the decisions they make about their own lives. Sue Rodriguez, Dr. Donald Low, Gloria Taylor, and I believe God, would want it that way.


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28 thoughts on “Going into that Good Night

  1. Thank you for your wisdom on facing death. My father died 8 years ago at 91 with ALS he had many good years up about the age of 87 when his health started to fail. The medical people thought he was having little strokes…. so at 91 failing he was finally diagnosed with ALS. It was only in the last 10 days that he wanted to die. Rev. Chris Levan came to visit both my parents as they were both in the hospital at the same time from Nov to January 2006. It was a difficult time for all of us to stand by and watch him suffer and this is where one should be able to say “enough is enough” It was difficult for my mother who was also 91 to watch from her bedside. I believe it is our choice. We should have the right to say I want to die. We waited and watch with him until Jesus Christ called my Dad. Eight months later my mother was called to be with my Dad. And in the December of 2006 my mother’s sister died so we lost three members of our family. She was 85. There is something about watching death come it can be peaceful or it can be difficult. They are at peace now.

    Blessings to you and to your family.

    Linda Parsons

  2. Rev Gary. I so value and respect your writings. Your writings are so clear ansd concise. They reflect the deep thought and prayer that goes into your lveryday living . I admire that very much. Thank you for your writing On Going into that Good Night. It helps those of us struggling with those issues.

  3. My mother died from lung cancer over 40 years ago.Myself & my 2 sisters took turns at her bedside in a small town hospital in Nova Scotia the last weeks of her life .She had a morphine drip ,did not suffer pain,she had what I consider to be a “good death”.
    I think the fear of assisted dying is that in some cases death could be made to happen for other people’s gain rather than to benefit the person who is dying.

  4. Thank you for a very sincere approach to a very delicate subject. If I were afflicted with what is determined to be terminal, then I would want to die peacefully with some dignity and not after my body had been eroded away to a fraction of what it once was.
    I feel the choice should be our own on whether to pull the plug or not. Then once dead crank up the oven and call the fire dept. to have a controlled burn . It would be my express wish to have the ashes put in the ground by our church and Thankfully No money wasted on an expensive little box. I rather prefer the simple end and yes we all know it is coming so why have loved ones suffer needlessly.
    Make my vote a big Yes and Thank you for making us more aware of what has to come.

  5. I think the Supreme Court has a better understanding of the issues, and has identified the risk that the most vulnerable would be exposed to if euthanasia and assisted suicide were legalized. Does the fact that those peoples concerns are all but ignored in your blog represent christian ethics well? Maybe its worth another look.

  6. I am 86 and a United Church member. For many years I have supported Dying with Dignity and firmly believe in an individual’s right to choose death when diagnosed with a terminal illness or approaching senility. My husband had prostate cancer which led to bone cancer. He was administered morphine to control the pain. He asked for assistance to die but it would have been a criminal offence for our doctor to cooperate. We learned that if his cuminum was discontinued he would have a major clot and die. Our doctor agreed to stop the medication and my husband died peacefully. His children and I were joyful that he got his wish.

  7. I have stage 4 primary peritoneal cancer, and my oncologist believes my cancer will kill me in the next few years, despite her best efforts to stop the cancer’s growth. My body has developed a resistance to the first-line chemotherapy. I am currently on a chemo holiday, while my blood and bone marrow cells recover from the toxicity of the chemo.

    I don’t know what my illness will eventually do to me, in terms of pain and quality of life, but I am thankful for the quality of life that I currently enjoy.

    My brother and I had to make the difficult decision to withdraw a feeding tube and IV from my mother after she suffered the second of two major strokes about 14 years ago. She had suffered major brain damage, and doctors had told us that she would be in a permanent coma. We felt that we made the right decision, but my brother and I still felt the heavy burden of our decision. We loved our mother dearly.

    I have tried to give my brother and daughter permission to make similar decisions — without guilt — for me when the time comes, when death is near and the quality of my life declines to nothingness.

    That said, I am thankful for every moment of life I have left. As long as I can, I will cherish the experiences that make life worth living.

    My thinking on euthanasia is akin to my thinking about abortion. I don’t think I would ever request either euthanasia or abortion (if I were still fertile and not post menopause), but I also don’t think legislators should outlaw either or that any human has the right to judge the patient who requests euthanasia or abortion. I do hope the laws put forth a legal and ethical framework that protects the vulnerable from abuse and doesn’t force anyone to act against conscience.

    • Thank you so much for making these videos available. I’m so very impressed and have been enriched. Eleanor Orr

  8. This is a well thought out and balanced opinion. Through the late 80’s and early 90’s I watched my community die of AIDS. I have thought about death, mine and others. I have come to the conclusion that no one has the right to interfere with my relationship with the Divine. Each of us chooses to walk the path God has set for us. We can choose to listen and obey or not. It is our, not our families, or a priests, or a ministers, or a judges choice to make. Even more important it is certainly not societies choice. The best we can do for anyone no-matter what their state of health is to help them hear what God is saying to them and respect their choice.

  9. It is a difficult subject. I don’t know.
    The comments on sanctity of life , i believe are just words. In the past life was considered sacred. period. Now, evidently we add buts to it. Times change. The bottom line is when the majority changes its views, our viewpoints from a religious viewpoint changes accordingly. We will add the buts where none existed before. Maybe that’s a good thing? However in making that decision we must consider logic and reasoning ..If we accept change we must also accept that individuals should have the right to terminate their life whenever they choose and for whatever the reason. And maybe that’s not a bad thing?

  10. Thank you for this. To me sanctity of life does not mean keeping a body alive at all costs: costs to the person, the family and the public purse. Life means more than a heart beat achieved by mechanical means. Time was when a person died naturally, without CPR, tubes and ventilators. Fifty years ago my mother died peacefully without intervention: no tubes, no surgery for her ailing heart, just one day in hospital after a heart attack. She was ready to join her husband and didn’t fear death. We forget that we all have to die. Why prolong the process once we are facing the end?

    • Thoughtful comments. As a minister attending the dying I often observed persons attending a loved one – trying to get them to eat and drink – orally and intravenously to “keep hope alive” and to deny the inevitable. Even when the person had said “no – I do not want anything” their voices were not heard.
      The gift of presence while attending the dying – sometimes saying nothing, doing nothing can be seen as a blessing to the dying. In an early visit training to be a chaplain – I visited a patient who was sent to the hospital to die as the care home they were in did not want persons they were serving to die in the care home. After a couple of questions I asked were not answered, I continued to sit and ponder the situation for over an hour. When I took my leave I heard a response – “Thanks for being here with me!”

  11. Hmm – mixed feelings indeed. I think there are very rare, very select cases in which euthanasia ought to be allowed, but the burden of proof ought to lie with those who wish for death, rather than those who seek to preserve life. Allowing someone to die naturally is not the same as assisting someone to die – this article and many of the responses blur that distinction. I don’t see anyone commenting on the value of suffering (an odd omission for a Christian discussion), the “privilege” of such decisions where most of the world don’t have an option as to whether to suffer or not to suffer, the issue of life belonging not just to the individual but to the community (where is our communitarianism, Canadians, and our sense of the body of Christ?) and of course to God. What if, for example, my mother wants to die but her life still has value to her family? What of the lessons we learn through caring for others through the worst of their suffering – does this not make us more compassionate, more wise, more self-sacrificing? Do I have the right to take the privilege of caring for me away from those I love? What about the sharing of wisdom from generation to generation, when one generation chooses to end its life early? And what about the fact that life is a gift from God? Doesn’t that make any difference at all?
    I believe there’s a lot more to consider – and I believe that we as the United Church need to be very careful not to simply bless ideas prevalent in the society with “church-speak”. I respect the opinions and experiences shared by folk here, and the thoughtfulness of my fellow UCCers – but this worries me deeply. Let’s keep praying and talking about it. As someone who’s recently embarked on caring for an older relative, I’m aware how exhausting and draining it can become, and my heart goes out to those who suffer and those who feel helpless in the face of their loved ones’ suffering.

  12. Gary, thank you for this thoughtful reflection on a very difficult issue. The United Church, indeed the entire body of the Christian Church, is blessed by your compassionate, faithful and courageous leadership and voice.

  13. Thank you for planting seeds for a continuing conversation. This is such an important field.
    When I consider the “life is a gift from God” argument against intervening to end suffering, I bump up against the extent to which medical science has eliminated what were previously “natural” deaths of age – heart conditions, stroke, pneumonia, for example. Human ingenuity has already intervened in the gift.
    My wish would be as expressed in this article, that fully conscious choices be made by people surrounded by love and support. From the beginning to the end of life.

  14. Dear Gary, I really enjoyed reading this post. I could not agree more that as an increasingly secular society we have moved from an acceptance of death as a natural part of life, to a mass cultural denial of death. Instead of facing death surrounded by family and a spiritual leader such as a priest as it has been in the past, death is now so often medicalised and consequently feared. I am all in favour of acknowledging and talking about death, and for those who believe, the survival of the spirit, which gives such comfort. I think it is so important that we have the choice for assisted death in situations such as you have described. The option of a dignified death as opposed to an artificially prolonged life should be one each individual has the right to make .

  15. A wonderful, sensitive and powerful article. There is much to reflect on and you have presented a complicated issue in a clear understanding format. Blessings and deep, deep thanks.

  16. Thank you!! I am very grateful for the comments being shared here, and the heartfelt stories of walking with father, mother, husband, wife, friend, parishioner, in the last days of living and dying, sometimes with a deep sense of peace, and in other cases, with a wish that more choices had been possible.

    The question of doctor-assisted suicide has no easy answers. But having faithful, ethical conversations is something the church has a long history of engaging in, and this is one those moments, when a new context, a new time, invite us into a discussion about dying, sanctity of life, death with dignity, doctor-assisted suicide.

    I believe that the community of faith has an opportunity (and maybe a call) to “host” such honest conversations, not only for members of the church, but for the wider community… conversations about death and dying, where people can share their own experiences, their fears and apprehensions, their questions.

    It’s what’s happening here, as people respond, and raise concerns. For instance, how do we strongly proclaim the value of all lives, explicitly addressing the deep worry among people living with disablilities who feel vulnerable; and who can imagine subtle pressure (and perhaps not so sublte) to choose an assisted-suicide ending? How do we make sure that we have done everything to strengthen palliative and hospice care? And as you noticed, the position I have taken doesn’t apply to people with dementia, who may have made a “living will” but who are not capable of making a decision in “real time,” I have argued that there must be conscious consent at the time of the final decision, the choice for doctor-assisted suicide. Do you agree?

    The conversation needs to continue. I know some have begun Facebook conversations;And I suspect that these questions are surfacing in homes, in churches, out there in the community. So let’s keep the conversations going.

  17. Like many, I journeyed with a dying loved one. 4 years ago I spent 9 days with my mother in palliative care. We laugh. We shared stories. We ate strawberries. I also saw her in pain and the confusion due to morphine. The last day was very difficult. Her mind was gone. She had water in her lungs. She could not breath properly. The medical staff tried to entube her without success. The sound of her struggle to breath still haunt me today. It was absolutely peaceful. As I was witnessing this, questions came to my mind. What is the use of all of this? What difference those extra hours will make? If God has something to teach me, why should my mother suffer from it? And most importantly, who is playing God here? 50 years ago, she would have died much sooner. Why is it okay for human being to add time to the life God gave and not the other way around? Since that day, I am more convince than ever that life is precious and dignity should be extended to every human being. I am proud of my church for wrestling with today’s question. I am proud of my Moderator to be courageous enough to make a statement. I am pruned to be the son of a mother.

    • Sorry I make a mistake. Her breathing was absolutely NOT peaceful. It was horrible.

  18. Interesting topic
    In some ways it is similiar to the debate on abortion. Everyone centered on its need for rape victims, for medical safe procedures etc. However in Britain etc it has become abortion on demand. Period. I believe the same will happen in respect to this topic. Instead of discussion been centered on situations of terminal pain etc it should instead be on the right of people to chose.
    If i was 85 and headed to a seniors home i may not want to spend the $8,000 a month which will eliminate my savings. Instead i would want to leave it to my children.
    Also our hospitals are full of people who are waiting for admission to seniors homes. Often it takes months. They often are in bad shape and it is only a matter of time.They are confined to a bed. What type of life is that? Does it make sense to spend much needed resources in such situations. Isn’t it more beneficial for everyone to move on and terminate?
    In my opinion before we make a decision as a society we need a full discussion of the advantages and the dangers. The discussion should be on the person’s right to choose. Forget about only in certain situations. That is not going to work.

  19. This piece though heartfelt is terribly naive. Once the law allows for certain cases it morphs into a monster. I won’t write an essay but here are some things everyone should know. Quebec’s Bill 52 has been characterized as “safe” in editorials in both the Globe and Mail and National Post. Shortly after one of the architects of Bill 52 said that the bill is fine but eventually will need to capture more maladies and remove the minimum age of 18. Then look at how this morphed in Belgium and Holland. Belgium now has no minimum age. You can now be euthanized for many ailments including depression and chronic pain. Do your own reading. Don’t let emotion carry you away. Before legalizing the killing of our fellow citizens we need to vastly improve our palliative care, make sure it’s available to everyone and create a national pain management program. Thanks for reading this.

  20. It’s not about ‘legalizing the killing of my fellow citizens’ it’s about taking control of our own lives. As Sue Rodrigues said, ‘Who’s life is it anyway?’

  21. I cannot argue with your blog or comments on CBC today. I share your concern for painfully exceptional cases beyond what we can do today. You emphasized the importance of hospice palliative care and I would like to put that into perspective. I understand that there are almost 400 residential hospice beds in Calgary & Edmonton compared to 20 beds in adult residential hospices in Toronto. We have been working for 10 years to establish another 10 beds and while we have the support of the province, we are currently being challenged at taken to the OMB by City of Toronto lawyers. They don’t seem to think that we are in the right area. After 10 years of competing with condo developers, we haven’t had much choice! Our Community needs more public enlightenment as to the shortage of hospice palliative care. We must build a public awareness that while it is the most humane and economically sensible path to take, far too many road blocks are put in our way. The shortage of hospice palliative care contributes to the “need” or “desire” for assisted suicide which may be acceptable under some circumstances, but it should not be default action in times of pain. As I experienced with the passing of my father, for the last months or days of life, too many of us only remember the suffering. We tend to forget that there can be pain free periods that mean a great deal to both the person dying and his or her spouse, children, grandchildren and friends. Help us promote hospice palliative care!

  22. Very encouraging to hear the head of the United Church speaking on CBC about assisted suicide for those terminally ill, & in excruciating pain which CANNOT BE MANAGED!. I’d like to draw to his attention an article by Rev. Dr. Reg Stackhouse, principal emeritus of Wycliffe College U. of T., in this last month’s The Anglican newspaper, titled – “Time to talk openly about it” (assisted suicide). Excellent article too. My Dad suffered 2 1/2 years of hell on earth in hospital after a deadly car accident His whole family went through agonies when he begged us to help him die. There was no help for his unendurable journey to his release in death.
    I think Gary Patterson, & Reg Stackhouse should touch base with each other, & maybe those of us who are all in favour of bringing this about, can do it collectively

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