January 25, 2018                                                                                                                       Conversion of St. Paul                                                                                                                    (Revised version)

A Pastoral Reflection on Medical Assistance in Dying 

Dear Sisters and Brothers in Christ,

In our Catholic tradition we often refer to the Church as our Mother. We perceive her as a mother who lovingly accompanies us throughout life, and who especially wishes to support and guide us when we are faced with difficult situations and decisions. It is from this perspective that we, the Bishops of the Atlantic Episcopal Assembly, wish to share with you this pastoral reflection on “medical assistance in dying”. 

Federal legislation passed in June of 2016 has legalized “medical assistance in dying” in our country. This new legislation allows physicians and nurse practitioners to provide two types of medical assistance in dying: directly administering a substance that causes death (voluntary euthanasia), or giving or prescribing a drug that is self-administered to cause death (medicallyassisted suicide). This new legislation raises many questions and concerns for the sick and suffering and for their family and friends. Likewise it raises questions and concerns for medical professionals, health care providers and the pastors of souls. It challenges us as a Church and as individual Catholics to defend, with renewed commitment, that life in all its stages is a sacred gift from God; to affirm that, while something may be legally acceptable, this does not make it morally acceptable; to grow in our understanding of the Church’s moral teaching on this issue, and it calls us to discern how best to accompany those who find themselves struggling with illness, pain and difficult medical circumstances. 

Euthanasia and assisted suicide is a highly complex and intensely emotional issue which profoundly affects all of us. It makes us aware that some people have become convinced that, at a certain point, there is no longer any “value” in their lives, because their suffering has become unbearable or they cannot function as they once did or they feel a burden to their family and society. People with such a conviction or in such circumstances deserve our understanding, respect for their point of view, but also a compassionate pastoral response for it is our belief that a person’s value arises from the inherent dignity persons have as human beings and not from how well they function. 

In our efforts as Christians to understand and respond pastorally to this issue, the example of Jesus’ own ministry is an important starting point. He ministered to those who were disillusioned as he walked with the disciples on the road to Emmaus (Luke 24:13-35). He listened attentively to the stories of these disciples, and his profound attention allowed them to share the things that troubled them deeply. He eventually led them, through a reflection on the scriptures, to a new awareness and encounter of his presence as they recognized him in the breaking of the bread. The example of Jesus shows us that pastoral care takes place in the midst of difficult situations, and that it involves listening closely to those who are suffering and accompanying them on the journey of their life situation. 

Pope Francis also calls us to practice this “art of accompaniment”, removing our “sandals” before the sacred ground of the other (cf. Ex 3:5). The Holy Father writes that this accompaniment must be steady and reassuring, reflecting our closeness and our compassionate gaze which heals, liberates and encourages growth in the Christian life (Evangelii Gaudium – The Joy of the Gospel, no. 169). He says that to accompany requires prudence, understanding, patience and docility to the Spirit. He focuses on the need to practice the art of listening which requires the opening of one’s heart to a closeness which can lead to genuine spiritual encounter (Evangelii Gaudium – The Joy of the Gospel, no. 171). Pope Francis reminds us that the one who accompanies others must realize that each person’s situation before God and his/her life of grace are mysteries which no one can fully know from without. He goes on to say that “the gospel tells us to correct others and to help them to grow on the basis of a recognition of the objective evil of their actions (cf. Mt 18:15) but without making judgments about their responsibility and culpability (cf. Mt 7:1;Lk 6:37) (Evangelii Gaudium – The Joy of the Gospel, no. 172). 

Especially within the context of the Church’s teaching on suicide, this pastoral approach of accompaniment is extremely important in our contact with, and ministry to, those who are suffering intensely and who are considering asking for euthanasia or assisted suicide. The Catechism of the Catholic Church (CCC) teaches us that God is the sovereign Master of life. We are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of (CCC, no. 2280). The Catechism teaches that suicide contradicts the natural inclination of the human being to preserve and perpetuate one’s life (CCC, no. 2281). However, the Catechism also notes that “grave psychological disturbances, anguish, or grave fear of hardship, suffering, or torture can diminish the responsibility of the one committing suicide” (CCC, no. 2282). Such circumstances can sometimes lead persons to so grave a feeling of desperation and hopelessness that they can no longer see the value in continuing to live, thus diminishing the responsibility for their actions. 

The goal then of Pastoral Accompaniment is not only to be attentive to the circumstances that could cause a person to consider euthanasia or assisted suicide but to lead them with love and compassion to choose life rather than death. As Pope Francis says: “true compassion is undertaking to bear the burden” but can never be used to justify or condone euthanasia or assisted suicide. (Pope Francis, Address of His Holiness Pope Francis to Directors of the Orders of Physicians of Spain and Latin America, 9 June 2016.)

As bishops of our local churches, we must have a primary concern for the pastoral wellbeing of all those entrusted to our care. This pastoral concern is symbolized by the image of the Good Shepherd and reminds all involved in pastoral care to make visible to the flock, the very ministry of Jesus Christ. This ministry is summarized in four key words: healing, guiding, nurturing and reconciling. These four words capture the heart and actions of the Lord as he encountered people in his public ministry. These words reveal the Lord’s attitude, his mission of mercy and his ministry of reconciliation. We believe that all priests, deacons and lay ministers, particularly those who care for the sick and vulnerable every day, at home, in hospices and in hospitals, need to be compassionate expressions and effective sacraments of this mercy of God in all that they do and with whomever they encounter. Euthanasia and assisted suicide may be legal, but they do not reflect our Christian view of life, suffering and death. The Gospel is a message of good news and hope in the face of pain and suffering. The Gospel offers a vision of life and death focused through the central mystery of our faith, the Resurrection. When we proclaim that Christ has died, Christ is risen, and Christ will come again, we profess that death is not the last word on life and that life for a Christian is not terminated by dying.

In the pastoral care of those who are contemplating euthanasia or assisted suicide, we must remember that the purpose of pastoral care is to communicate the compassion of Christ, His healing love, His mercy and the sacredness of life even in weakness. Furthermore, we must take into account the suffering person’s emotional, family and faith context when responding to their specific requests for the reception of the Sacrament of Penance and the Sacrament of the Anointing of the Sick, the reception of Holy Communion and the celebration of a Christian Funeral.

As the Catechism of the Catholic Church reminds us, the Lord, as physician of our souls and bodies, continues his work of healing and salvation through the ministry of the Church and particularly through the sacraments of healing: the Sacrament of Penance and the Sacrament of the Anointing of the Sick. (CCC, 1420-1424)

It is expected that anyone who approaches the Sacrament of Penance, does so after a proper examination of conscience, to obtain pardon from God’s mercy for any offences committed against him. Along with a firm purpose of amendment, it is the purpose of the penitent to respond to Jesus’ call to conversion by disclosing and confessing one’s sins to seek forgiveness and reconciliation.

In the accompaniment of a person in an end of life situation, these are the dispositions to be discerned. It is helpful to keep in mind what the Catechism also states, specifically about suicide, that “we should not despair of the eternal salvation of persons who have taken their own lives. By ways known to Him alone, God can provide the opportunity for salutary repentance.” (CCC, no. 2283)

The Sacrament of the Anointing of the Sick is for strengthening and accompanying someone in a vulnerable and suffering state. It presupposes a person’s desire to follow Christ even in his passion, suffering and death; it is an expression of trust and dependence on God, particularly in difficult circumstances (CCC, no. 1520-3).

The reception of Holy Communion as a person approaches the end of this life can assist that person to grow in their union with Christ. This last Communion, called Viaticum, has a particular significance and importance as the seed of eternal life and the power of resurrection (CCC, no. 1524).

In our pastoral approach, no one should ever be denied the grace of these sacraments whenever there is faith, hope and openness to an acceptance of the gift of life. Sadly, there may be circumstances when, despite our care and compassionate accompaniment, a person is resolutely determined to choose to end their life. While such a determined choice makes the celebration of the sacraments impossible, we can never abandon them as we continue to demonstrate our pastoral solicitude in the spirit of Christ’s compassion for all.

As for the Church’s funeral rites, there are a number of possibilities available. However, in discerning the type of celebration most pastorally appropriate to the particular situation, there should always be dialogue with the persons concerned which is caring, sensitive and open. The decree of promulgation of the Order of Funerals states that: “By means of the funeral rites it has been the practice of the Church, as a tender mother, not simply to commend the dead to God but also to raise high the hope of its children and give witness to its own faith in the future resurrection of the baptized with Christ” (Prot. No. 720/69).

As people of faith, and ministers of God’s grace, we are called to entrust everyone, whatever their decisions may be, to the mercy of God. To one and all we wish to say that the pastoral care of souls is a demanding commitment of fidelity to Christ and to the faithful entrusted to the Church’s ministers, but it cannot be reduced simply to norms for the reception of the sacraments or the celebration of funeral rites. Persons, and their families, who may be considering euthanasia or assisted suicide and who request the ministry of the Church need to be accompanied with dialogue and compassionate prayerful support. The fruit of such a pastoral encounter will shed light on complex pastoral situations and will indicate the most appropriate action to be taken including whether or not the celebration of sacraments is proper.

In connection with this entire issue of euthanasia and assisted suicide, we must also emphasize how critically important palliative care is for dying patients, their families and loved ones. Our palliative care professionals and volunteers bring light, hope, and comfort into very difficult life situations, both in homes and in health care facilities. Instead of providing ways to hasten death, those who serve in palliative care bring support and hope to the suffering person and to their family and friends. Likewise, in our efforts as Church to minister to the vulnerable at all stages of life, pastoral ministers and caring pastoral communities must continue to seek out new ways to be evermore present to the dying and to the families of the dying. Furthermore, we must strongly encourage our governments to provide the financial resources needed to strengthen palliative care services in hospitals, long-term care and community care facilities, hospices and homes. Finally, as difficult as it may be to do so, it is important that we have conversations in our families about the need for quality end of life care that is reflective of our values and beliefs because it is important that we all understand the implications of the new law on medical assistance in dying, and that we offer truly loving and merciful alternatives.

May the Holy Spirit grant us all wisdom and guidance as we face this difficult moral and pastoral situation.

 Most Rev. Anthony Mancini                  Most Rev Martin Currie           Most Rev. Valéry Vienneau Archbishop of Halifax-Yarmouth           Archbishop of St. John’s            Archbishop of Moncton

Most Rev. Brian J. Dunn        Most Rev. Anthony Daniels       Most Rev. Claude Champagne, omi    Bishop of Antigonish                  Bishop of Grand Falls                     Bishop of Edmundston     

Most Rev. Richard Grecco                 Most Rev. Peter Hundt                    Most Rev. Robert Harris Bishop of Charlottetown          Bishop of Corner Brook and Labrador      Bishop of Saint John      

Most Rev. Daniel Jodoin                                                                                                                  Bishop of Bathurst

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