Christian Service for Death by Medical Assistance in Dying (MAID)

As I noted in my Winnipeg Free Press column about Medical Assistance In Dying (MAID), it is becoming more acceptable among religious people. Yet there are no formal Christian liturgies or services available for those who choose the procedure.   

For the dying through MAID of John Regehr, his son, Rennie, prepared his own liturgy/service, which he has given me permission to share.

Service for the Medical Assistance In Death of John Regehr, November 7, 2019.

Prior to the service, the doctor arrived. The family was ushered out of the and John was once again asked to confirm once again that he wanted to go ahead with MAID. 

His answer: “My wings are poised. I’m ready for flight.” 

Outside the room, the family was told what would happen, the drugs involved, how they worked and in what sequence. They then rejoined their father and the service began. 

Family Blessing 

First reading: Isaiah 41:10. 

Fear not, for I am with you:

Be not dismayed, for I am your God.

I will strengthen you;

Yes, I will help you.

 

John Regehr’s Blessing for the Family

 

Second reading: Numbers 6:24-26.

 

(The ancient blessing, as written by John, and read by Rennie on his behalf as John could no longer speak.)

 

The Lord bless you

with all manner of good,

and keep you

from all manner of harm.

The Lord make his face shine upon you

and be gracious to you,

assuring you that you belong to him,

and he delights in you.

And when you stumble,

and are burdened with regrets,

the Lord will turn his face toward you

in compassion and love,

and give you peace again.

 

Scripture Reading

 

Psalm 23.

Liturgy of Committal and Blessing 

 

Jesus said, "I am the resurrection and the life" (John 11:25-26). “I am he that lives, and was dead,” says the LORD, “and behold I am alive forevermore. Amen” (Revelation 1:8). 

So … “Blessed are those who die in the LORD from now on. Yes, says the Spirit, they are blessed indeed, for they will rest from their hard work, for their good deeds will follow them” (Revelation 14:13). 

And “this is the promise that He has given to us, even eternal life” (1 John 2:25). 

“Can anything separate us from Christ’s love? … I am convinced that nothing in all creation will ever be able to separate us from the love of God that is revealed in Christ Jesus our Lord.” (Romans 8:35-39) 

And then, directing a question to John: 

“John, can anything separate you from the love of Christ?” 

Shaking his head emphatically, he unequivocally answered: “No!”. 

Response: “This then is our hope and this is our life. That Christ lives and will return again; and we live with him. 

Benediction 

John, go forth from this world: 

In the love of God the Father who created you,

In the mercy of Jesus Christ who redeemed you,

In the power of the Holy Spirit who strengthens you.

And as you join the communion of all the faithful who have gone before you, may you dwell this day in peace.

Holy Lord, almighty and eternal God, hear our prayers as we entrust John Regehr to you. Enfold him in the arms of your mercy, and into your eternal rest, through Jesus Christ our Lord.  

We look forward to the great resurrection at the last day when those who die in the Lord shall be raised to eternal glory and an endless life of joy and peace with God. 

We ask now that you would renew us with hope for the future. As you receive John’s spirit we pray that you would strengthen our spirits. Keep us faithful as we await the day of resurrection when we meet you face to face. 

May your Spirit give comfort to loved ones gathered here, and those who are present in spirit. Be gracious to them, comfort them, and grant them your peace. 

Now may the grace of the Lord Jesus Christ, and the love of God the Father, and the presence of the Holy Spirit be with you all, Amen.” 

Sending music 

At this point, the family indicated to the medical team that the drugs could be administered. Rennie then began to play one of John’s favourite hymns on his viola: Wehrlos und verlassen. (In the Rifted Rock I'm Resting.)

When it was over, the doctor leaned over and listened to his silent heartbeat. “He’s in flight,” 

Conservative Christians, Atheists and Fear of Death

“Why are evangelical Christians and conservative Catholics over-represented among those who experience higher levels of guilt, regret and uncertainty in the face of impending death?”

That’s a question a friend who works as a spiritual health care provider asked recently.

His question was prompted by being at the deathbeds of some very religious people who were deeply afraid of what would happen after they died.

He mentioned an older woman who had lived a full, productive and largely joyful Christian life.

“She was a very good person to whom God was mightily important,” he said. Yet, as death approached, she was worried that she wasn’t good enough to be accepted into heaven.

Or, as my friend put it, “the ‘blessed assurance’ of which she'd sung so confidently for decades had evaporated into question marks.”

Another devout Christian, who had also lived a full life of service for others, also worried about his worthiness as his life neared its end—he worried about the things in the Bible he had failed to do.

My friend wondered: Why was he now worried mostly about the things he should have done instead of being content with the many good things he had accomplished?

My friend realized not every devout believer felt that way. “Yet it seems to be generally true that the most devout of conservative Christians have a tougher time . . . at the end of life,” he said.

“They respond with guilt and self-loathing to a greater extent than those of more liberal practice, or, indeed, those with no declared religious affiliation.”

His comments made me curious. Was it true?

A comprehensive review of 100 studies by researchers at the University of Oxford, found mixed results.

Eighteen percent of the studies indeed did find that some religious people struggle with death.

According to one of those studies, these tend to be people who have been taught to believe in a demanding and vindictive God, and who may have received a lifelong dose of sermons about the Hellfire and punishment awaiting those who don’t measure up.

Some of the studies accounted for this by distinguishing between what they called intrinsic religiosity—where belief motivates behaviour—and extrinsic religiosity—where behavior bolsters beliefs.

Those who had intrinsic faith tended to be more at peace about dying, compared to extrinsic believers who worried they weren’t doing enough to please God.

The review also found another group of people who approach death with a sense of peace: Atheists.

This isn’t surprising; if you don’t believe in an afterlife, whether that’s a belief in a heaven or in Hell, then there’s nothing to worry about either way.

As Hemant Mehta, host of the podcast The Friendly Atheist put it:

“It actually makes a lot of sense. When you realize death is just a natural part of life, and you’re confident about what will happen after you die, and you’re focused on making the most of the life you have, it’s not surprising that atheists don’t fear death.”

But back to my friend; what does he think about those people who were very religious, yet fearful of death?

For him, “guilt is the common denominator. And fear.”

This may be because their “spiritual formation likely included more of an emphasis on Hell than in many other traditions, and a sense that ‘I have to get it right’ in order to avoid damnation and experience paradise.”

For him, legalism and moralism “produce unhealthy guilt, leaving many dying people to wonder if they actually got it right. They seem to be projecting onto God the rigidity of their practice.”

When that happens, it’s hard for people “to truly relax in the arms of grace when you've spent much of your religious life emphasizing holy living.”

At the bedsides of people who feel this way, his goal is to “remind them that the steadfast love of the Lord endures forever . . . I suggest that God honours the direction of their heart's desire, and that a desire to please God matters more than the finer points of their doctrine. God can be trusted.”

From the Nov. 18 Winnipeg Free Press.

Spiritual Care Helps Patients, Saves Money

Illness is a spiritual experience for most patients

Shockwaves rolled through Canada’s spiritual health care community in March when the government of Saskatchewan eliminated pastoral care services in that province.

While increasing the overall health care budget very slightly (by 0.7 percent), the province cut several services it considered non-essential—like spiritual care.

“In recognition of the fiscal situation we’re in, it’s about trying to get to the core services of health,” Health Minister Jim Reiter said. “The services that we cut, while they’d be nice to have . . . they certainly wouldn’t be what we’d consider the core services of health.”

The cut to spiritual health care services will save the province $1.5 million a year.

Following Saskatchewan’s decision, there was concern in Manitoba that something similar might happen here as the province tries to maximize efficiency in the healthcare system.

“We are imagining that many (or most) of us are concerned about the upcoming provincial budget,” the executive team of the Canadian Association for Spiritual Care wrote to spiritual health care providers in Manitoba in March, before the budget was tabled.

The news from Saskatchewan, “is concerning,” the letter continued, “and we are aware of the stress that some are carrying because of this.”

As it turns out, their fears were unfounded. 

The Manitoba government did not cut spiritual care services, although a decision to reduce management jobs means at least one spiritual health care director position will be eliminated at Winnipeg’s Health Sciences Centre.

Altogether, in 2016-17, the Winnipeg Regional Health Authority (WRHA) budgeted $3 million for 46.75 full-time equivalent spiritual health care positions. An additional $600,000 was raised by religiously-based institutions such as assisted-care homes.

That’s not a lot out of a total budget of $2.8 billion a year. But with pressure on from the provincial government to trim $83 million in 2017-18, why should scarce resources be used for spiritual care? 

That’s the question I posed to Adel Compton, Regional Director of Spiritual Health Services for the WRHA.

For Compton, spiritual care is an essential part of whole-person care in the health care system.

“Each of us tries to make sense of life,” she says. “But when we end up in hospital, that sense of meaning can be challenged, especially if we are very ill or facing death.”

Spiritual care, provided by trained spiritual health care providers, “can help people understand what’s happening to them, and what choices are available to them that fit into their life and values.”

Providing these services is also an aid to nurses and doctors, who are often very busy and have not enough time to spend with patients.

“We have the time to listen to people, to calm them down, help them make informed decisions for treatment,” she says.

“We help people connect with whatever it is that gives them the strength” so they can cope with their medical situation, she adds—and make it easier for the medical team to do their jobs.

All of this not only helps patients and staff, but it saves money, too. “There are numerous studies that show that spiritual health care results in better patient outcomes,” she says.

A quick Google search shows she is right. Over 400 studies have found that religion or spirituality helps patients cope better with illness, and deal better with the stress caused by health problems.

The studies also show that religion or spirituality promotes hope for recovery, and provides rituals and behaviors that helps people ease anxiety, lessen depression and promote greater overall well-being.

“Illness is a spiritual experience for most patients,” especially those with serious illnesses, says Tracy Balboni, an associate professor at Harvard Medical School.

Balboni, who has been conducting research into how spirituality affects the experience of patients in hospitals, adds that “patients want to be seen as whole persons, not just as bodies affected by illness.”

Through her research, Balboni has also has found when religious or spiritual needs are not addressed, it reduces a patient’s quality of life and satisfaction with care, and doubles or triples healthcare costs towards the end of life.

So while the Saskatchewan government’s decision to cut spiritual care services might save a few dollars now, maybe it won’t turn out to be such a good move in the long term.

Guest Post: Time To Face The Facts of Death

Physician-assisted suicide is in the news these days as the Canadian government tries to come up with a new law governing the practice. In this guest post, my friend Doug Koop reflects on the issue from his work as a Winnipeg-based spiritual health practitioner.

I was fielding questions at a palliative-care conference when the issue arose. "Doug, I hate to ask you this, but what are your feelings on physician-assisted suicide?"

I was not particularly surprised. The matter of medical aid in dying is very much in the news, and many medical teams and palliative-care workers are wondering how its impending introduction in Canada’s health-care system will affect them.

It’s a politically and emotionally volatile issue, with strongly principled activists of various convictions currently holding centre stage in the public debate.

But while it made perfect sense for the question to come, I had not prepared myself to face it, and eased into the discussion with something of a disclaimer.

"At one level, it doesn’t matter what my feelings are," I began. "The freedom for qualified patients to choose medical aid in dying — and the responsibility of the system to make it available — is about to become the law of the land."

Meanwhile, I work in a major hospital where this option is likely soon to be a recurring reality. It’s coming to my workplace, and I’m certain to encounter it in the months and years ahead.

I returned to the original question and tried to make a general point.

"On the whole," I said, "I think it will be better if people with palliative-care and spiritual-care sensitivities are available to patients and families who are making these decisions for themselves."

When I do find myself in such a situation, it will be important for me to suspend whatever judgments I might be inclined to make in order to offer the best spiritual care I can provide, and that the patient and family can receive.

Another hand went up. "I’m going to have to disagree with you, Doug. I believe in the sanctity of life from conception until natural death. No life is ours to take. We cannot make those calls. It’s up to God to decide when a life is to end."

I listened attentively as she gave eloquent expression to her deep convictions, and concluded with an air of finality.

"Yes," I acknowledged. "And that perspective has very much been a part of the broader public conversation. However, it doesn’t have much bearing on my response as a spiritual-health practitioner in a public institution. I feel that it’s better to be present to people in these circumstances, rather than to be absent on principle."

We left it there.

Facts of death

Personally, I believe we all need assistance in both living and dying, and that everyone should be involved. We are interdependent beings. It takes a village for a person to live well... and to die well.

I’m in favour of person-assisted dying (and pastor-assisted dying, and physician-assisted dying, for that matter) when it means we honestly and empathetically help people to be at peace with their impending death.

We need to face the facts of death. For some, that means letting go of the unrealistic expectations that so often hinge on the fixes and cures medical science strives so hard to deliver. 

We are mortal beings, and our lives are ultimately beyond the reach of even the most sophisticated medicines and techniques.

I’m not one to try to either hasten or forestall the inevitable. Yet there is work for spiritual-health practitioners — and others — to do, even at the bedside of a person who’s deliberately choosing a medically induced demise.

It’s good when any of us can provide some assistance in the difficult work of releasing our tenuous grip on the things of this world.

DK.

Read more about the dilemma of my own dad's death and the issue of assisted dying.

Religion, Euthanasia and the Dilemma of My Dad's Own Death

The recent ruling by Canada's Supreme Court permitting physician-assisted suicide reminds me of columns I have written that touch on the subject of death and dying. They include this one, written in 2013 about religious views of physician-assisted suicide—and the decision I faced as my own father faced death.    

When it comes to physician-assisted suicide, it doesn’t matter what religion you are, the answer is pretty much the same.

It isn’t permitted.

The Roman Catholic Church, Protestants of many kinds, Muslim, Jews, Buddhists, Hindus and others all agree that life is sacred, and nobody should assist it to end.

Christians and Jews often refer to Deuteronomy 30:19-20 to bolster the case:

"I have set before you life and death, the blessing and the curse. Therefore choose life, that you may live, you and your descendants, by loving the LORD your God, by obeying His voice, and by holding fast to Him; for this is your life, and the length of your days."

Today, however, a majority of Canadians disagree—something that the Supreme Court recognized.

A poll conducted by the Environics Institute in two years ago found that that almost 70 percent of Canadians are in favour of euthanasia generally, and that 68 percent say those who help seriously ill people to commit suicide should not be charged with a crime.

The poll found majority support for euthanasia among every age group and in every region of Canada .

The highest support was found in Quebec and B.C., at 79 percent. The lowest, at 62 percent, was found in Manitoba and Saskatchewan .

The poll also found that older Canadians were more likely to support the practice than younger people—not surprising, since older people are closer to the time when that kind of decision needs to be made.  

If we’re honest, most of us are conflicted on the issue.

We believe life should be preserved and supported, but we don't want to see loved ones suffer—or contemplate our own suffering as we grow older. We wonder if helping someone pass from this life to the next isn’t a caring response.

Four years ago, I had to deal with this dilemma on behalf of my father.

A day before I arrived at his bedside in his nursing home in Ontario, he had slipped into a coma after a short illness. Nothing moved except for his chest, which heaved laboriously as he tried to breathe.

Medical staff at the facility asked if I would be OK with them giving him doses of morphine to ease his suffering. I readily consented to the request.

And who wouldn’t? It hurt to see him in such distress, especially since there was no hope of his ever wakening.

After receiving the morphine, his breathing grew easier. He settled down. He seemed at peace.

I was glad for him. But in my heart I knew—as I’m sure the medical staff knew—what was really at play here: We were assisting my dad to die.

The next morning, he slipped quietly and peacefully away while I held his hand and cradled his head.

Before he died, my dad had often expressed the wish for his life to be over. He wasn't suffering, but at the age of 86 he had lost interest in living.

 A widower, he was lonely, tired, often sick, required the use of a wheelchair, could no longer enjoy his books, had trouble swallowing, and sometimes was in pain.

He was ready to die; every night, he told me, he prayed that he would not wake up in the morning.

Some would say I assisted him to die. Others would say that I only helped to ease his suffering—death was a byproduct.

Whatever the answer, the line between the two is thin and fuzzy for me.

I think it probably the same for many others, too. 

Click here to read a collection of reflections in the Winnipeg Free Press about how the Christian, Jewish, Buddhist, Muslim and Hindu religions view the issue of physician-assisted suicide.

Click here to read my earlier post on this topic: Growing Old and Praying to Die.

Growing Old and Praying to Die

The recent ruling by Canada's Supreme Court permitting physician-assisted suicide reminds me of several columns I have written that touch on the subject of death and dying. They include this one, written in 2008 during my dad's last year of life when he was praying each day to die.  

It’s not easy growing old. Just ask my dad.

Now 86, he lives in a nursing home. As a younger man, he worked hard to support his 
family, running machines at the factory, loading trucks.

But now he is frightfully thin, frail and weak, and uses a wheelchair to get around. His hearing isn’t very good, he finds it hard to read, and his memory is slipping.

Sometimes he remembers I am coming; other times it’s a surprise. Sometimes he thinks I’m coming when I’m not, and then he is hurt and angry.

Even the small pleasure of eating is denied him. In his nursing home, residents eagerly look forward to mealtimes—they help break up the day.

But even that holds little joy for my dad; since he has trouble swallowing, his food is mostly pureed.

“It tastes bland,” he says. He’s right; in order to achieve the right consistency, the dining hall staff have to add water.

Then there’s the loneliness. Most of his friends are gone, and so is his wife—she died almost four years ago. They were married for 53 years.

Sure, they sometimes argued, and sometimes very loudly. But now he has nobody to talk to at all.

Add it all up, and he wonders: Why keep on living?

In fact, what he most wants in life is to die. Every night he prays that God will take him home. Every morning, when he wakes up, he is disappointed.

“I just want to go peacefully, in my sleep,” he says. 

He can’t understand why God won’t answer that one, simple prayer.

I don’t blame him for feeling that way. It must be hard to depend on others for the simple necessities in life. It must be hard to be constantly surrounded by illness, decline and death.

It must be tough to feel like you are caught in a real-life version of the movie Groundhog Day—each day is like the day before.

No wonder he has so little interest in living.

My dad isn’t the only one who feels this way. Gerhard Friesen, a chaplain at a Winnipeg personal care home, says that he often hears older people say they wish they could die.

“It’s normal for people to feel that way,” he says. “Everything aches, and they’ve suffered so many losses in life—friends, home, possessions, and sometimes a spouse.”

He tells them that God will take them home in His own good time but, as long as they are still here, he will be there to care for them—and tell them that they matter to him, their families and to their church, if they belong to one.

But they don’t always get that message from their churches. Instead of feeling loved and cared for, they often feel that they don’t matter.

This is especially true on Sunday mornings, when some churches send volunteers to offer worship services. Sometimes they feel that churches are doing the minimum possible—sending less than their best. 

“Residents will tell you on Monday morning when the service was bad,” says Friesen. “They say, ‘They think that’s good enough for us.’”

That’s too bad. When it comes to the elderly, caring is non-negotiable—especially for people of faith. The world’s great religions all teach that older people should be respected, honoured and cared for.

But as Canada ages, providing care for seniors will become a challenge. How will places of worship minister to the large numbers of elderly people in their midst?

Will there be enough clergy who are trained in the area of spirituality and aging?

Will we be ready to wrestle with profound issues around the end of life?

Sitting with my dad a week ago, those thoughts went through my mind. As I watched him sleep, I knew he was lucky to be in a great personal care home—the staff are friendly, compassionate, considerate and professional. The level of service is excellent.

But still, his life is hard. He wants God to take him home. “I pray that one night I will just lay down and not get up,” he says.

Some days, I find myself praying that for him, too.

Postscript: Edward Longhurst died on Feb. 4, 2009 after slipping into a coma.