Submission of Saint Joseph's College to the Government of Alberta on Physician Assisted Death

This is a response to the invitation for submissions by Hon. Brandy Payne of 9 March 2016

Introduction

Saint Joseph's College was incorporated with Royal Assent in the Province of Alberta on April 8, 1926 as a College in Edmonton "for the promotion of any and all useful branches of higher education" with "full power and authority to become affiliated with the University of Alberta . . . ". On April 28, 1926 Saint Joseph's College affiliated with the University of Alberta and received land from it for the purpose of "supplying educational and residential facilities for a College of Arts and Sciences under the auspices of the Roman Catholic Church; such instruction may be for both men and women; such residential accommodation to be separate for men and women."

Currently, the College provides residential facilities for 347 University of Alberta students from multiple faith traditions: 284 women and 63 men. It offers a range of University of Alberta credit courses and programs, averaging slightly fewer than 2000 course enrollments annually.

Through its Student Life and Campus Ministry teams, as well as some members of the academic faculty, the College dedicates significant resources to suicide intervention and prevention. These resources are made available to all staff and students who require them and not just those who reside or take courses at the College. Although most University of Alberta students might not meet the Supreme Court of Canada test, namely, "a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition", our concern is that legislation permitting Physician Assisted Death (hereafter PAD) may have the unintended social-psychological effect of "normalizing" suicide. As such, we believe it would have an adverse impact on our efforts of preventing suicide among a well-documented high-risk population, namely, University of Alberta students. We acknowledge that most students at risk do not and likely will not in future have need of the assistance of a physician to take their own lives; however, we contend that legalizing PAD will contribute to a perception that suicide is an acceptable response to difficult life situations.

Our concern stems not simply from our direct experience of the suffering and chaos a University student's death has on his or her peers and family members, but from a very long-standing and well thought out moral position stemming from our religious belief about the sanctity of human life. Further, we argue in the final section of this submission that the philosophical principle underlying the Supreme Court's PAD decision - not all lives are worth living - requires much more elaboration particularly because we are dealing with fundamental issues of life and death.

Impact on Efforts at Suicide Prevention in a High Risk population

From the early years of St. Joseph's College, Campus Ministry (chaplaincy) has been a resource to students and the wider University community. As a community we desire to support the whole person, helping students and other members of the community to find balance in their lives and to experience emotional, mental, physical and spiritual well being. This can be a challenge because university students in particular are in an especially fragile situation. University life is a "pressure cooker" of stress that can often lead to mental and emotional instability.

Suicide is one of the leading causes of death for people between the ages of 15-24 (Centres for Disease Control). Reputable studies affirm that the population we are working with at the University is already vulnerable to suicide. In 2013 a National College Health Assessment (NCHA) study showed that 8.5%, or 3,120 University of Alberta students seriously considered suicide. In addition, 1.4%, or 514 actually attempted suicide in 2013.¹

Responding to this study, St. Joseph's College and the University of Alberta have together worked very hard to put into place supportive programs to help prevent suicide and support the mental well being of students. Examples of these include suicide awareness and prevention programs, such as ASIST training for all residence life staff; QPR and Community Helpers; peer support programs such as Mentorship programs and Peer Support Groups. We have created an environment where students know that their lives are of value to us, that they are important to us and that we want to see them flourish, succeed and live - in short, that all lives are worth living.

As a College we are concerned that the legalization of PAD will lead to an eroding of this life-affirming culture that we have worked to build at the College and the University as a whole. We fear that, as PAD becomes normative and even supported by physicians, in the eyes of students who may be already vulnerable to suicidal thoughts, suicide will appear to be a reasonable solution to their problems.

At present, suicide is not viewed as a reasonable solution. We do not want any student who feels desperate, alone and depressed to think that death is a viable answer. The University of Alberta along with St. Joseph's College, have worked together to create a climate of support in which life is affirmed and suicide is not an option. We believe that PAD legislation threatens to undermine these efforts, precisely by giving students the impression that suicide is in fact a socially accepted and reasonable option - even if they do not seek the assistance of a physician in ending their lives.

Regardless of legislation, St. Joseph's College, as a Roman Catholic institution, will never cease to affirm the value and dignity of life at every stage. We will always seek to support the emotional and spiritual well being of students and we will never refer a student to a physician who would offer to assist them in taking their own life. However, we fear that very soon we will be immersed in a culture that sends students the message that death is a reasonable choice in the midst of their suffering.

Concerns about Physician assisted Death grounded in the Catholic Faith

As members of St. Joseph's College, a Roman Catholic institution in the heart of the University of Alberta, we wholeheartedly support recent statements made by the Canadian Conference of Catholic Bishops along with many other Canadian religious leaders and individuals,² and by the Catholic Bishops of Alberta,³ which make it very clear that we consider all killing, the intentional hastening of death of innocent human beings (i.e., who are not unjust aggressors) to be gravely morally wrong in every circumstance.

We also affirm that the right of freedom of conscience, thought and religion (see the UN Declaration of Human Rights and the Canadian Charter of Rights and Freedoms) gives Catholic health care facilities the right to be havens where no human beings are killed or helped to take their own lives. Together with our bishops, we strongly affirm that physicians and other professionals (e.g., nurses, pharmacists, counselors and chaplains) should in no circumstances be required or pressured to provide a referral to a practice that they deem to be immoral (see also the response to the Parliamentary Committee on 26 Feb. 2016 by Dr. Jeffrey Blackmer, Vice-President of the Canadian Medical Association).

The unique and sacrosanct dignity of every human person is based on both sound reason and faith. The nature of the human person includes physical, intellectual, moral and spiritual capacities. Human persons also constitute the human community, our sisters and brothers, as it were, in the human family. As such, human persons are never to be treated as mere means. Moreover, bodies are not disposable property, which in turn implies that human beings are not to be discarded either by killing them or by assisting them to kill themselves - even if they ask for this.

Christian faith gives us further reasons for valuing the dignity of every human person, whom we believe is created in the image of God. One of the ten commandments of the Jewish-Christian Scriptures forbids the killing of innocent human beings. For example, our society accepts eating the meat of animals but condemns cannibalism as an affront to the dignity of persons who belong to the human family.

We need to improve what is already a good Canadian human health care system so that it provides even better and more widely accessible palliative and home care for all who can benefit from such compassionate care, and accompanies those who suffer rather than eliminating them. We support palliative care (which properly understood does not include killing) including where necessary effective pain management.

We support real, effective compassionate care for suffering human persons at all stages of life. This includes the university students, most of whom are young adults, whom we serve. With the stresses of university life, many suffer from depression and entertain suicidal thoughts. We need to help them address their needs and to find meaning and hope, rather than promoting a culture that we believe wrongly considers suicide to be an acceptable option.

Concerns about Physician Assisted Death Grounded in Logical Principle

PAD presumes that some lives are not worth living. Advocates of PAD may try to avoid this presumption by explaining that they are not declaring that any life is not worth living. They hold rather that those who decide that their lives are not worth living should be able to act according to their belief, and that the medical profession in general, if not any specific member of it, has the obligation to help them implement their wish to die.

However, the problem does not go away that easily. Unless they allow PAD for anyone who desires it, advocates for it must make a distinction. Specifically, persons with complaints that fall under category X will have a right to seek their own death and to have medical help in bringing it about; however, persons without complaints that fall under category X will not have that right.

Accordingly, advocates must then determine what kind of complaint falls under category X. They must, in other words, provide criteria for questioning whether a given life is worth living.

Once we get into this question of what makes one life more worth living or less worth living, we have entered deep and murky waters. Any answer to this question requires that one address the very meaning of life. Different religions provide different ways of understanding this; philosophers, too, have pondered the issue at length.

For example, some have concluded, after much thought, that if there is no overall meaning to life, if it is just a matter of getting through each day with its various problems, joys and sorrows, then life is meaningless and the logical response is suicide.

Others, who espouse neither a religious nor a philosophical view, usually do not face the question of meaning; live day to day, they imply, and hope for the best. This is a more palatable perspective, but not an especially reassuring one.

This being the case, on what basis will advocates for PAD provide criteria for deciding that certain complaints fall under category X, that is that call into question whether a particular life is worth living? Will they say that because the decision belongs to each individual, the question is irrelevant? If so, they should grant to anyone who wants to commit suicide the right to a physician's assistance in bringing about their death.

Moreover, even if they allow the wish of the individual to be the determining factor, on what basis do they do so? Philosophers at least as far back as Plato have argued persuasively that people's wishes at any moment are not reliable guides to what is right and good.

The advocates might declare that they are not going to get involved with all those esoteric concepts with which philosophers or religious people are so concerned. They then will simply argue that common sense can determine which complaints fall under category X. However, the "common sense" in this case cannot reflect an overall understanding of the meaning of life. It will be something akin to what we usually describe as a "gut" feeling. These vary from person to person, and there appears to be little reason to favour the feelings of certain officials over the long-standing arguments proceeding from religion or philosophy, or for that matter, to favour them over similar feelings of that large number of citizens who have rather different feelings. On what basis can I argue that my feelings about the matter are correct and should be enshrined in law?

Surveys show that politicians in our society are not among the most trusted persons, even when they are dealing with matters that should be within their areas of expertise. Why should we suppose that they are experts on life and death issues? Most of them are not qualified by extensive studies in ethics, nor for the most part have they been elected because their credentials in this area impress voters. Likewise, Supreme Court justices have not been chosen for their sophistication in dealing with life and death issues.

Of course our present Supreme Court and the parliamentary committee that has suggested widening the criteria for assisted suicide are not the first officials to take upon themselves the decision about which lives need not be protected. Totalitarian governments have done so regularly in the 20th century, with predictably horrible results. Democratic governments have more recently travelled the same road in the matter of the lives of the unborn.

It would make sense for provincial governments to send the issue back to the Supreme Court of Canada, explaining that it is impossible to frame laws in accordance with the mind of the Court until it explains, in principled argumentation, the basis on which a complaint deserves to be included under category X. Surely the variations in opinion among different persons working on the issue suggest that more guidance, and especially more reasoned guidance, is needed.

Fr. T. Kersch, csb
Fr. J. Gallagher, csb
Fr. D. McLeod, csb
Prof. P. Flaman, PhD
Ms. T. Robinson, MDiv