Ethics Is Not A Zero Sum Game

With Alberta's Catholic Bishops having stuck their oar into the secular sphere of public services several times in recent months, making hardline declarations about what their faith supports and does not support.  

Let me be clear, I don't really care if the Catholic Church wants to declare that being LGBT is some kind of mortal sin, or that Physician Assisted Death (PAD) is "morally corrupt".  Those are both moral positions within the context of their faith that the Church is perfectly entitled to ask its membership to abide by.  I may stridently disagree with the rationale they use, but that's another matter.  That isn't the topic I want to discuss today.

In both the matter of school safety for LGBT students and the PAD issue, the Bishops are making this an "all-or-nothing" proposition.  Essentially, they are placing their Church's moral dictates at the top of some imagined hierarchy of rights.  This is neither reasonable or appropriate.

The problem here is the idea that there is some kind of moral absolute involved which trumps everything.  This is far from being a reasonable approach to ethical issues.  The Canadian Medical Association's policy statement on Physician Assisted Death reflects the actual complexities involved. It reflects the fact that a physician must consider far more than their "deeply held faith" (or whatever phrase you want to throw at it).

1. "Consider first the well-being of the patient." This means that the care of patients, in this case those who are terminally ill or who face an indefinite life span of suffering or meaninglessness, must be physicians' first consideration.
2. "Provide for appropriate care for your patient, even when cure is no longer possible, including physical comfort and spiritual and psychosocial support."
3. "Provide your patients with the information they need to make informed decisions about their medical care, and answer their questions to the best of your ability."
4. "Respect the right of a competent patient to accept or reject any medical care recommended."
5. "Ascertain wherever possible and recognize your patient's wishes about the initiation, continuation or cessation of life-sustaining treatment."
6. "Recognize the profession's responsibility to society in matters relating to
. . . legislation affecting the health or well- being of the community . . ."
7. "Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants."

Consider these ethics statements for a moment.  They don't say "your faith trumps the patient", nor do they say that a physician must participate directly in a process that they disagree with, or feel is inappropriate.  Far from it.  Rather, the physician is obliged to weigh the entirety of the situation as they see it.

However, we have to recognize that in these situations that the patient is likely psychologically competent and capable of participating in those decisions.  These decisions are not entirely at the whim to the doctor.  The doctor has other considerations they must give weight to.

A physician should not be compelled to participate in medical aid in dying should it be become legalized. However, there should be no undue delay in the provision of end of life care, including medical aid in dying.

The importance of this one statement cannot be underestimated.  Although it does not stipulate that there is a duty to refer, it essentially is saying that the doctor's role is not to confound the patient.  So, if the doctor has reason to suspect that the patient is incompetent, or perhaps that  the desire to end their life is temporary, then the physician needs to act accordingly to ensure that the patient has appropriate psychological supports.  If this is not the case, and all other things being equal, the physician should not act in a manner which confounds the patient's wishes.  There is an important principle at play here - and that is the patient's ability to participate in informed consent.  There is a considerable difference between a patient who is suffering chronic depression that has become suicidal and a patient who is suffering from terminal illness who says "it's time to go", and wants to exert some control over the circumstances of their death.

Similarly, I consider the issue of LGBT supports in the schools another case of weighing the interests of the parties involved to be critical.  Calgary's Bishop Henry has argued that because the Church teachings reject the validity of (in particular) transgender identities, that the Catholic Schools should not be obliged to provide supports for transgender students.  Yet, as much as the Church is free to claim that it doesn't believe that transgender identities are valid, there is clearly a body of students within their schools who are transgender.  A little like Iran's former president saying that Iran has no homosexuals the denial is a bit like sticking one's head in the sand.

However, the role of a school is first and foremost to ensure that their students are appropriately educated.  Even a school with affiliations to a particular religious faith must ensure that the environment is conducive to learning for all of the students who go to that school.  (and yes, there are transgender people who are Catholic in this world, in spite of the Church's teachings)

So, we have an ethical issue here.  The Church's position and past conduct of school administrations has been identified as creating an environment which is counterproductive to the learning needs of LGBT students in general, and transgender students in particular.  So, should the Church's doctrine trump the stated needs of LGBT students to have a safe learning environment?  Do the Bill 10 and related policy guidelines that Minister Eggen has put forward prevent the teaching of Catholic doctrine in those schools?  These various interests exist in a state of mutual tension.  An absolutist position such as the Bishops in Alberta have put forward on the matter naturally compromises the creation of an appropriate learning environment for these students in favour of an insistence on all aspects of a Catholic school reflecting Church teachings.  In taking such a position, the Bishops are essentially telling school boards, teachers and administrators not to follow the ethical obligations of being educators for one particular group of students.  Are Catholic LGBT students not worthy of ethical consideration?  A more reasonable approach would be to acknowledge that these students do exist, and that the schools have a universal obligation to ensure that the learning environment is appropriate and safe.  There is nothing in providing such accommodations which precludes the teaching of Catholic ideals in the classrooms.  LGBT students may not like certain aspects of Church dogma as it relates to them, but the classroom and the church are appropriate places to stand up and challenge those teachings.

Religious Truth is a concept, and aspirational ideal at best.  It deserves to be considered as an aspect of the ethical decisions we all have to make in our lives, but not as a trump card every time a difficult issue comes.

Speaking Of Hypocrisy

So, the Catholic Church thinks it has something relevant to say about physician assisted death?

After reading through the Bishops' letter to Alberta's Premier Notley, it's an amazing piece of hypocritical nonsense.

The Catholic Church is committed to protecting and caring for the most vulnerable people in our society; this includes, of course, those who suffer and dying Albertans. Catholic healthcare in Canada, and in our province, has given witness to this from our earliest history.

Except for those Albertans who happen to be LGBT, apparently.  

We want to be clear that, from a Catholic perspective, the intentional, willful act of killing oneself or another human being is morally wrong. Therefore, no Catholic - including elected officials and healthcare professionals - may advocate for, or participate in any way, whether by act or omission, in the intentional killing of another human being either by assisted suicide or euthanasia.

Once again, we see the Church attempting to dictate the actions of its membership through coercion.  I saw Bishop Henry use exactly this tactic during the gay marriage arguments in the 2000s, where he threatened to excommunicate any Catholic politician who voted for gay marriage.  It wasn't persuasive or relevant then, it isn't now.  

First, if laws and regulations governing the legalized acceptance of assisted suicide and/or euthanasia are to be adopted, then we must accept that they will, in principle and practice, affect all Albertans. Therefore, we ask that your government undertake a consultation process open to any and all who wish to speak to the issue.

Well, since the laws involved are predominantly Federal jurisdiction, I don't see where Alberta's government has much to say about the matter.  Outside of Quebec, no province seems to have significant plans on this matter, and are waiting for June when the Federal Government has to have passed new legislation.

Second, we are gravely concerned that the legalization of assisted suicide and/or euthanasia will place certain members of our common home at serious risk. In jurisdictions that have already adopted laws permitting euthanasia and assisted suicide, what are purported to be “safeguards” against abuse of the law have proven in practice to be no safeguards at all. The measure of a just and ethical society is the extent to which it cares for - and protects - its most vulnerable members.

Really?  What examples would you cite?  Oh, I know, you'd probably dredge up the idiotic crap that LieSite has been spouting ever since a couple of countries in Europe changed their laws.  Besides being largely hysterical reporting, LieSite has an extreme agenda to start with.

However, then the Bishops delve into the bag of "pro-life" lies on the subject:

These are our mothers and our fathers; they built our homes and our province. They are not a burden, and they must not be led to feel that way through our individual and collective indifference.

Yeah.  Sure.  People are not going to ask the doctor to kill their parents off.  However, these Bishops might want to spend some time in a palliative care ward filled with people dying slow, agonizing deaths at the hands of disease before they pull such emotional arguments out of their cassocks.  (I'll come back to this in a moment)

Even today, many of these people often experience unjust discrimination and the sting of stigma from their family, friends, colleagues and society. In other jurisdictions, this group has in particular been disproportionately represented in cases of assisted suicide and euthanasia.

Coming from a Church which denies the validity of transgender identities, and calls homosexuality "a sin", this position is almost laughable.  I wonder if it has occurred to them just how much their teachings contribute to an attempted suicide rate among transgender people that runs upwards of 40%?

They save the money shot for the very end, and delve into the messy pot of issues called "Conscience Rights":

Third, other provincial jurisdictions in Canada have proposed regulations that undermine the conscience rights of physicians and other healthcare workers. This must not be allowed to happen here. Physicians, other medical professionals, and our institutions have to be allowed the freedom that is theirs by right to exercise their conscience, not only to accord with our Charter of Rights and Freedoms, but also as a matter of good medical practice.

Conscience rights is nothing more than the latest pro-life gambit to create a hierarchy of rights that places an individual's religious conscience at the top of the heap.  

Let me be clear.  Assisted death is a very prickly, emotional subject.  Yes, there are religious and conscience issues involved.  Lots of religions teach a particular ethic about life, and even without that stricture in someone's life, many would be rightly uncomfortable with such decisions.

However, it is far too simplistic to simply say "it's a sin, therefore it should be banned".  One only has to spend time in and around palliative care wards watching people in their last days and weeks to know that exiting this world is not always a peaceful, quiet experience.  Terminal illness can be painful and brutal, robbing people of autonomy, dignity and peace.  It's a terrifying, painful experience for some, and one that is not always remediated well by painkillers.

This is a matter of patient rights to self-determination and caregiver ethics coming into some degree of conflict.  Most ethics codes reflect the right of the patient to informed consent, and to refuse treatment.  We have to remember that the person at the center of this discussion is the patient, not the caregiver and definitely not the caregiver's church.  Even the CMA's statement on this subject is fairly clear - a doctor does not have to participate in the actual act, but they are not allowed to be an obstacle to it either.

Where the religious notion of "conscience rights" becomes problematic is that they have begun to extend it to include being "complicit in the deed", usually as a means to try and sidestep the duty to refer to a caregiver who is willing and capable.  We've seen this played with the abortion game, and I have no doubt that's what the Bishops would advocate here as well.  This is where we tip the scales and pass from supporting the individual's conscience rights and it becomes a matter of imposing one's conscience objections on the patient.  Considering the patient's state and vulnerability, this is not only problematic, it is arguably exploitative as it places the patient in a jeopardy situation where they then would have to find the means to access a willing caregiver.  (Which, if you are hospitalized or bedridden, can be damned difficult)

Alberta's Bishops would do us all a favour if they took a more nuanced approach to matters rather than simply trying to railroad the rest of the province with centuries old dogma.