Mindfulness, Ethics and End-of-Life Care: The impact of Canada’s Supreme Court decision

Today, February 6, 2015, the Supreme Court of Canada allowed the appeal against the “blanket prohibition on assisted suicide.” An earlier appeal by Sue Rodriguez (Rodriguez v. British Columbia) in 1993 to have the Criminal Code ruling against assisted suicide declared unconstitutional was denied. The upholding of the current appeal (Carter v. Canada) is destined to be controversial for many reason, not the least of which is the ethical weight it will place on health care practitioners. The ruling is clear that while the Criminal Code is still valid for assisted suicide, it is over-reaching in its application in regards to persons who suffer from intractable medical conditions that compromise their ability to live well. It states that the Criminal Code infringes on the individual’s “right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

“…and are of no force or effect to the extent that they prohibit physician‑assisted death for 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.”

There will be many issues to clarify as this ruling enters the health care system. Parliament could enact a legislation should it “choose to do so” though whether it will be in favour is in some contention given the current government’s opposition to assisted suicide. Not only are there definitional issues, there will also be issues of a chain of decision-makers who can effectively guide and support individuals who wish to avail themselves of this right. Ultimately, one would hope this does not become a decision that is relegated to the hands of a few but one that will be made in community with compassionate support and wisdom of our past experiences. In order to meet these demands, we will be called upon to examine our own values and conscience with regard to a primary precept we hold, especially as mindfulness practitioners: What are the nuances of the ethic of respecting life in this context?

Can Mindfulness Practices Have an Ethical Role in Physician-Assisted End-of-Life Care? stump w flowersThe complex issues facing us will be challenging. More and more in the writings on mindfulness, an important point is being made that the practice of mindfulness must contain an ethical core. That means not doing harm, avoiding acts that encourage or precipitate harm, and respecting life in all its intricacies. Will we therefore wonder, as mindfulness teachers, if supporting requests for mindfulness training in cases of assisted suicide is ethically within our scope of practice? There are no easy answers however, as with all koans it invites us to examine how these questions play out in our life.

A common question asked of secular mindfulness teachers is – given the purported absence of ethics in a mindfulness program – whether one can therefore rob a bank mindfully or shoot and kill someone mindfully. This argument maintains that what we learn in a mindfulness program is how to pay attention to what is unfolding in the moment and letting it be. Thus, we can bring our attention to the gun, the bank, the person we are about to kill and let that be without engaging in any critical thinking that may have us wonder if this is the right thing to do. Similar arguments may end up being levelled against an involvement of mindfulness teachers in end-of-life care that involves assisted suicide. (I should note that end-of-life work by many conscientious and compassionate colleagues is a powerful part of health care.)

It’s important to ask these questions. It’s also important to use the right understanding of what mindfulness practice actually is. If paying attention is the sole characteristic of a “mindfulness” practice, then the practice is missing a crucial component. Attention by itself generates raw and unusable data. Heat, cold, tingling, blue, red, grey, snow, sun and so on are data points but have no intrinsic ability to change our life path. Remembering consequences of past experiences and recalling our intention for paying attention makes the data meaningful. Mindfulness practice is the opportunity to cultivate wisdom from information to which previously we were reactive but which we now can hold with equanimity to facilitate a better choice. So, there is no mindfulness involved in knowing one is in that bank with a gun pointed at the clients and employees. Mindfulness is in remembering that this action is about to bring harm and recalling a core value.

How might this play out in the potential future of end-of-life and assisted suicide? We have to ask which carries the greater potential to harm: teaching someone to “live well” with a grievous, intractable, unendurable illness or teaching them how to be truly mindful by opening to all the consequences of their wish to be free of pain and suffering. I believe, in this context, the former risks reducing our work to trite phrases like “be grateful for the life you have,” “be in the moment,” or any of the aphorisms we find in mindfulness memes these days. The later however may allow for a clarity of mind in our clients and therefore a range of decisions they can make in conjunction with family, faith communities, physicians, psychologists and all other health care support available to them.

We are entering interesting times.

———-
Edited at 16:43 for typing errors & paragraph spacing.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s