Hello (again) world! I know it’s been some time since my last post. The reasons are plentiful: word weariness after finishing my book, the breakneck pace of my caseload, and guitar lessons. Although, in all honesty, the guitar lessons and the following practice only account for probably 0.023% of my time. But given some prior conversations and a free afternoon, I thought I’d pick up the keyboard again.

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The topic of physician-assisted suicide, more commonly referred to as medical assistance in dying (or simply MAiD), has been an interest of mine for some time. In 2014 I offered a presentation at the annual Association of Professional Chaplains conference regarding the debate regarding voluntary euthanasia, offering my own opinion on what I saw as the key underlying concerns of those for and against physician-assisted suicide, as well as how hospice and palliative care were uniquely situated to address those concerns.

Now, over ten years later, a lot has changed in this landscape. The number of states offering legal MAiD went from four in 2014 to twelve in 2024. Several states are considering legislation this year to offer MAiD, which, if they all pass, would make MAiD legal in over half of the states in the country.

Canada has also moved rapidly to open up access to MAiD following a landmark 2015 court decision that struck down a nationwide federal ban on MAiD. It has since become a significant part of the Canadian medical system, to the point where approximately 1 in 20 deaths is due to medical assistance in dying.

Within the hospice community, MAiD and “death with dignity” are topics of intense discussion. This would naturally be the case, given that the goals of hospice care are explicitly to provide the dying with a comfortable and dignified death, respecting patient choices and autonomy as much as possible. While none would argue against these goals, the discussion of the appropriateness of MAiD in achieving these goals is ongoing.

Within the field of hospice, especially hospice chaplaincy, I’ve seen that at least anecdotally, support for MAiD professionally is at the level where it is usually assumed that if you’re working in hospice, you are in favor of “death with dignity” laws. Professional discussions of MAiD typically focus on removing barriers to its implementation in states that don’t have it in place, assuming that medically assisted suicide is an assumed good within the community. During a recent call with hospice chaplains nationwide that I sat in on, discussion of PAS and MAiD assumed common agreement on the need to further support such laws nationwide so that universal access to services were available. This assumption belied the fact though that not everyone agrees that MAiD is something that chaplains can advocate for.

One reason for this is that chaplaincy, for as far as it has come, remains dominated by a Christian worldview – and a particular Christian worldview at that. Chaplaincy of course encompasses a wide variety of faiths: Christian, Jewish, Muslim, Buddhist, and Humanist to name some of the most common faith groups represented in chaplaincy. Yet the current discussion of MAiD in hospice spiritual care may not be including the voices from minority faith groups as equal partners in the conversation. For example, Muslim and Jewish faith groups almost universally condemn any form of medically-assisted dying. It should not then be assumed that Muslim and Jewish chaplains would necessarily have the same beliefs regarding “death with dignity” and MAiD as their contemporaries, simply because they are involved in hospice or palliative care. There are many Christian chaplains as well, myself included, who are more hesitant to accept MAiD to the extent that others do, and at the very least desire to continue the conversation rather than assume that we have all reached the same conclusion.

Chaplains are a significant voice in ethical discussions regarding end-of-life care. However those voices can often be drowned out in a field that, when discussing things like “quality of life”, tends to be driven by data like FAST and PPS scores. It’s imperative that chaplains continue to raise concerns and keep the conversation going. In critical medical situations where the tendency is to move quickly and perhaps rush to conclusions based on the opinions of one or two people, chaplains are good at the task of slowing things down and making sure that all the voices have been considered, without assuming that everyone at the table shares the same underlying assumptions.

I don’t pretend to have all of the answers in this field. I’m still very much a learner, but an active learner. Further, this post shouldn’t be construed as a definitive statement regarding MAiD and PAS for the field. This is all very much in process. I welcome your thoughts and insights.