Opinions sought on euthanasia.

Was Robert Latimer justified in killing his severely disabled daughter, Tracy, in order to end her suffering?

Twelve-year-old Tracy had cerebral palsy which left her unable to walk, talk or feed herself. She had endured a number of operations in her life.

Some Canadians say Mr. Latimer acted with the best of intentions and ought not to be treated like a murderer. Others, notably representatives for people with disabilities, say allowing Mr. Latimer to serve a shorter sentence than other killers would lead to open season on people who are less than perfect.

The Latimer case is one of the real-life situations raised in a study guide, Care in Dying: A Consideration of the Practices of Euthanasia and Physician Assisted Suicide, newly released by the Anglican Church of Canada for reflection and comment.

A task group of the church's Faith, Worship and Ministry Committee prepared the study guide for use by Anglicans in response to a General Synod request in 1998. The group had presented a draft statement that opposed legalizing euthanasia and synod members felt it deserved wider comment.

The committee is hoping for feedback before the next General Synod in 2001.

While Mr. Latimer's appeal remains before the courts, the church's ethics consultant, Rev. Eric Beresford, is convinced Mr. Latimer should not have unilaterally taken the decision he did.

"He was too close to his own pain and the damage inflicted on his family to be the only person who could decide," said Canon Beresford, editor of Care in Dying.

The Latimer case "points to the duplicity of our own motives."

"We're not really always transparent to ourselves. We may convince ourselves we are doing firings for good motives," because we can't face up to the facts our motives may be mixed.

"That's part of the human condition. It's not unique to Robert Latimer. Therefore the laws need to recognize this conflict of interest."

A conflict of interest is also what makes this a particularly bad time in the history of Canadian health care to be considering a move to legalize euthanasia, Canon Beresford said, noting there is already enormous pressure on the medical system to move people out of hospital as quickly as possible, for example.

"When conflicting interests are at work, that's when things tend to go wrong," he said.

The task group has issued a pastoral guideline on euthanasia rather than a policy statement, partly to recognize that Anglicans hold widely diverging views.

"It allows the church to take a position without placing an intolerable burden on those faithful Anglicans who don't agree," Canon Beresford said. "One's view on euthanasia isn't what makes you an Anglican or not an Anglican."

That's not to say the group doesn't take a clear stand: it comes out squarely against legalizing euthanasia, for both practical and theological reasons.

The guide notes the experience in the Netherlands, where doctors may assist in killing a terminally ill patient who is experiencing unbearable pain and suffering after a process of counselling and consultation that must involve at least one other physician.

But research shows Dutch physicians have often failed to complete the reports required in cases of euthanasia, sometimes issuing death certificates claiming death was from "natural causes." Studies have also found a slide from voluntary into non-voluntary euthanasia.

The guide also notes the "long tradition in Christian theology that allows for the removal of therapies that are useless or unduly burdensome, on the grounds that these therapies serve to prolong the process of dying rather than to save life."

People are often confused about just what constitutes euthanasia, Canon Beresford said. He said the definitions in the guidebook may be among its most useful parts.

It is not euthanasia to allow your elderly father suffering from the end stages of terminal cancer to not be resuscitated, he said.

"We need to make a clear distinction between saving life and prolonging dying," he said.

The question the group kept returning to was the therapeutic intention of a particular action, and how that intention is expressed in care, he said. Much of medicine today is focused on curing, while historically the priority was care of a patient. Sometimes a duty to care involves using heroic medical measures, sometimes it doesn't, Canon Beresford said.

The study guide doesn't force readers to come to the same conclusions as the task group. It discusses the issue and offers case studies, both real and fictional. It raises questions but does not provide answers.

Canon Beresford acknowledges polls indicate Canadians favour a move to legalized euthanasia. He questions, however, what sort of euthanasia people would find acceptable. He also suspects much of the support is based on misinformation and misplaced anxiety.

Everyone has terrible scenarios in their minds of being kept alive while in agony, but those situations are rare, he said. As well, better pain management and palliative care can go a long way towards easing a person's final days.

The task group recommends a focus on palliative care initiatives and sensitive pastoral support of people facing end of life decisions.

DEFINITIONS

Brain death and removal of life support

Often confused with passive euthanasia, brain death occurs when the entire brain has irreversibly ceased to function. Since such patients are dead, the removal of life support cannot briny about death and such an action cannot be construed as euthanasia.

Termination of treatment

Also often confused with passive euthanasia, this refers to cases when medical treatment is no longer indicated and all treatment except palliation (food, water, pain relief) is withdrawn. The intention is not to cause death, but rather to recognize that it can no longer be effectively resisted.

Passive euthanasia

The intention is to allow the patient to die by not treating a condition that, left untreated, will cause death.

Physician assisted suicide

The physician provides the means or information to allow a patient to end his or her life.

Euthanasia

The physician intervenes directly to bring about the patient's death, for example, by providing the necessary drugs or by injecting a patient with a lethal dose of morphine.

Voluntary euthanasia

An informed and competent patient has requested the death.

Involuntary euthanasia

A person who is competent to consent has been killed without requesting the death, perhaps because a family member is moved by his or her suffering.

Non-voluntary euthanasia

A patient who is incapable of requesting death is killed, such as a child, someone who is mentally ill or who is unconscious.

From Care in Dying: A Consideration of the Practices of Euthanasia and Physician Assisted Suicide by the Task Group of Faith, Worship and Ministry Committee.