Yuri Bilinsky, New Pathway – Ukrainian News.
He is a French Canadian who works as a general internist at the North York General Hospital in Northern Toronto. He is also Ukrainian Greek Catholic and a member of the Toronto Catholic Doctor’s Guild. By virtue of having his conscience rooted in his Christian faith, Pascal Bastien has a very strong position with regards to “Medical Assistance in Dying”. This term denotes legalized euthanasia and physician-assisted suicide in Canada after the Supreme Court judges in the Carter case ruled two years ago that it was against the Charter of Rights to prevent someone who was encountering a very severe suffering to ask their physicians to end their lives.
Bastien believes that euthanasia is not good for patients and is not the true compassionate way to deal with the suffering and hardship that people could encounter in their chronic disease. Moreover, he opposes the fact that all physicians in Ontario are now asked to “be cogwheels in the system”, as he put it. Bastien did not lack strong words for the current situation with euthanasia: “I am particularly concerned with the fact that it is no longer considered a crime for physicians to kill people under certain circumstances but rather it is seen as a medical service. I am concerned with how medicine is evolving in our country and in our province.” The NP-UN interviewed Pascal Bastien to find more about this controversial situation.
Yuri Bilinsky: Do you think that euthanasia in the future could be applied to people under 18 years of age, which is among the biggest concerns of the euthanasia opponents?
Pascal Bastien: In Canada, we initially excluded children, teenagers and mentally ill from the categories to whom euthanasia can be applied, perhaps to appear as though we’re taking the middle ground. We also have restricted access to people who are no longer able to make decisions for themselves. So, if I’m 95 years old with dementia and my children feel that I wouldn’t want to live this way, they cannot now say “please doctor just eliminate my father.” Many European countries, where euthanasia has been legal for years now, have progressively opened up their gates to a larger public including children and people who suffer from a psychiatric disease. Once people actually believe that bringing death actively is a compassionate thing to do, it completely changes how they perceive humanity in general and each human life. The question becomes: why wouldn’t you open the flood gates? I truly believe that people who promote euthanasia, while completely misguided in my opinion, do it with the genuine perception on their part, that they are bringing relief and kindness to the world. Once you buy into that idea, then why wouldn’t you want to bring this supposed kindness to children or to the mentally ill and so on. The true question is whether euthanasia is a good thing or whether there are better ways to accompany people through suffering.
Yuri Bilinsky: What is the perception of euthanasia in the Canadian society and are there any chances that the public could oppose it?
Pascal Bastien: There is a very active ideological subset of people, many of whom are in power and in spheres of influence, who believe that euthanasia is good. Although there are many polls showing that the majority of Canadians support assisted suicide, I believe that most people, if they sit for coffee with you and discuss euthanasia, would very quickly come to realize that there is a hole in this theory. To build strong opposition to euthanasia we would need a very significant change in the general culture in Canada and an engagement of certain parts of the population that have remained silent until now.
Yuri Bilinsky: Are doctors in Ontario now allowed to pursue their conscience and not participate in euthanasia?
Pascal Bastien: No. A few months before the decriminalization of euthanasia came into effect, the College of Physicians and Surgeons of Ontario (CPSO) issued a policy on Professional Obligations and Human Rights in which they lay out that physicians, who are asked to do legal medical acts that go against their conscience, still have the duty to refer to a non-objecting physician, or to do it themselves in cases of perceived urgency. A doctor could lose their license for saying “I am happy to explore palliative care with you for your grave suffering, but if truly your heart is set on getting euthanasia, forgive me, I simply cannot accompany you in that path.” Of note, in the CPSO consultation that preceded the publication of this policy, approximately 17,000 people wrote in saying physicians should be allowed to maintain their conscience right, while 2,000 people wrote in saying the contrary, evoking fear that physicians would block their patients’ access to care or impose their morality. The 17,000 were ignored.
Yuri Bilinsky: What are the main arguments which prove that the theory of euthanasia is wrong?
Pascal Bastien: First, high-quality palliative care is extremely good at relieving suffering. People worry about physical pain, shortness of breath, choking, and hear examples of patients with Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), or catastrophic strokes. I can assure you that even my colleagues, who don’t share my views on the inherent sanctity of human life, do not believe the rhetoric that is being used to promote euthanasia, because it relies on the notion that we cannot correct these problems. We are extremely good at alleviating these symptoms. What we don’t have medications for, unfortunately, is a loss of sense of self-worth. If people believe that they are useless, that they have become a burden on society, that no one loves them and that they are just wasting resources, we don’t have medications for that. What people need is love, a family or friends that come and visit them. It is in that sense that there are many very lonely people who do not get full relief of their human suffering by the visit of a palliative care doctor. If we, as a population, say “No, I don’t want to be bothered by my neighbour who is sick, I don’t want to visit someone who is in a hospital, it makes me feel unwell” then we need to have a way to get rid of these people. I think when people start seeing euthanasia for what it truly is, the evil that it represents will become more obvious.
Yuri Bilinsky: So, many times, it’s not just that the person feels that they are not needed, but that the relatives think that this person is not needed anymore?
Pascal Bastien: Correct. I had one case where this woman was asking for euthanasia before it was legalized. She was a widow and had one son who lived in another country and never visited her. One of her friends was coming to the hospital every day. And she said to me in front of this friend that she felt that her friend was wasting her time on her. There is a problem when suddenly society agrees with her, when society effectively says, “You’re right, your life is actually not worth anything, let’s get rid of you.” The society is not saying “Let’s spend time with you and hold your hand at the bed, your value is not proportional to how much you have in your bank account.” Many people see those words as an ancient talk. This, mind you, doesn’t mean that we have to do absolutely every extreme thing in medicine to prolong life indefinitely. This is another lie that the proponents of euthanasia try to spread. It is okay in certain contexts to simply use medication to keep one comfortable when problems arrive and allow a natural death to occur. But it’s a very different philosophy from actively seeking death.
Yuri Bilinsky: Where do you think the idea of euthanasia comes form?
Pascal Bastien: The proponents of euthanasia believe that if life is not providing any pleasure, then it has zero value and you do not lose anything by ending it. If anything, you are gaining something by removing suffering. They also believe in our right to control every aspect of our lives. The word euthanasia means “good death” in Greek, and it’s an old concept. But even before the Christianity, Hippocrates in his famous oath made it clear that he did not believe that physicians should be providing potions to end life. Physicians should be responsible for healing. In recent years, this point was brought up in negotiations with the government, since it doesn’t have to be physicians that perform euthanasia: it does not require that much training to end someone’s life. Euthanasia breaks the very nature of a physician-patient relationship. Once physicians enter this realm, they can participate in healing and in killing on the same day. Even the patients who are not seeking euthanasia become victims of this change of attitude. I have many conversations about my patients who are dying and the fear in the eyes of the family members is visible. They often don’t understand the difference between palliative care and euthanasia. Now that physicians participate in euthanasia, patients are losing their trust in the medical profession.
Yuri Bilinsky: So, patients are now afraid that they will be put to death by doctors?
Pascal Bastien: Exactly. Some of these fears may not be justified – I’ve not seen healthy people being euthanized, nothing to that extreme. But we can observe changes in practice which do not get labelled formally as euthanasia. I have come across blurry situations where critically ill patients may receive very generous doses of medications aimed at comfort, and where good palliative care principles such as progressive dose escalation were not taken. It happens in the context of people who might have died in the span of a few days but end up dying in the span of a few hours or less. In a society that doesn’t consider bringing death quickly as a problem, why would a physician need to be cautious and give you a small dose of opioid first, and only bigger doses later, if necessary?
Yuri Bilinsky: But would the relatives still object against that and file a law suit?
Pascal Bastien: That could happen, and they would have a right to do so. A nurse colleague told me about her own experience at a different hospital with her dying father. Her father, whether totally lucid or not, had said “I’ve had enough, I can’t take this anymore.” The doctor went ahead with very generous doses of opioids, and within the hour her father had passed away. I think in that case, it’s not going to go to a law suit, but those events had an enormous impact on that family’s healing process.
Pascal Bastien grew up in a Roman Catholic family. He said, “Like most teenagers, I had some struggles and questions about the world and my Christian faith. When I reached my university years, I had an occasion to attend vespers at St John the Baptist Shrine in Ottawa. And it was never the same after that. I could not suppress the desire to return and pray vespers again and again. I started doing more spiritual readings and had as spiritual father a priest of the seminary in Ottawa. I had some tendency to be almost exclusively intellectual in my quest for God, and at times I found this can lead to a dead-end, because at the end of the day, God is completely above our understanding. Eastern Christianity is perhaps particularly well-suited to help us understand this great mystery of God beyond all understanding. I made the official move to become Ukrainian Greek Catholic because I wanted my children to grow up and receive the sacraments in this Church.”
Yuri Bilinsky: What does the Ukrainian Greek Catholic tradition have that adds value?
Pascal Bastien: There is a very strong practical sense in this tradition that our entire life is rooted in the Liturgy. While we are called to pray on our own and build a personal relationship with God, in a very real sense, we are also very much connected in the Body of Christ. This is true for all Christians, but this is so easily understood and felt for someone who participates in the Ukrainian Greek Catholic Divine Liturgy and in the sacraments in our tradition. Our liturgy so clearly allows all of us to bring our prayers forward through the ancient hymns and beautiful singing, such that we could hardly fall into the trap of thinking that somehow going to church is just to listen to a priest. It’s easier for us to become engaged. The very powerful words of liturgy are a form a mosaic of Holy Scripture that Church Fathers sewed up together, to fuel our prayer life even as we leave church. I sometimes meet Ukrainian Catholics who for various reasons, often because of language, have not gone to a Ukrainian church for a long time. They’re quite surprised to see my enthusiasm for our Church with its Kyivan roots. I tell them “You have to re-discover the spiritual heritage of the Church of Kyiv.” At times, they can be rekindled to discover this beauty.
Yuri Bilinsky: What is Toronto Catholic Doctors Guild and what is its mission?
Pascal Bastien: It is the Toronto branch of the Canadian Federation of Catholic Physicians Societies. We have approximately 100 members who attend various events. The guild has been gaining momentum in recent years. People lead busy lives and it’s not always obvious to them why it is important to belong to a group of Christian physicians. It becomes very clear, though, when a challenge like euthanasia is brought up and there are going to be consequences for choosing to live a life of a Christian at work. It becomes clear that you need a little bit of support. I have friends who are Sikh, Hindu or agnostic and who are not comfortable with euthanasia. They were very resistant two-three years ago, but they don’t feel like they have any leg to stand on now. They say “Well, I’m not going to promote it, but if I’m asked, I will do the bare minimum.” They reluctantly accept to refer. You have to find a support group to have strength to say “No, I really can’t become a cogwheel in the system, I have to remain true, do it lovingly, with a lot of compassion.” It’s crucial to have support in those circumstances.