Voluntary Assisted Dying

Background

Recently, I have had both the honour and the challenge of journeying with Maria*, on a journey as she prepared for and completed the VAD process. Maria was a practising Catholic with a terminal illness. She had struggled with her illness for years and, following her latest hospital admission, was informed that she had only months to live and that her symptoms would continue to worsen. She subsequently chose to pursue VAD.

Maria initially sought pastoral care from the local Catholic parish. However, when the priest visited Maria and learnt of her decision to pursue VAD, he chose to withhold the sacraments and informed her that he could not support her through this process, which he believed to be a sin.

I was then contacted and asked whether I would be willing to offer pastoral and sacramental ministry to Maria while she went through this journey. I agreed. Although I still have reservations about VAD legislation and the process itself, I have taken the view that I will not deny care and support to anyone who freely chooses to engage in this process.

Over the next three weeks, I met with Maria every two or three days, providing Holy Communion and spending time chatting about her life and family. Maria had a strong faith, and it was genuinely hurtful for her to feel that the Church to which she had been committed had abandoned her during her toughest struggle. She declared herself no longer a Catholic and said to me, “I’m whatever you are now”.

Maria had experienced significant challenges throughout her life. She was a single mum who had struggled to have children before finally having her only child later in life. Sadly, Maria and her now-adult son were estranged. Although her son did visit twice, these visits generally led to negative outcomes and the need for additional pastoral support.

The End of the Journey

I joined Maria and some of her friends at the hospital at around 4 pm. We shared a cuppa and a chat. She made jokes and told stories. She insisted that no-one be “morbid”.

At about 5 pm, we went outside with her, and she had her last two cigarettes. We then went back inside. The doctor arrived and spoke with Maria about the process, making it very clear, repeatedly, that there was no compulsion to proceed and that she could withdraw at any time if she was unsure. Maria was very clear that she wanted to go ahead.

The doctor left to organise the medications.

We shared Holy Communion.

The doctor returned and again asked Maria whether she was sure. Maria said yes. The doctor inserted two cannulas into Maria’s arm. She then explained that the insertion of the cannulas did not mean Maria had to proceed; she could still choose to cancel or postpone.

Maria cheekily made jokes about postponing.

The doctor explained that she needed to be serious about such matters and again asked Maria to confirm that she wanted to proceed.

We were then given some time for final goodbyes while the doctor went to get a registered nurse (RN) to act as a witness. Maria said goodbye to her friends and me, and thanked us all for being with her.

She asked me to play her favourite hymn. I played it several times while we waited for the doctor to return. At one point, Maria ushered me over and whispered, “If we play it enough, the words might sink into them!” She was referring to her friends, who were not active members of a church or faith community.

The doctor returned with an RN. She explained the procedure that was about to take place and asked Maria to formally state whether she wanted to proceed. Maria indicated that she did.

The process was different from what I had expected. I had imagined that it would involve an automated drip set up to administer the medications one by one in the correct order.

However, the process in this particular case was different from what I had anticipated:

1. The doctor administered a dose of a strong sedative manually through one of the cannulas inserted earlier.

2. The doctor then administered a second medication, an anaesthetic.

3. Finally, the doctor administered the medication that caused death.

While the process took place, we played Maria's favourite hymn again. After the administration of the second medication, I performed an anointing, sometimes referred to as the ‘last rites’, which Maria had requested.

Following the administration of the third medication, the doctor flushed the cannula with saline and immediately attempted to take Maria’s pulse. She could not find one. She then used her stethoscope and performed the usual checks before confirming Maria’s death.

The whole process, from the commencement of medication administration to the declaration of death, took approximately three and a half minutes.

Reflection

To participate in this process was both an incredible honour and an immense challenge. For me, the journey was a roller-coaster of emotions, and for Maria, even more so.

The method of administration was the most confronting part of the process for me. The very deliberate, practical manner in which the medications were administered was challenging to witness. I imagine that it must also be incredibly challenging for the doctors who administer them.

I was honoured to get to know Maria, to share in her story and to give her the time and space to express her fears, regrets, loves and hopes. It was a privilege to walk beside her and assure her of God’s love for her.

This experience has reinforced for me the importance of providing pastoral care without making that care conditional on a person’s decisions. While I continue to have reservations about VAD, particularly regarding the safeguards, I believe that accompanying someone through a difficult and deeply personal journey is an important part of pastoral ministry. Maria needed someone who would listen to her, respect her decisions and assure her of God’s love, even when her choices differed from my own convictions.

I was also struck, once again, by the importance of simply being present. Much of my time with Maria involved ordinary conversation, listening to her stories, sharing a laugh and providing Holy Communion. These seemingly small acts became an important part of our relationship. They allowed her to speak openly about her life, her regrets, her hopes and her relationships without feeling that she was being judged.

Finally, the experience brought home to me the difference between understanding VAD as a concept and being present when it actually takes place. Witnessing the practical administration of the medications was confronting in a way I had not anticipated. I would approach a future experience with a greater understanding of what to expect and a clearer appreciation of the emotional preparation that may be needed.

Would I Do It Again?

In short: Yes.

While this was an emotionally challenging experience, I would be willing to journey with someone through the VAD process again. My experience with Maria has reinforced my belief that pastoral care should not be withdrawn simply because someone makes a decision about which I have reservations or with which I disagree.

However, I would seek to be better prepared for the practical and emotional realities of the process. I would consider the circumstances of each individual situation, my capacity to provide appropriate support, and whether I could participate in a way that remained consistent with my own convictions and responsibilities in other areas.

I recognise that every future situation will be different, and I would not necessarily make the same decision in every circumstance. What I can say is that this experience has not changed my willingness to offer compassionate pastoral care to someone undertaking this journey.

*Name and some personal details changed to protect privacy.