by Olivia PhillipsEarlier this year, a visceral social media debate was sparked when a Canadian pastor reached out to their North American colleagues for support in understanding how best to offer pastoral care to an individual seeking Medical Assistance in Dying (MAiD). Differences in traditions, ages, cultures, life experiences, and educational backgrounds led to very distinct interpretations of how the Scriptures ought to be applied to the question of how to support individuals facing terminal illnesses. One unifying truth emerged in the difficult space of conversation: as medical assistance measures for terminal patients change, so too must our response as clergy.
I want to preface this article with the consideration of my own space in this conversation. I have spent more than my fair share of time in funeral homes. As a young member of a predominantly older-aged family, this was to be expected. By the age of 10, I knew which of the local funeral homes had the best hot chocolate, and where to find it in the kitchenette if the coffee stand was empty. Out of this strange comfort with death and dying, I have consistently found myself journeying with those facing terminal illness.
While it is not my primary role as a pastoral educator, the palliative bedside has become a sacred space in my ministry. When I began my bachelor’s degree, I was shocked to learn that approximately 75% of my classmates had never been present at a funeral before they studied pastoral care. I was even more shocked in my graduate degree to learn that nearly 40% of my cohort had no experience with funerals or death. For some of us, the tension of discussing MAiD is amplified by how little experience we may have with death and dying.
I recognize that not every individual has the same level of comfort with death and dying, but we are all called into this space at some point during our lives. It is perfectly understandable and reasonable to be uncomfortable with death, but this doesn’t have to be a space or a conversation we feel unprepared for or afraid to engage. For this reason, I write with the hopes of empowering you—whether clergy or layperson—to better understand and greet death.
Dissecting our Understanding of Death and Dying
When we know the process of dying well, believers in the space of end-of-life care are better equipped to administer spiritual care—as medical professionals, clergy, or as the loved ones of those personally facing terminal illness. Understanding our role in an age of Medical Assistance in Dying (MAiD) begins with establishing our understanding of euthanasia. While euthanasia may already feel like a loaded word for this conversation, let’s consider the whole picture together.
There are two kinds of euthanasia offered to terminal patients; these are distinguished by their medical responses as passive and active. Passive euthanasia does not require the intentional intervention of an individual to terminate life. This would include an individual choosing to refuse a potentially life-extending treatment (i.e., chemotherapy, etc.), or the use of medications intended to improve quality of life which have the potential for adverse effects. Conversely, active euthanasia requires the choice of an individual to seek the intervention of an individual for the purpose of terminating life (i.e., MAiD).
Passive Euthanasia
Passive euthanasia practices have long been embraced by individuals within communities of faith. The medical choices to refuse extraordinary care in terminal illness, sign DNRs (Do-Not-Resuscitate), or to use pain management systems to ease an individual’s pain in death have rarely been seen as contrary to Scripture’s incredible value of human life. The goal of these personal care choices is to safeguard the quality of life remaining for individuals with terminal illness without inducing death directly.
Active Euthanasia
Active euthanasia is the process wherein an individual seeks medical assistance for the induction of death. Commonly referred to as MAiD in Canada, assistance is offered to terminally ill adult patients.[1] It is also important to note that in Canada, MAiD also includes a second form of medically induced death—Assisted Suicide. This key distinction identifies that under the umbrella of medical assistance, there are both self-administered and physician-administered forms of the death induction process.
Theological Reflections on Death
Our ecclesial homes shape each of us immensely, as do our cultures, life experiences, and educational backgrounds. These experiences form our views of the sanctity of life as a theological premise and dictate our spiritual practices. In saying that Scripture calls us to uphold the sanctity of life, we must be mindful of how our theological positions will impact the nature of our end-of-life care.
“For those who believe in the Communion of the Saints, is there a way in which membership in community is sustained no matter how death is accepted? Is it possible that, when death becomes inevitable and surrender to God is made in the face of it, then communal bonds can be preserved and not violated in an active as well as a passive dying-into-life?” [2]
If we view the sanctity of life through the premise that life must be preserved at all costs, the theological implication then is that suffering will be inevitable. Out of this view, it is perfectly rational to interpret Scripture and determine that inviting death through any means is sinful. If we try to preserve life at all costs, it is merely incidental that we may cause more suffering to the individual, and many traditions view this suffering in death as a natural consequence of the fall of humanity.
If, however, we view the sanctity of life through the premise that the quality of life must also be preserved, our theology could potentially develop to view suffering itself as sinful to allow. If suffering is due to the fall of humanity, then as believers, to embrace that suffering is to cosign with death and sin rather than the hope of Christ’s redemptive work. From this position, individuals will seek to embrace practices which alleviate the suffering of others—including active assistance in death.
As a Wesleyan pastor in this conversation, I believe that we must strive to find“a more balanced Christian view… recognizing both a duty to preserve life and reasonable limits to this duty.” [3] I believe that all lives are wonderfully precious in God’s sight, but I also believe that each life should have quality. While I do not support or advocate for the use of active forms of euthanasia, as a pastor I will not withhold Christian compassion and presence from those who seek active assistance in death.
We must be careful not to trivialize the suffering of those facing life-altering and terminal illnesses. Whether we support the practice of actively inducing death or not, our compassion and spiritual care must extend to those asking for MAiD or assistance in suicide. Minister faithfully to them as a believer, and do not judge those who choose to die. Pain is a vulgar beast that excels at stealing hope.
If the Holy Spirit convicts you to speak against a choice, remember to speak out of the fruit of the Spirit. A conversation about death saturated in grace, love, and gentleness may be the balm needed for a weary individual facing an exceedingly difficult choice. Upholding the sanctity of all life does not give us license to say that God will condemn those who choose to escape their suffering. The grace of God is greater than the power of death. Our presence may be the hope that others need to carry them through seasons of palliative care—both for the terminally ill individual and for their family members. Regardless of which position you take on medical assistance, your role is not to win a debate, but to help others see the redemptive work of Christ and the glory of God’s coming Kingdom.
Advocating for Quality of Life
The extension of life must not be the only goal for us—we must also strive for the extension of quality of life.“[End-of-life] care ideally takes account of the holistic needs and concerns of patients, not just their physical needs and concerns.” [4] Whether or not you agree with active euthanasia as a means of alleviating suffering, we must be quick to advocate for the needs and quality of care given to terminally ill individuals. If we are not actively advocating for holistic care, we are not truly committed to the sanctity of life.
It is not adequate care to merely counsel terminally ill individuals and their families to choose a life of suffering or to choose medically induced death. If we want to offer God’s grace in end-of-life care, we must be willing to advocate with and for their physical, spiritual, emotional, and relational needs. “Palliative care… increases the quality of life, lowers the rates of depression associated with advanced illness, and prolongs life without the use of aggressive and often burdensome treatment.” [5]
This means we must ensure that their requests for help with pain management, extra blankets, presence, and simple joys do not go unheard. Choices are often made for terminally ill patients in their final weeks, days, and hours without consent or consideration. They often have very little say in the kinds of foods they eat, clothes they wear, medications they are given, and even the bedding on which they rest.
When we discuss end-of-life care, we must have a holistic view of the individual. While we may enter this conversation with our own understandings of dignity and the limits of care, we must be willing to serve those who approach this sensitive time of life with different views, as well as the families they will leave behind.
Doctors, nurses, social workers, and long-term caregivers are uniquely positioned to help uphold the sanctity of a life that is entrenched in suffering. Believers in these roles are uniquely qualified to understand not only the medical and social supports available, but also the spiritual supports available for individuals facing terminal illness. In your presence with individuals considering MAiD or assisted suicide, you alone have the space to administer grace, love, and compassion to those who have no home in faith. While there may be restrictions in the workplace about the kinds of conversations which are appropriate with patients, know that the Holy Spirit will always speak through our willingness to be present with others in suffering. Speak the blessings of Scripture over those in your care—even in the privacy of your own prayers.
Spiritual Care
How we care for individuals in their final days of life is not always a straightforward decision or enactment of will. In many cases, a medical proxy is required due to the nature of disease. Unfortunately, spiritual care can often be overlooked by those planning for their potential future needs, or by those empowered to care for loved ones unexpectedly.
Those who have not often engaged with end-of-life caregiving typically feel that it is not their place to intrude in the lives of those receiving palliative care. When we approach spiritual care in this manner, we dictate the conclusion of someone else’s race of faith. Some individuals will find the prospect of seeking the help of spiritual caregivers to be intimidating. Break down this barrier by reaching out to families and letting them know you are willing to enter difficult spaces with them.
Our fear of engagement in end-of-life spiritual care can have detrimental effects for both patients and their immediate medical caregivers. “For people facing terminal illness… spiritual distress is often experienced along with increases in pain severity, a loss of meaning and purpose, and significant disruption to their personal beliefs and values.”[6] Studies have shown that “pain is very common in people receiving palliative care … [and] spiritual care can improve pain outcomes.”[7]
Likewise, as spiritual caregivers have distanced themselves from the hard conversations surrounding MAiD, medical caregivers have been forced to begin filling the role. Our absence “has called for more emphasis in training and given rise to changes in the medical school and postgraduate curricula, through which medical students and residents learn to address spiritual and religious issues of patients in the context of providing holistic, patient-centered, and compassionate care.”[8] We must not abdicate our spiritual responsibility to care for those who need to experience the love and comfort of our chosen family most. Enter the hard spaces and conversations with grace and love—regardless of the choices individuals make about their process of dying.
Remember that as a believer you are also a spiritual caregiver to others. Every parent raising kids, every child in a classroom, every gas station attendant, and every CEO has a role as a spiritual leader to fill. In each of our spaces as spiritual leaders, we must be attentive to those around us—especially in the discomforts of death and dying.
Churches must be responsible for offering believers the tools, resources, and training that many hospitals are scrambling to find for their doctors, nurses, and long-term caregivers. Recognizing the limitations you may have on how you share your faith in the workplace, there are believers already uniquely placed in medical settings who can offer care for individuals in palliative care situations that clergy would not be welcomed to enter. When believers are empowered to act and serve beyond the vocational roles of clergy, we catch a glimpse of the glory of God and the eternal Kingdom.
As the spiritual caregivers from our faith community gathered around my family members in their seasons of palliative care, it was not unexpected to find that they had expressed their love in a tangible way or visible act. We would enter the care home and find a nurse had been asked to help George sit more comfortably, a new pair of fuzzy socks donned Florena’s chilly toes, or Norma’s favorite forbidden treat had been gifted and quickly devoured. Each moment reminded me of the glory of God in the witness of their love.
When my grandfather, my great-aunt, and my grandmother were in the end stages of their battles with Alzheimer’s, they each had an amazing team of spiritual caregivers. People from their church congregation gathered around them and made space to lift them in prayers. They made space to bless them with presence. Each time I entered the nursing home to visit my family members, I wondered who I might meet at the bedside that day. Each of these family members had given their lives to serve the church as lay leaders, and in the time of life in which they most needed support, it was given in abundance.
End-of-life care extends beyond the life of those who are in the palliative process, and into the hearts of those who sit at their bedside. The dignity of spiritual care given should also be extended to those who stand in the position of caregivers and loved ones. I cannot begin to tell you the significance of the simple offering of a cup of hot chocolate in the midst of my own extended periods of grief.
When it was time for my child to be dedicated, we chose the same pastor who was among the many to give palliative spiritual care to my grandfather. In the absence of her parents, when my mom was ordained, she chose to invite a family friend to sit with our family during the ceremony because this woman had also sat daily with my grandmother in her care home. The formerly atheist nurse who prayed nightly with my family members in their palliative care has shaped the way I view prayer. Her intentional efforts to honor the spiritual care she saw others giving my grandmother led her to accept Christ as her own Lord and Savior. These small acts of grace and love in palliative care can make an extraordinary impact on individuals and their families. Their presence and love forever change us.
Leveraging Privilege to Create Quality of Life
It is also critically important that we remember that disparity exists within end-of-life care. Women and those in the BiPOC community are generally less respected when it comes to matters of end-of-life care.[9] It can be incredibly difficult for women and people of color to be heard in their efforts to self-advocate for necessary care such as pain management.
Given that those who are facing disparity may be led to disproportionate experiences of pain and suffering, it is important to consider how a person’s intersectionality may be affecting their choices regarding medically induced death. When personal care needs are met, individuals may feel like they can choose to embrace a more meaningful quality of life during their terminal illness. The goal is to help remove the mitigating factors that pressurize an individual’s choice about death, rather than to remove their choice forcibly.
If you are a person of privilege, take care to listen to others and advocate for their needs genuinely. It may seem strange to think of it in this way, but whatever privilege you have can be seen as a tremendous gift from God—be it skin tone, position of power, gender, or otherwise. Follow the wisdom of Dominique Du Bois Gillard, and leverage your privilege for all the glory and honor you can bring to the God who created us.[10]
As one point of caution here, be mindful of what the underrepresented and underserved individuals in your community need most. Do not be so arrogant as to think that you know what others need by simply observing others. When we assume to know the needs of others, we not only further their alienation—potentially increasing difficulty with pain and symptom management—but we take on the role of an insincere savior. This kind of care only serves the reflection in our mirror. Ask, listen, and allow your vision to be corrected as needed in your approaches to palliative support.
Embrace our Sacred Call
In a personal email conversation with Rev. Dr. Keith Drury, we discussed the experience of aging believers and those facing terminal illness. His insight has shaped my own vision for end-of-life care: “This is where our vision of pro-life is tested at its upper limit.” Sanctity of life exists in both the extension and in the quality of life. Whether we ultimately support medically induced death or not, we have a sacred calling to our social applications of the sanctity of life.
Dignity at the deathbed means that we are actively listening and engaging with both the individual receiving palliative care and their caregivers. It is a balance of inquiry, invitation, and the creation of meaningful space. There is an ugliness to death that cannot be escaped, but in our intentional movements towards dignity, we can give transformative, grace-filled care to individuals and their families.
It was the end of Martin’s life.[11] Each of us who gathered around him knew this, and so we sat with sorrow mingling deeply with our joy. To the sounds of machines monitoring his slowing heart rate, we lifted the cup of the covenant and broke bread for the last time together. I walked to the car and returned my portable communion set to the trunk where I kept it for moments like this. My heart was breaking, but our souls were nourished in the presence of Christ and one another.
[1] Although legislation was briefly considered for individuals under 18 with terminal illness, it was ultimately rejected. More information on the current (July 2026) parliamentary rules and regulations in Canada can be found at: https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html
[2] Margaret A. Farley, “Issues in Contemporary Christian Ethics: The Choice of Death in a Medieval Context,” in Moral Issues & Christian Responses, 7th ed., ed. Patricia Beattie Jung and L. Shannon Jung (Belmont, CA: Wadsworth Publishing, 2003), 195–205, 202.
[3] Michael R. Panicola et al., eds., Health Care Ethics: Theological Foundations, Contemporary Issues, & Controversial Cases (Winona, MN: Anselm Academic, 2011), 281.
[4] Panicola, et al. Health Care Ethics, 327.
[5] Panicola, et al. Health Care Ethics, 341.
[6] Philip D. Austin and Melanie R. Lovell, “Spirituality and Pain Management in Palliative Care,” in Spiritual Care and Why It Matters, ed. Megan C. Best (Sydney: Springer, 2024), 197–211, 198.
[7] Austin and Lovell, “Spirituality and Pain Management,” 207.
[8] Aza Abdulla et al., “Toward Comprehensive Medicine: Listening to Spiritual and Religious Needs of Patients,” Gerontology & Geriatric Medicine 5 (2019): 1–6, 4.
[9] James F. Keenan, “The Case for Physician-Assisted Suicide,” in Moral Issues & Christian Responses, 7th ed., ed. Patricia Beattie Jung and L. Shannon Jung (Belmont, CA: Wadsworth Publishing, 2003), 186–193, 188.
[10] Dominique DuBois Gilliard, Subversive Witness: Scripture’s Call to Leverage Privilege (Grand Rapids, MI: Zondervan, 2021).
[11] Name changed to respect the privacy of individuals involved.
Olivia Phillips is an Ordained Pastor in The Wesleyan Church of Canada, and a doctoral student studying Polarization Practices in the Church at McMaster Divinity. She has pastored in both the US and Canada, serving in both local churches and executive leadership roles within the Wesleyan denomination. Her book, Becoming Community: Meeting in the Intersection of Truth and Love, was published through Wipf & Stock in 2021. She is an advocate for those who are ostracized and deeply loves ministering to families and individuals journeying through end-of-life care. She is an adjunct professor with Kingswood University for their online Undergraduate and Graduate Programs.