Archbishop Christian Lépine of Montreal has been an outspoken critic, together with the other Quebec bishops, of the province’s “Medical Aid in Dying” Act passed in June 2014. The Act allows for terminally ill patients to choose medically assisted suicide if they can demonstrate that their condition is incurable and they are enduring unbearable suffering. In February 2015, physician-assisted suicide became legal throughout Canada as a result of a nationwide Supreme Court ruling. The provincial law came into force after the high court ruling.

Days after the state of Colorado and the District of Columbia took steps to legalize the practice within their respective jurisdictions, I sat down with Lépine in his Montreal offices to discuss what advice he has to offer to other states and countries facing such legislation. I asked him also about the Church’s pastoral response to suffering and dying — and what happens if a Catholic seeking an assisted suicide is seeking the sacraments.

Since the enactment of physician-assisted suicide legislation in the province of Quebec, what have been the effects that you’ve witnessed and what has been the response of the Church here?

The full effect, I think, is still to be seen. We can look at Belgium or the Netherlands to see what effects this practice has had on a society. There’s certainly an effect on the freedom of conscience for the doctor and also an effect on public perception, in the sense of what’s going on in people’s minds. For instance, in Belgium and the Netherlands, there’s often confusion between euthanasia and ceasing disproportionate treatment. People will say they don’t want any more treatment, and somehow it’s associated with euthanasia and the attempt to help someone die.

But ceasing treatment is recognized both ethically and legally. When treatment is disproportionate, you can refuse treatment. Still, the confusion persists and it was there during our debates. Many efforts were made to clarify the vocabulary, but the vocabulary used by different groups is not always the same.

As Christians, we have our own vocabulary, and it’s not always easy to make it understood by others. Even Christians don’t always see the distinction. Clarity in our vocabulary is always important and something we must work on, because ceasing disproportionate treatment is often seen as what this law is all about — but it’s not; it’s about causing death.

What types of conscience protections are in place for Catholic hospitals and Catholic doctors who do not want to participate in the practice?

This is a work in progress because every province in Canada oversees the delivery of health care; so, in every province, it’s a debate. Some provinces have Catholic hospitals and others don’t. Major hospitals in Quebec are dependent upon state funding, which comes with policies attached, so the freedom-of-conscience issue in these cases is primarily a question of promoting the freedom of the doctors or medical staff who do not want to participate in assisted suicide.

There are also about 30 institutions dedicated to palliative care in the province. The majority of them—except for two at the moment— want to offer palliative care only. They don’t want to practice euthanasia or to participate in physician-assisted suicide. This is what we have to protect.

This is an ongoing challenge, and there is pressure and criticism if someone doesn’t want to participate.

From a pastoral perspective, I know there has been some debate among church leaders as to whether priests should give the last rites or preside at funerals for Catholics who are seeking assisted suicide. What’s your approach?

There are two aspects: the aspect of what’s going on before someone seeks assisted suicide and how we can help them, and secondly, how we respond once/if it happens.

Regarding the sacrament of the sick, it’s not a matter of deciding in advance whether to offer the sacrament or not but a question of meeting the person, recognizing their inherent dignity and journeying with them.

I respond to such requests hoping that the person will commend their life completely to God. In one sense, asking for the sacrament is already an act of commending oneself to God or it’s an important first step in the process of doing so.

First, always meet and spend time with the person, and be ready to respond to any openness they show with regard to prayer, the love of Jesus Christ, the desire for forgiveness, the willingness to commend their life to God, and the acceptance to commend the moment of their death to God.

One cannot ask for the sacrament of the sick and, at the same time, ask to determine the moment of death; it’s contradictory. But going to meet the person who requests the sacrament is an opportunity to offer them an experience of God’s love and truth and to help them to place their life in God’s hands.

Regarding funerals for those who have obtained assistance to end their life, we must keep the following in mind. We really never know everything that has happened: what went on in the person’s mind, what went on in the family, whether they were divided. So, our first response should be to meet with the family and the people involved.

We also need to consider this: What’s the purpose of a funeral? How do we accompany the family?

The purpose of a funeral is to pray for the person who has died. It’s not a canonization process; it’s not recognition of the sinfulness or holiness of the person. We’re there to pray for the person who has died. A funeral is neither the time nor the place to conduct politics; it’s the time and place to pray for the departed person. We can pray for a criminal; we pray for the salvation of his soul. It doesn’t mean we agree with his or her actions, but we still pray.

When we adopt this approach then the funeral becomes a time of comfort and even of conversion. I’ve seen many conversions after funerals. We have to focus on encountering people where they are. We are all sinners and so we must pray for the dead and entrust them to God’s mercy. We must stay focused on its purpose, and it should be prayer. But this approach, however, does not imply the condoning of physician-assisted suicide or euthanasia.

Given the availability of physician-assisted suicide, what practical steps can we take as a Church to make sure those who are suffering don’t feel as if they’re suffering alone?

We know that these are difficult and delicate situations. Suppose someone says: “I can’t bear things anymore, I just want to die.” It’s reasonable to think that when someone says this, they really mean: “I need help.” So, we need to learn to listen attentively to people and to respond to this call for help. Help means presence and being there so that those suffering are not lonely or abandoned.

Palliative care, for example, is about being there both for the person who is suffering and for their families. Spiritually, there are numerous dimensions that are a part of this process. The experience of spiritual presence might come from a family member, a friend who is there to help, or a priest who visits. The end of life is the means through which we prepare ourselves to meet God. We’re always called to entrust our lives to God, but certainly sickness and death are times to commend ourselves more fully to God.

The question for us becomes: how can I help to facilitate this for that person? The first thing is to have a meaningful encounter with the person and to listen. When I visit the sick, I always have in my jacket a small cross, a rosary and the sacrament for the sick. This doesn’t mean that during the visit I’ll propose all three. Maybe I’ll do nothing and just listen. Maybe there will be an opportunity to talk about Jesus Christ who offered his life and to ask the person if they want my crucifix. Or maybe we’ll talk about prayer, and I’ll offer a rosary.

I’ve never witnessed an encounter without some transformation occurring, but sometimes it takes a couple of visits. I’ve always seen a transformation — sometimes it’s the person dying and sometimes it’s me. Sometimes you go to comfort them, and they’re the ones comforting you.

How would you advise your neighbors to the south in the United States who are witnessing the creep of assisted suicide throughout the country?

On one hand, never stop promoting the sanctity of life. But this is also about the sick, so never stop promoting palliative care. You can’t promote the sanctity of life without promoting palliative care and creating space for a person to find meaning in suffering.

We’ve certainly seen in the Western world a tendency, like here in Quebec, toward accepting euthanasia and physician-assisted suicide, which I find very troublesome. It was difficult to convey these concepts [the Catholic view of sanctity of life and palliative care] to the public and in the media when the language used was “aid in dying,” which caused much confusion in differentiating between assisted suicide and palliative care. I placed a paid advertisement in the major newspapers circulating within the diocese containing a short message entitled A call to conscience. It was a reminder that “aid in dying” is not aid in dying — it’s actually crossing the line.

When we cross the line and decide for ourselves that there are reasons for which you can kill someone, it’s very dangerous for society and democracy. Once you accept in your mind that there are reasons to kill an innocent person, even if it’s only for a few exceptions, you begin to accept this principle. You can’t just say: “We have strict guidelines and we’ll control the application of the law.” The guidelines don’t work because you’ve already crossed the line.

It plants a seed of death within democracy, because as a society, we’ve provided a reason for killing someone willfully and directly. Even when you want to believe that you have good reasons, such as to relieve suffering or pain, you’ve crossed the line. And then your reasons to do so expand to include more and more exceptions.

This is not just about God; it’s about all of us and the frailty of life and how we view it. Christians have a very beautiful view of the value of life. Every person is created by God and in the image of God, and is created to be in alliance with God and to be a child of God.

From the Christian point of view, there’s no greater value than the human person, and we have to convey that message. We’re losing track of this understanding of the inherent dignity of the person and of human life, and Christians must proclaim this message and help those who suffer. We can’t just do one of the two, we must do it on both fronts.