That people should be able to request medical assistance in dying peacefully if they face a long and painful death due to illness or chronic pain is something that many people can sympathize with it. But implementing such a program in practice can create problems for the family and the medical professionals involved. Canada legalized the practice following a supreme court decision in 2015 and has seen a rapid rise in what are called MAID (Medical Assistance in Dying) deaths. The August 11, 2025 issue of The Atlantic magazine has an article by Elaina Plott Calabro titled Canada is Killing Itself that takes a very deep dive into this ethically challenging area.
When Canada’s Parliament in 2016 legalized the practice of euthanasia—Medical Assistance in Dying, or MAID, as it’s formally called—it launched an open-ended medical experiment. One day, administering a lethal injection to a patient was against the law; the next, it was as legitimate as a tonsillectomy, but often with less of a wait. MAID now accounts for about one in 20 deaths in Canada—more than Alzheimer’s and diabetes combined—surpassing countries where assisted dying has been legal for far longer.
…The new law approved medical assistance in dying for adults who had a “grievous and irremediable medical condition” causing them “intolerable suffering,” and who faced a “reasonably foreseeable” natural death. To qualify, patients needed two clinicians to sign off on their application, and the law required a 10-day “reflection period” before the procedure could take place.
Once the door has been opened to allow the practice, it develops a dynamic of its own that results in restrictions as to who can get one getting looser over time. What is driving it is the right of patient autonomy.
It is too soon to call euthanasia a lifestyle option in Canada, but from the outset it has proved a case study in momentum. MAID began as a practice limited to gravely ill patients who were already at the end of life. The law was then expanded to include people who were suffering from serious medical conditions but not facing imminent death. In two years, MAID will be made available to those suffering only from mental illness. Parliament has also recommended granting access to minors.
At the center of the world’s fastest-growing euthanasia regime is the concept of patient autonomy. Honoring a patient’s wishes is of course a core value in medicine. But here it has become paramount, allowing Canada’s MAID advocates to push for expansion in terms that brook no argument, refracted through the language of equality, access, and compassion. As Canada contends with ever-evolving claims on the right to die, the demand for euthanasia has begun to outstrip the capacity of clinicians to provide it.
There have been unintended consequences: Some Canadians who cannot afford to manage their illness have sought doctors to end their life. In certain situations, clinicians have faced impossible ethical dilemmas. At the same time, medical professionals who decided early on to reorient their career toward assisted death no longer feel compelled to tiptoe around the full, energetic extent of their devotion to MAID. Some clinicians in Canada have euthanized hundreds of patients.
The article discusses cases where people use the right of autonomy to choose to die in cases where other people might think it premature. This was enabled by the opening up of what is called Track 2 options to the earlier more stringent Track 1.
In retrospect, the expansion of MAID would seem to have been inevitable; Justin Trudeau, then Canada’s prime minister, said as much back in 2016, when he called his country’s newly passed MAID law “a big first step” in what would be an “evolution.” Five years later, in March 2021, the government enacted a new two-track system of eligibility, relaxing existing safeguards and extending MAID to a broader swath of Canadians. Patients approved for an assisted death under Track 1, as it was now called—meaning the original end-of-life context—were no longer required to wait 10 days before receiving MAID; they could die on the day of approval. Track 2, meanwhile, legalized MAID for adults whose deaths were not reasonably foreseeable—people suffering from chronic pain, for example, or from certain neurological disorders.
How far should patient autonomy prevail? As in all such cases, there are extremes that test the limits of the system, like the case of a 30-year old man who was diagnosed with cancer and wanted to die even though his prognosis was good, with a 60% chance of a cure. He did not want to experience any pain at all, even the side effects of any treatment. He claimed that even a colonoscopy had traumatized him, and colonoscopies are actually painless.
The Track 2 causes problems for the medical people who carry out the procedure because they are sometimes confronted with patients who say they want to die under conditions where others might choose otherwise.
There is no clear official data on how many clinicians are willing to take on Track 2 cases. The government’s most recent information indicates that, in 2023, out of 2,200 MAID practitioners overall, a mere 89 were responsible for about 30 percent of all Track 2 provisions. Jonathan Reggler, a family physician on Vancouver Island, is among that small group. He openly acknowledges the challenges involved in assessing Track 2 patients, as well as the basic “discomfort” that comes with ending the life of someone who is not in fact dying. “I can think of cases that I’ve dealt with where you’re really asking yourself, Why? ” he told me. “Why now? Why is it that this cluster of problems is causing you such distress where another person wouldn’t be distressed? ”
And then of course there is the problem that people might be pressurized into choosing that option, not because they really want to, but by being made to feel that they are a burden on their family and society, both financially and emotionally.
For these critics, the “reasonably foreseeable” death requirement had been the solitary consolation in an otherwise lost constitutional battle. The elimination of that protection with the creation of Track 2 reinforced their conviction that MAID would result in Canada’s most marginalized citizens being subtly coerced into premature death.
…Nearly half of all Canadians who have died by MAID viewed themselves as a burden on family and friends. For some disabled citizens, the availability of assisted death has sowed doubt about how the medical establishment itself sees them—about whether their lives are in fact considered worthy of saving.
…Earlier this spring, I met in Vancouver with Marcia Doherty; she was approved for Track 2 MAID shortly after it was legalized, four years ago. The 57-year-old has suffered for most of her life from complex chronic illnesses, including myalgic encephalomyelitis, fibromyalgia, and Epstein-Barr virus. Her daily experience of pain is so total that it is best captured in terms of what doesn’t hurt (the tips of her ears; sometimes the tip of her nose) as opposed to all the places that do. Yet at the core of her suffering is not only the pain itself, Doherty told me; it’s that, as the years go by, she can’t afford the cost of managing it. Only a fraction of the treatments she relies on are covered by her province’s health-care plan, and with monthly disability assistance her only consistent income, she is overwhelmed with medical debt. Doherty understands that someday, the pressure may simply become too much. “I didn’t apply for MAID because I want to be dead,” she told me. “I applied for MAID on ruthless practicality.”
…Marcia Doherty agrees that it should never have come to this: her country resolving to assist her and other disabled citizens more in death than in life. She is furious that she has been “allowed to deteriorate,” despite advocating for herself before every agency and official capable of effecting change. But she is adamantly opposed to any repeal of Track 2. She expressed a sentiment I heard from others in my reporting: that the “relief” of knowing an assisted death is available to her, should the despair become unbearable, has empowered her in the fight to live.
Finding the limits to patient autonomy is not easy.
When autonomy is entrenched as the guiding principle, exclusions and safeguards eventually begin to seem arbitrary and even cruel. This is the tension inherent in the euthanasia debate, the reason why the practice, once set in motion, becomes exceedingly difficult to restrain. As Canada’s former Liberal Senate leader James Cowan once put it: “How can we turn away and ignore the pleas of suffering Canadians?”
In the end, the most meaningful guardrails on MAID may well turn out to be the providers themselves. Legislative will has generally been fixed in the direction of more; public opinion flickers in response to specific issues, but so far remains largely settled. If MAID reaches a limit in Canada, it will happen only when practitioners decide what they can tolerate—morally or, in a system with a shrinking supply of providers, logistically.
This can take a toll on medical practitioners who are torn between wanting to meet the needs of their patients and yet feeling that they cannot in good conscience assist in the death of someone whom they feel could live quite well.
The MAID program is due to expand even further in 2017 to allow for cases of mental illness, creating even more dilemmas.
Is there a requirement that one be Canadian or a permanent resident? Can one just travel to Canada from the US and get the procedure?
Yes, MAID does create some ethically difficult situations, but everyone I know who’s experienced it has been very grateful that this option exists.
You don’t have to be Swiss to get it in Switzerland. Death Tourism is pretty common there.
There’s no avoiding that some will take advantage of this law to bully and browbeat inconvenient dependents into ending their lives, and even that happening once is untenable. Conversely, I also think it untenable to be condemned to have to live if you’re suffering, and I find the thought of that even more distressing.
How do I reconcile those conflicting thoughts? It’s inevitable that some people will slip through the cracks, but I would want to choose my own fate and never be forced to live and suffer. To me, suffering can easily be worse than death.
Admittedly though, I don’t value my own life much, but I decided long ago to be stubborn and wait it out. But if a plane I’m in suddenly goes into a death spiral, oh well, it could be worse.
One of the qualifications for assisted dying in Canada is to be eligible for government funded health care. Some non-Canadians are eligible for government health care:
Permanent Residents (PRs): Typically eligible for healthcare coverage in their province or territory of residence, but some provinces may impose a waiting period (e.g., up to three months) before coverage begins.
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Temporary Workers: If you hold a valid work permit, you may qualify for a health card in the province where you reside. Some provinces may require your work permit to be valid for a minimum duration (e.g., six months or more).
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International Students: International students studying in Canada may also qualify for health coverage in certain provinces, such as Saskatchewan, if they are enrolled in a recognized educational institution.
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Refugees and Asylum Seekers: Refugees and asylum seekers may qualify for interim healthcare coverage through the federal government or provincial programs, depending on their status and location.
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Visitors and Tourists: Visitors and tourists are not eligible for a Canadian health card. They are encouraged to purchase private health insurance before arriving in Canada.
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Each province and territory manages its own healthcare system, and the eligibility criteria and application process may vary. It is essential for foreign nationals to understand their eligibility and the specific requirements of the province or territory they wish to reside in.
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Mano colonoscopies certainly can be painful, the ‘corners’ of my colon seem to be rather difficult to get round and the discomfort does rise to pain on occasion, despite copious gas and air.
I hope we get euthanasia in the UK for people whose death isn’t reasonably foreseeable. I have a condition that causes chronic pain, it will get worse but it won’t kill me. The pain is reasonably well controlled with drugs at the moment, but it is very likely to become impossible to control with the prescription drugs available for home use at some point. I do not want to live with that level of pain every day, it makes doing anything very difficult. I do appreciate that this is not something current doctors signed up for, personally I would be happy to be prescribed something that I could take myself that would definitely kill me, although I’m not sure how much that would ease the difficulty for the doctor doing the prescribing.
A friend of mine went for the MAID program here after several years of dealing with cancer that was known to have metastasized. In fact he deliberately chose the hospital he was staying in for hospice care because it had a MAID program. (Obviously, the Catholic-run hospitals generally don’t.) This was pre-COVID.
He’d been a friend from back in our university days and a member of a local movie/anime group for years, so for a few months we alternated between having the weekly movie night at the usual host’s house and having it at the hospital in one of the little meeting rooms.
One of the requirements for the program is a psych evaluation so the doctors involve can sign off that this was done of the patient’s own free will (and to reduce some of the possible issues with outside pressure). This was what actually what led to the final decision: after spending most of a week delirious as the result of a bad infection, and was worried that if anything like that happened again he wouldn’t come out of the delirium and wouldn’t be able to die on his own terms. So, a couple of days after recovering from the infection, they went through with the process.
So… yeah. The whole thing was not uncontroversial when it was set up, and it still isn’t. There are active protections in the law against the most obvious potential abuses. Whether they’re sufficient is a different question. And, as “file thirteen” says above, this is one of those legal situations where there is almost certainly no way to thread the needle and create a perfect system that can allow anybody who truly needs it to take part but will block people from being pressured into it. A lot of disability advocates are obviously not happy with how available it is, because that makes it more likely that people who are, say, in wheelchairs to be pressured into taking their own lives by family who don’t want to deal with the situation.
That said, I also remember back in 2012 there was a convention up in Ottawa called Eschaton (PZ was one of the main speakers at it), and one of the panels there was someone discussing the amount of effort that had gone into finding a place where his wife could get some form of medically assisted suicide; this was obviously before it was legal in Canada. It certainly got me thinking about the situation and the complexities.
‘Not an easy problem’ is putting it mildly.
I’m with Marcia Doherty quoted in the article. A lot of people wring their hands about this, but don’t want to create situations where disabled people can thrive. If you don’t want us to die then maybe give us the resources to live?
Also as a trans person it’s interesting seeing the people who are opposed to euthanasia (and claim to be opposed to suicide), are also in favour of psychologically torturing us. *looks at the Catholic church*
A lot of people want us dead, but don’t want to feel responsible
Jazzlet @#6,
I am sorry to hear about your pain condition.
And I should not have been so quick to say that colonoscopies are painless, since I only had my own experience and those of people I know to go on.
As the article says, just having the option available can ease some of the anxiety associated with anticipating a difficult future. Every country should have the option but the US is so backward that I cannot see it coming soon.
Dangerousbeans @ 8
“A lot of people want us dead, but don’t want to feel responsible”.
Considering that Stephen Miller plagiarized a 1932 speech by Joseph Göbbels, some republicans are prepared to go the extra step. Which is why you all need to vote in the midterms.
(And/or move to Scandinavia. We are more boring than the Brits, but we have no brownshirts. Yet.)
Maybe doctors can look to veterinarians for lessons on how to cope with euthanasia? I’ve had some sort of pet (that is, dog or cat) in my home for literally decades and have had to make the choice for euthanasia a number of times. Only once have I had a vet say they wouldn’t euthanize, but I’ve had vets agree with me and cry through the procedure with me many times. There’s even a quality of life calcuator to help guide the pet owner in trying to decide whether it’s time. There are times when it is a kindness to end suffering--for people and also for animals.
One of the things that I am (morbidly) curious about is that excluding some terminally ill people who may not be able to take any action themselves but for the cases being discussed , what prevents the person in question from committing (some painless form of) suicide? (if they feel for e.g. that their suffering exceeds their will to live) -- why the insistence on a Government approved method ?
Jazzlet @6I
I had a colonoscopy without sedation (I had to drive myself home afterwards so it wasn’t an option) and going around the corners
was painful, but bearable. The nurse who was shifting my guts around to straighten out the corners good have taught Gordie Howe* a thing or 2 about elbows. At least now when somebody tells me that I have my head up my ass I can tell them that I know what that would look like and that I am not seeing that.
*Original 6 Hockey Player
Deepak Shetty @12
I think there are a few reasons. A peaceful and painless suicide is not a trivial matter. There are a lot of ways it can go wrong and having a medical professional with established procedures can make the process more humane and reliable. In addition, non-doctors mostly can’t get drugs that can easily cause death. A doctor is needed for those prescriptions. In general, I would say that a doctor should be able to make the whole process more professional and humane. I mean, if my cat needs to be put down, I’m sure I could come up with any number of ways to do the job, but I’ll leave the job to a professional if the need arises.
@10 birgerjohansson
That works, given valid and fair elections when the time comes. I guess we’ll see.
Assuming you can somehow scrape enough funds to get there, find a job, a place to live, etc., as the feds continue to extract taxes from you (unless you’re rich enough to fight the legal barricades that make renouncing US citizenship a difficult and time-consuming thing to do). Not to mention convincing your new government that no, just because you’re old and retired doesn’t necessarily mean you just want free health care.
@birgerjohansson
I’m an Australian commenting on Canadian policy, but sure I’ll vote in the USA elections
Also you might want to check how easy it is for disabled people to immigrate to various countries
Thank you Mano.
Militant Agnostic, I get combative when given sedation as well as finding the experience terrifying, so it’s gas and air both for my sake and for the sake of the staff who are looking after me.
Two points here:
1) I don’t see the “about one in 20” statistic as intrinsically problematic. If you’ve read some book by a knowledgeable medic such as Sherwin B. Nuland’s How We Die, you’ll know that even if you avoid the worst horrors that tend to be emphasised in pro-MAID literature, dying is often a pretty unpleasant experience. Choosing your own time to die, and having professional assistance, is very likely to be less so.
2) The fact that more people choose MAID in Canada than in “countries where assisted dying has been legal for far longer” suggests that the increase in Canada is not an inevitable result of making MAID legal. A proper comparative analysis covering all the jurisdictions where it is legal might indicate why Canada is an outlier, but I don’t know of one -- let alone one produced by relevant experts without overbearing ideological commitments in either direction.