John Milloy gives us an insight into the realities of legalising assisted dying from Canada. What lessons can the UK learn? 18/11/2024

How did assisted dying become so commonplace in Canada? Like the old quote about bankruptcy, it seemed to happen slowly and then all at once. 

In 2016, in response to a Supreme Court decision, the Canadian Parliament passed a law allowing those whose death was “reasonably foreseeable” to seek assisted dying. The law was later broadened in response to another court decision to include those whose death was not imminent but who had a “grievous and irremediable” condition.  

That was not the end. The province of Quebec recently allowed advance requests where someone diagnosed with an illness like dementia can agree to be euthanized in the future once they have declined and can no longer give consent. And although the government has promised to extend Medical Assistance in Dying (MAiD) as it is known in Canada, to those with mental illness, they have delayed its implementation until 2027. 

Despite being initially presented as a procedure of last resort, the rate of increase in Canadians accessing MAiD is the fastest in the world.  

Does the Canadian experience hold any lessons for the UK? I am a retired Canadian politician teaching public ethics at an Ontario university and I would never be bold enough to advise UK citizens about how they should decide this issue. The Canadian experience might, however, help inform your debate. 

This is about more than individual freedom  

Unlike other emotional debates, such as the one over same–sex marriage, assisted dying never prompted the type of heated discussion in Canada that might have been expected. Many saw it as simply an issue of personal choice. Few seemed to question what type of society we were creating. Was it appropriate to create a system where doctors or nurse practitioners routinely help those desperate to die kill themselves? We also rarely discussed whether assisted dying was the right response to suffering, decline in quality of life, or a perceived loss of dignity. 

This was a significant oversight. Studies show that Canadians accessing MAiD seek the procedure for reasons that often go beyond immediate pain, including: the inability to participate fully in daily living or pursue meaningful activity; loss of control of bodily functions; fear of being a burden; or even because of loneliness.  

Instead of simply offering assisted dying, did we need to rethink concepts like “meaning” and “dignity”? One of the few groups to raise those questions in Canada were persons with disabilities who continue to challenge assisted dying as a response to physical limitations or fear of being a burden.  

Might assisted dying become a response to underfunding in our healthcare and social assistance systems? During the initial debate in Canada, such questions were dismissed as alarmist. But since then, we have seen studies and media stories about individuals accessing the procedure because of poverty or the inability to find medical treatment. Perhaps most concerning, about one third of Canadians surveyed support poverty as a reason to seek assisted dying. 

Once the procedure is in place, further discussion is difficult 

As someone working in the field of public ethics, I found the original debate over assisted dying different from discussing other controversial issues. While the procedure remained hypothetical, concerns could be freely raised without causing offense. Then the law was passed and the circle of those with a loved one who had accessed MAiD began to grow. An air of defensiveness began to take hold, and assisted dying joined the ranks of those issues that progressive people don’t question. 

That point became apparent to me when I witnessed a Member of Parliament correct someone for using the term “assisted suicide”: “We need to call it Medical Assistance in Dying”, she said, “so as not to stigmatize those who access it.” Allowing a narrow law to be passed and taking a “wait and see” approach won’t be doing yourself any favours. 

Limiting it to only those who are dying will not end the debate  

Canada’s original decision to limit MAiD to those whose death was “reasonably foreseeable” didn’t end the debate. Why only those at the end of their life? What about those who live daily with intolerable suffering with no relief in sight? What about individuals with severe mental health issues? Shouldn’t those diagnosed with dementia be allowed advance consent to access the procedure in the future?  

It was difficult to respond as we hadn’t worked through why MAiD was only limited to the dying. As Nick Spencer pointed out in a recent Theos blog post, “unless there is an underpinning philosophical logic” behind who can and can’t access assisted dying, it is difficult to argue against its expansion.  

When a lower court ruled that the law must be broadened, the Canadian government didn’t appeal the decision even though many experts felt there were legal grounds. Because we hadn’t firmly established why only the dying were eligible, there was a sense that the law’s expansion was inevitable.  

Where will it end? The Canadian government is considering offering advance requests nationwide. Will the procedure be extended to those with mental illness in 2027? Many Canadians oppose the idea including the opposition Conservatives who are ahead in the polls, but the absence of clear reasoning as to why any category of suffering should be excluded has made debate difficult. 

Conclusion 

There is considerable support for MAiD in Canada. It has, however, changed us as a nation and not necessarily for the better. I often ask myself whether it has weakened our collective sense of responsibility to support and encourage those who feel their lives have lost meaning. The speed with which we made assisted dying part of our culture has me feel more than a modicum of remorse. I hope that the people of the UK consider all the implications before moving forward.  

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