In 2016, Canada legalized euthanasia for adults suffering severely and incurably near the end of life. Four years later, it legalized euthanasia for adults even if death is not “reasonably foreseeable.” Next year, euthanasia is set to become legal also for adults whose sole medical condition and source of suffering is mental illness. Recommendations have been made to legalize euthanasia for minors whose death is “reasonably foreseeable.” The organization that regulates physicians in the province of Quebec has suggested that euthanasia should be available for infants with severe disabilities or illnesses that render them unlikely to survive.
Between 2016 and 2022, close to 45,000 Canadians died through what is officially termed “medical assistance in dying,” or MAID. As of 2022, euthanasia was virtually tied with cerebrovascular disease as the fifth-leading cause of death in Canada (with only accidents, COVID-19, cancer, and heart disease causing more deaths). In each of the preceding years starting in 2016, the number of deaths by euthanasia grew significantly. Between 2019 and 2022, the average increase was just over thirty-one percent per year.
These statistics reveal disturbing truths about what happens when a society legalizes euthanasia. Canadians have been told by advocates, legislatures, and courts that euthanasia is a basic good. But in truth, euthanasia teaches that human dignity is degradable rather than enduring. It creates hierarchies of personhood by calling into question the worth and value of certain individuals based on their strengths and abilities—things that, by nature, are mutable. This is always and everywhere a fundamental injustice. In Canada, this injustice is surfacing in deeply damaging ways.
These warnings are not new. When, in 2021, Canada was about to expand euthanasia to scenarios in which death is not near, three UN officials—including the special rapporteur on the rights of persons with disabilities—wrote to the Canadian government to express concerns about how this step would affect individuals in Canada living with disabilities. The authors noted that if euthanasia is “made available for all persons with a health condition or impairment, regardless of whether they are close to death, a social assumption might follow (or be subtly reinforced) that it is better to be dead than to live with a disability.”
This point is accurate, but it has a broader reach. When euthanasia is legalized, the social assumption that it is better to be dead than to continue living takes hold in all the scenarios in which euthanasia is legal. And one must ask: what factors would lead us to think that it is better to be dead than to continue living in these scenarios? Advocates for euthanasia will point to quality of life, autonomy, dignity, pain, and suffering. But the deeper message embedded in these advocates’ words is that some of us are no longer persons. If we find ourselves eligible for euthanasia, we are not really living anymore. And if that is true, euthanasia seems like a sensible choice.
When it comes to euthanasia, quality of life and autonomy have been inextricably linked to dignity, which has affected how we understand personhood. As my quality of life and autonomy decline, so too does my dignity. As my dignity declines, so too does my personhood. Once my personhood has sufficiently faded away, it is cruel for the state to stand in the way of letting me die. In fact, it is cruel for the state to refuse to help me die. Enter euthanasia, provided through the healthcare system.
We are witnessing, in other words, a reconstruction of personhood—a reconstruction that began before euthanasia was legalized in Canada or other countries. This reconstruction professes that, while some of us may technically be here, we are not here in any meaningful sense. Legalizing euthanasia is not only a natural plank of this reconstruction. This step also accelerates this process and takes it to new places, all the while claiming to render societies and each of us more respectful of human rights and thus more humane.
As it turns out, the vision of personhood conveyed and reinforced by euthanasia has led to violations of the same rights that were allegedly violated by a ban on euthanasia—rights that speak to personhood. In a 2015 case, the Supreme Court of Canada relied on the constitutional right to “life, liberty, and security of the person” to strike down Canada’s ban on euthanasia. This ruling led to the legislation of 2016 that legalized the first version of euthanasia across Canada.
Since 2016, it has become clear—if it wasn’t clear before—that legalizing euthanasia endangers life, liberty, and security of persons. If it is easier to be euthanized than it is to find adequate or affordable housing, personhood properly understood is far from being respected. The same is true when euthanasia is offered to veterans contacting the government for assistance, when euthanasia is viewed as the only viable option by a quadriplegic mother who cannot find adequate support to live with her disability, or when public health authorities provide information sessions on euthanasia to pensioners as they contemplate their retirement years. When a federal minister admits that in some parts of Canada it is easier to access euthanasia than it is to obtain a wheelchair, alarm bells should be ringing.
And if even one person in Canada has chosen euthanasia because that person considers him- or herself to be a burden on others, or because he feels isolated and lonely, Canada is failing to protect the life, liberty, and security of persons. Faced with these realities, one of the rationales for a total ban on euthanasia—namely, the practical impossibility of avoiding abuse and misuse—comes into clear focus.
A case in point is that of Kathrin Mentler, a woman in her thirties who in June of this year admitted herself to a Vancouver hospital due to depression and suicidal thoughts—conditions she has lived with for some time but that had become more acute owing to a recent traumatic event. Once at the hospital, Mentler was taken to a room where a clinician told her that the healthcare system is “broken” and that the wait time to see a psychiatrist would be significant. The clinician then asked her if she had ever considered euthanasia, noting that it would be more “comfortable” than committing suicide through overdosing on medication, a concern that Mentler specifically had in mind when she went to the hospital that day. In her words, “I very specifically went there that day because I didn’t want to get into a situation where I would think about taking an overdose of medication.”
For decades, societies like Canada have rightly spent time, money, and resources on suicide prevention. Mentler’s case reveals a disturbing shift on this front: she wished to live, yet death was suggested to her. While the exchange between Mentler and the clinician was brief, and the hospital says that the question about euthanasia was simply a way to evaluate Mentler’s level of suicidality, the notion that Mentler’s personhood was fading away seems to have been at work. If a society is offering euthanasia as a solution to persons who are suicidal, we have arrived at a destination where personhood has been reconstructed beyond recognition.
Mentler’s case is also revealing because euthanasia was brought to her attention at a time when she appeared to be ineligible for it. Euthanasia for persons suffering solely from mental illness will not be available in Canada until next year. Perhaps the step of legalizing euthanasia for individuals in other circumstances—in circumstances that are currently covered by the law—has activated a radar within some Canadians for other cases in which euthanasia should be legal. The legislation of 2016 taught us the basics of when euthanasia should be granted, and now we are applying these lessons to novel situations.
That radar now seems to be picking up members of society who find themselves in particularly dire straits, such as persons who are homeless and struggling with unemployment, mental and physical illness, and addiction to drugs or alcohol. Areas of Canadian cities where these challenges are especially visible, such as the Downtown Eastside of Vancouver, are now being spoken of in the same breath as euthanasia. One recent article suggests that individuals with substance use disorder may qualify for euthanasia once mental illness is added to the eligibility criteria. The article, in making this forecast, also gestures to how euthanasia is eroding the concept of personhood. As an advocate for the Downtown Eastside quoted in the article puts it, to render individuals afflicted by substance abuse eligible for euthanasia is to say that these individuals “aren’t really human.”
In Canada, we are witnessing the powerful ramifications of legalizing euthanasia, euphemistically calling it “medical assistance in dying,” delivering it through a publicly funded healthcare system, wrapping it up in distorted understandings of dignity and rights, and demonizing individuals and institutions that believe (and wish to act on the belief) that euthanasia is killing and a mark of an uncivilized and inhumane society. This is a cautionary tale that must be told.
Some euthanasia advocates will say that these statements are hyperbolic fearmongering. They said the same when critics of euthanasia warned that opening the door in 2016 would lead to euthanasia in other cases and contexts: where death is not foreseeable, when minors are involved, in cases of mental illness, and beyond. And look where we are, less than a decade later. Forget the slippery slope. This has become a sinkhole.
Much work must be done to restore the proper understanding of personhood—what it means to be human—in societies that permit euthanasia. This work will take not just years, but decades and possibly even longer than that.
But that work must begin somewhere. I believe it begins with telling the truth. Euthanasia does not erase a shell of a person. It erases a person, each and every time.
Image by “freshidea” and licensed via Adobe Stock. Image resized.
