The UK’s first atheist prime minister, Keir Starmer, is planning to fast-track a bill legalizing assisted suicide, telling the BBC on October 4 that he is “pleased” to be able to do so. Euthanasia activists have been waiting for this moment and are ramping up their campaigns. Labour MP Kim Leadbeater wrote an editorial for the Guardian in which she stated, with admirable honesty: “Life is precious. But so is choice.” She makes it clear—although without moral clarity—that between life and choice, we must always pick choice.
Wes Streeting, Starmer’s Secretary of State for Health, has stated that he opposes legalizing euthanasia because the state of end-of-life care in the UK is horrifying—and because the notion of choice, considering the availability of palliative care, is farcical: “When I think about this question of burden, I do not think that palliative care … in this country is in a condition yet where we are giving people the freedom to choose without being coerced by the lack of support available.” Similar concerns were raised in a 2023 parliamentary report that emphasized the need for “major improvements” in end-of-life care.
Labour’s disabilities secretary, Sir Stephen Timms, also expressed his opposition. In 2022, he stated, “If we were to legalise assisted dying, we would impose an awful moral dilemma on every conscientious frail person nearing the end of their life … If ending their life early were legally permissible, many who do not want to end their life would feel under great, probably irresistible, pressure to do so. There is no way to stop that happening.” At least five senior ministers have already indicated that they plan to vote against assisted suicide. Starmer hasn’t confirmed his vote, but he has expressed support for assisted suicide in the past.
The most insidious aspect of this is that Starmer knows what will happen if assisted suicide and euthanasia are legalized. His own health secretary has made it clear. So has the disabilities secretary. In fact, Canada—a Commonwealth country—has provided a singular case study over the past several years, with many euthanasia horror stories being featured prominently in the UK press. None of those supporting euthanasia have taken the trouble to rebut the assertion that ‘choice’ will play little role in many deaths. Considering the prevalence and prominence of the evidence, it is difficult not to conclude that they believe that is an acceptable price to pay.
Alexander Raikin has been covering Canada’s euthanasia regime for years and has consistently broken stories that other journalists missed (or ignored). His work on euthanasia and assisted suicide has been cited by The Atlantic and the New York Times and has been featured in cover stories for National Review and The New Atlantis. Now a Visiting Fellow in Bioethics and American Democracy Program at the Ethics and Public Policy Center, he is based in Washington, D.C. In an interview with TEC, he described how Canada’s euthanasia regime became an international cautionary tale—and gives a glimpse of what may unfold in the UK.
In your view, why did Canada’s euthanasia regime go off the rails much sooner than other jurisdictions that have legalized euthanasia/assisted suicide?
The premise of your question is interesting. When the Supreme Court of Canada decriminalized euthanasia, it was based on the argument of a right to life—that those who would die from euthanasia would have otherwise died from suicide. It was a lesser evil. Yet every day in 2022, on average, Canadian physicians and nurses ended the lives of more than 36 people. It is now quadruple the official suicide rate.
In an ordinary country, in an ordinary time, this would be considered a national crisis: a royal commission would be called and weekly press conferences by worried government officials would dominate the news cycle, especially if the victims were all people with disabilities and the elderly. Instead, we now have cognitive dissonance of a national variety. News media credulously write about the horror of a Canadian man selling suicide kits online—and then reportalmostmonthly on how a state-sanctioned, state-funded, and state-administered death from euthanasia is “beautiful.” Or how the lethal injection of prisoners in the U.S. is cruel and unusual, unless a prisoner denied for parole in Canada asks for a lethal injection instead.
This dissonance is reflected in what our public healthcare system funds. The median wait time for a CT scan in Canada was 66 days in 2023. A government-funded suicide, meanwhile? Only 11 days in 2022. I don’t know any elective medical procedure in Canada that is as rushed as euthanasia.
Canada is, of course, not the only jurisdiction with horror stories of what happens when we selectively decriminalize murder and assisted suicide by physicians and nurses. Every jurisdiction that has legalized permissive euthanasia or assisted suicide has seen wrongful deaths that shouldn’t have happened. It is as true in the Netherlands and Belgium as it is in Switzerland or Oregon. I could spend the rest of my life counting these cases: consider, for instance, the dozens of reported cases of euthanasia based on autism or an eating disorder that sparked some worldwide interest. The Swiss Medical Association had to issue a statement that suicide “for healthy persons is not medically and ethically justifiable.” Yet, even in a limited assisted suicide program which requires a terminal diagnosis with less than six months of natural life, we have seen the same excesses. In Washington state, according to the physicians responsible for ending their patients’ lives, 10% of all assisted suicides in 2022 were because their patients were concerned with “financial implications of treatment.” Not one media account reported on it.
But Canada surpasses all these jurisdictions, at least in how quickly we’ve seen the same stories. It was in the first hundred cases of euthanasia in Ontario, for instance, that we saw anorexia as a qualifying condition for euthanasia. Not a single newspaper reported on that either. There is no innate reason for why Canada’s euthanasia program has turned to be such a catastrophic failure in terms of human rights, especially for the people that the Supreme Court of Canada described as “vulnerable persons” who must be protected. On paper, Canada should have one of the strictest euthanasia programs in the world: the eligibility criteria and the safeguards are written as exemptions—in the Criminal Code—from homicide and aiding suicide. If a physician or a nurse practitioner breaks any provision, they would not be protected by these exemptions and could therefore face up to 14 years in prison. That hasn’t happened.
I have some speculations about why Canada’s euthanasia program has turned into a global canary in the coal mine for permissive euthanasia. It’s not because physicians or nurses in Canada are any more diabolical than in other jurisdictions—the vast majority have no interest in killing their patients, even as it becomes a surefire route for a promotion and a leadership position. The irony, of course, is that the exact physicians you don’t want to be involved in ending their patients’ lives are those who are most interested to do so.
I think the more likely reason is because of how Canada was forced to decriminalize euthanasia by the courts. Leon Kass warned that a ‘right to die’ invariably becomes a ‘duty to die.’ Once the Supreme Court of Canada enshrined this right much more forcefully than in other jurisdictions, the Criminal Code protections became moot—the relationship between physicians and their patients were ruptured. If it is a legal right to die, then there is no purpose for anyone else to be involved in this decision, even if it is a cop or a judge. No one else is in that room. It means that a physician and a nurse—who self-selected to reject their roles as healers—can break as many rules as they want, or pressure their patients to die from euthanasia.
It’s not a direct pressure, of course. It is more subtle: if you are suffering, why not be treated by this painless, ‘100% effective’ medical treatment? You are dying anyhow, even if it is a year or four decades from now, and other medical treatments are months away. Why not die? You feel in any rate like a burden to society, to your family, and to me, your caregiver. That is not a hypothetical: according to ‘MAID providers’ (their preferred description), over a third of their patients expressed that as at least one of their reasons to die.
Your reporting has uncovered many disturbing aspects of Canada’s MAID system. What are some aspects of the way MAID has been implemented that would (or should) shock people?
Let’s start with something I found today. The Government of Canada created a website to tell physicians and nurse practitioners how to interpret its euthanasia legislation. It states, quite clearly, “Provinces and territories may create further policies and standards with respect to MAID. However, they cannot permit actions that the Criminal Code prohibits.”
Later this month, Quebec is set to unilaterally permit actions that the Criminal Code prohibits—it will allow people to sign an “advanced directive” for a clinician to end their life in the future when they lack the capacity to consent to their death. Let’s be clear what this means: physicians will have to approach a person with dementia, confused and unaware of what is happening, possibly emotional, and then restrain them and end their life. What if these patients changed their mind, maybe regained lucidity for a time, or learned to live a meaningful life with their condition? It wouldn’t matter. It is a murder warrant. One doesn’t have to go as far to read John Locke to know the virtue of why common law has made it so that no one can consent to their own death or harm. The idea that this can ever be made ‘safe’ is wrong.
Yet the truth of the matter is that Canada has already and quietly allowed a version of this. For National Review, I wrote a cover story last year about how Canada removed the requirement for final consent before a death from euthanasia, if a patient enters in a written agreement with one of their two MAID assessors. The form doesn’t need to be signed, and no one else needs to know about it. The exception is that, if a patient shows any verbal or physical signs of “refusal or resistance” to their death, then the euthanasia cannot proceed. MAID providers found and laughed about a loophole instead: they first sedated the patient who “is now delirious, shouting, pulling their arm away as one tries to insert the IV to provide MAID.” There can be no resistance for euthanasia if the patient is first sedated. These physicians then discussed with a bioethicist on the value of having this procedure potentially done away from the family of the deceased, because it would otherwise be distressful.
There are too many stories of abuse in Canada’s MAID program. I wrote about a suicide attempt that failed and then was ‘completed’ through MAID, even though a prominent supporter of MAID believed that it was potentially illegal. I’m writing a story right now on the Criminal Code violations of MAID. But these concerns were known virtually from the beginning of Canada’s euthanasia program. The Office of the Correctional Investigator said, in 2019, “There is no legal or administrative mechanism for ensuring accountability or transparency for MAiD in federal corrections.” Nothing was done. Yet think about what this statement means. It means that the MAID process, in itself, has no legal or administrative mechanisms to keep even the most watched people in our society safe. The federal government has explicitly excluded itself from any oversight role for a policy it created and a criminal law that it is meant to enforce.
In your view, why have so many non-religious voices—suicide prevention advocates and disability rights activists—been ignored by the government and groups like Dying With Dignity?
Well, that the government ignores certain groups is not exactly controversial. But I think these groups are ignored not just because they lack a large lobbying purse or political power.
My theory—and I would prefer if I were wrong—is because these non-religious groups sound too much like religious groups. They both rely on an unprovable and therefore uncontestable notion of equality. Your next question asks me about my views on the lawsuit filed by disability organizations in Canada, which claims that Canada’s euthanasia program for people with disabilities who are not terminally ill is discriminatory and unconstitutional. I was listening to their first press conference last week. Heather Walkus, the National Chairperson of the Council of Canadians with Disabilities, Canada’s oldest disability organization, said at the press conference that “CCD will always fight for life.” Fight for life? In 2024?When was the last time that you heard those words from any Canadian or American NGO, let alone a progressive organization—or a religious group nationally in Canada?
Suicide prevention advocates, mental health professionals, disability rights activists: virtually all of them are opposed to the idea that certain lives are less worthy of living. The corollary is that each life has an inherent dignity by virtue of being alive. Call it anti-ableism or a culture of life, imago Dei or article 10 of the Convention on the Rights of Persons with Disabilities. We either believe that disabilities do not make a person less worthy of dignity and life, no matter how severe or life-altering, or we do not. Either we believe that human life is sacrosanct, or else that it is disposable.
A government that decriminalizes suicide and murder for only some people is fundamentally unjust. If it is true, as argued Lord Rabbi Immanuel Jakobovits, the late chief rabbi of the United Kingdom, “The value of human life is infinite and beyond measure,” then it logically means that “Any part of life—even if only an hour or a second—is of precisely the same worth as seventy years of it, just as any fraction of infinity, being indivisible, remains infinite.” That certainly doesn’t mean that a person who is dying and in pain must suffer: we have developed, even if we don’t fund it adequately, the most advanced form of palliative care, and dual intent for palliative medicine to treat suffering that shortens life is almost universally accepted in medicine and among faith groups. But to cross that line, to treat a patient’s suffering by ending the patient, is the difference between healthcare and deathcare.
I spoke to someone whose sister died from MAID. She had a non-terminal illness, and should therefore not have been eligible for MAID, at least according to the law at the time (in 2021, Canada expanded euthanasia to non-terminal illnesses and disabilities). He told me that, if his sister would have been on the side of a bridge, he wouldn’t have pushed her. But her MAID assessor believed otherwise. His sister couldn’t find a medical treatment option for her in Canada—besides euthanasia.
What is your view of the Charter of Rights and Freedoms challenge filed in Ontario Superior Court by a coalition of disability groups and two affected individuals?
It is the start of litigation. It won’t be the end. If a law values some lives as less worthy of living than other lives—be it on the basis of disability, age, or identity—then that law is unjust. There’s a joke in Futurama of a suicide pod in the future where you must pay a nickel. It’s not a joke in Canada. When I lived in Canada, I needed to pay for my drug prescriptions. But MAID is free, always free. The financial and moral costs are paid for by society.
At this point, we need to put some limits on MAID legislation. Even by disability organizations simply launching a lawsuit, it is enough to say to people with disabilities across Canada that they matter, that their lives are worth living, and that simply having a disability is no good reason for suicide. It was a message that, a decade ago, healthcare practitioners used to say to their patients. Now it is disability organizations that are quite literally collecting names of their dead.
