Canada has seen a significant cultural shift since euthanasia was legalized, marked by unsolicited offers of assisted death, lives being ended prematurely, and what some critics call its “glamorization” as an act of personal autonomy, says an advocate for the prevention of euthanasia.
The shift in public perception of assisted death is largely attributed to the expansion of euthanasia in Canada since its legalization in 2016, as well as growing acceptance of physical or emotional suffering as sufficient grounds to consider a life less bearable or no longer worth living, Amanda Achtman said in a recent interview with Jan Jekielek, host of The Epoch Times
program “American Thought Leaders.”
Achtman cites Canadian government data showing that the “loss of ability to engage in meaningful activities” was the most commonly reported source of suffering among recipients of medical assistance in dying (MAID) in the last two years for which data is available, cited in 86.3 percent of cases in
2022 and over 95 percent in
2023.
“Many people are sensing a loss of meaning as they approach the end of their life,” she said, pointing to cases where individuals suffer from loneliness, feel like a burden to their families, or are told that their suffering qualifies them for an assisted death.
“Though [the data] is in the public health care and medical context, [it] really marks an existential crisis–a crisis of meaning.”
A key part of changing attitudes toward euthanasia is a
shift in language, she said, noting that the term “assisted suicide” has become “aid in dying” or “medical assistance in dying,” and children are referred to as “mature minors” in this context.
“This linguistic shift has been a big part of the desensitizing of the population around what is really going on, where a doctor or nurse is prematurely ending a patient’s life,” Achtman said.
The cultural shift is also driven by the media
’s portrayal of assisted death, she said, where news reports often “sensationalize euthanasia deaths” by, for example, focusing on stories of people choosing to die together or on significant dates. In one recent example, a New Brunswick couple suffering from cancer chose to die next to each other, with a
media report offering a supportive account of their decision.
Achtman said the cultural changes can be seen in simple instances, such as people writing their own obituaries. She recently read one that began with the words, “Hello, everybody.”
“We
’re not meant to have self-authored, first-person obituaries–it defies the genre in multiple senses,” she said. “This cultural shift is so intense, and it
’s changing the fabric of our society.”
Legalizing MAID
MAID ranked as the sixth-leading
cause of death in Canada in 2022, just behind cerebrovascular diseases, with 13,241 cases reported that year. In 2023, MAID rose to become the fourth leading cause, accounting for nearly one in 20 deaths, at 15,343 cases.
Meanwhile, Health Canada discourages labelling MAID as a cause of death, citing the World Health Organization’s definition of cause of death as the “disease or injury that initiated the train of events leading directly to death.”
“MAID, by contrast, is a health service provided as part of end-of-life or complex care, which a person can access in very limited circumstances,” Health Canada said in its fifth annual
report on assisted death, published last year.
Euthanasia became legal in Canada in 2016, and in 2021, the federal government
passed legislation that eliminated the requirement that a person’s death must be “reasonably foreseeable” in order to qualify for medically assisted death.
“The Government of Canada is committed to ensuring our laws reflect Canadians’ evolving needs, support their autonomy and freedom of choice, and protect those who are vulnerable,” Ottawa
said at the time.
It also said it would continue to explore areas such as “the eligibility of mature minors, advance requests, mental illness, palliative care and the protection of Canadians living with disabilities.”
The legalization of euthanasia came about after the Supreme Court of Canada in
2015 ruled that sections in the Criminal Code prohibiting physicians from assisting in the consensual death of another person are unconstitutional.
Eligibility and Equality
Canada had planned to expand eligibility for MAID to include individuals whose sole condition is a mental illness,
saying “mental illness can cause the same level of suffering as that of physical illnesses.”
However, amid concerns by activists and the Opposition, the government in 2024
paused this expansion for three years, until March 17, 2027, saying the system is not yet equipped to handle the change.
In response, advocacy group Dying With Dignity
filed a constitutional challenge in August 2024 against the government
’s temporary exclusion of people whose sole condition is a mental illness, saying the policy amounts to “discrimination on the basis of the type of disability experienced.”
“In total, this is a six-year delay for one category of people with a disease or disability–only this one group is singled out for disadvantage,” the organization said in an Aug. 19
press release. “The continued exclusion reinforces the stigma and historic prejudice against people with mental illness.”
Achtman argues that the government’s expansion of MAID may continue based on subjective reasons.
“Once legalized, euthanasia cannot remain limited,” she said. “Once it is presumed to be a good and compassionate response to suffering, it will be expanded to more and more people on the grounds of equality.”
A United Nations report earlier this year
urged the Canadian government to repeal the expansion of MAID for those who are not terminally ill. It criticized expansion for the disabled and said the focus should be on helping them live. It recommended that Ottawa address “systemic” shortcomings that could lead disabled individuals to seek assisted death.
Facing Suffering
Achtman says the way people choose to die sends a “social message,” particularly to younger generations, about how to face suffering. She argues that choosing to die early to avoid pain misses the chance to model how to confront what she describes as the inherent suffering of life.
Facing suffering and death “would be educative for the rising generation about how to contend with the whole ordeal of the lives we lead,” she said. “We can easily forget that we belong to one another and that our deaths do reverberate and send a social message–so how we die actually matters.”
Achtman said the importance of demonstrating resilience in the face of suffering is reflected in how people often admire those who have endured hardship.
“If I were to ask you to share about someone you admire and consider exemplary, I’m sure the person who comes to mind suffered,” she said. “It is precisely in that resilience, it is precisely in the noble response to the suffering they faced that is the basis for your admiration.”
Achtman is concerned that people’s final decision to endure suffering may be influenced by increased access to MAID as an option at their most vulnerable moments.
She recounted that while working with a member of Parliament on a response to the federal government’s proposed expansion of euthanasia, she asked people who did not support expansion to share their stories.
“People were writing to us, saying that they had struggled with suicidal ideation, that if this law had been in place when they were struggling, they would not be here,” she said.
“And so the weight that we felt working on this issue, knowing that if this law passed many people would be lost, was quite overwhelming.”
Unprompted Offers
Another factor that may affect a person’s decision to endure suffering or choose an earlier death is their awareness of being eligible, she said. Knowing that one qualifies for assisted death can have an emotional impact.“We know that there are certain demographics who are being met with this offer of state-facilitated assisted suicide,” she said. “To be told that you qualify for a premature death is already killing the person; it already deflates and defeats your sense of worth.
“That’s the impact that euthanasia is having on Canadians.”
MAID has come under scrutiny in recent years after reports of Canadian veterans being offered the procedure unprompted.
In one of the latest known
cases, veteran David Baltzer said he was offered MAID by Veterans Affairs Canada (VAC) in 2019 after he learned his income replacement support would be ending.
He said the offer made him consider, “Is my life worth living?” The incident caused him to decide to “go hard and just do whatever I can and get ahead in life at that time.”
A similar case
drew national attention in 2022, when a House of Commons committee heard testimony from Christine Gauthier, a veteran who suffered from a back injury. She said she was offered MAID after contacting VAC to get a wheelchair lift installed at her home. She was the sixth veteran who had reportedly been offered the procedure at the time.
Veterans Affairs said later in 2022 that the person who made the offer is “no longer employed” at the department.
Further
concerns emerged recently about people in difficult socioeconomic conditions accessing MAID without being offered options to improve their condition.
In one case, a man with inflammatory bowel disease, mental health issues, and addiction was offered assisted death during a psychiatric assessment without being offered access to addiction treatment, according to an Ontario MAID death review
report published last year. He ultimately received MAID.
In another
case, a B.C. family is suing federal and provincial authorities after a man with mental illnesses received euthanasia while he was on a day pass from a psychiatric ward in Vancouver in 2022.
Safeguards
The Canadian Association of MAID Assessors and Providers has
said all its members receive specialized training for thorough assessments and that all MAID requests are patient-driven.
“Any individual seeking MAID goes through a rigorous, patient-initiated process that prioritizes autonomy, dignity, and compassionate care,” the organization said in a
press release last year. “Multiple safeguards are in place to ensure this is the case.”
Health Canada also
says it has extra safeguards for MAID requests where natural death is not reasonably foreseeable. Those include having a medical assessment conducted by a practitioner with expertise in the applicant’s condition, and ensuring the person is informed about available resources to alleviate their suffering, such as counselling services.
Achtman says the cases where safeguards failed to protect MAID applicants shouldn’t be dismissed as rare exceptions but as indication of potential gaps in the system that warrant further examination.
“Some people would dismiss this and say, ‘Well, those are outliers, by and large, the system is working well,’” she said. “Well, would you say that to the family?”
“These stories are not reducible to statistics,” she added.
Finding Meaning
Achtman recalls taking part in a Holocaust study trip to Germany and Poland some years ago, an experience she says changed her perspective on life.“I travelled with two survivors, walking hand in hand with them to the sites of their trauma, and it awakened me,” she said. “Those were the moments that helped me to take life seriously.”
She says that an appreciation of natural death may required more open conversations about suffering and dying in order to create a “more human picture” of the experience. She also emphasizes the importance of human connection and support in helping people endure suffering.
“I think that people can bear things when someone comes alongside them and has a posture of saying, ‘what do you have to teach me?’” she said. “But when everyone falls away and that person is abandoned in their loneliness, of course, we have a crisis.”
“Euthanasia is not a declaration of freedom. It’s a declaration of defeat, and no point of pride for a society,” she added.
Matthew Horwood and Jennifer Cowan contributed to this report.
