My Reservations About Medically Assisted Dying

“Canada Is Killing Itself” is the attention-grabbing headline on an article in the current (September 2025) issue of The Atlantic by Elaina Plott Calabro. The article’s subtitle is almost more striking, “The Country Gave Its Citizens the Right to Die: Doctors are Struggling to Keep Up with Demand.”

Writes Calabro, “MAID (Medical Assistance in Dying),” which was legalized in Canada in 2016, “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.” Between 2016 and 2023 (the last year for which we have data), roughly 60,300 Canadians died by MAID.

And Canada is rapidly expanding who qualifies for MAID. Initially, the law required that a person have “a grievous and irremediable medical condition,” one that caused “intolerable suffering,” and for which death was imminent. In 2021, eligibility for MAID was extended for adults whose deaths were not imminent nor reasonably foreseeable but who might, for example, suffer chronic pain. Further extensions are now under consideration, and appear likely, to those who have a mental illness and to “mature” minors (under 18) who elect MAID.

I understand that there are some, perhaps many, who regard all this as a sign of progress. And I understand that there are cases where some version of physician-assisted dying may be the best of bad options. I also understand that people with a terminal illness and the possibility of pain that cannot be adequately treated may wish, as my sister did, to have physician-assisted dying as an available option even if they do not ultimately use it. (My sister did not.)

All that said, I’ve long had reservations about physician-assisted suicide (PAS) and euthanasia for the dying (and now the not-dying). There is a distinction between the two methods. Euthanasia is performed directly by a doctor, usually by injection, while PAS is administered by the patient, usually orally, with a doctor’s support and supervision.

Why do I have reservations? Three reasons.

The first is pretty much philosophical or theological. There is nothing our culture prizes more than control. We are always to be “in control,” and “on top of the situation.” Given these predispositions, moving death into the orbit of our control seems to make perfect sense.

But I’m not sure that prizing control above all has made us better humans. Sometimes it seems to have pretty much the opposite effect. Moreover, it is often our attempts to control other people that lead to life’s worst disasters. And, on the other hand, some of the best things to happen in life happen by chance and by grace.

Being human has something to do with accepting our limits and finitude, that we aren’t really much in control, or at least as much as we’d like to think. It involves experiencing our shared vulnerability as mortals. While exercising our power and agency in responsible ways is important, really essential, there are also points in this life when surrendering control, surrendering to God, is a path to wisdom and peace.

Some may read that last paragraph and say, “So I’m supposed to suffer intolerable pain or watch another do so, rather than have the power to control that?” No, I didn’t say that, only, at this point, that I suspect that an unexamined veneration of control has something to do with the push for MAID and similar programs. The expectation or pressure to be in control of all life and its variables is not an approach to life I find attractive or humanizing.

St. Paul wrote, “If we live, we live to the Lord; if we die, we die to the Lord — so whether we live or whether we die, we belong to the Lord,” (Romans 14: 8). We are not my own. I am not my own. I belong to God. I don’t believe in what Calabro sites as the moral and philosophical basis of MAID in Canada, that a person’s “personal autonomy is paramount.” “Autonomy,” after all means “self-law,” “auto” meaning self, “nomos” meaning law.

Am I then saying that any form or practice of PAS should be made illegal? No, I am not. I can imagine circumstances in which PAS is the best of bad options. Moreover, I can also imagine that a person might choose some version of MAID as an expression of their faith, surrendering one’s life before and unto God. I have been a pastor for people who have chosen to end a life-sustaining treatment or forgo other measures that kept them alive.

My second reason for having reservations about MAID as it is developing in Canada is I worry that people with less power and fewer resources or options, people who are more vulnerable for one reason or another, will feel pressured to choose MAID. Say, the combat veteran with PTSD, who is told by their doctor (as is apparently now required in Canada) that one “treatment option” is euthanasia. That could easily feel like pressure when a doctor brings it up as an option to consider.

Or the situation of the person whose family members await an inheritance they are counting on, and don’t want to see that money used up in mom’s care or treatment? Yes, that happens. Or the person who is experiencing a mental illness, say a severe depression, and who at the moment finds it impossible to imagine that their depression will ever end, when in fact many depressions do end or are otherwise successfully treated?

What may begin as an effort to reduce, control or eliminate suffering, may become a social policy that eliminates the people who are suffering.

NYT columnist David French recently wrote, “A decent society should do all it reasonably can to reduce human suffering. It should not, however, do so by extinguishing the lives of those who suffer or the lives of those who we believe might suffer in the future.” (With the latter phrase, who may “suffer in the future,” he has in mind the growing use of pre-natal screening.) French adds, “If cherishing the suffering can make a nation kind, then discarding the suffering makes it cruel. It can breed a sense of contempt — why should we care for this hopeless cause?”

MAID may be the right choice in a limited number of terrible individual circumstances, but as a social policy, especially one without adequate oversight and supervision, as Calabro indicates now seems to be the case in Canada, it is dangerous. I worry that it can become a way of discarding those who are suffering or pressuring them to choose their own death.

My third reason for my hesitation about MAID, and its extension, is that death doesn’t have to be, and most often is not, an experience of horrible and protracted suffering. Especially when good palliative care is available, death can be humane and an experience of great meaning for the dying and their loved ones. I strongly recommend the book by the British palliative care physician, L.S. Dugdale, The Lost Art of Dying.

Part of what drives MAID and similar programs is that many people today often have little or no experience of actual death. Death has been medicalized and moved into hospitals. The dying are isolated. Dugdale tells the story of many actual deaths and in doing so reduces our fears. American medicine needs to prioritize good palliative care.

Many complain that what modern medicine has achieved is not really living longer, but dying longer. There is truth in that. Yet we’re not always aware of choices we can make to tilt that balance.

In a provocative 2014 article, “Why I Hope to Die When I’m 75,” (also in The Atlantic) the physician Ezekiel Emmanuel suggested that people may, as they get older and their quality of life diminishes, elect not to undergo medical procedures that are likely to lengthen life.

For example, Emmanuel said he would refuse flu shots, PSA tests, and colonoscopies after turning 75. Or as another example, an aging person might elect to not have the standard pneumonia vaccine. One may not agree with Emmanuel’s recommendations, but the point is that we have other choices. It’s not, “Do everything you can to keep me alive and if and when that doesn’t work, I will elect MAID,” or some variation.

French concludes his column by citing a story from Calabro’s article. “I’m haunted by one of the anecdotes in Calabro’s story. A man sought euthanasia after he was badly injured in a motorcycle accident. He couldn’t walk, he was blind, and he lived in a long-term care facility and rarely had visitors. He made a request to die, and the state approved.

“Calabro tells us what happened next: ‘When his family learned that he’d applied and been approved, they started visiting him again. ‘And it changed everything,’ his doctor said.

“He was in contact with his children again. He was in contact with his ex-wife again. He decided, ‘No, I still have pleasure in life, because the family, the kids are coming; even if I can’t see them, I can touch them, and I can talk to them, so I’m changing my mind.”

“The lesson,” writes French, “is clear. Isolation brings death; community brings life. And we build community in part by recognizing that we are not in control and that each of us will one day desperately need someone else to love us, care for us, and cherish us.”

It may be the isolation of modern life, more than anything else, that is driving people to elect MAID.