Canadian Euthanasia as Moral Progress

Individual liberty, the common good, and human dignity

Canadian euthanasia is getting a lot of bad press. This article seeks to defend medical assistance in dying (MAID, sometimes referred to as “MAiD” for no good reason), and refute some of the main criticisms of the program as currently practiced while arguing that there’s little to fear from its imminent expansion. Canada has perhaps the most permissive euthanasia laws in the world, so by defending MAID, I will defend all other systems against attacks they go too far, and in effect argue that no nation in the world goes far enough in making assisted suicide available and convenient for those who want it.

First, I will show that the MAID program is currently small, and likely represents cases of the most extreme suffering given the data that we have. I then go on to refute arguments against MAID that have appeared in the popular press. Sometimes, these arguments are simply false, as when it is claimed that it will eventually lead to large numbers of healthy young adults killing themselves with state sanction. Other times, the arguments may be correct but actually make the case for euthanasia. It is true, for example, that some people might feel “pressured” to commit suicide because they don’t want to be burdens on their families or the government. I don’t think there’s anything wrong with this — in practically every other kind of situation, it is usually considered pro-social to care about the impact your life has on others. This gets to the point that my support for euthanasia does not simply rest on libertarian and utilitarian grounds, but also on the idea that people should behave in ways that consider the common good and that, yes, preserve human dignity. The state’s interest in saving costs, as long as it’s going to pay for healthcare, is also legitimate, although I won’t dwell on that here.

Belgium and the Netherlands have had permissive assisted suicide laws for two decades now, and I show that none of the horrors that opponents of MAID worry about have come to pass in those countries. Moreover, there probably isn’t a good slippery slope argument to be made here, but even if there is, it actually goes in the opposite direction of the one people usually worry about. Often, picking a policy will be a matter of deciding which slippery slope is more of a risk, and, given the culture of the West, we have more to fear from a slippery slope towards taking away individual liberty and allowing too much unnecessary suffering than we do of one where Canada and Northern European countries start culling the herd. Relatedly, I argue against the “culture of life” argument on the grounds that we place too much value on human life and it would be better if we placed less on it, a view that conservatives implicitly hold on topics like covid restrictions. For that reason, defending euthanasia isn’t simply a matter of preserving individual liberty and preventing suffering, but potentially also about creating better norms. Finally, I close with some arguments about the concept of human dignity.

MAID: The Basic Facts

Given the amount of misinformation that is out there on the topic, it’s important to start with some numbers. According to the Canadian government, there were 10,064 MAID cases in 2021, which represented 3.3% of all deaths in the country. The program has expanded over the years, yet one should put it in the context of how much suffering there is in the world. That same year, 229,200 Canadians were diagnosed with cancer, and 84,600 died of the disease. The country loses about 9,000 people a year to Parkinson’s. Around 8 million live with chronic pain. Clearly, assisted suicide has not become a common way out for people experiencing even extreme physical discomfort, much less psychological problems alone.

In 2021, the average age of a MAID recipient was 76.3 years. Almost two-thirds had cancer, 19% had cardiovascular conditions, 12% had chronic respiratory conditions, 12% had neurological conditions, and 8% had organ failure. Canada recently expanded its assisted suicide program to cover those without a terminal condition, a fact that has gotten a lot of attention, but in 2021 only 2% of deaths fell under this new category.

Source

About 81% of MAID recipients had received palliative care, and 88% were eligible for it. The Canadian program therefore overwhelmingly reaches people who are genuinely suffering by any standard. The increase in MAID deaths in 2021 over previous years is often understood by critics as a sign something has gone wrong, but it can just as easily be seen as a sign that the Canadian program is meeting previously ignored demand, and in most other times and places it has been too difficult to end one’s life. The percentage of MAID participants who had received palliative care in 2021 was about the same as in 2019 and 2020, indicating that the composition of the program hasn’t changed much, but it is now providing more relief to people who are suffering.

Critics of MAID often argue by anecdote. Sometimes, you’ll see headlines along the lines of “I needed crutches and they offered me euthanasia.” These are practically always one-sided stories that haven’t been verified, amplified by a network of social conservatives, disability activists, and socialists who are opposed to MAID or want to use it to achieve other political ends like a more expansive welfare state. Yet one has to employ a bit of common sense. If the Canadian MAID program is overwhelmingly used by the sick and the elderly, how likely is it that doctors are pushing suicide in cases like this? The Canadian government report notes that only 139 MAID recipients were between 18 and 45 in 2021. I would bet a lot of money that the vast majority, if not all of them, had at least one extremely painful and incurable physical condition.

Even the examples used by MAID critics strike me as instances where the system worked. In The New Atlantis, Alexander Raikin writes about the case of Rosina Kamis, a 41 year old who “was in constant pain from her fibromyalgia, had chronic leukemia and a myriad of other mental and physical illnesses, a long list of medications, and a rotating cast of attending physicians and nurses.” However, Raikin questions whether she should have met the legal requirements for the program because she told people in her personal life that loneliness made her condition worse, and she didn’t want to be a burden on others.

Note that this is the best that opponents of MAID can do. Raikin helpfully provides a video and some recordings of Ms. Kamis, and she clearly appears to be in constant pain. It’s truly heartbreaking, and I don’t think that just because some third party can concoct a story about how her “real” problem was loneliness she should’ve been forced to live like this for another half century. Physical and mental health problems are obviously deeply intertwined. It is unrealistic to call for a system where the government needs to reliably untangle them and assess their relative weights, and the question is simply one of whether these matters are left to individuals and their doctors or to the state.

As far as I know, there’s not a single case of assisted suicide we can find where practically everyone would look back and say it clearly should not have happened. This is despite the practice being legal in over a dozen countries, in some cases for decades. In the Netherlands, it was reported that a 17-year-old-girl had been euthanized for depression after having been sexually assaulted. It turned out to be fake news. Even if this story were true, one mistake would not invalidate a policy that thousands of people use as intended each year. People keep getting mad at me for my euthanasia takes on Twitter, and they still keep sending me the same fake story of the 17-year-old Dutch girl, which indicates that if they had real examples of legalized assisted suicide being abused in this way they would use those instead. But it seems likely that they don’t, because the programs are working well, if they’re not too conservative.

False Positives and False Negatives

Many people are inclined to take a moderate position on euthanasia. They may acknowledge that yes, in certain cases, a person can be justified in seeking out help in ending their life, but think that we want to make sure that it happens only under the right conditions. The problem with this approach is illustrated in the aforementioned report in The New Atlantis. The author complains, for example, of doctor shopping. Someone could be rejected for euthanasia by one physician, and then keep looking until he finds one that agrees to the patient’s preferred treatment.

A moment’s thought, however, reveals that “doctor shopping” is an inevitable part of any but the most totalitarian healthcare systems. When one doctor refuses to carry out euthanasia and another does, Raikin simply assumes that the one who chooses the outcome he likes is correct. Doctors disagree on treatments all the time. Dentists often can’t agree on whether the same tooth needs a root canal, and that doesn’t even involve the complex psychological judgments necessary to decide whether someone is “really” allowed to end their life. To demand complete consistency in the application of a euthanasia program is holding it to an impossible standard, one we do not apply anywhere else in medicine. Similarly, just because you can find individual doctors who behave irresponsibly does not discredit the entire program. If your standard for accepting euthanasia is “the healthcare system can never make mistakes and should have 100% consistency in its applications,” you will never be satisfied.

Appearing on the podcast Institutionalized, Raikin makes clear that he’s against all euthanasia no matter what condition a patient is in. Complaints about shortcomings of MAID should be understood from this perspective. This is why you don’t argue from anecdote, and instead rely on data and priors when trying to understand a government program. And if people are arguing that a euthanasia program must meet standards we set in no other public policy area or kind of medical practice, this should be understood as a strategy used by those who would deny even people who are undergoing the most horrendous forms of suffering the right to end their own lives.

I’m not going to lie to you and say Canada, or any other country, never makes mistakes. But one has to also worry about cases where people are forced to live decades in miserable conditions. Yes, for most people you can always kill yourself by jumping off a bridge, but I don’t think people should be tortured because they lack the courage to do that. “Grandma doesn’t need state-sponsored euthanasia, she should have the balls to blow her brains out on the carpet” isn’t a humane approach. And many are of course disabled and unable to commit the physical act of suicide.

This leads to the question of whether we should worry about too many suicides or too few. Again, the fact that the Canadian program is increasing rapidly does not by itself mean that anything is going wrong. It could just as easily indicate that people are too willing to infringe on individual liberty and force others to suffer against their will, and Canada is more morally advanced than the rest of the world in this area. I don’t think we need many safeguards in a euthanasia program because the best safeguard is that people usually want to live, and despite what MAID opponents say, our culture generally discourages suicide. Those who don’t want to continue living are very rare, and since no one can truly understand the mental state of another person, I will defer to their own judgments about their condition. On the other side of the issue, preventing someone who genuinely wants to die from ending their life is literally torturing them for decades. Given how much hysteria there has been about a Canadian program that is almost exclusively used by the elderly and sick, the idea that any Western nation will start eliminating depressed teenagers, or even adults without serious medical conditions, on a mass scale has to be written off as out of touch with reality.

Opponents of euthanasia sometimes pretend as if they want people to make the decisions most consistent with their true beliefs, but it’s clear that they just want to stack the deck against them ending their own lives. For example, Raikin has talked about how some people have suicidal thoughts after say becoming severely disabled, but eventually learn to accept their condition. He argues that they therefore shouldn’t be given the option to end their lives when facing tough circumstances. Notice that he again treats the decision he likes as the correct one, and the decision he disapproves of as wrong. One could just as easily say that people who want to kill themselves after becoming disabled are seeing things more objectively, and when they accept their condition they’re coping and living under a kind of false consciousness. I’m pretty sure I would want to kill myself if I was ever paralyzed, and I grant it’s possible that maybe I would change my mind after a while. But I wouldn’t want to become reconciled to living with such a condition. The idea that I might accept it would for me be even more reason to commit suicide, lest I get used to accepting a defective version of myself. I’m sure Raikin and many others feel differently, and would want to hang around in a vegetative state and burden everyone else in their lives as long as possible. But that’s the beauty of individual choice — you don’t have to live by an alternative value system that you find repulsive.

To me, the most disturbing part of Raikin’s recent podcast (about 11 minutes in) is when he denounces the “coffee treatment” given at least once, as far as I can tell, in the Netherlands. A woman expressed that she wanted to die when the time was right, but the problem was that she eventually became unable to consent to treatment, so her doctor made the news for slipping the drugs into the coffee of the patient. It’s pretty strange to in some contexts argue that people can’t make the choice to commit suicide because they’ve temporarily lost the capacity to do so, and then in other instances say that an individual making a decision as an Alzheimer’s patient should be able to override a decision that was made when they were considering what to do with their life while operating under full capacity. I think what’s going on here is that opponents of euthanasia know that they have to pretend to care about individual liberty and reducing suffering because those are the values most people have, but they simply want to stop euthanasia under any circumstances and will rely on whatever arguments they can come up with on a case-by-case basis.

“Dying of Poverty” as Emotional Manipulation

Another argument being put forward against MAID is that some people are choosing to end their lives because they’re poor. This has been the line taken by liberal activists and journalists opposed to the Canadian program, and conservatives have repeated their arguments, seemingly without realizing that they contradict the ways in which they usually think about individual liberty. Again, this is one of those arguments that sound reasonable at first glance, but if you actually unpack it a bit, you see that it has quite ridiculous implications. Imagine two men, A and B, both suffering from the exact same painful medical condition. A is a billionaire and can hop on his jet and go to a private island in the Pacific any time he wants. B is a middle-class professional who lives in Ontario and makes $70,000 a year, or whatever the equivalent of that is in Canada.

It’s possible that A chooses to keep living, while B doesn’t. B might say “if only I had a billion dollars, I’d continue to live, but society is too stingy, so I’m going to end it.” Maybe he’s telling the truth. Does society have an obligation to meet whatever demands he sets so he does not take advantage of MAID? If you believe nobody should commit suicide due to a lack of resources, then you have to answer yes. Good luck administering that system without spending 100% of GDP paying off those who make the most exorbitant demands.

Maybe you would say that $70,000 a year is not poverty, but we can require some arbitrary minimum income that someone must have before they are allowed to end their life. No matter where you set the number, however, there will be people who will want to kill themselves unless they can achieve a higher standard of living. We have a capitalist society, and generally accept income inequality. Given that, one can’t turn around and say financial considerations should never have a role to play in the decisions people make.

You can see the tone of some of the “death by poverty” coverage here.

Sometimes, people would send them groceries or other essentials via Amazon Wishlist; sometimes, they’d get some canned goods at local food banks. Often, they’d get by on only one meal a day.

In May, Victoria took a hard look at their budget. They couldn’t go on like this for long. “Mom,” Joan recalled Victoria telling her, “I don’t think we can survive. We have to apply for MAiD.”

If only inflation hadn’t been so high this quarter, then we could’ve had a free society! The fact is no matter how much of a welfare state you provide, someone will always say that they would continue living if only you gave them another dollar. This kind of ridiculous emotional blackmail can’t be allowed to pollute public discourse. If you believe in an expanded welfare state, fine, but the argument needs to be made on its own terms, rather than used to manipulate people into taking away the choices of others.

But if opponents of MAID really believe their argument that it’s about protecting people in poverty, there’s an easy solution. Simply set a minimum income you need to have before you can agree to be euthanized. The rich and the middle class should have that option, while the poor are forced to continue living in pain until we achieve an even larger welfare state. Of course, nobody suggests this, because the argument about people being driven to kill themselves due to poverty is simply a rhetorical ploy put forward by those that oppose euthanasia for other reasons, or who just want more redistribution anyway. If the welfare state was doubled or tripled in size, I don’t think anyone doubts that they’d continue to make the exact same arguments, because there would still be leftists advocating for more government suspending and using euthanasia as a way to guilt others into giving them what they want.

Which Slippery Slope?

One may acknowledge that MAID works as intended now, and accept all the reasons for this view given above, but argue that we should worry about slippery slopes. In March, Canada will allow those suffering only from a mental illness to end their lives, and there is talk of allowing “mature minors” — that is, those under 18 judged capable of making their own medical decisions — to do so too. Even though it hasn’t happened yet, some worry about the possibility that we are headed to a place where the state starts pressuring people who would otherwise enjoy fulfilling lives to die, including healthy adults and even children.

“Mature minors” is a legal term of art, and applies to children who are judged competent to make their own decisions. Note that this is a proposal — it hasn’t happened yet, and if it does we don’t know what safeguards there will be or how often minors will take advantage of the program. Death with Dignity Canada, a group that advocates for assisted suicide, wrote a blog post about minors using MAID in 2021, and even they stress that it should only happen in rare and extreme circumstances. As Sydney Campbell, a PhD candidate at the University of Toronto, says in an interview,

In the Netherlands assisted dying for children has been legal since the original legislation was implemented in 2002; data from between 2002 and 2015 has indicated that seven children had an assisted death in the Netherlands. In Belgium, assisted dying for children has been legal since 2014, and data from between 2016 and 2017 showed that a total of three children received medical assistance in dying. These data indicate that there is likely a small number of young people that would be accessing this form of end-of-life care in Canada — but that number still represents real individuals with interests and needs.

Mature minors who might be seeking to access MAID in Canada would likely be very similar to the adults who seek to access MAID: individuals with a grievous and irremediable medical condition who are facing significant physical/mental suffering. Among the adults who have accessed MAID in Canada since 2016 there has been a variety of underlying conditions, though cancer was most common, so this may be reflective of mature minors who would be interested too. That said, there is not much data on the families or mature minors who have inquired about MAID at this point, so there is still a lot that is unknown.

The data from the Netherlands and Belgium stresses something that really should be obvious and go without saying, which is that most people do not want to put children to death except to alleviate the most extreme and pointless suffering. One does not need “safeguards” against this, because we already have human nature and public opinion, and there is nothing to indicate that we would ever be on a slippery slope towards euthanizing large numbers of minors. If you think that Canadian medicine is turning out psychos who want to start slaughtering children in their offices, and they’d be able to get away with it, we have much bigger problems then any deficiencies in MAID. It’s a paranoid fantasy, and the people indulging in it seem to be either right-wingers who think the state wants to kill them or the kinds of liberals who think not wearing a mask in public is “eugenics.” Given that the problems people worry about are theoretical and unlikely to come into existence, the state placing restrictions on the kinds of decisions individuals and families can make when it comes to ending one’s life likely does nothing more than prolong unnecessary suffering.

We don’t really need to speculate on the slippery slope of assisted suicide leading to a culture of death, because we can actually look at cross-national comparisons, and check whether countries that have legalized the practice show other indications that they don’t respect human life. See the map below.

Source.

The Netherlands and Belgium both legalized euthanasia in 2002. Over the last two decades, have these nations devolved into anti-human dystopias? Are they in any way distinguishable in their respect for human life from Sweden or Norway, which don’t allow the practice? And are the countries where assisted suicide and euthanasia remain the most taboo, like Saudi Arabia and China, known for otherwise being enlightened on issues of morality? It’s interesting to note that, compared to other Western European states, the Nordic countries have more restrictive laws relating to euthanasia but showed more respect for individual freedom during covid-19, so maybe each policy area stands on its own, and no particular law is influencing the culture all that much.

Slippery slope arguments are always plausible, but usually false. Nonetheless, to the extent that one does exist in this case, I’d argue that legalized euthanasia not only preserves individual liberty and reduces suffering, but in a broader sense renders us a service by creating norms that help us get over our aversion to death, protect individual liberty, and normalize cost-benefit analysis.

Like opponents of MAID, I worry about slippery slopes, but in the opposite direction. The fact that there’s so much criticism of Canadian euthanasia, when all the data indicates that the safeguards of the program work extremely well, shows how strongly biased society is against allowing individual choice on these matters, and implies we should be wary of listening to those who would restrict liberty, especially given that they are clearly misrepresenting MAID because they can’t argue against the program as currently practiced and have to rely on unverifiable anecdotes and paranoid prognostications.

Pro-lifers and opponents of euthanasia often argue that we should be working to create a “culture of life.” In some cultures, this might be necessary. The Aztecs would cut out the beating hearts of warriors to please Huitzilopochtli, and I think I would’ve agreed with someone who in the early sixteenth century would’ve argued that Mesoamerica needed to develop more respect for human life. But it is possible to go too far in the other direction. In one policy area after another, I would argue that in the modern West we put too much value on human life, and not enough on making life worth living or protecting the interests of future generations.

The best example of this is the covid-19 pandemic, when governments across the world locked people in their homes and made them cover their faces, sometimes for years, in order to preserve human life. Philippe Lemoine has shown that even if we grant the most generous assumptions to the other side, lockdowns never passed a cost-benefit test. China under Zero Covid was even more extreme, and one could argue that Xi Jinping creating a three-year dystopia made him the greatest valuer of human life of our generation. Conservatives, interestingly, think we should apply cost-benefit analysis in the case of covid restrictions, but seem extremely hostile to the idea that a government euthanasia program should do the same. The argument for restricting freedom to preserve life in the case of covid lockdowns is even stronger than in the case of euthanasia, since people who die from covid are often not at fault, while those who take advantage of assisted suicide programs choose to do so.

As a teenager and young adult, I remember the war on terror being the first political debate I paid close attention to, and being shocked by the irrationality of the discourse, which assumed that it was worth spending infinite resources to get the already minuscule threat of terrorism down to zero. I identified with liberals at the time, and as much as my views have developed since then I’ve always agreed with those who thought in terms of freedom and cost-benefit analysis instead of preserving human life, even if that side could be on the Right or Left depending on the specifics of any particular issue.

In another instance of us placing too much value on human life, nuclear power has been strangled in order to prevent meltdowns. We’re so squeamish about death even for the worst among us that most advanced countries don’t use capital punishment at all, meaning you can rape and murder little girls and the government will give you a bed and free healthcare for the rest of your life. The modern criminal can even write letters taunting the families of his victims, knowing that whatever jurisdiction he is in, the death penalty is either banned or takes many decades to carry out because we “value human life.” I could go on for a very long time.

Closer to the assisted suicide debate, a massive portion of medical spending goes to end of life care across developed countries. And of course, most nations do not allow any form of assisted suicide, even in the most extreme conditions.

Humans have an aversion to death, which is generally good! But, this aversion has gone too far and become pathological in modern societies, leading to all kinds of policy mistakes. We can see people die from covid in front of us, but not the relationships that will never be formed or the children who will never be born because of lockdowns or masks. We (well, not me) squirm when watching a murderer being put down by lethal injection, but find it easier to look away from the families of his victims who want closure and must spend the rest of their lives suffering in silence due to our “humane” criminal justice policies.

One can arguably understand the slowdown in economic growth over recent decades as government strangling progress in the name of saving lives. The TSA and the Nuclear Regulatory Commission don’t alone create a stagnant society, but when you add up all the programs and regulations aimed at preserving life that don’t pass a cost-benefit test, the impact is massive.

Why Suicide Can Preserve Human Dignity

I don’t worry about MAID putting us on a slippery slope towards devaluing human life due to our cultural aversion to death, how the Canadian euthanasia program has functioned so far, and the experiences of Western Europe. Even the Canadian program, which as I’ve noted is small and almost exclusively used by the very old and very sick, has caused a moral panic. That being said, I’m sure it’s true that some people are pressured to commit suicide because they’re burdens on their family or the rest of society.

What opponents of euthanasia call undue pressure, however, I would call providing information that is relevant to making an informed and moral decision. If you’re on the fence about killing yourself, the fact that you’re a burden on your family or the wider society should be taken into consideration.

I find it strange that anyone would argue otherwise. Since when do we denounce people considering how their actions will affect others? Should a good euthanasia program go out of its way to hide the costs and impacts someone has on the rest of society? On Twitter, some have accused me of being a doctrinaire libertarian on this issue, but I actually believe that it is morally correct to take into account the common good in deciding whether to commit suicide, and would reject a system of ethics that said an individual’s own hedonistic pleasure should be their sole consideration.

This brings me to another point, which is the strange way opponents of MAID use phrases like “human dignity.” I don’t like inconveniencing others, and for many parents the possibility that one day they could be a burden on their children scares them much more than death. I think this is a noble sentiment, and would gladly sacrifice myself when I’m old so that those I care about can live better and more fulfilling lives. If we’re going to talk about human dignity, I could think of nothing less dignified than ending a proud and successful life in diapers and with your brain rotting away, making your children miserable and preventing them from reaching their full potential.

Recently on Twitter, Ross Douthat encouraged me not to hide behind rhetoric of individual choice and acknowledge that I bring my own moral values to this issue. I agree with him. If the state is going to provide healthcare, it should acknowledge that suicide is a legitimate choice for people to make. I wouldn’t say the same about gender-affirming surgery, which I think the government shouldn’t pay for (though I’ll bite the bullet and let people pay for it themselves), with the important distinction being my own judgment about the value of each procedure. Suicide is in many cases a noble and heroic act, and it should therefore have state sanction. For those who are suffering, it can be a gift to their families, and by allowing them to determine their ultimate destiny give them a way to reassert control that they’ve lost in every other imaginable sense. We can be inspired at the end of a movie by a protagonist who kills himself once he has failed in his mission or his continued existence harms those he loves, but never by a story that ends with the hero being hooked up to machines, unable to take care of himself, and slowly deteriorating. If he can’t do it himself, we understand and sympathize with a friend who carries out the act. I don’t think my views are that unusual here — we still have kids read One Flew over the Cuckoo’s Nest. The Romans had a concept of “patriotic suicide” in which death was preferable to dishonor, and despite two millennia of Christian influence we can still be inspired by the idea.

I acknowledge that many people on the other side of this issue simply differ too much from this perspective for me to be able to convince them of anything. I just read this 1996 article from Leon Kass against euthanasia, and realized that there is probably no way the author and I could ever have a meeting of the minds on this issue. I recognize the essay as containing words with the correct morphology and in the right syntax to be considered grammatical English, but the moral views and the outlook in the piece are as foreign to me as would be an Aztec explaining why of course the Sun God needs beating hearts in order to not destroy the world and you must be a moral imbecile to ever think otherwise.

In one of the more original arguments against euthanasia I’ve seen, Michel Houellebecq in 2021 wrote that he doesn’t believe in death with dignity because he’s never had dignity in the first place.

We have seriously deviated from the Kantian definition of dignity by substituting, little by little, the physical being for the moral one (and maybe even denying the very notion of a moral being), substituting the human capacity for action with a shallower more animal concept of good health — turned into a sort of pre-condition of all possibility of human dignity, even maybe its only true meaning.

Put in this way, I have rarely had the impression that I have manifested extraordinary dignity at any time in my life; and I do not have the impression that this is likely to improve. I am going to end up losing my hair and my teeth. My lungs will be reduced to shreds. I will become steadily more or less impotent, more or less incapable, perhaps incontinent and possibly even blind. Once a certain stage of degradation has been reached, I will inevitably end up telling myself (and I will be lucky if it is not someone else pointing it out to me) that I no longer have any dignity.

Well, so what? If that is dignity, one can very well do without it. On the other hand, everyone more or less needs to feel themselves necessary or loved; and, failing that, esteemed—even in my case admired. It is true that can also be lost; but one cannot do much about that; others play in this respect the determining role. And I can easily imagine myself asking to die in the hope that others reply: “Oh no, no. Please stay with us a little longer.” That would be very much my style. And I admit this without the slightest shame. The conclusion, I am afraid, is inescapable: I am a human-being utterly devoid of all dignity.

I find this passage quite sad, and would have more sympathy for these people if they would take their idiosyncratic understanding of human dignity and only apply it to their own lives instead of trying to make it the basis of public policy.

Nonetheless, polls show that around two-thirds of Americans support the right to end one’s life, indicating that most people share my intuitions about the importance of bodily autonomy, reducing suffering, and not burdening others. This is why MAID opponents need to misrepresent how the policy is working, cherry-pick anecdotes, scaremonger about future abuses that are unlikely to occur, and make arguments about dying from poverty that have a kind of superficial appeal but can’t withstand logical scrutiny.

For the rest of us, it’s important to understand the real nature of the Canadian program, and the kind of manipulative arguments that are being made in order to attack it. With the rise of secularism and an aging population, we will likely see more support for death with dignity across the developed world in the coming decades. Whether or not opponents of MAID are successful in temporarily blocking its expansion in the near term, Canada will hopefully one day be applauded for showing moral leadership on this issue.