Canada is widely seen as one of the world’s most progressive nations in the world, “leading the way” (depending on where you stand) on a variety of social issues. But in recent months, Canada has been garnering some less than savoury international attention because of the dark side of one of its recent progressive accomplishments, namely the assisted suicide regime that has been created since the Supreme Court struck down prohibitions on assisted suicide in 2015. The tragic situation that has developed in Canada offers a warning to Britain and other countries considering going down a similar path, both to be cautious about opening the assisted suicide floodgates and about empowering judges to decide whether such things should be allowed.

When Canada’s enlightened judicial philsopher kings and queens overturned criminal prohibitions on assisted suicide in Carter v. Canada, they overturned their own precedent. In 1993 a majority of the Supreme Court found that the criminal code provisions that prohibited assisted suicide did not ultimately violate the Canadian Charter. In 2015 the Court changed its mind. The law didn’t change, of course, but the court decided that “the matrix of legislative and social facts” surrounding the case had changed. Thus the interpretation of constitutional rights must change with them.

Plenty of the same people who were outraged that the United States Supreme Court would overturn precedent on seminal abortion decisions, seemingly had no problem with the overturning of precedent in this Canadian case. This is because implicit in the view of rights and judicial review that many progressives hold, is that it is perfectly acceptable to overturn precedent in the name of expanding or establishing some newly discovered right — but once this is done, the debate is settled and there can be no reasonable dissent or change of heart. History, it seems, only marches in one direction. 

An important part of the Carter decision, where the court determined that relevant social facts had changed, was essentially a blithe dismissal of exactly what has come to pass in Canada less than a decade after the decision. The court rejected the concern that once assisted suicide was allowed in some rare cases, there would be a “slippery slope” from helping terminally ill people end their lives, to a system in which vulnerable people like the disabled were caught in a euthanising net. 

Evidence presented in the case by a medical expert from Belgium that this might be possible, was dismissed by the court because “the permissive regime in Belgium is the product of a very different medico-legal culture”. Unlike those barbaric Belgians, enlightened Canada could avoid sliding down this slippery slope in which safeguards are easily gotten around. They would avoid the creeping expansion of eligibility by setting up a “carefully regulated scheme” that would keep its application narrow and exceptional. 

Disabilities advocates in Canada have been sounding the alarm

Yet just seven years after the decision, the exact scenario dismissed by the court has come to pass. Who could have seen this coming? Well, all sorts of people, and not just religious voices. Disabilities advocates in Canada have been sounding the alarm on the path Canada was headed down since 2015, seemingly ignored by the courts and government. 

After the initial 2015 decision, the then newly elected Liberal government passed legislation that did attempt to place strict boundaries around assisted suicide eligibility. This legislation would have restricted access to mentally competent adults with “enduring and intolerable suffering” and in cases where natural death is “reasonably foreseeable”. It also mandated a ten day reflection period. But this legislation, specifically the notion that death must be reasonably foreseeable, was struck down by a Quebec court in 2017 as too restrictive, and Canada now has a “medical assistance in dying” (ominously referred to as MAID) in which competent adults whose deaths are not reasonably foreseeable are eligible if they have a “grievous and irremediable medical condition”. Next year, Canada will begin allowing mentally ill individuals to qualify for assisted suicide under this formulation, and it is likely that this autumn the government will receive a parliamentary report recommending that children deemed competent (“mature minors”) should also be eligible.

So much for that rigorous regime that created safeguards that would prevent Canada from becoming Belgium. Once the proverbial cat is out of the bag, it’s very hard to get it back in. A problem with determining whether there is some sort of right to having help to end your life, is that it is hard to deny it to mentally competent adults who want it regardless of the nature of their motivation. Why should a right depend on someone’s reasoning? 

Recent reporting has detailed all sorts of tragic cases where vulnerable people are being caught up in the MAID net. Stories in Canadian media have emerged of people with disabilities unable to afford basic living standards seeking MAID. Recent reports from the Associated Press detailed a series of disturbing cases in which patients were euthanised despite concerns raised by their families, or when the only official reported condition of a patient was hearing loss. The reporting also details a case where a patient records a hospital “ethicist” telling him about his $1500/day hospital costs. Figure out for yourself why this is relevant. 

So much for it remaining rare: 3.3 per cent of all deaths in Canada in 2021 were assisted deaths. This has matched and surpassed the rates in places like Belgium and the Netherlands, despite it being available in Canada for less than a decade. It turns out that Canada’s “medico-legal culture” isn’t so different after all. If anything, it may only be different in that it is even more permissive and willing to see suffering as diminishing and destroying the value and worth of human life. 

It suggests that certain people lead lives that are less valuable

Canadian health minister Jean-Yves Duclos is reported by the AP as saying that Canada’s euthanasia laws “recognizes the rights of all persons … as well as the inherent and equal value of every life”. But the underlying logic of Canada’s assisted suicide regime suggests otherwise, or at the very least suggests a new and novel understanding of the value of human life that makes its value conditional. If suffering from “grievous and irremediable medical conditions” means one should have the right to seek public assistance in ending life, then it implies that human life is no longer inherently and intrinsically precious. At some point, suffering makes life not worth living, a view that the Canadian government and law now effectively endorses. In the 1993 Rodriguez decision, part of the reasoning of the majority upholding the law, was that prohibitions on assisted suicide were the norm across western democracies, and that these prohibitions affirmed the value of human life by deeming it worthy of protection. The ending of this prohibition would normalise a diminished view of the value of human life. 

There’s something especially tragic about the coming expansion of access to the mentally ill. Canada, like many countries, has rightly devoted significant money and resources into helping build support and services for people struggling with mental illnesses. Things like campaigns to destigmatise mental illness, or suicide/distress hotlines to help people in need are just a few examples. But how can we seriously claim to be supporting people with mental illness whilst also saying that if you really want to, your mental illness means we’ll help you end your life? 

We can hope that as more and more tragic cases emerge in Canada, public pressure may begin to force legislators to take action to restrict access to assisted suicide. But once a change like this happens, it’s hard to ever imagine it being fully reversed. The underlying logic of a “right” to assisted suicide, and the view of human dignity it affirms, ultimately undermines the value of certain lives and certain standards of living. It suggests that certain people lead lives that are less valuable. We should reject this view and affirm the sanctity of all human life, and we should seek to build a society and culture premised on this. But if there’s one lesson to learn from this, it’s that we should be wary about overturning and abandoning old taboos or restraints simply because “it’s time”.