In the long-running debate over medically assisted dying, one country has recently taken centre stage: Canada.
A common argument against legalising assisted dying is that it risks descent down a 鈥渟lippery slope鈥�, where the rules are loosened over time. Critics say this is happening in Canada, with the criteria for assisted dying having expanded once already and a further change planned for next year. So, is this argument fair?
Assisted dying is usually when people at the end of their lives die by receiving an injection or, if they can still swallow, by drinking a strong drug cocktail.
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In 1942, Switzerland became one of the first countries to allow medically assisted dying. After a lag, other places followed suit, including the Netherlands, Belgium, Luxembourg and, more recently, New Zealand and most of Australia. It is also legal in 11 US jurisdictions, with a 2014 campaign by a young woman with terminal brain cancer called Brittany Maynard catching the country鈥檚 attention.
Those in favour say that people who are in extreme discomfort deserve medical help to die quickly and painlessly. Arguments against the practice include that it risks people being pressured into ending their lives by others and that health systems should instead focus on improving the treatment of symptoms at the end of life.
Canada鈥檚 system, known as Medical Assistance in Dying or MAID, was introduced in 2016, but has entered the spotlight in the past couple of years, as uptake has risen. A report published last month on how the system worked in 2022 , up from 3.3 per cent the year before.
When MAID first came in, it was allowed only for people who were terminally ill. An amendment in 2021 expanded the scope to include people with a 鈥済rievous and irremediable medical condition鈥� whose deaths weren鈥檛 imminent. This might cover someone with Huntington鈥檚 disease, says at Dying with Dignity Canada. Huntington鈥檚 is a progressive condition, where people may spend the last year or two of their life unable to move and with worsening dementia.
The amendment to MAID also allowed people to access assisted dying due to 鈥渆nduring psychological suffering鈥�, rather than physical symptoms only, although this aspect hasn鈥檛 yet come into force.
Critics point to Canada as evidence that if assisted dying is introduced with tight controls, they tend to loosen. 鈥淲e are seeing [UK politicians] referencing Canada,鈥� says Alistair Thompson at the UK anti-euthanasia campaign group . 鈥淭hey see how quickly it span out of control.鈥�
Yet the broadening of criteria to include people who aren鈥檛 terminally ill accounts for very little of the rise in euthanasia cases in Canada. In 2022, only 3.5 per cent of MAID cases involved people whose deaths weren鈥檛 imminent.
And the rising uptake of MAID may be a natural consequence of people becoming more used to the idea of assisted dying and being aware of it as an option. In fact, the equivalent figure in the Netherlands was slightly higher, with assisted-dying fatalities . Perhaps Canada鈥檚 rate is getting more attention because assisted dying is a relatively new process there and the increase in cases has been steeper.
On the other hand, in Oregon 鈥� which, in 1997, became the first US state to legalise medically assisted dying 鈥� the figure has remained very low. In 2022, . It isn鈥檛 clear why the number of assisted dying cases in Oregon and other parts of the world are so different. 鈥淭he question isn鈥檛 鈥榳hat鈥檚 the right figure?鈥欌�� says Heim-Myers. 鈥淭he question is: 鈥榙id those people who [wanted] MAID have access to it? Is the law being followed?鈥欌��
In the UK, campaigns for assisted dying have been ongoing for many years, but legislation does seem on the verge of being passed soon in two small corners of the British Isles: the Isle of Man and Jersey, in the Channel Islands. In the US, campaigns to allow assisted dying continue in nearly all states where it isn鈥檛 permitted.
In March 2024, Canada鈥檚 system is set to expand to include people with severe mental illnesses, something critics say is the opposite of good psychiatric care. For now, it looks like the spotlight on Canada will only intensify.
