The Ultimate Act of Compassion?

It began with the best of intentions. To stop the needless suffering of people who are terminally ill. To relieve unbearable pain and give people a dignified exit when medicine had nothing left to offer. It was, ostensibly, the ultimate act of compassion.

In 2016, Canada introduced MAID-Medical Assistance in Dying. Only a handful of people chose it. And, only as a last resort.

By 2023 more than 60,000 people had committed suicide in Canada, with the assistance of a Physician. That’s nearly five percent of all deaths in Canada. Enough to fill New York’s Madison Square Garden three times. Physician assisted suicide 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.

South of the Border

In the US, twelve (mostly blue) states offer various forms of medically assisted suicide. California’s End of Life Option Act (EOLOA) allows Physicians to prescribe a high powered barbiturate for self administration at home. The drug causes sedation, followed by respiratory arrest. The concept of personal freedom in dying is gaining traction in the US. A 2024 Gallup poll found that 71% of U.S. adults believe doctors should be legally allowed to “end a patient’s life by some painless means”. That is, if the patient and family request it.

Today, MAiD is one of the fastest growing medical services in Canada. Doctors receive between $300-$500 in government payment for ending a life. Fees in the US are significantly higher than in Canada, because U.S. patients often pay privately. Some Physicians charge as much as $5,000 to end a life in the US.

The End of Life’s Indignities

The infomercial version of Canada’s MAID is about terminal illness. Some dreadful form of Cancer for which there is no effective treatment or cure. But the reality? People are choosing medical suicide not as an end to disease, but as an end to life’s indignities. In 2021, Canada expanded the law to allow eligibility for people with “severe suffering, but whose death is not imminent”. So far, no US states have expanded to this language but you and I both know it is inevitable.

The concern is the term “severe suffering”. What about those suffering from dementia? Or, those who are lonely? Or disabled. Or those born with developmental disabilities? They all qualify if they can convince a doctor that their situation results in “severe suffering”, regardless of whether that suffering may result in death.

In Ontario, nearly a third of “severe suffering” suicides lived in the poorest neighborhoods. Canada excludes those solely with mental health conditions from MAID eligibility. But, in March of 2027, that exclusion expires. So far, no US state allows Physician assisted suicide for mental health conditions.

Some might suggest that the excessive cost of healthcare is to blame. But, Canada has government funded healthcare. Citizens pay little or nothing out-of-pocket for their care. Patients often wait several months for specialty care. But, the wait for medically-assisted suicide is typically less than three weeks.

In Quebec, MAID already accounts for 7% of all deaths. The government even considered expanding it to those with mental illness as their sole condition. That’s been delayed until 2027 — but the fact it’s even on the table should stop you cold.

When Compassion Becomes Convenience

The math is simple: it costs far less to assist someone’s death than to fund decades of medical care and support. That should horrify you, especially if you’re covered by a government funded program. (Roughly half of all care in America is covered by a government program like Medicare, Medicaid or the VA.)

The Question That Won’t Leave You Alone

So here’s where we are: most people favor the concept of dignity in dying. But, if we reduce it to dollars and cents, the balance sheet will always tilt toward death.  We’d like to think that such cold calculations only exist in dystopian novels or movies. But the speed, scale, and normalization of MAID in Canada should give Americans pause. Especially if you are a student of history.

Who doesn’t want a dignified exit? Who doesn’t want to relieve suffering, right? The problem is that suffering is subjective. And once suffering becomes the threshold things get very gray. What was once an emergency escape hatch for the terminally ill is now quietly expanding to include poverty, disability, loneliness, and social isolation.

Americans are watching Canada closely. And while the U.S. prides itself on liberty, it also runs one of the most profit-driven healthcare systems in the world. That’s a combustible mix.

It always begins with compassion, with the easing of “suffering.” And it always ends with convenience, with cleaning up the “burdens on society”. What begins as an act of compassion risks ending up as a quiet form of controlling the cost of healthcare. A system that tells the most vulnerable among us: we can’t fix your life, but we can help you end it.

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