Assisted Suicide: A Slippery Slope?

In 2015, the Supreme Court of Canada decriminalized the prohibition on assisted suicide, a decision which led to the legalization of assisted suicide (when an individual ends her own life with the help of another, usually a physician) and voluntary active euthanasia (when someone gives permission to another person – again, usually a doctor –  to end her life).

When the Supreme Court reached its verdict, a number of bioethicists applauded, seeing the decision as demonstrating a recognition of the right of individuals to exercise their autonomy. I call this group of bioethicists the optimists – for them, assisted suicide and voluntary active euthanasia are good, even wonderful, things, offering people a last choice when they have few others open to them, and allowing them to die a painless and dignified death at a time of their own choosing.

Supreme Court justices, Canada, 2015

The Supreme Court justices pose for a group photo during the official welcoming ceremony for Supreme Court of Canada Justice Suzanne Cote at the Supreme Court Tuesday 10 February, 2015 in Ottawa. Top row, from left, Justice Clement Gascon, Justice Andromache Karakatsanis, Justice Richard Wagner, and Justice Suzanne Cote. Bottom row, from left, Justice Thomas Albert, Justice Rosalie Silberman Abella, Justice Beverley McLachlin, Justice Marshall Rothstein and Justice Michael Moldaver.

Another group of bioethicists, however, believed this decision was a mistake – indeed, a tragic mistake – opening the door, to mix my metaphors, to the slippery slope that leads directly to the euthanizing of people against their will. Moreover, they argued, allowing doctors to kill their patients would change the ethos of medicine, and would eventually require even those physicians who, for religious or other reasons, did not approve of euthanasia to participate in this act.

They also feared that the categories of people who would be considered eligible for an assisted death would expand (to include, perhaps, those suffering from mental illness or dementia), and that the change in the law would lead to a profound shift in societal attitudes about how we ought to treat the dying. The legalization of assisted suicide, they feared, would, on the one hand, make the need for good palliative care seem less urgent, and, on the other, allow us to think of assisted death as a convenient way for the health care system to save money. This group can be called the pessimists.

It is relatively easy to sum up the difference between the optimists and the pessimists in the following way: the optimists tended to focus on individual rights, including the right to decide how and when we die, while the pessimists focused primarily on the institutional and societal effects of this profound change in the law. Consequently, as in the case of the abortion debate, the two sides are not so much talking to one another (which requires the use of some common foundational principles) as past one another.

Approximately five years after the ruling, it is time to begin assessing whether the hopes of the optimists or the fears of the pessimists have been borne out. Perhaps paradoxically, I want to say they’ve both been proven right.

The optimists are correct in their assertion that legalizing assisted death and voluntary euthanasia has given individuals more power to choose how and when they die, and has saved thousands of Canadians from dying deaths filled with suffering and pain.

The pessimists, however, were also right to have concerns about the way in which the change in the law is changing the way in which medicine is practiced, and altering societal norms. Again, if we recognize that each side focuses on something entirely different (individual rights versus the community considered as a whole), we can see how this confusing assessment is possible.

Since the argument of the optimists is clear and easy to understand, and its appeal a powerful one – who among us can really feel sorry that we have one more option open to us at the end of our lives? – I want to spend some time in this column (and next month’s as well) detailing some of the changes that seem to support the more pessimistic perspective.


One concern expressed by the pessimists was that legalizing assisted death would encourage us to see the deliberate taking of someone’s life to be a normal part of medicine and that it would lead, in time, to the expansion of the categories of people for whom euthanasia is considered appropriate so that, eventually, we will be euthanizing those who are, it seems, suffering, but who cannot, for reasons of competency, give consent.

I suspect the pessimists are right about this, and that euthanasia will eventually be administered to those who are, for example, suffering from dementia, and who put this wish in their advanced healthcare directives. Again, whether you think this is a good thing or a bad one depends on whether you fall into the optimistic or the pessimistic camp: on one hand, allowing individuals to put a request for euthanasia in an advanced directive reinforces the belief that individuals have the right to determine for themselves how they want to be treated; on the other, this also opens the door to potential abuses.

So, what observations might support the pessimistic position, and give the optimists at least some pause for thought?

B0NNRP Syringe and a bottle of morphine

B0NNRP Syringe and a bottle of morphine

First, what the Supreme Court ruling did was decriminalize assisted suicide for a certain category of persons. As noted above, assisted suicide means providing the tools (such as a noxious drug) to someone, so that that person can end their own life. Oregon legalized assisted suicide a number of years ago, and its law allows people to get a prescription for a drug that they can then take themselves. This means that the individual who chooses this option is the one who performs the final action that ends their life.

However, when the Canadian government passed legislation to respond to the Supreme Court’s ruling, it allowed not only assisted suicide but also what bioethicists have long called “voluntary active euthanasia” – the deliberate killing of one person, with their consent, by another. The reason for this is obvious: some people (such as those with conditions like ALS or quadriplegia) are clearly suffering, but are unable to perform the action which will cause their own deaths, and so they must ask another person for assistance. (In Canadian law, that other person must be a physician or a nurse practitioner). The legislation also makes use of the euphemistic term, Medical Assistance In Dying, or MAID.

While those who are unfamiliar with the bioethical literature (or with theoretical ethics more generally) might think that there is little or no moral difference between providing someone with the means to commit suicide and actively killing them with their consent, for many bioethicists, there is all the difference in the world.

In one case, the person who dies is responsible for their own death; in the other, someone else is. To paraphrase an analogy sometimes used in the literature, there is a moral difference between watching a child drown in the bathtub, and pushing their head under the water – or, to put the point another way, there is a difference between selling someone a gun which they later use to commit suicide, and deliberately shooting them in the head. Moreover, it can be argued that asking someone to kill you places a heavy moral burden upon them.


Second, I believe that the way in which we talk about the issue, the language that we use, is ethically troubling, and, consequently, that this lends support to the pessimistic position. One of the first rules I (and many of my bioethical colleagues) tell students is that “good ethics begins with good facts.” To which I often add, “good ethics also begins with precise and accurate language.” That is to say, to evaluate an issue, we need to know exactly what we are talking about, rather than using euphemisms or other forms of imprecise language.

Although the Supreme Court ruling was made only about five years ago, the precise language of “assisted suicide” and “voluntary active euthanasia” has already largely disappeared from our public discussions about this procedure. Now, both in healthcare settings and outside them, we refer only to MAID. What is problematic about the acronym “MAID” is that it is both euphemistic and imprecise. It is euphemistic because, almost without exception, whenever I hear someone use the term MAID, it is clear from the context that what they are actually talking about is active voluntary euthanasia. If we think that the change to the law is a positive one, why are we so afraid to use the correct term? I believe that the term MAID allows us to feel more comfortable with what we are doing than if we called it by its real name – who could possibly be against providing people with assistance when they are dying?

Proposed 10-bed Hospice Residence for Cape Breton Regional Hospital

Proposed 10-bed Hospice Residence for Cape Breton Regional Hospital. (Source: Hospice Palliative Care Society of Cape Breton County

Moreover, as noted above, the term “medical assistance in dying” is imprecise, because the concept of providing people with assistance as they die could, in fact, mean anything from palliative care to the most aggressive treatments as someone is going through the dying process. The fact that it has come to mean assisted suicide, or, even more often, voluntary active euthanasia, again raises the question of why we are so uncomfortable correctly naming what we are doing. This kind of imprecision, in short, really worries me as a philosopher.

Third, and most importantly for me, there is some evidence that, with the legalization of MAID, governments may allocate fewer resources to palliative care. My friends who work in palliative care tell me that only about 30% of Canadians actually have access to good palliative care, and that, further, most of those who receive good palliative care don’t ask for MAID.

While I fully respect everyone’s right to make an autonomous choice about how they want to die (and I am personally very glad that the option of euthanasia now exists), it is hard to be certain that someone’s choice of MAID is entirely voluntary, if their only options are inadequately treated pain and consequent suffering, or death. Given the moral complexity of euthanasia, and the radical shift in the ethos of medicine that this legislation has brought about, it seems to me that increasing spending on palliative care so that all Canadians have access to good care at the end of life is the best way to ensure that all requests for MAID are fully voluntary. What will happen instead, I fear, is that fewer resources will be devoted to palliative care now that MAID is an option.


Rachel Haliburton

Wolfville native
Rachel Haliburton teaches philosophy at the University of Sudbury. Her latest book, The Ethical Detective: Moral Philosophy and Detective Fiction, was published in February by Lexington Books.