When the hospital staff called me to my patient’s bedside, I could see her distress was severe. She was agitated and breathless, her face etched with discomfort and frustration. “I can’t take this anymore,” she cried.

She had suffered for years with chronic illness and had been admitted to my intensive care unit with acute complications. She was debilitated and exhausted, and her grief and frustration had come to a head. “I just want to die,” she wept.

Her friend was standing next to me at the bedside, and he was clearly upset by her distress. “Just ask for MAID,” he told her, using the popular acronym for medical assistance in dying, often referred to as physician-assisted death. “Then you can end it all now.”

I was startled by his statement. Though physician-assisted death is available in Canada, where I live, I had not expected the conversation to move in that direction. Yet I saw that he was feeling desperate and helpless at the sight of her distress.

After some gentle exploration, we quickly realized that the patient didn’t really want to die; rather, she needed relief from her pain and anxiety and to understand her acute illness and what it meant for her future. She still wanted time with her loved ones. We worked to address her symptoms and concerns, and she soon felt calmer and more comfortable. Watching her rest and converse with family made it hard to believe she was the same person who only hours earlier had cried out to have her life ended.

What is more unbelievable is that the ability to have one’s life ended on short notice is an increasingly acceptable option for Canadian patients—with implications that will reverberate around the globe.

When I was young, I dreamed of being a doctor. The profession of medicine seemed a noble calling, at once intellectually demanding and profoundly humanistic. I devoted myself to the long journey required to become a fully qualified physician.

In the early days, my idealism about medicine’s power to dignify the suffering of fellow human beings prevented me from appreciating its susceptibility to broader cultural and social changes—or appreciating the ways in which medicine has, throughout history, served to undercut rather than protect that dignity.

In 2014, not long after I had finished my training as a specialist in intensive care medicine, serious conversations began in the Canadian medical profession and the wider culture about the possibility of legalizing physician-assisted death.

A high-profile legal case involving two women with degenerative diseases seeking to end their lives garnered a wave of public support for the practice. Death was increasingly regarded as an act of compassion rather than an existential threat. Many of my fellow physicians joined in advocating for this shifting moral consensus. Society wanted the option of physician-assisted death, they argued, so medical professionals had a responsibility to provide it as a matter of compassion and respect for patients.

Image: Illustration by Hokyoung Kim

I distinctly recall the day when it dawned on me that those of us who refused to participate in assisted death would be regarded as physicians of questionable ethics. We might be seen as more concerned for our own personal moral hang-ups than for the welfare of the patient. Where causing death was once a vice, it was soon to be a virtue.

In the name of moral “progress,” the profession was taking on a new role and assuming a new power unto itself: the power not only to save life but also to take it. The ground was shifting beneath our feet. What did this mean for those who refused to shift with it?

Sue Rodriguez was a 42-year-old woman from British Columbia with a dreaded disease: amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease). Faced with progressive disability, in 1993 she appealed to the Supreme Court of Canada to overturn the Criminal Code’s prohibition on assisted suicide so she could seek one herself. The court denied her appeal and upheld the prohibition, stating that “this state policy is part of our fundamental conception of the sanctity of life.” The court also cited “concerns about abuse and the great difficulty in creating appropriate safeguards.”

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Twenty years later, a very similar case was brought before the court. This time, things were different. Years of observing liberal assisted-suicide regimes in Belgium and the Netherlands seemed to show that safeguards could protect the vulnerable from being euthanized against their will.

Canadian social values had shifted as well, according to leading Canadian bioethicists. An influential report prepared by members of the Royal Society of Canada in 2011 claimed that the “attempts at linking appeals to dignity and the sanctity of human life have been widely criticized by philosophers” and that “the value of individual autonomy or self-determination … should be seen as paramount” among the “values over which there is broad [Canadian] societal consensus.”

The report concluded that

there is a moral right, grounded in autonomy, for competent and informed individuals who have decided after careful consideration of the relevant facts, that their continuing life is not worth living, to non-interference with requests for assistance with suicide or voluntary euthanasia.

Legal permissibility soon followed moral permissibility in short order. Gloria Taylor, who also suffered with ALS, brought her case to the Supreme Court of Canada. She sought the possibility of assisted death, saying, “I live in apprehension that my death will be slow, difficult, unpleasant, painful, undignified and inconsistent with the values and principles I have tried to live by.”

Other witnesses in the court’s proceedings testified that “they suffer from the knowledge that they lack the ability to bring a peaceful end to their lives at a time and in a manner of their own choosing.”

In a landmark decision issued in 2015, the Supreme Court held that the criminal prohibition on physician-assisted suicide and euthanasia violated the Canadian Charter of Rights and Freedoms, specifically the right to life, liberty, and security of person.

Grounding the freedom to be killed in the right to life might seem counterintuitive, but the court reasoned that the criminal prohibition on physician-assisted death could force “some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.” Moreover, the court deemed the prohibition on physician-assisted death as an interference with individual decisions about bodily integrity and medical care—rights of liberty and security.

One year later, the Canadian government followed the court’s instruction and legalized medically assisted death. Initially the law stipulated that assisted suicide was restricted to those with “grievous and irremediable suffering” for whom “death was reasonably foreseeable.” However, as the practice has grown in frequency and social acceptance, the restrictions intended to safeguard vulnerable populations have been progressively eliminated.

In 2021, the “reasonably foreseeable death” requirement was removed, and otherwise healthy people with physical disabilities became eligible for assisted suicide. In the course of parliamentary deliberations on that change in law, I testified before the Canadian Senate alongside two women with visible and severe physical disabilities. They shared eloquently about the adverse impact the change in law would have on the disability community in Canada.

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I found it gut-wrenching that Canada would declare them eligible to have their lives ended, while someone like me without any recognizable physical disability was barred from medically assisted death. What did this say about our society’s valuation of the disability community?

In the past five years, the number of patients dying with physician assistance in Canada has grown tenfold, from around 1,000 in 2016 to more than 10,000 in 2021—3.3 percent of all deaths in Canada that year, according to official government reporting.

The available data suggest that patients are not being coerced against their will into physician-assisted death, and yet the “culture of death” (a term I initially resisted as needlessly provocative) has taken hold in insidious and surprising ways. Assisted death is no longer seen as a desperate option of last resort but rather as one “therapeutic option” among many, a reasonable and effective means of definitively resolving suffering offered not only to the dying but also to those whose lives are not regarded as worth living.

Some patients with disabilities or mental illness reported that assisted death was proposed to them without their instigation. Patients have sought and obtained euthanasia because they were unable to access affordable housing. There are even reports that patients have received physician-assisted death based on misdiagnosis, discovered at autopsy. Next year, Canada will expand the law to allow patients to obtain euthanasia for mental illness reasons. Some are even pushing to allow it in certain cases for children and youth.

Once death is deemed a form of health care, health care “providers” will be expected to offer it.

The logic of assisted death has proven inexorable: If death is therapy that addresses psychological wounds of suffering and the feeling that life is pointless, then who shouldn’t be considered eligible?

It was clear this moral evolution has placed immense pressure on doctors who refuse to participate in assisted death. The pressure on medical professionals is not so much to perform the act of ending the life as it is to knowingly refer a patient to someone who will. But a referral is no light thing; we are culpable if we knowingly send our patients to a doctor who will treat them in a manner deemed unethical.

The famous Austrian physician Hans Asperger recently fell into disgrace for his involvement in the euthanasia of children during the Nazi occupation of Austria. Though he didn’t directly kill them, he referred children with intellectual disabilities to a Third Reich clinic that did and became complicit in their deaths.

A number of Canadian doctors have partnered with colleagues around the world to advocate for freedom of conscience in the practice of medicine, but the pressures are immense. Several jurisdictions in Canada became the first in the world to require effective referrals with the threat of potential disciplinary action, and California will shortly join them. Once death is deemed a form of health care, health care “providers” will be expected to offer it.

Medical assistance in dying is legal in ten US states and the District of Columbia, where thousands have lawfully been prescribed life-ending medications in the past decade and a half. It is also practiced in seven countries.

Christians should pay special attention to the evolution of ethical and cultural acceptance in Canada, because the US may not be far behind. California, where euthanasia has been legal for six years, significantly eased restrictions on assisted death this past January.

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The story of how euthanasia came to Canada runs much deeper than the deliberations of academics or the machinations of courts. It is in part a story of the triumph of aesthetics over ethics.

The case for assisted death was grounded not so much in rational moral deliberation but rather in the appeal of taking control over death. Alasdair MacIntyre observed that emotivism is now the dominant moral paradigm. For emotivists, something is good simply because it feels good. And assisted death, some have argued, just feels right.

It is also the story of how secularism can function in a surprisingly religious manner. There was a time when the fear of death prevented us from using death to escape earthly suffering. Contemplating suicide, Shakespeare’s Hamlet was dissuaded by “the dread of something after death / The undiscovered country, from whose bourn / No traveler returns.” Conscience, he concluded, “doth make cowards of us all.”

If suffering is absurd, it can seem natural, even rational, to choose death.

But if God is dead, conscience no longer calls for caution. We assume we know what death brings. One Canadian provider, sounding more like a priest than a physician, confidently described assisted death as “a peaceful transition into the afterlife,” a claim that can never be tested in clinical trials.

(This hasn’t prevented “innovative” techniques: Last year, a Swiss euthanasia activist announced plans to test a 3D-printed “suicide pod” for a “stylish and elegant” assisted suicide experience). This practice expresses blind faith in a godless but no less religious concept of reality.

Most of all, this is a story of individuals struggling to find meaning in life and purpose in suffering. Quoting Friedrich Nietzsche, Jewish psychiatrist and Auschwitz survivor Viktor Frankl observed: “He who has a why to live can bear almost any how.” As “liberated” individuals, we insist on finding our own personal meaning, yet such invented meaning proves hollow when we are confronted with irremediable suffering.

How can suffering possibly be meaningful? What would make life with suffering worthwhile? If suffering is absurd, it can seem natural, even rational, to choose death. As the French author and playwright Albert Camus put it, “Dying voluntarily implies that you have recognized, even instinctively … the uselessness of suffering.”

How then can we as Christians respond to the matter of physician-assisted death? First, we can call upon reason and the light of nature to affirm absolutely the value of life. Assisted death and suicide is said to be a matter of respect.

But to value a person is to value their existence. A willingness to deliberately end someone’s existence therefore necessarily devalues the person. If people matter, we must not intentionally end them.

Second, our churches can be communities where assisted death is inconceivable because the weak, the aged, the disabled, and the dying are regarded as priceless members of the community. We can be a place where those who suffer enjoy the devoted companionship, love, and support that reminds them of their value and bears them up through pain. This is, after all, what all of us long for.

Third, we can advocate for access to the very best medical and palliative care for those who are suffering or dying. The palliative care movement was started by a Christian physician, Dame Cicely Saunders, and has transformed medical care at the end of life. Yet access to good palliative care in the US, Canada, and the rest of the world is still far too limited.

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We can also advocate for the right to freedom of conscience for doctors and nurses who care for the sick and dying, so that they are not forced to participate in assisted death.

Finally, the message of the cross of Christ we bear for the world empowers faith, hope, and love in the face of suffering and death. We have faith in God’s purposes for ultimate good, we have hope in God’s power to redeem, and we have the love of God poured into our hearts.

Suffering cannot rob us of our true meaning—to know and commune with the one who gave himself for us. Indeed, by God’s grace it serves to deepen that communion. To depart and be with Christ is far better, but with patience and faith, we will wait for the master’s call.

Ewan C. Goligher is assistant professor of medicine and physiology at the University of Toronto.

If you or someone you know needs help, call the Suicide & Crisis Lifeline at 988 or text a crisis counselor at the Crisis Text Line at 741741. In Canada, call Talk Suicide Canada at 1-833-456-4566.

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