The clock is ticking, with just over three months to go until euthanasia and assisted suicide are legal in New Zealand. After years of debate, only time will tell exactly what impact the End of Life Choice Act has on dying and on our society more generally. But in the meantime, we can glean clues about what’s in store for us from other countries reporting on their experience. The most recent cab off the rank is Canada’s annual report for 2020, featuring an eye-watering increase in what they euphemistically call MAID, or medical assistance in dying.
Here are the headline stats: over 7,500 Canadians were euthanised in 2020, representing 2.5% of all deaths in Canada, a growth rate of 34% on the previous year. That growth rate is growing—it was 26% the previous year—and a mere 6% of requests for euthanasia or assisted suicide were declined. The next time sometime tries to tell you that “slippery slope” arguments are invalid, show them this graph.
The Canadian authorities speculate that this growth is due to “increased awareness and greater acceptance” of euthanasia and assisted suicide. Presumably that means more Canadians now think that offering someone a lethal injection is an appropriate response to them suffering “loss of ability to engage in meaningful activities” (a reason for choosing euthanasia cited by 84.9% of patients) or “loss of ability to perform activities of daily living” (81.7% of cases) rather than, say, supporting those who are staring into the abyss. Some may see these statistics as a victory for autonomy and patient rights; others, like me, see them as evidence of an increasingly shallow and callous society.
If this weren’t enough, future stats are likely to look worse as the law has just been changed to remove one of the limitations on eligibility. In the past, a patient requesting euthanasia had to show that their “natural death” was “reasonably foreseeable.” That requirement, deemed unconstitutional by Canadian courts, was removed by lawmakers as of March 2021. It follows the same pattern seen in other jurisdictions, like Belgium, where the scope of euthanasia tends to expand over time.
There are some important differences between our End of Life Choice Act and the Canadian law, but unless we make a conscious and sustained effort to prevent it we should expect to see similar trends here. New Zealanders will only be eligible for euthanasia or assisted suicide if doctors think they are likely to die within 6 months, a tighter threshold than Canada’s “serious and incurable illness” that should keep our case numbers lower. But like Canada, and unlike jurisdictions like Oregon, we will be offered not just self-administered assisted suicide but doctor-administered euthanasia. In Canada last year there were just 7 cases of assisted suicide in 2020, which amounts to 0.09% of the total of 7,595, suggesting that people prefer death at a doctor’s hands to death at their own and that death rates are therefore likely to be higher when euthanasia is available.
I’ve argued previously that we can change this trajectory, that we can choose something other than the inexorable expansion of euthanasia. Canada’s stats remind us how hard we will have to work to achieve that, and how much is at stake if we don’t.