Mark D’Souza: A warning from Canada on euthanasia – do not open Pandora’s Box

Mark D’Souza is a Toronto-based physician and author of Lost and Found: How Meaningless Living is Destroying Us and Three Keys to Fix It.

As a former palliative care physician, I left the field when my line in the sand – conscience rights – was crossed. Canada’s embrace of euthanasia has transformed from a supposed “rare and exceptional” measure into a dystopian nightmare.

What begins as a compassionate act inevitably morphs into a witch’s brew of moral ambiguity, economic incentives, and quiet coercion. Once the legal door opened, it quickly became apparent that for the activists driving the agenda, the revolution would not stop there.

Now, with the United Kingdom on the precipice of legalizing assisted dying, understand this: once Pandora’s box is opened, the bait and switch begins.

Canada’s journey began with the passage of Bill C-14 in 2016. This was neatly branded under the Orwellian doublespeak term of “Medical Assistance in Dying”, or MAiD for short; a name so sanitized, you might mistake it for a home-cleaning service.

At the time, the law restricted euthanasia to individuals whose deaths were “reasonably foreseeable.” The vagueness of this definition was intentional, leaving room for interpretation. Four years later, Bill C-7 removed even this restriction, permitting euthanasia for those whose deaths were not imminent. The next frontier – euthanasia solely for mental health conditions – has been temporarily delayed, but how long until it resurfaces?

In less than a decade, Canada has found something else to dominate besides ice hockey: euthanasia. In 2023, 4.7 per cent of Canadian deaths (about 15,000) were due to assisted suicide – just shy of the Dutch at five per cent – but we boast the fastest-growing euthanasia program in the world. Only 3.5 per cent of requests are declined, and with criteria so broad, poverty and homelessnes now seem like valid justifications.

Lonely? Sign up today! Half of non-terminally ill applicants cite loneliness. Disabled or struggling with mental health? You’re encouraged to enroll. Even Canada’s prison system is in on the action. And in our public-only healthcare system, where patients languish on waitlists instead of receiving actual care – and where financial and housing supports are often non-existent – is ending your life truly an autonomous decision? It’s as if the government is saying if you can’t live with dignity, at least you can die with “dignity.”

Ominously, physicians in my province of Ontario are legally required to omit any reference to euthanasia on death certificates, instead listing the underlying condition as the cause of death. The state’s Ministry of Truth enforces the fiction that these patients died naturally. Where in history has government-mandated linguistic misdirection to obscure uncomfortable truths ever ended well?

Make no mistake: activists have always had grander ambitions. Even at the inception of Canada’s euthanasia program, they wanted access for minors and disabled infants, and advance requests for dementia. These were dismissed as alarmist speculation – until they weren’t. Just recently, Quebec approved advance requests for dementia.

What endgame do they envision? On-demand euthanasia, as commonplace as ordering from McDonald’s? Would you like fries with that?

The economic pressures are undeniable. It’s estimated that euthanasia will save up to $139 million in precious healthcare dollars. (The Nazis also calculated government savings when people with disabilities were euthanized.) With an aging population, strained healthcare budgets, and intergenerational tensions over inheritance, euthanasia is quietly being smuggled in as a release valve for these societal challenges.

But at its core, this issue is a profound battle of values. Like wolves in sheep’s clothing, euthanasia activists often present themselves as paragons of compassion. But their definition is shallow. They claim to champion the downtrodden, suffering, and vulnerable. Yet true compassion demands depth. It means guiding addicts to detox and recovery, providing suffering individuals with palliative care and social supports, and creating the economic conditions whereby people can lift themselves out of poverty–not simply offering them a prescription for death.

In Canada, the values imposition became evident early on. When doctors objected to participating in any part of the euthanasia process on moral grounds, the activists insisted on “effective referrals,” which meant signing off on the procedure. It wasn’t enough for conscientious objectors to provide a patient’s chart or refer them to a hotline.

The message was clear: you must agree with us or face professional repercussions. That freedom of conscience is enshrined in the Canadian Charter of Rights and Freedoms was meaningless. This drive to enforce ideological conformity revealed the movement’s true nature. In 1984, Orwell suggested that it’s paramount for authoritarian regimes to control their subjects’ perceptions.

The field of medicine itself is being reformatted away from its foundational principle of “do no harm”, as well as the explicit forbidding of taking a life in our Hippocratic oath. This is part of a wider trend of medicine, where even this millennia-old oath has been rewritten to make medicine about social justice activism. Consequently, the patient’s well-being becomes subservient to the state’s moral vision.

As death cafés where people talk about death spring up around the world, and death doulas have become a profession, it looks like tradition is fighting a losing battle.

But re-engineering medicine’s ethical foundation wasn’t enough – the next step was to rebrand death itself. Activists teamed with the utilitarian Canadian government to romanticize death with first-rate marketing. Something that was until recently criminal has suddenly become accepted as a default moral position. To name just a few examples, euthanasia was briefly advertised in an urgent care waiting room, and Canadian fashion retailer Simons produced a glossy cinematic tribute to the assisted suicide of a woman in her thirties. (The Nazis, too, had their own propaganda filmsnormalizing euthanasia.)

Russian novelist Fyodor Dostoevsky foresaw that the atheist left might one day produce scores of people choosing suicide if the physical pain of the procedure was nullified. In Demons, his ultra-rationalist character Kirillov took his own life as an assertion of absolute autonomy, believing that by choosing death, you can become your own god. Has Dostoevsky’s nightmare become reality in Canada, where the state eagerly facilitates this “ascension”?

But what starts as existential autonomy soon transforms into societal expectation. “Last resort” is where it starts, but I guarantee this is not where it ends. Give the activists an inch and they will take a mile.

Britain proposal includes a multidisciplinary panel representing law, psychiatry, and social work. That is a significant safeguard, but not a foolproof one. Even such luminaries can be bullied by activists who moralize dissenters as cruel and uncaring. The superficial social and emotional levers of control belong to the activists, and are very difficult to counter outside of a thorough debate.

As healthcare resources grow scarcer and societal narratives portray the elderly and disabled as burdens, euthanasia becomes less of a choice and more of an expectation. This is where the right to die will have transformed into a duty to die.

To the UK, I offer this warning: do not open Pandora’s box. Euthanasia is not merely a medical procedure; it is a profound shift in how society values life. Say no to state-sanctioned death. Because once you start down this path, there is no turning back, and inevitably the slippery slope gives way to freefall.