“Once you accept that people ought to have autonomy—once you accept that life is not sacred and something that can only be taken by God, a being I don’t believe in—then, if you’re in that work, some of us have to go forward and say, ‘We’ll do it.’ ”
Jonathan Reggler, family physician, Vancouver Island.
This quote was part of a long review of MAiD law, policy and practice written by Elaina Plott Calabro, titled Canada is Killing Itself printed in The Atlantic Magazine, August 11, 2025. It’s a great article, well worth reading, but behind a paywall. I could have chosen other quotes to lead my post, but this one, for me, gets at the existential essence of the problematic way in which medical assistance in dying is operating in Canada — and it IS operating, full tilt. Over 60,000 people have ended their lives with the help of a doctor or nurse practitioner since the system’s inception — and that’s from the latest report, which is already two years out of date.
Calabro writes that “this is the story of an ideology in motion, of what happens when a nation enshrines a right before reckoning with the totality of its logic. If autonomy in death is sacrosanct, is there anyone who shouldn’t be helped to die?”
Is autonomy in death sacrosanct? If so, is it pretty much the only value that counts anymore? And why doesn’t that value, autonomy in death, require that the individual be the one to take the pill, insert the syringe, pull the trigger or the plug? How does handing over one’s power to a doctor or nurse, whether at the end of natural life, or at the end of one’s patience with it — how does that even qualify as autonomy? In Canada, it qualifies because the person signed the paper, or was deemed to have consented more informally. Was there pressure, either from a system strapped for cash, or from an impatient relative? We will never know because death has ended each discussion. (Provincial Coroners have established panels to review cases after the fact, and doubts have been raised in more than one case.)
But I’m here to tell you that disabled people feel pressure. After all, people are dying to avoid becoming like them, whether through aging, injury or illness: needing assistance with personal hygiene, facing limits on their activities including earning power, facing the social stigma and rejection that come from occupying an unusual, altered or changing body. Many non-disabled people, including medical professionals, cannot conceive of why disabled people are still alive. “Don’t we have MAID for people like you? Why haven’t you “chosen” it yet? ” While that is a made-up quote attributable to nobody but me, I have spoken to enough disabled folks who have encountered this attitude from social workers, food bank personnel, riders on public transit, people on the street, etc., to feel confident in my suspicion that I’m not all that far off.
Back to the original question, though: is anything sacrosanct if you don’t believe in God? Is there anything we really need to be careful of, to treasure or protect? Is there anything “wrong” if there’s no God to say it is? Bioethicist, Dr. Raymond De Vries, writes, “As societies move from religious to scientific cosmologies, moral authority moves from the sacred to the rational.” He notes that “bioethics frequently bumps up against religion.” In other societies, less devoted to “rational” decision-making and more traditionally community oriented, autonomous decisions occur in a social context, “in consultation with … recognized authorities.” In Canada, however, it seems that doctors — along with family members and others — are expected to yield to the will of the autonomous patient who wishes to die. One of Canada’s MAID doctors, Madeline Li, argues that doctors need to take their professional consultation responsibilities seriously, instead of just bowing to the wishes of the patient. (She was quoted in the Calabro article).
It seems to me that Canada has veered dangerously towards the atomistic interpretation of “autonomy” to the exclusion of other, more communal, cultural interpretations of that word. The disabled community has strongly argued for the principle of “nothing about us without us”. I would point out they have NOT argued for “nothing about me without me”. Around the world, solidarity — the “us” of the disabled community — is the sacrosanct value. Whether you’re a doctor, a nurse practitioner, or anyone else, when you take one disabled person’s life, you take away a member of a community (whether or not the person knowingly, or even willingly, identified with that community). When you fail to support the continued existence of a person because you fail to find a way to support them in meeting their needs, you let down the whole community of people who share many or all of those needs.
According to de Vries, “bioethics, as a field, avoids discussion of human suffering. The commitment of bioethics to be the secular approach to moral decision-making has weakened the ability of the field to respond to (inevitable) suffering and to fully appreciate the ethical aspects of illness and its treatment.” This is particularly worrisome here in Canada, as a patient’s subjective suffering is the only yardstick by which to measure the patient’s eligibility for MAID. They have to have an illness, disease or disability that can be pointed to as the source of their suffering, but they need not try available treatment options, and they cannot be refused on the basis that they are not suffering enough, since such an evaluation would undermine their “autonomy”.
Dr. de Vries notes that, “In overlooking the universality of suffering, bioethics misses the opportunity to engage in a deeper understanding of who we are as humans – an understanding essential to moral foundations of medicine. Exploring suffering can tell us something about the nature of persons, the relationship between persons and their bodies, the goals of medicine, the relationship between persons and their communities, and the place of the spirit in the lives of individuals.”
Without engaging with these very human questions, assisted death is a technical matter of mechanics. How many syringes, which substances in what order, how many minutes until death can be pronounced. Clinical, disengaged and — may I venture — cold.
Is anything sacred if you don’t believe in God? I think so. I think anything requiring tenderness, patience, gentleness, kindness, empathy, solidarity — anything that calls upon us to be the best humans we can be under difficult conditions — those are the holy things. We don’t need God, religion, or the concept of a deity to tell us that. We just know.
Perhaps in my next post, I will address the other question that lingers from Calabro’s article: Why are Canadians killing themselves in such high numbers that doctors are having a hard time keeping up with demand?