If you've ever wondered where the much feared slippery slope ends up, it has to be Canada.   Opponents of MAID grow apoplectic describing in mock horror the extremes to which our northern neighbor allow their MAID law to bend, seemingly willy-nilly and without even a modicum of screening.  It's as if, horror of horrors, the law were designed to make assisted dying easily accessible, rather than festooned with redundant safeguards, failsafes, endless waiting periods and other obstacles, as is the case in the relatively few US states which have enacted legislation.  Take, for example, a recent cover story in the prestigious conservative journal National Review-- "Pushing Death: the Alarming Spread of Assisted Suicide". The author describes a system run amuk where MAID is pushed on the unwilling; where the  expansion of its availablity to those suffering from an illness for which death is not necessarily reasonably foreseeable has led to a 31% YoY increase.  Doctors opposed to MAID are chastised or professionally ruined and feel their commitment to saving people's lives and providing altneratives such as palliative care/hospice are ignored.  Catholic hospitals which do not allow MAID are nationalised by hostile governments to allow such services.

And nothing so outrages opponents as the imminent expansion of Canada's law to allow persons suffering from incurable mental or psychiatric illnesses to be able to avail themselves of the law.  This ground-breaking expansion of the law is scheduled to come into effect in March 2024 and will allow Canadians whose sole underlying condition is a debilitating mental illness to opt for MAID.  One woman particualry relieved of this amendment to the law is 47-year old 47-year-old Lisa Pauli whose lifelong anorexia has made her life unbearable and who may well qualify for the MAID law as amended next year."Every day is hell," she said. "I'm so tired. I'm done. I've tried everything. I feel like I've lived my life."

There has been pushback in Canada to the expansion allowing severe mental illnesses to qualify for MAID, as if people with psychiatric suffering are incapable of a rational decision concerning their own autonomy.  Several practicing Canadian psychiatrists responded eloquently, explaining that Canada's law is not outside the mainstream of what other countries have implemented, and from an ethical point of view is consistent with the notion that all suffering patients need to be treated equally.

What is important to note is that while opponents of MAID view Canada's ever expansive law as proof positive of the slippery slope towards the bottom, for MAID advocates around the world Canada is the Promised Land.

What Canada has chosen to implement is a law which recognises that it is a basic human right when confronted with a terminal illness or an incurable illness causing immense suffering, whether physical or mental, the right to say "Enough is enough.  I'm done!"  Opponents cannot accept such a creed.  They believe, as did English kings of old, that the State has a vested interest in preserving everyone's life, regardless of their preferences.

Canada makes MAID as accessible as can be-- an applicant must confer with a qualified physician to ensure they are indeed either near death or suffering from an illness which causes intolerable suffering.  In the US, by contrast, the individual has to have a life expectancy of less than 6 months.  In Canada, the physican, at the patient's request, can adminsiter a fast-acting barbiturate intra-venously which is near full proof.  By contrast, in the US, the individiual must be able to self adminster a 4-drug cocktail which only takes effect when it enters the gastro-intestinal tract, leading at times to as long as a 20 hour dying process.   And of course, those unable to self-adminster, because of paralysis, or severe tremors, are cruelly (and some would argue unconstitutionally)   excluded from the law.  Finally, in Canada, there is no criminal or civil liabilty for a loved one who helps the patient to have the medicine adminstered, unlike in 35 states where a loved one helping somone to self adminiser a terminal cocktail can face prosecution as a felon.

One innovation now pending is a law passed in Quebec, which would allow the execution of a SADD-- a Supplmental Advanced Directive for Dementia to allow a health care proxy to determine if the principal has reached a state of advanced dementia and would want a doctor to euthanise them.  It is not clear if the Canadian Federal Goverment will challenge or adopt such a law.

Most people agree Canda has dramatically simplified the applicaiton process and expanded the availablity of MAID.  So one might expect that the number of people using MAID would have risen to alarming, almost epidemic, numbers.  The truth is the opposite.  In the last year of recorded data, 2022, only 4.1% of all deaths in Canda were through MAID.  THe highest province was Quebec with 6.6% uptake.  Canada's national average is lower than the Netherlands which has had the MAID law available since 1997 of 4.5%; neighbor Belgium which has also a very generous law averages 2.4% of all deaths.  By contrast, the highest percentage of the 11 US jurisdictions with MAID is Oregon, whose law was the first in the nation in 1997, at 0.8%.

What to make of the data compared with the apocalyptic prognosis of MAID oppoents, as exmeplied in the National Review cover story?  The take-up is in fact very modest indeed.  In the jurisdcitions with the highest percetnage usage, some 93.4% of eligible patients don't opt for MAID.  As facile, even trivial, as it is to get a presecription according to MAID's opponents  the overwhelming majority of people are happy to let nature take its course.  And that's a blessed thing.  Nobody wants people to use MAID if they prefer hospice or palliative care.  But everyone is happy to know that an option is there should they change their minds.  It is providing an option when the cancer, ALS or schizophrenia  seems to be making all the decisions which can give people hope, and a flickering but still glowing will to live.

So opponents may point derisively at Canada's MAID law as Apocalypse Now, causing an epidemic of wannabe suicides.  The truth is that very few people do make the choice even when it is readily available...but for those that do, it's a blessing and for those who let nature take its course, it's also a blessing which leads to better end of life care for all and a greater self awareness of one's agency and autonomy even at end of life.