Governments that promote euthanasia do so with the utmost commitment to preserve respect for the freedom and autonomy of their citizens and with the sole intention of providing solutions to a life of “suffering due to an incurable disease or condition that the person experiences as unacceptable and that has not been alleviated by other means”.

The reality, however, is that in countries where euthanasia and assisted suicide have been regulated, the criteria for euthanasia are gradually being relaxed, to the point of ending the lives of people without incurable diseases, of those with disabilities, mental illness or without an explicit request.

As far back as 2002, countries such as Belgium, the Netherlands and Luxembourg legalized euthanasia and assisted suicide by prescription of a lethal medication for self-administration.

What is quite certain is that the approval of these laws implies significant savings in healthcare costs for government coffers. A paradigmatic case of this situation is what has been happening in Canada.

Since 2016, Canada has had a bill (C-14) allowing euthanasia and physician-assisted suicide. Both forms of ending a life are included in the concept of “Medical Assistance in Dying” (MAID). Here again we find the issue of language, using euphemisms like “medical assistance in dying” to avoid terms such as euthanasia or assisted suicide that clearly define these practices but may be perceived more negatively by the public.

According to data collected in the third annual report on “Medical Assistance in Dying” (MAID) in Canada 2021, the Ministry of Health recognizes more than 30,000 deaths under this bill. In the Canadian province of Quebec, 5.1% of deaths are due to the practice of MAID.

Bill C-14 permitted MAID for adult Canadians diagnosed with a “grievous and irremediable medical condition”, through a request to be signed by two independent witnesses, with the opportunity to withdraw the request at any time and after a mandatory period of reflection.

However, in February 2021, a new law (C-7) came into force that repealed the requirement for natural death to be “reasonably foreseeable”, in order to qualify for MAID; consequently, it opens up the possibility of being able to cause death to people with non-terminal chronic diseases, disability, or with physical or psychological suffering considered intolerable.

Bill C-7 initially excluded psychiatric disorders from the grounds for seeking MAID, as did its precursor C-14. However, there was some confusion with regard to the concept of psychological suffering, which was indeed provided for in the Bill as a reason for requesting MAID.

This exclusion of mental illness to access MAID was considered by advocates of euthanasia as discrimination of people with psychiatric disorders. As a result of this controversy, an amendment was presented to the Canadian Senate that, 18 months after the adoption of Bill C-7, removed the exclusion of MAID for the mentally ill and accordingly, euthanasia and assisted suicide could now be applied to patients with psychiatric disorders.

The ethical implications of this decision — which expands on those of euthanasia and assisted suicide — are huge and a prime example of how the law of the slippery slope is fulfilled: once the existence of expendable lives has been accepted, there are no longer any reasons or rational restraint to limit what is considered a right.

In the words of Wesley J. Smith JD, a well-known American lawyer and writer, “Once a society accepts doctor-prescribed death as an acceptable answer to human suffering or as some kind of fundamental liberty right, there are no brakes. We only need to look at European countries that have gone down the Euthanasia Highway to see how society is impacted deleteriously by accepting killing as a suitable answer to the problem of human suffering”.

This and other similar laws that allow the application of MAID to the mentally ill will mean a radical and profound change in the professional practice of psychiatrists. They must decide “which suicides should be prevented or which should be allowed or abetted”. And questions will be asked, such as to what extent should suicide prevention efforts continue to be pushed, if assisted suicide is considered an option in patients with persistent depression? This is another clear example of progressive permissiveness with restrictive measures that highlights the reality of the “slippery slope”

Another striking aspect of the C-7 Act is that it establishes a two-tier system for access to health services. Terminally-ill patients can be evaluated for euthanasia, and may even be administered it on the same day, with no waiting period. Meanwhile, patients who do not have a terminal illness may have to wait 90 days or more to be seen for psychiatric or other treatments. As a result, the despair and helplessness of those waiting for an alternative to manage their situation is exacerbated, with respect to those who, at a certain point at which they experience intense suffering, are provided with the resources for MAID extremely quickly.

A debate has now begun in these countries about “other non-medical conditions” not directly related to health, such as lack of meaning or existential fatigue to justify euthanasia or assisted suicide. In Switzerland, there are also different associations that offer the means to self-administer lethal medicines to carry out assisted suicide. This is leading to the emergence of so-called “death or suicide tourism”…. a slippery slope with no brakes.

Data on euthanasia and assisted suicide practices in Canada

The data collected in the third annual report on “Medical Assistance in Dying” (MAID) in Canada 2021 are extremely revealing of the impact of this law and the real impact of the slippery slope effect.

In 2021, 10,064 euthanasia or assisted suicide practices were performed in Canada, accounting for no less than 3.3% of all deaths in the country. This figure represents a 32.4% increase compared to the figures in the 2020 report.

The progressive permissiveness of the MAID laws has led to a parallel growth in the number of these practices that is clearly visible in light of the data on the number of euthanasia acts and assisted suicides carried out:  in 2016, 1,018 were performed, in 2017 there were 2,838, in 2018 the number of cases had already risen to 4,480, in 2019 they reached 5,661, in 2020 there were 7,603 cases, and the aforementioned 10,064 cases in 2021. That is, a total of 31,124 deaths due to euthanasia and assisted suicide in Canada since 2016, the first year of application of Bill C-14, later expanded and amended by Bill C-7.

These data reveal a deep substantive social problem that is taking root in first world countries. It is a simplistic vision in which life only makes sense without suffering.  This ends up making us increasingly vulnerable to the unwanted reality, highlighting our great difficulty — if not complete inability, personal, social and political — to face it.

The lack of personal resources in the face of suffering translates into a society with less and less tolerance for frustration. “In this society of multiculturalism, globalization, emotivism, individualism, of digital, technological and scientific revolution and ideological relativism … suffering has no place.

Happiness and suffering appear as opposites, immiscible and incompatible. The search for happiness thus becomes a mere flight from suffering.

In our Western societies, suffering is not expected, it should not exist: it is even considered a right not to suffer. When it appears… it is a “failure of the system”.

This leaves us increasingly exposed and helpless in the face of inevitable suffering, in the face of the meaninglessness of suffering that we do not know how to interpret; and for that very reason, we cannot incorporate it into our lives, so much so that we are incapable of assuming it and coping with it, that we prefer to cause death, ending the suffering, yes, but also ending everything…absolutely everything that makes us human.

In our modern society, in order to avoid suffering, there are more and more “renunciations” of life; of that real, non-idealized life in which good is present, but also evil; and therefore suffering as the personal experience of that evil .

The economic dimension of euthanasia and assisted suicide

Euthanasia and assisted suicide undoubtedly have another very significant dimension that is not usually emphasized but which, nevertheless, is very important to understand the reality we are experiencing: the economic impact of their implementation.

To a large extent, one can understand the interest of certain governments in facilitating and promoting these practices because, in short, they allow an early end to the lives of socially unproductive citizens with a high consumption of public and social resources.

They are measures with a not inconsiderable impact on the state accounts, which entail significant economic savings without a significant electoral cost, as they are described as a social advance and not as a cut in investment in care for the most vulnerable. They are often justified by arguments such as the fact that healthcare costs to care for patients in their last year of life are “disproportionately” high: these individuals account for only 1% of the population, but consume between 10-20% of healthcare costs. This is without taking into account that, in addition to spending, the vast majority are socially unproductive due to their own personal situation.

But let’s provide some figures: in Canada, since these practices were legalized in 2016, the state has saved 66 million dollars. It seems evident that the “slippery slope” progressively translates into more and more savings.

The more outspoken proponents of euthanasia — such as Hemlock founder Derek Humphry — have admitted that cost control is the “undeclared argument” in favor of legalization.

Researchers at the University of Calgary say the savings could be as much as $139 million annually.

While the economic argument is not publicly admitted or used to defend the euthanasia stance because of its difficult ethical fit, it is undoubtedly a “side effect” much appreciated by governments that legalize and encourage euthanasia and assisted suicide.

Germán Cerdá

Bioethics Observatory – Institute of Life Sciences

Catholic University of Valencia



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