By Christina Lamb and Daniel Wainstock

Judith Butler once wrote, “Precisely because a living being may die, it is necessary to care for that being so that it may live. Only under conditions in which the loss would matter does the value of the life appear.” As the Assisted Dying (AD) debate progresses following its passage through the UK Parliament, this perspective cuts to the heart of what’s at stake: does the value of life only come to light when we recognize the fragility of its end?

At the forefront of the UK’s Assisted Dying debate is the push to make AD legally available for those with terminal illnesses. Terminal illness is a stark reality for many Britons, and much has rightly been said about the courage shown by those confronting such illnesses. Yet, as we move into the implementation phase, little attention has been given to the broader social and ethical questions: What does it mean to die, and how might death be meaningful outside an AD context? What can we learn from other places where AD exists? Moreover, if the bill becomes law, healthcare professionals will be the ones to carry out these decisions—a role that brings significant ethical challenges deserving thoughtful consideration.

Let’s look at Canada, where the meaning of death and dying has taken a back seat to their Medical Assistance in Dying (MAiD) program. Fast becoming a fixed feature of their healthcare system, in the 8 years since the decriminalization of AD into Canadian healthcare, an average 36 Canadians die each day from AD, typically at the hands of a clinician. This means that healthcare professionals regularly enact death. However, research from Quebec, Canada – arguably the most liberal province in favour of AD – shows that even when healthcare professionals support AD, some stop enacting death related, in part, to the emotional and psychological effects of killing people.

Contrary to popular demands to legalize AD for terminal illness, annual reports show Canadians are choosing death because they will lose the ability to do something. This means Canadians are not solely choosing AD for terminal illness. Wait times have reduced to AD being requested and enacted in the same day; no one needs to be terminally ill to receive AD, and totally dependent persons, such as neonates with severe disabilities may be next in line in Quebec to receive AD. AD was initially thought to be safeguarded by being available solely upon patient request. Now, Canadians with disabilities and in poverty are being offered AD. In another instance, AD was suggested to a veteran. As slippery slope critics predicted, Canada’s AD program has derailed.

For some, the Canadian situation might be a distant concern at best, and a radical comparator at worst. After all, AD in Canada evolved out of a rights-based rationale. When this happens, lack of access to AD can be touted as unfair and discriminatory. Interestingly, the language, momentum and justification in Britain to legalize AD isn’t too far off from the push for AD in Canada. But if the Canadian problem isn’t a deterrent, and, recent history doesn’t put you off, here are some other considerations that rarely surface in public and political AD debates in the west.

In 2022, the Lancet published a report on their Commission on the Value of Death: Bringing Death Back into Life. Contributors outlined the reality that worldwide, people are afraid of dying and death. Death is rarely talked about in healthcare. At the same time, death is becoming rapidly medicalized into western healthcare while few efforts are being made to improve palliative care. In the UK, hospice care is inadequate and subsequently unavailable to all dying Britons. Western healthcare systems are fiscally strained, without human resources to fill the care and access gaps. Basically, AD has been or could be implemented into inhumane healthcare.

What does this mean?

Proponents of AD say we shouldn’t let people suffer and everyone has the right to die and AD  offers people the choice to die with dignity. We can all agree that dying people shouldn’t suffer. Yet, the remit of healthcare isn’t to intentionally let people suffer. Instead, it is better to think about what kind of suffering dying people experience. Most if not all suffering from pain is resolved with excellent palliative care. Where that option doesn’t exist, it is paramount to forge opportunities for palliative care to become available. Because choice becomes less relevant when you don’t have options to choose from.

In terms of dignity, there is nothing undignified about falling ill, dying or death. Death marks our finitude: it brings us purpose. If we decide to live wholeheartedly, we need to think about ways to build communities of care, where people don’t have to be afraid of unnecessary pain and where dying can be re-appreciated as part of living. Leading international moral psychologist Jonathan Haidt points out that one of Sociology’s most significant contributions to the world has been the discovery that when people unite in communities to uplift and hold something sacred in common, people’s happiness increases, and suicide rates drop.

Regardless of how you view AD, the fact that people are seeking it should prompt us to compassionately consider why. But if we think the answer lies in advancing AD, as the best way to exercise choice and maintain dignity, we are failing to recognize the current, seismic care and values gaps in society and healthcare regarding the meaning of dying and death.

If the Assisted Dying movement teaches us anything, it is this: we’ve barely scratched the surface of understanding what death truly means and how dying can be a profound and meaningful part of life. This realization urges us to reflect deeply on our values and practices surrounding death, prompting us to reimagine a society and a healthcare system that honors the significance of life’s final chapter, transforming death from a topic of fear to one of meaningful dignity, compassion and understanding.

Authors: Christina Lamb and Daniel Wainstock

Affiliations: CL: Athabasca University; CCBI, St. Michael’s College, University of Toronto, Canada ; DW: Pontifical Catholic University of Rio de Janeiro, Brazil

Competing interests: None to declare