The Canadian Way of Death

The nation legalized assisted suicide—and exposed the limits of liberalism, David Brooks wrote in the June 2023 issue.

“The Canadian Way of Death” is a must-read for anyone dealing with prolonged suffering or observing it in loved ones. Rarely has incisive research been combined with a humane perspective so convincingly and compellingly. Thank you, David Brooks, for expressing so well the underpinnings of our deep doubts about assisted suicide.

Susan C. Matson
Hightstown, N.J.

My husband chose to have medical assistance in dying years after receiving a terminal cancer diagnosis. Reading David Brooks’s article, I feel he romanticizes the value of life and dismisses the extreme suffering and stoicism of those who are dying, and in doing so, he vilifies MAID administrators and physicians, who provide the option of a dignified and carefully chosen form of death. My husband was a life-affirming person; his motto was “Life is good.” For seven of the 10 years that followed his cancer diagnosis, he received extraordinary care from a team of amazing cancer specialists and lived a rich, active, and meaningful life. He selected MAID because despite his extraordinary life force, he needed to be released from extreme suffering, immobility, and pain. His decision permitted a month of meaningful visits with his family members and allowed them to be gathered around him at the moment of his death, neither of which could have happened without MAID. I wish Brooks had considered both the strict procedures in place to protect vulnerable applicants and the stories of people like my husband. Brooks’s analysis, which paints MAID administrators as unfeeling, unethical bureaucrats who “erase” human dignity, does an immense disservice to these courageous and caring professionals, and to those humans who love life but in their suffering deliberately choose a dignified path for leaving this Earth.

Daiva Stasiulis
Ottawa, Canada

The “gifts-based liberalism” that David Brooks describes sounds like a dog whistle on behalf of anti-abortion advocates. If the right to determine how one ends their life emerges from the wicked frontiers of liberalism run amok, is the same true of the right to terminate a pregnancy? I wish Brooks had clarified how—or if—they differ.

Sigmund Kolatzki
Crossville, Tenn.

The public debate over Canada’s MAID policy has been much richer than David Brooks suggests, more subtle and humane than the bald assumptions he attributes to “autonomy-based liberalism”—that “I am a piece of property” and “the purpose of my life … is to be happy.” MAID involves complex, morally difficult decisions. Cramming it into an argument about liberalism does it a disservice.

Richard Harris
Hamilton, Canada

“The Canadian Way of Death” is one of the most thought-provoking articles I have ever read. I’ve always been in favor of allowing assisted suicide, and I still am—but now with reservations.

Without realizing it, I have been living the philosophy of autonomy-based liberalism; I wasn’t aware of gifts-based liberalism’s more nuanced approach to life. David Brooks made such a compelling argument for this viewpoint that I’ve had to reevaluate my own position.

Gary Rosensteel
McMurray, Pa.

As a retired geriatrician and medical educator, I found “The Canadian Way of Death” extremely misleading. I am a longtime proponent of MAID and have advocated for it publicly—but I would never be in favor of a system that allowed doctors or nurses to give lethal injections to anyone. Most of my colleagues with whom I interact in this space feel the same way: Indeed, of the 10 U.S. states that have adopted MAID, none permits providers to give lethal injections.

In the U.S., Oregon has the longest track record with MAID; it was passed by a ballot measure in 1994. Over the decades, nothing even remotely resembling what David Brooks describes has happened in the state. To be eligible, patients must be mentally competent, have less than six months to live, and, most important, administer the lethal medications themselves. Thirty to 40 percent of people who receive a lethal prescription never use it. The majority of patients are financially stable, contradicting the “slippery slope” that critics like Brooks claim is inevitable. To suggest that MAID legislation will lead to the Canadian model ignores an abundance of data from U.S. programs and does a disservice to those of us who wish to see other states adopt it.

Robert L. Dickman
Newton, Mass.

I consider myself closely aligned with what David Brooks calls “gifts-based liberalism,” yet I support the Canadian MAID policy. Society should aim to make aging dignified and as pain-free as possible—but it should also create an honorable place for a person who is ready to die and seeks help in making that choice.

My grandmother died at home with little medical intervention. The integration of her death into the life of the family was a source of bonding. But that type of bond is largely broken: Seniors are housed apart. We employ every medical skill to extend their lives—and their suffering. My mother languished with dementia for several years before her body let her die. The last lucid words she said to me were, “Why does it take so long?”

The repetition of this personal tragedy across thousands of families opened Canada to a debate about MAID, and now the policy makes it possible for Canadians to say goodbye and to die with much less suffering. I agree that we should age with pride, finding new ways to live and to contribute. But we also need to recognize that the decision to die may be another way to affirm life. Brooks should have looked more deeply into the Canadian experience with MAID and the debate in Canada about its future.

Norman Moyer
Ottawa, Canada

I would consider myself a “gifts-based liberal.” What David Brooks wrote about viewing yourself as part of a procession, of building a society in which the greatest achievement is just to participate, to be engaged and present with one another, really resonated with me. But I disagree that MAID is necessarily antithetical to such a view. Sick people do not exist to show healthy people, as Brooks puts it, “what is most important in life.” They don’t exist to awe us, the healthy people, with their “unbowed spirit,” to borrow Wilfred McClay’s phrase, even in the face of debilitating illness. I think this framing undercuts the actual, exhausting pain that chronically ill people suffer from. MAID, at the very least, shows that we as a society are willing to see that pain. MAID can be framed as empathetic, rather than calculating and autonomous.

Kate MacDonald
Toronto, Canada

David Brooks replies:

I’m grateful for the intelligent and heartfelt letters I received. As I wrote in my essay, I don’t oppose assisted suicide for people in great pain and near death. Nor am I dog-whistling for the anti-abortion movement. What troubles me is Canada’s rapid expansion of its law beyond its originally well-defined limits. That’s a failure of public philosophy. Law ought to venerate life above individual choice. I’d be curious to know whether my critics think that if people are persistently suicidal, we should do nothing to prevent them from acting on that choice.

American states, such as Oregon, that have assisted-suicide laws have not experienced the slippery slope I identify, because people have set reasonable limits on their programs. In the years to come, I’m hopeful that Canada will do the same.

Behind the Cover

This month’s cover story, “The Ones We Sent Away,” is a personal essay about Adele Halperin, Jennifer Senior’s aunt, who was born with a condition known as Coffin-Siris syndrome 12. In 1953, Adele was institutionalized while still a toddler and spent the rest of her life living apart from her family. Senior’s essay examines how America’s treatment of people with disabilities has evolved and considers what her family lost by sending Adele away. Our cover image is an illustration by Georgette Smith that imagines a young Adele separated from her family.

— Oliver Munday, Associate Creative Director

This article appears in the September 2023 print edition with the headline “The Commons.”