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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.”

Zak Podmore did not bring down a corrupt mayor. He did not discover secret torture sites or expose abuses by a powerful religious institution. But there was something about this one article he wrote as a reporter for The Salt Lake Tribune in 2019 that changed my conception of the value of local news.

Podmore, then a staff journalist for the Tribune and a corps member of Report for America, a nonprofit I co-founded, published a story revealing that San Juan County, Utah, had paid a single law firm hundreds of thousands of dollars in lobbying fees. Among other things, Podmore found that the firm had overcharged the county, the poorest in the state, by $109,500. Spurred by his story, the firm paid the money back. Perhaps because it didn’t involve billions of dollars, but rather a more imaginable number, it struck me: In one story, Podmore had retrieved for the county a sum that was triple his annual salary.

[From the November 2021 Issue: A secretive hedge fund is gutting newsrooms]

You’ve probably read about the collapse of local news over the past two decades. On average, two newspapers close each week. Some 1,800 communities that used to have local news now don’t. Many of the papers still hanging on are forced to make do with skeleton staffs as their owners, often private-equity firms, seek to cut costs. The number of newspaper newsroom employees dropped by 57 percent from 2008 to 2020, according to a Pew Research study, leading to thousands of “ghost newspapers” that barely cover their community.

For the past 15 years, I have been part of an effort to reverse this trend. That means I’ve grown used to talking about the threat that news deserts pose to American democracy. After all, the whole concept of democratic self-government depends on the people knowing what public officials are up to. That’s impossible without a watchdog press. Researchers have linked the decline of local news to decreased voter participation and higher rates of corruption, along with increased polarization and more ideologically extreme elected officials. At this point, I can make high-minded speeches about this stuff in my sleep, with Thomas Jefferson quotes and everything. Recently, however, I’ve come to realize that I have been ignoring a less lofty but perhaps more persuasive argument: Funding local news would more than pay for itself.

Unlike other seemingly intractable problems, the demise of local news wouldn’t cost very much money to reverse. Journalists are not particularly well compensated. Assuming an average salary of $60,000 (generous by industry standards), it would cost only about $1.5 billion a year to sustain 25,000 local-reporter positions, a rough estimate of the number that have disappeared nationwide over the past two decades. That’s two-hundredths of a percent of federal spending in 2022. I personally think this would be an amount well worth sacrificing to save American democracy. But the amazing thing is that it wouldn’t really be a sacrifice at all. If more public or philanthropic money were directed toward sustaining local news, it would most likely produce financial benefits many times greater than the cost.

What do government officials do when no one’s watching? Often, they enrich themselves or their allies at the taxpayers’ expense. In the 2000s, some years after its local paper shut down, the city of Bell, California, a low-income, overwhelmingly Latino community, raised the pay of the city manager to $787,637 and that of the police chief to $457,000. The Los Angeles Times eventually exposed the graft, and several city officials ended up in prison. Prosecutors accused them of costing taxpayers at least $5.5 million through their inflated salaries. These salaries were approved at municipal meetings, which is to say that if even one reporter (say, with a salary of $60,000) had been in attendance, the city might have saved millions of dollars.  

Sometimes the work of journalists prompts government investigations into the private sector, which, in turn, produce fines that go into the public’s bank account. After the Tampa Bay Times found that a battery recycler was exposing its employees and the surrounding community to high levels of lead and other toxins, regulators fined the company $800,000. A ProPublica investigation into one firm’s questionable mortgage-backed securities prompted investigations by the Security and Exchange Commission, which ultimately assessed $435 million in fines. A review of more than 12,000 entries in the Investigative Reporters and Editors Awards found that about one in 10 triggered fines from the government, and twice as many prompted audits.

In other cases, local-news organizations return money directly to consumers by forcing better behavior from private institutions. MLK50, a local newsroom in Memphis, teamed up with ProPublica to report that Methodist Le Bonheur Healthcare had sued more than 8,300 people, many of them poor, for unpaid hospital bills. In response, the faith-based institution erased nearly $12 million in debt.

Of course, most journalism does not convert quite so immediately into cash on hand. The impacts may be enormous but indirect. One study of toxic emissions at 40,000 plants found that when newspapers reported on pollution, emissions declined by 29 percent compared with plants that were not covered. The study did not track the ripple effects, but it stands to reason that residents in the less polluted areas would have fewer health problems, which in turn would translate to lower medical costs and less lost work time. Another study, by the scholars Pengjie Gao, Chang Lee, and Dermot Murphy, looked at bond offerings in communities with and without local news from 1996 to 2015. It concluded that for each bond offering, the borrowing costs were five to 11 basis points higher in the less covered communities. That translated to additional costs of $650,000 an issue, on average.

[Amanda Ripley: Can the news be fixed?]

One academic tried to track the economic effects even further downstream. In his book Democracy’s Detectives: The Economics of Investigative Journalism, the Stanford professor James Hamilton looked at a series by KCBS in Los Angeles that uncovered a flawed restaurant-inspection program. The exposé prompted L.A. County to require restaurants to display their inspection scores, which in turn led to a 13.3 percent drop in L.A. County hospital admissions for food poisoning. Hamilton estimated a savings of about $148,000. In another case study, Hamilton analyzed a series by the Raleigh News & Observer that found that, because the state criminal-justice system didn’t adequately keep track of those under supervision, 580 people on probation in North Carolina killed someone from 2000 to 2008. After the state implemented reforms, murders committed by people on probation declined. Applying the statistical “value of human life” used by the U.S. Department of Transportation, Hamilton concluded that society saved about $62 million in just the first year after the policy changes. The series cost only about $200,000 to produce.

Ideally, investment in local news would come from the federal government, which has more freedom to think long-term than cash-strapped states and municipalities do. The Rebuild Local News coalition, of which I am president, supports legislation that would provide a refundable tax credit for news organizations that employ local reporters, and a tax break for small businesses that advertise in local news. A new version of the bill was just introduced in the House of Representatives by the Republican Claudia Tenney and the Democrat Suzan DelBene. Civic-minded philanthropists focused on high-impact donations should also put money into local news, given the likely societal returns. It’s impossible to quantify exactly how much money would be generated for government and consumers by restoring the health of local news. But it’s nearly as hard to deny that the investment would pay off handsomely. And the saving-democracy part? Well, that’s just gravy.