Built to Coerce: Canada’s Laboratory of Euthanasia

This article was published by The Pulse on October 14, 2025. The Pulse is the research publication for the Catholic Medical Association.

By Yuriko Ryan, DBe, MA, HEC-C

One summer morning my husband and I stepped into a Catholic hospital through a main entrance we both knew well. It was where he was born, where he practiced almost daily as a family physician for 35 years, where we returned to countless specialist visits, outpatient appointments, palliative care meetings with dear friends, and the joy of welcoming babies in the maternity ward. For us, the hospital was a constant holy presence, an unwavering witness to the dignity of life.

Previous articles about the Shoreline Space (Articles Link).

But this visit brought something unexpected into view. On the left wall, a new mural of muted mountains and shoreline scenes quietly caught our attention. There were no familiar reminders – no mission statement and no donor plaques. The absence felt unsettling and eerie. Beside the mural was a locked door, labeled not with Providence or St. Paul’s Hospital but with the name of the regional health authority and Shoreline Space. Outside it, elderly patients unsuspectingly sat in wheelchairs, on walkers, or on chairs, waiting for their ride in a handicapped-accessible van. This was the wall and the door to the euthanasia clinic, conjoined to our Catholic hospital. The mural and the doorway together became more than décor – they became a map of contested moral space.   

Canada – Laboratory of Euthanasia

Canada has transformed into a real-world testing ground for euthanasia – what the law calls medical assistance in dying (MAiD). Initially permitted only in cases of suffering with terminal illness, [i] MAiD has rapidly expanded through court challenges framed as rights. Law makers and healthcare systems have responded with unexpected enthusiasm by widening eligibility to include patients with chronic conditions, disabilities, mental illness, frailty, and various perceived sufferings.

By the end of 2024, around 90,000 Canadians had died by MAiD since it became legal in 2016.[ii] In 2023, MAiD deaths accounted for 4.7% of all Canadian deaths,^[iii] making it the fifth leading cause of death nationwide. The pace of growth is nearly the same proportion the Netherlands reached after twenty years.[iv] Today, MAiD requests are rarely denied. [v]

Article: There were around 16,500 euthanasia deaths in 2024 (Link).

Spatial Ethics

Spatial ethics, despite their significance to environmental and behavioral psychology,[vi] [vii] [viii] [ix] and moral theology, including principles such as cooperation with evil,[x] have received scant attention. Yet the arrangement of care spaces profoundly shapes our moral imagination and our moral discourse. Hospitals and hospices are not the only ones facing spatial ethics issues. Risks to patients or individuals residing in long-term care homes and other congregate housing settings may be elevated due to the shared use of common areas and, frequently, rooms among clients. They may not be able to express their concerns adequately due to their cognitive decline, serious chronic illness and comorbidities, lack of care advocates, language barriers, and loneliness and isolation. For patients with disabilities, frequently, the limited access to home care, disability support and services in their own communities result in unwanted hospitalization. And MAiD assessments are more readily available in hospitals. These care spaces may implicitly communicate to vulnerable populations that their lives are burdensome.

Built To Coerce

When my poster Built to Coerce: Ethics of Imposed Euthanasia (MAiD) Provision in a Catholic Hospital Space received recognition at the Catholic Medical Association conference, the moment was bittersweet. The award affirmed the urgency of examining how legal and healthcare structures can pressure Catholic and other mission-driven organizations, medical professionals, and patients toward euthanasia through spatial arrangements. Yet the recognition could not erase the grief that such coercion exists, nor the weight of knowing that euthanasia clinics are being embedded in contested care settings across the country, reshaping not only the geography of care but the very meaning of healthcare itself.

Meanings of Healthcare Space

Traditionally, healthcare spaces served as operational, missional, and moral actors. The euthanasia clinic I described is located immediately inside a main entrance of our Catholic hospital. Its placement – on the main floor, adjacent to high-volume outpatient specialty clinics and diagnostic labs and visible along corridor sightlines – functions as an operational and missional signal for the regional health authority and the government. It implicitly states who matters and who is deemed peripheral. Despite a pre-existing agreement signed two decades earlier, denominational healthcare organizations now face human-rights legal challenges and mounting pressure to provide euthanasia onsite in exchange for a license to operate and receive public funding. This forced presence demands collective moral reflection and renewed missional rigor – not only for Catholic healthcare organizations but for any organization striving to remain a witness to the dignity of life.    

On the Ground

British Columbia – our province – has the second-highest per capita rate of MAiD deaths across the country.[xi] By 2023, MAiD deaths had already surpassed deaths from illicit drug overdoses.[xii]In 2024, MAiD accounted for 6.7% of all deaths in BC.[xiii] [xiv] Of the 3,000 MAiD deaths in 2024, nearly 90 % were seniors aged 65 and over. 35% died by MAiD for “Other Conditions” – not cancer or cardiovascular diseases –, with frailty being the leading cause under the “Other” category. MAiD has become a solution to old age. In 2024, approximately 40% of all MAiD deaths in BC occurred in private residences.[xv] Their last breaths in the air of family spaces risk shared memories being tainted. Spatial ethics issues surrounding MAiD now touch every care and housing setting.[xvi]

It is not difficult to imagine how frail seniors reach such decisions, surrounded by cues embedded in care spaces. In hospitals, they overhear conversations about MAiD in multi-occupancy rooms or find pamphlets left at their bedside. In hospices, if MAiD is openly celebrated next door, the space begins to speak to the minds of the dying. Stand alone MAiD suites are also appearing in business complexes, without clear signage, mission statements, or donor plaques – eerily similar to Shoreline Space. One is built in direct view of a community dialysis clinic, remains unmarked with smoky windows, passed daily by unsuspecting patients and office workers.

A Warning to the World

Canada is a warning to the world as an experimental laboratory of euthanasia. When healing and killing share a wall, corridor, and a roof, they become each other’s gatekeepers, and the very meaning of healthcare space is at stake. An unsuspecting patient walking past a MAiD clinic is not only a Canadian story. It is a parable of what hospitals, hospices, and nursing homes elsewhere may soon confront. Built to Coerce was not only the title of a poster; it is the reality inscribed in our healthcare architecture. The question is not whether pressures will come – they already exist. The question is where we will find the courage to preserve spaces where life is reverenced before the geography of care is irresistibly altered.

Build to Care, Not to Coerce  

If Catholic healthcare is to remain a witness to the dignity of life, then MAiD-free zones cannot be left to chance, convenience, or the whim of those who promote euthanasia.  Catholic Medical Association members and all who serve in healthcare are called to remain a constant presence and an unwavering witness to the dignity of life, safeguarding spaces that are theoretically sound, theologically rooted, and morally grounded. Let us call our brothers and sisters, regardless of vocation, to build to care, not to coerce.

Dr. Yuriko Ryan is a bioethicist and gerontologist based in Vancouver, Canada. She serves on the Catholic Medical Association’s Ethics Committee and the International Ad-hoc Committee. Her writing explores the moral contours of artificial intelligence, aging, and end-of-life care, appearing in Momento, her weekly bioethics newsletter, and feature articles for AI and Faith. Through her lectures, publications, and committee work, she advocates for human dignity across all stages of life, guided by a Catholic lens. 

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[i] The Government of Canada. Medical Assistance in Dying: Overview. Accessed August 1, 2025.Accessed August 30, 2025. https://www.canada.ca/en/health-canada/services/health-services-benefits/medical-assistance-dying.html

[ii] Schadenberg, Alex. (September 29, 2025). Accessed September 30, 2025. Euthanasia Prevention Coalition Euthanasia Prevention Coalition: There were around 16,500 Canadian euthanasia deaths in 2024, 5% of all deaths.

[iii] Health Canada. (2024, December 11). Fifth annual report on medical assistance in dying in Canada, 2023 (Cat. No. H22-1/6E-PDF; ISBN 2563-3643). Accessed September 30, 2025.  https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-medical-assistance-dying-2023.html

[iv]   Regional Euthanasia Review Committees. (March 25). Accessed September 30, 2025. Annual reports (English, Spanish, French and German) | Regional Euthanasia Review Committees

[v] Th Fifth Annual Report on Medical Assistance in Dying in Canada, 2023 – Canada.ca

[vi] Kahana, Eva. “A congruence model of person-environment interaction.” Aging and the environment: Theoretical approaches (1982): 97-121.

[vii] Bell, Paul A., T. Green, Jeffrey D. Fisher, and Andrew Baum. Environmental psychology. New Jersey, 2001.

[viii] Ajzen, Icek. “The theory of planned behavior.” Organizational behavior and human decision processes 50, no. 2 (1991): 179-211.

[ix] Stamps, Arthur E. Psychology and the aesthetics of the built environment. Springer Science & Business Media, 2013.

[x] Meany, Joseph. Referral as Formal Cooperation with Evil – F.I.A.M.C.

[xi] See Health Canada’s 5^th annual report.

[xii] BC Coroners Service. Unregulated Drug Deaths – BC. Notes: 2588 deaths due to unregulated drug deaths in 2023. In the same year, 2,759 MAiD deaths were reported.

[xiii] BC Medical Assistance in Dying (MAiD) Statistical Report 2024. Accessed September 28, 2025. bc-medical-assistance-in-dying-statistical-report-2024.pdf

[xiv] Statistics Canada. Accessed September 30, 2025. Estimates of the components of natural increase, quarterly

[xv] BC Medical Assistance in Dying (MAiD) Statistical Report 2024. Accessed September 28, 2025. bc-medical-assistance-in-dying-statistical-report-2024.pdf

[xvi] Angus Reid Institute (December 12, 2024). Division over aspects of assisted dying, including MAiD-free spaces. Accessed August 10, 2025.  https://angusreid.org/wp-content/uploads/2024/12/2024.12.12_MAID_free_discretion.pdf