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.
[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 5th 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