Bioethicists: Euthanasia Okay for ‘Unjust Social Conditions’

This article was published by National Review online on December 13, 2025.

Wesley Smith

By Wesley J Smith

Once killing the sufferer becomes a societally acceptable means for ending suffering, there becomes no end to the “suffering” that justifies human termination. We can see this phenomenon most vividly in Canada, because it is happening there more quickly than in most cultures. 

For example, a recent poll found that 27 percent of Canadians polled strongly or moderately agree that euthanasia is acceptable for suffering caused by “poverty” and 28 percent strongly or moderately agree that killing by doctors is acceptable for suffering caused by homelessness.

Euthanasia mutates a society’s soul. I can’t imagine that being true ten years ago before euthanasia became legal.

This kind of abandoned thinking finds enthusiastic, albeit not unanimous, expression among secular bioethicists. In fact, two Canadian bioethicists just published a paper in the Journal of Medical Ethics — a prestigious British Medical Journal publication — arguing that “unjust social conditions” justify lethal jabs (euphemistically called MAiD, for “medical assistance in dying”). The argument claims that killing is a form of “harm reduction.”

The authors even admit such cases have already occurred legally in Canada. From “Choosing Death in Unjust Conditions: Hope, Autonomy, and Harm Reduction” (my emphasis):

In 2022, an individual in Canada, who had been diagnosed with multiple chemical sensitivities (MCS), received MAiD. However, by their own description, their decision to choose MAiD was driven primarily by the fact that they were unable to access affordable housing compatible with MCS. While it was true that they suffered from an illness, disease or disability that caused ‘enduring physical or psychological suffering that is intolerable to them and cannot be relieved under conditions that they consider acceptable’ as specified under the eligibility criteria of Bill C-14 [that recently expanded eligibility beyond death being “reasonably foreseeable], the primary source of their suffering was an inability to find appropriate housing, not the condition itself. Another person, also with MCS, writes: ‘I’ve applied for MAiD essentially because of abject poverty’.

Good grief. The patient in question is dead — not because of their medical but housing conditions. And doctors used the physical issues as pretext for justifying the killing as within the law!

The authors approve of allowing euthanasia for reasons of social injustice as a means of “harm reduction.” And in the context of medical issues, the authors claim that this includes killing patients who would not want to die if they could access proper treatment:

In the case of the availability of MAiD in Canada to people who not only might but have explicitly said they would choose differently if they had access to the options they preferred, we argue that the least harmful way forward is to allow MAiD to be available.

This, even though Canada’s socialized health-care system is in crisis:

Access to healthcare across nearly all dimensions continues to deteriorate in the wake of the pandemic even outside of long-term and palliative care, from basic care, to surgical backlogs, to a general consensus that the system is in a state of collapse. In this context, refusing options to people who autonomously pursue MAiD amounts to perpetuating their suffering, hoping that this will ultimately lead to a better, more ‘just’ world. This is a world that currently does not exist and is unlikely to emerge in the near future. Even if it did, it is unfortunately even more unlikely that the people whose current suffering has led them to request MAiD will realise its benefits.

So, socialized medicine fails, and a splendid answer to the problem for patients in need is euthanasia. Do you see now why I call euthanasia/assisted suicide “abandonment?”

The authors conclude:

We disagree with any claim that the unjust lack of choices available to people is alone sufficient to undermine their autonomy. Those who launch legal proceedings or request and receive MAiD are unlikely examples of people whose reduced opportunities have led them to lose all hope and motivation for pursuing personally meaningful courses of action. Moreover, neither a reduction of opportunities in itself, nor the existence of oppressive ableist norms, is sufficient to directly undermine autonomy…Restricting an autonomous choice to pursue MAiD due to the injustice of current non-ideal circumstances causes more harm than allowing the choice to pursue MAiD, even though that choice is deeply tragic.

Bioethics is growing increasingly monstrous. And that matters because these are the so-called “experts” who exert tremendous influence on our laws and regulations, in court rulings, over the attitudes of journalists, among the purveyors of popular culture, and, ultimately, upon public attitudes.

Moreover, Canada is our closest cultural cousin. If such a crass death-embracing attitude developed there so quickly with the legalization of euthanasia, it will happen here too — and, indeed, almost all state laws allowing doctor-prescribed death already expanded their guidelines. Which is why, if we want to follow the truly compassionate course, it is a matter of great urgency that we reject all further legalization of assisted suicide in the United States.

Euthanasia and Assisted suicide are about killing people.

Alex Schadenberg

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

I received a message asking me:

Do you oppose a peaceful end to life?

The message assumed that I lack compassion by stating:

You'd rather see your loved one suffer in unimaginable pain and agony, by blocking their decision for a peaceful exit?

The message ended by expressing his pain:

I just hope that you never have to experience a loved one suffering as I have.

Yes, I oppose killing people and I don't want people to suffer. 

The death lobby creates a false dichotomy. They want you to believe that there are two choices, to suffer to death or be killed.

Medicine has the ability to relieve pain and symptoms without killing people. We urge the medical system to make the relief of suffering a priority. (Article Link).

It is easier to attack me for being opposed to killing people than it is to challenge the medical system for not providing effective pain and symptom relief. Nonetheless:

• Yes, the improvement of good end-of-life care is a necessity,
• Yes, euthanasia is discriminatory towards people with disabilities,
• Yes, euthanasia is the abandonment of people in need, and more.

There is need for better end-of-life care but there are also people, who die by euthanasia, while on a waiting list to receive treatment. (Link). Improving medical care is significant.

Legalizing euthanasia has greater societal effects.

Legalizing euthanasia effects attitudes towards people with disabilities, elderly frail people and people living with chronic conditions. (Links to Article 1, Article 2, Article 3, Article 4)

As much as I oppose killing people, it is also not safe to give medical practitioner the right in law to kill their patients.

When a person asks a medical practitioner to end their life, that person may or may not be living with a terminal condition. But if the medical practitioner agrees to euthanasia, the doctor is actually saying that he/she agrees that your life is not worth living.

The doctor is also saying you are not worth treating, you are not worth providing excellent pain and symptom management for, you are not worth the time and effort to care for you.

They say it is about choice, but really it is about abandonment.

Why are people asking to be killed?

Most people who ask to be killed are living with a difficult physical and/or psychological condition. They often: 

• feel alone and are lonely,
• fear possible future pain and symptoms, 
• fear being a burden on others,
• feel that their life has lost meaning or value,
• feel that they are better off dead.

Legalizing euthanasia has given medical practitioners the right in law to kill people rather than care for people, in their time of need. Euthanasia is not about freedom, choice or autonomy rather it is about abandoning people in their time of need.

There are a lot of valid reasons to oppose euthanasia that are not included in this article, but it primarily comes down to opposing the killing of people.

A message to the world. Don't legalize euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Recently articles about concerning approvals and deaths by euthanasia (known as MAiD) in Canada have opened the question of have we gone too far in Canada?

The Euthanasia Prevention Coalition opposes all MAiD deaths, but sadly, we accurately predicted that once the line in the sand that gives doctors and nurses the right in law to kill their patients was crossed, the rules and reasons for approving medical killing (MAiD) would expand. This is what Canada has experienced.

Dr Ramona Coelho, a family physician who specializes in caring for marginalized people, recently wrote about two cases of premature deaths by MAiD in Ontario. Coelho wrote:

A man was admitted to hospital after suffering a small stroke affecting his balance and swallowing. He was feeling down and isolated due to a COVID-19 outbreak on his ward. The stroke neurologist anticipated he would be able to eat normally and regain most of his balance. Psychiatry diagnosed an adjustment disorder but noted his prognosis was very good. The patient then requested MAiD. Neither of his MAiD assessors had expertise in stroke rehabilitation and recovery. Because he was temporarily eating less, the MAiD assessors decided he could die right away instead of waiting the required 90 days for those living with disabilities despite having no terminal comorbidities. He received MAiD the following week. This man died alone and depressed and before he had tried proper therapy or reached maximal recovery.

A 71-year-old widower was admitted to a Southwestern Ontario hospital after a fall. His family says during his admission he contracted an infectious diarrheal illness. He was humiliated by staff for the smell of his room, his family said. He developed new shortness of breath that was not comprehensively assessed. In this context, a hospital team member suggested he would qualify for MAiD. The team said he had end-stage chronic obstructive pulmonary disease and it was terminal. The patient was surprised by the diagnosis but trusted the team. Within 48 hours of his first assessment, he received a medically assisted death. Post-mortem testing showed he did not have end-stage COPD. His family doctor, when notified of his death, also stated he did not have end-stage COPD, but the team had failed to contact her when they were assessing his history.

The first case concerns MAiD assessors who did not have enough knowledge or training to recognize that the patient's prognosis was very good. The patient needed treatment and time to recover, not death by lethal injection.

The second case concerns a hospital team that misdiagnosed the patient. Therefore, his approval and death by lethal injection was based on a misdiagnosis, and to make matters worse, the MAiD team didn't even contact the family doctor who would have told them that the patient was misdiagnosed.

Then there is the case of a woman in BC, known at Kat, who is living with Ehlers-Danlos Syndrome (EDS). Kat sought death and was approved for MAiD, not because she wants to die, but because she unsuccessfully fought to receive treatment. She said it was easier to be approved for MAiD than to receive treatment to live. Ehlers-Danlos Syndrome cannot be cured, at this time, but Kat is seeking treatment for her symptoms.

In April I wrote about the euthanasia death of a 51-year-old woman with chemical sensitivities. The story by CTV National News Medical Correspondent, Avis Favaro reported that the woman was not terminally ill but living with chronic chemical sensitivities and environmental allergies. Favaro reported:

She died after a frantic effort by friends, supporters and even her doctors to get her safe and affordable housing in Toronto. She also left behind letters showing a desperate two-year search for help, in which she begs local, provincial and federal officials for assistance in finding a home away from the smoke and chemicals wafting through her apartment.

“This person begged for help for years, two years, wrote everywhere, called everywhere, asking for healthy housing,” said Rohini Peris, President of the Environmental Health Association of Québec (ASEQ-EHAQ).

“It’s not that she didn’t want to live,” Peris said from her home in Saint Sauveur, Que. “She couldn’t live that way.”

I stated that the CTV news story represents how MAiD is abandonment. This woman was not killed because of "unremitting suffering" but because she didn't have appropriate housing.

In late April, Favaro reported on a case of a 31-year-old Ontario woman who was also approved for (MAiD) euthanasia for chemical sensitivities. Favaro stated that Denise (not her name) was also diagnosed with Multiple Chemical Sensitivities (MCS):

The chemicals that make her sick, are cigarette smoke, laundry chemicals, and air fresheners. She is at risk of anaphylactic shock and so has EpiPens at all times in case she has a life-threatening allergic attack.

Denise is also a wheelchair user after a spinal cord injury six years ago and has other chronic illnesses. In March 2021, the Canadian government passed Bill C-7 which permitted (MAiD) euthanasia for people who were not terminally ill, but living with chronic conditions. This has resulted in approvals to lethally inject (MAiD) people with treatable chronic conditions and it is exposing the reality that people with chronic conditions are often living in abject poverty and poor living conditions.

According to Favaro, Denise applied for MAiD based on poverty. The good news is that Denise did not die by MAiD because she found a clean place to live.

All of these stories are important as a federal government committee is currently examining the expansion of euthanasia (MAiD) to children, by advanced directive, and they are debating the rules for MAiD given to people with mental illness.

First of all, Canada's federal government needs to re-evaluate the MAiD program. From its inception, Canada's MAiD law employs undefined terms, and it states that the assessor only needs to be 'of the opinion' that a person fits the criteria of the law. Therefore, when cases of questionable euthanasia deaths are identified, the assessor is assured by the law that they cannot be prosecuted.

Secondly, countries that have not legalized euthanasia need to recognize that when the clear line (kill or not kill) is crossed and doctors and/or nurses are legally permitted to kill their patients, that the law will expand in its application. 

There are many reasons why someone may seek death; once death is deemed a reasonable response to human suffering, then more reasons will be approved for death.

Society needs to care for its citizens, not kill its citizens.

Canada is an example of how killing becomes contagious.

Important articles on this topic:

• Canada's Medical Assistance in Dying law is the most permissive in the world (Link). 
• 20-year-old man with undiagnosed condition is approved for euthanasia (Link).
• Euthanasia by advanced directive is a recipe for abuse (Link).
• BC woman approved for euthanasia but can't access healthcare (Link).
• Why euthanasia for children is wrong (Link).
• Euthanasia is out-of-control in Canada (Link).

Assisted suicide for anorexia nervosa expands assisted suicide from terminal to chronic conditions.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In January I wrote an article about assisted suicide for anorexia nervosa. In the article I quoted from a case report published by the ACAMAID, an organization of assisted suicide practitioners who approved assisted suicide for anorexia nervosa by defining the condition as being "terminal." 

An article by Jennifer Brown that was published in the Colorado Sun on March 14 reports on Dr. Jennifer Gaudiani, an internal medicine doctor who specializes in eating disorders and who published a paper on her experience with prescribing assisted suicide for three people with anorexia nervosa.

Gaudiani defines anorexia as a terminally illness. Colorado's assisted suicide law does not permit assisted suicide for chronic or mental illnesses. Gaudiani considers anorexia to be a terminal condition because of the high rate of death among those who struggle with the condition. Brown writes:

In the paper, published in February in the Journal of Eating Disorders, Gaudiani ... writes that, although anorexia doesn’t have delineated levels of severity like cancer, which has stages of progression and a terminal phase, it can be brutally lethal. It is widely believed to have the second-highest mortality rate of all mental illnesses, behind only substance use disorders.

Based on the fact that anorexia has the second-highest mortality rate of all mental illnesses, second to substance use disorder, does that mean that people with substance use disorder also qualify for assisted suicide?

Is anorexia nervosa a terminal or a chronic condition?

A study by Kamryn Eddy et al., published in the Journal of Clinical Psychiatry in February 2017 titled: Recovery from Anorexia Nervosa and Bulimia Nervosa at 22 year Follow-Up recognizes that some people with Anorexia Nervosa die from the condition, but the study considers anorexia nervosa to be a chronic condition, not a terminal condition. The study is based on a 22 year follow-up and it concludes that for many people recovery is slow but nearly two-thirds of the participants fully recovered by year 22.

The study by Eddy is significant as it began in 1987 and followed up the participants at regular intervals including the 9 year interval and the 22 year interval. The study found:

Results:
At 22-year follow-up, 62.8% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa recovered, compared to 31.4% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa by 9-year follow-up. Approximately half of those with anorexia nervosa who had not recovered by 9 years progressed to recovery at 22 years. Early recovery was associated with increased likelihood of long-term recovery in anorexia nervosa but not in bulimia nervosa.

Conclusion:
At 22 years, approximately two-thirds of females with anorexia nervosa and bulimia nervosa were recovered. Recovery from bulimia nervosa happened earlier, but recovery from anorexia nervosa continued over the long term, arguing against the implementation of palliative care for most individuals with eating disorders.

There are several significant findings in this study:

1. Recovery from anorexia nervosa was slower than bulimia nervosa. Whereas 31.4% of the participants with anorexia nervosa were fully recovered by year 9 and 62.8% were fully recovered by year 22, with bulimia nervosa 68.2% were fully recovered by year 9 and 68.2% were fully recovered by year 22.

In both anorexia nervosa and bulimia nervosa, some of the participants who had fully recovered by year 9 were no longer fully recovered by year 22, but that also suggests that these are chronic conditions. Anorexia nervosa often requires a longer term treatment commitment to achieve full recovery which also indicates that anorexia nervosa is a chronic condition andnot a terminal condition.

2. The data in the study indicates that of the 246 study participants 18 people were known to have died by the 20 - 25 year interval. There is some missing data since researchers lost contact with 15 of the participants, and 37 participants decided not to continue participating in the study, nonetheless, if anorexia nervosa were a terminal condition the death rate by the 20 - 25 year interval would be much higher. The study does not indicate if all of the 18 participants who were known ot have died, died from the chronic condition or if some died from another cause.

Eddy refers to a study by Hay and colleages who suggested that:

“both the clinician and [chronically ill] patient often share the experience of hopelessness and despair about the likelihood of meaningful change.”

I suggest that feelings of hopelessness and despair are leading assisted suicide clinicians to redefine anorexia nervosa as a terminal illness and thus prescribe death as a treatment.

The recent Oregon 2021 assisted suicide report also listed anorexia as a reason for assisted suicide.

 My earlier comments that assisted suicide for anorexia nervosa is abandonment is supported by the conclusion of the study which states:

Our data indicate that the majority will recover from anorexia nervosa and bulimia nervosa over time. Yet 2 decades of illness represents considerably meaningful life lost, and our findings emphasize the importance of developing interventions to reduce the duration of illness. Our findings that recovery remains possible even after long-term illness argue for active treatment rather than palliative care for most patients. Increased research attention to identifying early predictors, mediators, and moderators of recovery in naturalistic and controlled treatment trials is needed to guide treatment disposition recommendations.

By prescribing lethal drugs for assisted suicide or lethally injecting a person (euthanasia) the clinician is abandoning the patient rather than helping the patient find hope with the potential of long-term recovery.