The horror stories from Canada about pressure for “assisted suicide” choices on the disabled and those with profoundly-chronic illness rarely make news in American media outlets. That makes this report from the Associated Press eye-popping indeed. Disability advocates in Canada have leveled accusations that Canada’s nationalized health-care system has used the legalized assisted-suicide system as a vehicle for euthanasia and cost savings:

Nichols’ family reported the case to police and health authorities, arguing that he lacked the capacity to understand the process and was not suffering unbearably — among the requirements for euthanasia. They say he was not taking needed medication, wasn’t using the cochlear implant that helped him hear, and that hospital staffers improperly helped him request euthanasia.

“Alan was basically put to death,” his brother Gary Nichols said.

Disability experts say the story is not unique in Canada, which arguably has the world’s most permissive euthanasia rules — allowing people with serious disabilities to choose to be killed in the absence of any other medical issue.

Many Canadians support euthanasia and the advocacy group Dying With Dignity says the procedure is “driven by compassion, an end to suffering and discrimination and desire for personal autonomy.” But human rights advocates say the country’s regulations lack necessary safeguards, devalue the lives of disabled people and are prompting doctors and health workers to suggest the procedure to those who might not otherwise consider it.

Equally troubling, advocates say, are instances in which people have sought to be killed because they weren’t getting adequate government support to live.

Those stories have occasionally broken through, but not often. Four years ago almost to the day, Canadian outlet CTV reported that the government medical system had put pressure on Roger Foley to choose “assisted suicide” rather than continue to press for the institutional care to which the seriously disabled Canadian was entitled. Foley got so much pressure from health-care officials that he taped the conversations and made them public:

In the first recording from September 2017, a medical worker is heard telling Foley that he will be charged some $1,500 a day if he stays at the hospital.

Foley labels the attempt as illegal coercion and says his preferences have already been violated. He asks what the plan is for him moving forward.

“Roger, this is not my show,” the man responds. “I told you my piece of this was to talk to you about if you had interest in assisted dying.”

In the other audio recording, reportedly from January 2018, a medical worker is heard asking Foley if he would like to pursue assisted suicide and whether he has had thoughts of self-harm. Foley says he feels like he wants to end his life because of his experience at the hospital, but that if he were given self-directed home care, he would “be fine.”

“You can just apply to get assisted, if you wanted to end your life, you know what I mean?” the medical worker says. “You don’t have to do it in some dramatic manner, you can just apply.”

“Well, they already presented the outcome option to me, but it’s like, Why force me to end my life?” says Foley.

Horrifying. But it doesn’t appear to have changed much, regardless. Two years ago, data on Canada’s assisted suicides showed a significant number choosing it for reasons other than terminal illness:

Over 1200 practitioners in medically-assisted suicide performed 5,631 assisted deaths, the vast majority of whom were primary-care physicians (65%) rather than specialists. Oncologists, for instance, only represented 1.7% of all MAID providers, while palliative medicine represented just 9.1%. …

Only a narrow majority (54-56%) cited unmanageable pain, which is what most people have in mind when it comes to suffering that would justify medically assisted suicides.

For instance, the two leading causes cited are rather basic medical issues — loss of ability to engage in “meaningful life activities” (82%) and “activities of daily living” (78%).  Needless to say, these are common in some degree to all chronic medical conditions, which is why people go to doctors — specialists in particular — to manage those issues. How many of those cases did the Canadian health system enthusiastically try to alleviate? The fact that 65% of MAID providers are family doctors suggest that those efforts didn’t get much attention from specialists.

The more shocking numbers are those of “perceived burden on family, friends, or caregivers” (34%) and “isolation or loneliness” (13.7%). This suggests that one driving factor behind hundreds of assisted suicides, if not thousands, is the impression that people want them out of the way rather than help support the sick.

Also alarming, the number of assisted suicides had skyrocketed. Within just a span of four years, assisted suicides had gone from 1,015 in 2016 to 5,631 in 2019. Did Canada suffer a wave of terminal illnesses in that four-year span — or did its health system start selling suicide harder? Anecdotally, it very much looks like the latter.

Inevitably, “assisted suicide” goes from a humane choice to an expectation — especially given the financial incentives within nationalized health systems. As health care systems attempt to conserve resources, the economic incentives push these kinds of outcomes.  At a certain point, those incentives create pressure to portray assisted suicide as a duty to others and the desire to live portrayed as a vice. The disabled are particularly vulnerable for this kind of euthanasia policy, as are the emotionally and/or mentally ill.

The choice for assisted suicide may well be necessary and understandable in some limited circumstances. But in countries where there are no options for choosing one’s providers and payers, the economic imperatives that assisted suicide opens up will become imperatives for grotesque ends.