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The Cost of Living: Assisted Suicide and Poverty in North America

How can we understand the ethical complexity of “death with dignity”, considering free will, poverty, and the sanctity of life — and the right to end it?

By Paige HollowayPublished 4 months ago 6 min read
© Image created with AI; Paige Holloway assumes responsibility for the provenance and copyright.

The idea of medically assisted death is not new in North America. Dr. Jack Kevorkian, the infamous “Dr. Death,” thrust the concept of physician-assisted suicide into the public consciousness in the 1990s (Filc et al., 2019). Kevorkian’s homemade “Mercitron” machine, used to end the lives of willing patients, made him both a pariah and a pioneer. His actions ignited fierce debates about the ethics of euthanasia and the right to a dignified death.

Fast forward to 2011, and the landscape of euthanasia in North America had transformed. The ‘Death with Dignity’ Act in Oregon marked a significant turning point in the United States’ approach to medically assisted death (Oregon Health Authority, 2019). This legislation granted terminally ill adults the right to request lethal medications from their physicians, thereby legally enabling individuals to take control over their end-of-life decisions. The passage of the Act initiated a critical reevaluation of personal autonomy and the right to a dignified death.

Since then, attitudes towards euthanasia have continued to evolve, prompting a series of legislative changes across various states. By 2020, nine states, along with the District of Columbia, had laws allowing for medically assisted death (ProCon, 2020). This shift in societal and legal perspectives demonstrates a growing acceptance of euthanasia as a valid and ethical option for those facing unbearable suffering. In many cases, “death with dignity” is just that — an opportunity to end one’s life on one’s own terms rather than suffering indefinitely while waiting for the inevitable. However, in recent years, people who are suffering from preventable socioeconomic conditions have also been encouraged to consider medically assisted death, raising ethical concerns about what it means to be able to afford to live.

Canada’s Medical Assistance in Dying Program

In Canada, the discussion around euthanasia has followed a similar trajectory, culminating in the establishment of the Medical Assistance in Dying (MAID) programs (Government of Canada, 2021). Initially, these programs were perceived as a compassionate response to unbearable physical or mental distress, providing an avenue for those with no foreseeable improvement in their condition to end their lives with dignity.

However, as these programs have evolved, they have begun to raise unsettling questions. The dark joke, “In Trudeau’s Canada, the suicide hotline calls you,” captures the growing unease with the way MAID is being implemented (Pereira, 2011). Critics argue that the program is morphing into a cost-saving measure that nudges the impoverished and homeless towards medically assisted death rather than offering them comprehensive support to improve their living conditions.

The concern is that the MAID programs, while intended to alleviate suffering, may inadvertently encourage the most vulnerable among us to opt for death over life. It’s a disturbing prospect that challenges us to reassess the ethical implications of medically assisted death and the societal structures that make such a choice seem like the only viable option for some individuals.

Eugenics, Class, and Disability

The concept of eugenics, which emerged in the late 19th century, was predicated on the idea of improving the genetic quality of the human population by discouraging reproduction by those with genetic defects or presumed to have inheritable undesirable traits (Joseph, 2004). This concept, deeply rooted in classism and ableism, led to systemic discrimination, forced sterilizations, and even genocide during the Holocaust.

The shadow of eugenics looms over the modern debate on medically assisted death. Critics argue that the increasing accessibility of euthanasia, especially for individuals suffering from poverty or disabilities, could subtly imply that their lives are less worth living (Scoccia, 2014). This viewpoint contends that by making death more accessible to these groups, we are implicitly endorsing a form of modern-day eugenics, suggesting that their lives are less valuable and therefore more dispensable.

The intersection of euthanasia, disability, and poverty raises complex ethical questions. If we’re not careful, the right to die could quickly become a duty to die for the most vulnerable members of our society. It’s a moral minefield that demands careful navigation to ensure that we protect the rights and dignity of all individuals, regardless of their socio-economic or physical status.

Moreover, the societal structures that perpetuate poverty and disability discrimination must be scrutinized. Without addressing these systemic issues, the choice to opt for euthanasia may not be a free choice at all, but rather a reflection of societal pressures and biases (Scoccia, 2014).

Poverty and the Illusion of Choice

The discourse around assisted suicide often revolves around the notion of choice. Advocates argue that it offers individuals the “freedom of choice” — the right to determine their own fate (Dworkin et al., 1997). However, when placed in the context of poverty, this freedom is a hollow promise.

Consider the stark realities: as of 2019, 9.2% of the US population lived in poverty, according to the World Bank (2021). For these individuals, the choice between a slow, agonizing descent into destitution and a hastened, painless exit from a world that seems indifferent to their plight is hardly a choice at all. It’s a damning indictment of a system that fails to provide for its most vulnerable citizens.

The counterarguments to this position emphasize the importance of autonomy and individual rights, arguing that denying people the option of assisted suicide could be seen as paternalistic and even discriminatory (Dworkin et al., 1997). They argue that euthanasia should not be viewed as a solution to poverty but rather an option for those facing unbearable suffering, irrespective of their economic status. However, this perspective fails to account for the profound influence of socio-economic factors on individuals’ perceived quality of life and their consequent decisions about euthanasia.

Towards a More Compassionate Future

The current discourse around euthanasia necessitates a broader conversation about societal responsibility towards its most disadvantaged members. Rather than viewing euthanasia as a panacea for the hardships faced by those living in poverty, efforts should be concentrated on addressing the root causes of extreme poverty.

This could include advocating for affordable healthcare, accessible housing, quality education, and a living wage — fundamental rights that are often denied to those living in poverty (Sen, 1999). By addressing these systemic injustices, society can offer more options and support to individuals facing extreme poverty, making the choice of euthanasia less of a necessity borne out of despair and more of a genuine choice.

The future should also see greater emphasis on disability rights and the eradication of ableism in all its forms. Disabled individuals, who are disproportionately represented among the poor, face unique challenges and discrimination that can make their lives significantly harder (World Health Organization, 2011). Ensuring that disabled individuals have the same opportunities and rights as non-disabled individuals is a crucial part of creating a more equitable society.

We must remember that the inherent value of every life, particularly those of society’s most vulnerable members, is not negotiable. The debate over the right to die should not eclipse the fundamental right to live a life of dignity, respect, and justice. Our collective responsibility lies in ensuring that every individual, regardless of their circumstances, is given the choice to live a life of dignity and respect.


As the world continues to grapple with the ethical complexities of euthanasia, we must be cautious of falling into the trap of viewing death as a solution to societal failures. Instead, we should strive to create societies where every life is valued and every individual has the opportunity to live a full, meaningful life.

The right to die, while important, should not overshadow the right to live in dignity. As we move forward, let’s shift our focus from ensuring a dignified death for all to guaranteeing a dignified life for all.


About the Creator

Paige Holloway

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