"End-of-life decisions are profoundly personal," says health expert Sally Pipes. "They should be made by patients, families and physicians—not by governments or publicly financed institutions that may benefit when care is withheld."

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Medical assistance in dying now accounts for roughly one in 20 deaths in Canada, according to the latest government data. That makes it the country’s fifth-leading cause of death.

For patients facing severe illness and suffering, the option is framed as an act of compassion. But its rapid expansion raises uncomfortable questions about how government-run health systems respond to the reality of scarce public resources.

Caring for patients with complex, chronic or terminal conditions is among the most expensive obligations in any health system. That creates an inherent tension in systems where the government both finances care—and decides what care is worth covering.

Those tensions deserve attention in the United States, where government already finances roughly half of all health spending—and where calls for Canadian-style single-payer health care are growing louder.

Canada is not alone. Assisted-dying policies have spread across much of the developed world.

The practice has been legal in the Netherlands since 2002. Last year, more than 10,000 people were euthanized—a 3.8% increase from 2024.

In Belgium, nearly 4,500 patients died from medically-assisted suicide in 2025, accounting for 4% of all deaths. And in Spain, more than 1,000 patients received physician-assisted death last year. Other countries—including Luxembourg, Switzerland and Austria—have also legalized medically assisted dying. In the United Kingdom, the House of Commons passed an assisted-dying bill that has since stalled in the House of Lords.

What’s notable is not just the growth of these programs but their scope.

In some countries, eligibility has expanded beyond patients who are terminally ill to include those with chronic conditions or, in rare cases, severe psychological distress. In Spain last month, a 25-year-old woman received euthanasia after a lengthy legal battle with her family. She had been the victim of sexual assault and became paraplegic after a suicide attempt.

The case prompted ethical debates about where to draw the line between relieving suffering—and endorsing death as a solution to it.

Some Canadian patients have reported being informed about MAID alongside—or, in some cases, before—being offered alternative treatments or support.

Consider the case of Miriam Lancaster. The 84-year-old British Columbia resident was taken by ambulance to a Vancouver hospital last year with severe back pain. As she recounted to the National Post last month, “[The doctor] came in and said, ‘Miriam, I understand you’re in a lot of pain. We can offer you MAID [medical aid in dying].’”

It was only after she emphatically refused this option that the doctor suggested other treatments.

Six weeks later, Miriam had recovered and was able to walk her daughter down the aisle at her wedding. She has since traveled to Guatemala, where she rode a horse up the Pacaya volcano.

It’s no secret that government-run healthcare systems like Canada’s are under tremendous fiscal pressure. They typically respond by rationing care, forcing people to wait or denying access to expensive treatments. The median wait for specialist care following referral by a general practitioner last year was more than 28 weeks, according to the Vancouver-based Fraser Institute.

As those pressures grow, medical assistance in dying may seem like a prudent way to engage in triage—and ease people’s suffering. Over time, what was once reserved for those on death’s doorstep may be floated as an option to more and more people.

The steady rise in MAID deaths across countries with government-run systems should at least prompt serious scrutiny of how financial and structural incentives shape end-of-life care.

The United States is not Canada. But the share of health spending covered by federal, state and local governments in this country has been rising steadily. And assisted-dying laws are now on the books in more than a dozen states, including in New York, California and Oregon.

As a result, American officials may soon face some of the pressures that their peers in Canada and Europe do.

End-of-life decisions are profoundly personal. They should be made by patients, families and physicians—not by governments or publicly financed institutions that may benefit when care is withheld.