Canada’s Assisted-Suicide Boom Reveals the Human Costs of Single-Payer

I n Canada, access to medical care can take months. Access to assisted suicide, however, is much easier to come by.

Ten years ago today, Canada’s Medical Assistance in Dying (MAID) program was legalized, and this year, Canada is on track to surpass 100,000 assisted-suicide deaths. Earlier this year, an Ontario physician met a 45-year-old man outside a Tim Hortons restaurant to assess his eligibility for euthanasia. After approving him for MAID, the doctor drove him to the facility where the procedure was carried out.

Americans should pay attention. Progressive lawmakers — including Representative Alexandria Ocasio-Cortez (D., N.Y.) and Senator Bernie Sanders (I., Vt.) — continue to treat Canadian-style single-payer health care as ideal policy. But as our northern neighbor proves, when the government is put in charge of apportioning scarce health-care resources, the costs are often quite tragic.

Ocasio-Cortez and Sanders are not alone in their fondness for single-payer health care. Democratic congressional candidates across the country are putting Medicare for All at the center of their pitch to voters. In California, several Democrats hoping to succeed Governor Gavin Newsom have voiced support for a government takeover of the state’s health sector.

Advocates for single-payer health care insist it would guarantee care for every patient. Canada is often held up as a model to follow. But many Canadians would beg to differ. Patients north of the border routinely endure lengthy waits for necessary care. Last year, the median wait between referral from a general practitioner and treatment by a specialist exceeded 28 weeks, according to the Fraser Institute, a Vancouver-based think tank. They pay dearly for the privilege of waiting. The average Canadian family of four pays more than $19,000 in taxes for government-provided health insurance.

Despite those costs, many Canadians still struggle to access timely care. One health-care service, however, has become increasingly accessible — medically assisted death.

When Canada legalized MAID in 2016, the program was sold as an option of last resort for adults facing unbearable suffering near the end of life. Things have quickly changed. In 2021, the nation’s lawmakers extended eligibility to people whose natural deaths are not reasonably foreseeable. Beginning next year, patients suffering solely from mental illness will be eligible for medical assistance in dying, unless a parliamentary committee puts the expansion on hold.

According to Health Canada, 16,499 people received MAID in 2024 — an increase of nearly 7 percent over the previous year. From 2016 through 2024, 76,475 Canadians died through the program.

These developments did not occur in a vacuum. They emerged within a health-care system that has spent decades grappling with the trade-offs that government-run health-care programs routinely confront.

Canada is not unique. Britain’s National Health Service relies on the National Institute for Health and Care Excellence, or NICE, to determine which treatments taxpayers will fund. NICE bases many of its decisions on “quality-adjusted life years,” a formula that puts a price tag on the value of an additional year of life.

The result is rationing by spreadsheet. Therapies whose price exceeds NICE’s cost-effectiveness thresholds can be denied broad coverage regardless of what patients or physicians prefer. Critics have long warned that such a system effectively places a lower value on treatments for the elderly and disabled because those patients may be expected to gain fewer quality-adjusted life years from care.

Different countries ration differently. But Canada and the United Kingdom reflect the same reality. When government controls health-care budgets, access to care is inevitably constrained.

Today, close to 6 million Canadians lack regular access to a family doctor. Emergency rooms in many parts of the country are so crowded that some patients are treated in storage rooms or left waiting for days on overflow stretchers. This is in addition to massive procedure backlogs and health-care staffing shortages that have pushed the nation’s health system to the breaking point.

Against this backdrop, Canada’s embrace of MAID raises troubling questions about how a strained health-care system responds to suffering.

The kind of Medicare for All scheme endorsed by Sanders, Ocasio-Cortez, and other progressives would entrust even more power in the government than Canada’s or Britain’s system does. Such a system would quickly subject Americans to the same barriers to care now common in those countries.

Once millions of patients face long waits, limited treatment options, and constrained access to needed medical services, assisted suicide can begin to appear less like an extraordinary measure and more like a policy response to suffering that the health-care system struggles to address.

A health system should make it easier to live. Canada’s makes it far too easy to die.