Can a Person Decide to Die?

Readers respond to our September issue and more.

November 11, 2025, 7 AM ET

Canada Is Killing Itself

The country gave its citizens the right to die, Elaina Plott Calabro wrote in the September issue. Doctors are struggling to keep up with demand.

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I had two sisters in their mid-90s who availed themselves of Canada’s Medical Assistance in Dying program. Both were incapacitated; they had lost their dignity and were facing amputations or prolonged stays in the hospital with no hope of survival. They were subjected to multiple interviews making sure that they were lucid. Both died surrounded by their family and a multitude of friends. We celebrated their courage to leave their horrible situation with grace. Everyone in attendance stated that they hoped they would have the courage to do the same. I found the system to be run with sensitivity and efficiency. Reports about abuses are few and far between. Canada should be proud that people in unbearable pain can decide to die when life is intolerable.

Larry Shapiro Calgary, Canada

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The phrase I return to from Elaina Plott Calabro’s article is just eight words, spoken by the family physician Jonathan Reggler: once you accept that life is not sacred. With those words, Reggler explains better than anyone the horrifying expansion of euthanasia in Canada, my home country. Because regardless of whether you reckon that there is anything divine or even vaguely numinous in this world, sacred remains the best and most morally urgent word that human beings have for talking about life.

All of us, at some deep level, know that life is sacred. This is why we feel such distress when we hear news of starvation or deaths in war. To deny sacrality and to replace it with a new apex value called autonomy is, inevitably, to turn life into something like a possession that we may discard when it is worn out, when it becomes too expensive, or simply when we are tired of it.

My mother’s final two years, notwithstanding her physical and cognitive decline, were a beautiful time: She forgave her father for a decades-old hurt and found a deep contentment. Hearing a description of her symptoms in those days, one might imagine that hers was not a life worth living, that she ought to have applied for MAID. But such a conclusion would be disastrously mistaken. Her life was so special—all the way until the end. I am grateful that none of us was deprived of this time. It was in every way sacred.

Martin Elfert Portland, Ore.

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We are registered nurses with expertise in palliative care and the MAID program. “Canada Is Killing Itself,” by Elaina Plott Calabro, ignores key facts and frames MAID in an unflattering light. What might have been a fair exploration of MAID in Canada instead reads like a case assembled to argue against the practice itself. While there are moments of useful and fact-based information, they are surrounded by enough misleading half-truths, emotionally charged language, and selective omissions that it would be hard for a reader unfamiliar with MAID to parse the good from the bad.

Beyond the provocative title, Plott Calabro depicts a MAID conference as if it were a sinister gathering, reminds readers that MAID “would have been considered homicide” a decade ago, and describes MAID as an “open-ended medical experiment.” This suggests chaos where there is, in fact, rigorous regulation and ethical oversight.

The article repeatedly describes changes to MAID legislation as “expansion,” which ignores the legal history upon which the practice rests. Every so-called expansion has actually been an attempt to bring the law back in line with the supreme court’s Carter v. Canada decision. Any future evolution will also realign MAID legislation with the Carter decision and the Canadian Charter of Rights and Freedoms. To claim otherwise is to misunderstand how MAID became legal in Canada. Likewise, the claim that poverty or inadequate supports are driving people to MAID distorts the law, clinical practice, and federal data that say otherwise. Legislation explicitly prohibits approving MAID for social or economic reasons. People can request MAID for any reason they wish, but to be approved, suffering must stem from a medical condition, not their social circumstances. Social circumstances may influence a MAID request, but to suggest that they’re a systemic factor in approvals is untrue.

Perhaps most telling is how anti-MAID groups seized on this article, celebrating that mainstream media is finally amplifying their alarmist, fearmongering narratives. The article reinforces their false talking points about targeting vulnerable people, financial savings, and unregulated “killing,” while ignoring the many Canadians who describe MAID as bringing dignity and peace to themselves and their loved ones.

Paul Magennis and Kim Carlson Vancouver, Canada

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Regarding the right of the individual to choose death, the case of Adolf Ratzka is illustrative. Ratzka shared his story with the Mütter Museum of the College of Physicians of Philadelphia. Born in Germany in 1943, Ratzka was handsome and athletic, 6 foot 2 and 180 pounds, but totally immobilized by polio at age 17. He was confined to a mechanical breathing apparatus called an iron lung. He “wanted to die” because what he knew of life focused on the body and its role in human happiness. He said, “I would have been a perfect candidate for assisted suicide.” His change of perspective was gradual, but it hinged on a pivotal event when he was still using the iron lung: While he was being trained to breathe on his own, the device would be turned off for increasing periods. One day, the attending nurse didn’t immediately return to turn it on. Ratzka said, “I fought for my life until literally blue in the face.” In the process, he realized that he had called forth all his energies to remain alive. This was the beginning of an incredible life. He would marry, raise an adopted child, and obtain a Ph.D., and led global initiatives in independent living for similarly disabled individuals until his death, at age 80, last year.

Ratzka’s perspective as a teenager—and the perspective of every person contemplating an elective end of life—was limited by accumulated personal experience. We tend to believe that we can rely on experience to make all of our decisions. But there are certain aspects of life that we cannot anticipate or ever know. The mystery of the human condition alters the calculus in the choice to end a life.

Chris Burns Hanover, Pa.

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Elaina Plott Calabro eruditely depicts the ethical dilemmas facing MAID providers in Canada as they try to negotiate an ever-changing legal and moral landscape. However, by focusing on the most extreme cases, Plott Calabro does a great disservice to the many patients who have a legitimate need for MAID, and to the caregivers trying to counsel them.

In my role as a senior clinician at Vancouver General Hospital, I have been involved in counseling patients about MAID since its inception. Early data indicated that, of every 100 people who inquired about MAID, only 10 proceeded to a written request for the procedure. In my experience, those who did not continue had an overwhelming sense of relief in knowing that it was an option to be accessed if traditional palliative-care efforts failed, or if they felt, at some future time, that their symptoms had become intolerable.

MAID being a legal medical procedure in Canada, I felt it my professional duty to advise patients about it as a potential treatment option, along with all other treatment options. I hope I did this in a kind and considerate manner, never threatening or cajoling my patients or trying to impose my will upon them. Most were thankful that I had raised the issue with them, and open and frank discussions about all treatment options, including MAID, followed.

Iain Mackie Professor Emeritus of Medicine, University of British Columbia Vancouver, Canada

Behind the Cover

In our December 2025 issue, the Atlantic staff writer David A. Graham and J. Michael Luttig, a retired U.S. Court of Appeals judge for the Fourth Circuit, consider the future of elections in the United States. Graham details how the Trump administration could undermine the 2026 midterms; Luttig describes the powers the president has seized since returning to office, and explains how they could be used to remain in office beyond a second term. For our cover image, the illustrator Carl Godfrey imagined a classic VOTE poster with a rip down the center, a representation of the threat to free and fair elections.

— Paul Spella, Senior Art Director

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Corrections

“How Originalism Killed the Constitution” (October) stated that Antonin Scalia, Robert Bork, and Clarence Thomas had served on the D.C. Court of Appeals. In fact, they’d served on the U.S. Court of Appeals for the D.C. Circuit. The article also stated that J. Harvie Wilkinson III was retired. In fact, he is a judge on the Fourth Circuit Court of Appeals.

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This article appears in the December 2025 print edition with the headline “The Commons.”

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