Among advocates of government-run healthcare, Canada is often cited as a model system: single-payer coverage, lower costs, and universal access to care. What is not mentioned, however, is one of the outcomes of a system where resources for care are finite and demand is unlimited. In a centralized healthcare system where the state controls the care, it will, by default, gravitate towards those outcomes that are easiest and most cost-effective to reach. In the Canadian system, healthcare is literally a matter of life or death—and death is winning.
June 2026 marks the 10-year anniversary of Canada’s Medical Assistance in Dying (MAID) law. Passed in June 2016, this piece of national legislation allows eligible Canadian citizens 18 years of age or older to request medical assistance in their death. In 10 years, assisted dying has moved from a tightly constrained end-of-life exception to a routine medical response to suffering. Today, according to Health Canada’s Sixth Annual Report on Medical Assistance in Dying, 5.1% of all Canadian deaths occur through MAID, representing more than four times the number of suicides and about 20 times the number of homicides in the country.
When Canada legalized MAID in 2016, advocates promised a limited measure with strict safeguards and rare use. Since then, eligibility has expanded from terminal illness to chronic disease, disability, and, still on the horizon, mental illness. It should not be a surprise that MAID has grown so rapidly. Today’s radical individualism has shifted cultural attitudes away from seeing life as inherently valuable and towards seeing death as a personal choice, akin to “my body, my choice.” This shift, however, is more of a permission structure that makes MAID socially acceptable. When the government becomes the payer, provider, and regulator, scarcity of healthcare resources does not disappear; rather, it is merely managed toward outcomes that are cheap, predictable, and administratively easy.
Caring for a patient at the end of life is one of the most difficult challenges in any healthcare system. It requires time, staff, facility capacity, and family support, all of which are in short supply. In the United States, patients in their final year of life account for roughly 25 percent of traditional Medicare spending, according to analyses from the Center for Medicare & Medicaid Services (CMS) and the Kaiser Family Foundation.
In Canada’s single-payer system, the financial pressures are more acute because the government bears nearly all the cost and controls nearly all the access. In that context, one can see how assisted dying can be positioned as a compassionate yet cost-effective alternative. It is time limited, comparatively inexpensive, and easy to administer. Canadian legislators did not legalize assisted dying to save money, at least not explicitly, but the government’s own cost analysis showed MAID generated a cost-neutral situation and in some analyses a cost savings compared to extended end-of-life care. In a system burdened by waiting lists and budget limitations, practices that relieve those pressures will expand, even if no one is saying the quiet part out loud. Practices that require longer-term spending will erode.
Supporters of MAID or any similar legislation (medical assistance in dying is currently legal in 13 U.S. states and Washington, D.C.) argue that assistance in ending one’s life, or that of a terminally ill, chronically ill, or dementia-burdened relative, reflects autonomy or compassion. In reality, this type of “compassion” is shaped by what the state can afford and deliver reliably, ultimately becoming the path of least resistance. This is the unspoken lesson of the Canadian healthcare system.
Canada’s experience with MAID over the last 10 years shows a system that has adapted to scarcity. It shows what can happen when a degraded cultural attitude about the value of life permeates a system designed to enhance and preserve life. The government cannot eliminate the difficult decisions needed to manage healthcare, but as Canada has shown, it can centralize them. And once the state controls outcomes, it will inevitably be pulled towards outcomes that are easiest to reach.
When care becomes difficult and death becomes efficient inside a government-run healthcare system, efficiency will win every time.