Today (29/11), Labour MP Kim Leadbeater will introduce a bill in the House of Commons to legalise assisted dying for terminally ill people. In her defence of the coming bill, Leadbeater writes that “We should give people facing the most unbearable end to their life a choice about what that end is like.”

Predictably, all hell is now breaking loose. Media missives are being launched, those on either side of the issue are being called puritans, fearmongers, and fools, but the most vituperative insults from the anti-assisted dying crowd claim that pro-assisted dying groups are leading the UK down the “Canadian path.”

“A woman who requested a wheelchair ramp said she was offered assisted suicide instead”

As a Canadian, it’s true that I’ve been watching the debate over assisted dying in the UK with a sense of doom. It’s been bad back home: since introducing medical assistance in dying (MAiD) for terminally ill people in 2016, Canada’s been systematically expanding its eligibility criteria. Last month, the Associated Press reported that many MAiD deaths could be attributed to poverty and mental illness. One woman with a disability who requested a wheelchair ramp for her house said she was offered MAiD instead. Another man, who had experienced housing insecurity, cancelled his assisted death after his rent was successfully crowdfunded. While most MAiD cases still involve those suffering from terminal illnesses, it is a fact that Canadians with nonterminal conditions have sought medically assisted death because of socioeconomic reasons. Poverty and prejudice should not be determining factors in a single medically assisted death, but they have been factors. This is a problem for advocates of assisted dying. Assisted dying can have legitimate and limited medical use, but it does not represent unconditional and unambiguous progress: it can also provide cover for ableism and exacerbate class inequalities in deadly ways. Canada is the sorry proof of this.

Canada’s plans to expand MAiD eligibility to those solely living with mental illness, set to come into effect in March 2024, was delayed until 2027 amid warnings from healthcare professionals. In August, a group called Dying with Dignity filed an application in an Ontario Court claiming that the government of Canada was discriminating against people with mental illnesses by prohibiting them from seeking assisted dying. This line of argument is particularly concerning to me, and I have seen it reflected in the UK despite frequent assurances that the UK’s eligibility will not expand beyond the scope of terminal illness. We must resist this framing: just because mental illness is as real, or valid, as physical illnesses does not mean that they have equivalent causes, effects, or ‘cures.’ I fear that the rote repetition of “mental health is real health” among those who use that slogan to expand eligibility criteria in the Canadian mode is a pretence for a movement that seeks to further ostracise and harm those with disabilities, rather than a genuinely progressive stance.

“Assisted dying has legitimate uses, but it is not unambiguous progress”

The assisted dying ‘debate’ is dominated by bad faith advocacy groups, who often have links to historical eugenics movements on the one hand and misogynistic, anti-abortion religious fundamentalism on the other. An incredible amount of money is being spent to produce reports that trickle into editorial columns that invariably adopt the slogans of other struggles for and against bodily autonomy. Mired in a semantic swamp of our own making, we are now struggling to make policy decisions with clear heads. The conversation around Canada’s dying policy is particularly bleak: an article in the WSJ, subtly titled “Welcome to Canada, the Doctor Will Kill You Now,” uncritically parrots a study from an organisation called the Ethics and Public Policy Centre. This vague, neutral seeming name masks a deeply conservative attitude, and links to anti-abortion movements in the United States. In the same vein, a few of the more vociferous pro-assisted dying groups have historical links to figures that have advocated for eugenics.

The UK must throw off its draconian prohibitions on assisted dying. However, to dismiss concerns about the creeping influences of class and ableism, demonstrated in Canada’s system, as baseless could have grievous consequences. At the very least, we must develop a new lexicon of dying here – a lexicon that sheds loaded language grafted on from other struggles for bodily autonomy. If we don’t, we risk, at best, repeating Canada’s circular and muddled moral debate. At worst, we risk acceding to the accusations that assisted dying is not just a necessary medical provision but a classist, proto-eugenicist movement lying in wait.