Earlier this year, a funeral home on Montreal’s South Shore announced a macabre “turnkey package” for those undergoing medical aid in dying (MAID). For $700, someone suffering from a terminal illness or condemned to a life of torment due to acute pain can meet up with their loved ones at the funeral home to say their farewells, then undergo the procedure. The package also includes preparation of the deceased’s body for their funeral.

While medically assisted deaths have expanded dramatically across Canada since they were legalized in initially very limited circumstances in 2016, the funeral home denied that it was being “opportunistic,” only offering a cheap alternative.

The National Post, the mouthpiece of the most avowedly right-wing sections of the Canadian ruling class, published an article in May promoting the positions of two University of Toronto bioethicists who argue that denying medical aid in dying to poor people who, due to their want of money, can’t access the healthcare and support they desperately need is wrong and unjust.

“To force people who are already in unjust social circumstances to have to wait until those social circumstances improve, or for the possibility of public charity that sometimes but unreliably occurs when particularly distressing cases become public, is unacceptable,” wrote Ph.D. candidate Kayla Wiebe, and Amy Mullin, a University of Toronto a professor and bioethicist, in the Journal of Medical Ethics.

“A harm reduction approach acknowledges that the recommended solution is necessarily an imperfect one: a ‘lesser evil’ between two or more less-than-ideal options.”

MAID was introduced in response to a real and heart-wrenching problem—the plight of people forced to live in agony as they await a slow torturous death from a terminal illness. But under contemporary capitalism such “reforms” are immediately subject to the compulsions of the profit motive and a ruling class sinking ever deeper into reaction and outright barbarism.  

A generously-funded, high-quality public health system, including home care, retirement homes for the elderly, palliative care for the terminally ill, adequate provision of pain medication—in short, everything that would make it easier to live through old age or illness—is seen as a drain on profits and therefore denied to millions of people.

A decades-long assault on wages, pensions and public services to enrich a tiny minority at the top has been accompanied by an ideological assault on the very concept of the preservation of human life. This reactionary campaign, as the article published in the National Post shows, is increasingly reminiscent of the eugenics of the Nazi regime and the darkest chapters in human history.

All those from whom no surplus value can be extracted are deemed worthless. The resources and care that must be mobilized for them are presented as a burden that “costs society dearly.”

In 2017, researchers at the University of Calgary published a study suggesting that Canada could save $139 million a year in end-of-life care by legalizing medical aid in dying, in particular by “saving” on palliative care.

The authors of the study concluded that medical aid in dying should not be a financial burden on the healthcare system, and could become a source of substantial savings.

The Canadian government, for its part, has meticulously counted the “savings” achieved with MAID. In 2020, the Parliamentary Budget Officer published a report showing, in cold accounting language, the “net reduction in health spending” from the old, more restrictive MAID regime for the year 2021: $86.9 million. With the considerable expansion of access to MAID contained in Bill C-7, the same report estimates additional annual “net expenditure savings” of $62 million.

The number of MAID deaths in Canada has risen dramatically. From just over 1,000 in 2016, when assisted dying in Canada was officially legalized, it rose to a total of 31,644 by the end of 2021. More than 10,000 people died by MAID in 2021 alone, and it now accounts for 3.3 percent of all deaths in Canada.

The idea endlessly repeated by the capitalist media and politicians that the use of MAID simply represents a “choice” made by individuals and their families is a monumental fraud. Such “choices,” including whether or not to continue living, are made within a definite social, historical and ideological context.

Is it really a coincidence that, on the one hand, social programs have been bled dry for decades under the pretext that there's “no money” and social conditions are increasingly difficult for the poorest 90 percent of society, and that, on the other, more and more Canadians are making the “choice” of medical aid in dying?

The COVID-19 pandemic has exposed the indifference of the world's ruling classes to human life. Preoccupied solely with maintaining their profits, they removed all health barriers to resume economic activities as quickly as possible, causing the premature death of millions of human beings and exposing tens of millions more to the increased risk of serious illnesses associated with Long COVID.

Similarly, the US ruling class, supported by Canada and the other imperialist powers, is wasting enormous human and financial resources in its war against Russia—a war that has nothing to do with defending “Ukrainian democracy,” but rather with Washington’s attempt to secure control over a region of the world rich in energy and mineral resources, that it considers vital to its geopolitical interests.

The American ruling class and its Canadian ally could not be more indifferent to the lives of millions of Russians and Ukrainians, hundreds of thousands of whom have died since the conflict began. Washington and Ottawa are striving to escalate the conflict by sending ever more lethal weapons to Ukraine, bringing the world closer to a nuclear conflagration every day.

As the social and ideological assault on the working class continues, the criteria for eligibility for MAID are constantly being widened by capitalist politicians from all parties. In Canada, medical aid in dying was previously reserved for people whose natural death was rapidly foreseeable. In 2021, this assistance was extended to people who are not at imminent risk of dying, but whose illness, disability or disease is causing them lasting suffering that is difficult to bear.

Last month, the Quebec government amended its legislation on the subject. Within two years, the law will allow Quebecers suffering from Alzheimer's to request assisted-dying care before symptoms become too disabling. It will also make people affected by a “severe physical impairment resulting in significant and persistent incapacity” eligible. In 2024, Canada wants to make MAID possible for people suffering exclusively from mental illness.

This sustained ideological campaign has had some impact on the population. According to polls, around half of Canadians would agree to allow adults to apply for MAID because of an inability to receive medical treatment or a disability. Just over a quarter would be in favor of extending medical assistance to die to include homelessness or poverty.

Strong opposition, however, has come from organizations defending the rights of disabled persons. “Our biggest fear has always been that having a disability would become an acceptable reason for state-provided suicide,” says Krista Carr, vice-president of Inclusion Canada. There's the case of Roger Foley, a 47-year-old Ontarian with a neuro-degenerative disease, hospitalized and unable to move or care for himself. He recounted how he was denied home care and pressured to request medical assistance in dying. In court, he is demanding the right to “medical aid to live.”

After decades in which the working class has been paralyzed by a pro-capitalist union bureaucracy that sabotages its struggles for better public services and working conditions, the campaign by the capitalist media and politicians for MAID is creating a political opening for the religious right. Those elements reject the right to abortion in the name of the “sanctity of life,” while at the same time being among the staunchest supporters of the dismantling of social programs and imperialist war that causes mass casualties.

To combat “unjust social circumstances,” workers must confront the harsh reality that society as a whole is subordinated to the interests of a small capitalist clique. The right to a rich and full life—which medical advances can prolong while offering the necessary assistance in the case of a terminal illness—can only be achieved in the struggle for socialism, that is, the reorganization of socio-economic life to satisfy human needs, not the profits of a small minority.