Few questions in contemporary jurisprudence expose so profoundly the tension between law, morality and human dignity as the question whether a human being should possess the legal right to determine the circumstances of their own death. The issue is not merely whether a person may refuse medical treatment, whether a physician may administer medication to relieve suffering, or whether the state may intervene to prevent suicide. It is whether the constitutional recognition of life, liberty and security of the person can extend, under particular circumstances, to a legally protected choice to terminate life with medical assistance.
Canada
The question has acquired particular significance in Canada, where the Canadian Charter of Rights and Freedoms (Which is part of the Canadian Constitution) protects life, liberty and security of the person under section 7, while Parliament has established a statutory regime permitting medical assistance in dying (MAiD). The controversy has been sharpened by proposals to exclude persons whose sole underlying medical condition is a mental illness from eligibility. At stake is a conflict between two propositions, each possessing considerable moral force: that a competent individual should exercise meaningful authority over the most intimate decisions concerning their existence, and that a state committed to protecting life must exercise particular caution where a request for death may arise from psychological suffering, social deprivation or circumstances that might change.
The constitutional question cannot be resolved simply by elevating one proposition above the other. Life is not necessarily protected by denying every request for assistance in dying; nor is liberty necessarily vindicated by permitting every such request. The more difficult inquiry concerns the circumstances in which autonomy becomes legally cognizable, the evidential foundation upon which an irreversible decision may be made, and the extent to which the state can justify restricting individual freedom in the name of protection.
Section 7 of the Charter provides that everyone has the right to life, liberty and security of the person, and the right not to be deprived thereof except in accordance with the principles of fundamental justice. It does not expressly confer a right to die or an unconditional entitlement to medical assistance in ending life. Nevertheless, liberty encompasses important decisions concerning personal autonomy, bodily integrity and medical care. Security of the person protects important interests in physical and psychological integrity. These guarantees explain why a prohibition on medical assistance in dying may raise constitutional questions, even though the Charter contains no express right to assisted death.
In Rodriguez v. British Columbia (Attorney General), [1993] 3 SCR 519, the Supreme Court of Canada upheld the prohibition on assisted suicide against the constitutional challenge before it. The jurisprudential landscape changed with Carter v. Canada (Attorney General), 2015 SCC 5. The Court held that the blanket prohibition unjustifiably infringed section 7 insofar as it prevented a defined class of competent adults suffering from a grievous and irremediable medical condition causing enduring and intolerable suffering from obtaining assistance in dying, subject to the conditions identified in its judgment. The Court did not establish an unlimited constitutional right to death in every circumstance. Rather, it invalidated a prohibition to the extent that it applied to the class before it.
The distinction is fundamental. A constitutional right to make certain decisions concerning one’s life does not necessarily generate a universal positive right to require medical assistance in carrying out every decision to die. Nor does the recognition of constitutional liberty prevent Parliament from establishing eligibility requirements and safeguards intended to protect against coercion, impaired decision-making and other risks.
Section 15 of the Charter, which guarantees equality before and under the law without discrimination on specified grounds, including mental and physical disability, adds another dimension. If the law permits MAiD for certain forms of physical suffering while categorically excluding comparable suffering arising from psychiatric conditions, does that distinction protect vulnerable persons or unjustifiably discriminate against them? The answer cannot be determined merely by invoking autonomy on one side and the preservation of life on the other. It requires examination of the evidence, legislative objectives and constitutional proportionality.
The controversy surrounding mental illness illustrates the difficulty. Canada’s 2021 amendments to the Criminal Code removed the requirement that natural death be reasonably foreseeable for all eligible applicants, while temporarily excluding persons whose sole underlying medical condition is a mental illness. Parliament subsequently postponed the proposed extension of eligibility. Bill C-218, the Right to Recover Act, sponsored by Conservative MP Tamara Jansen, sought to make the exclusion permanent by providing that a mental disorder would not qualify as a grievous and irremediable medical condition for MAiD purposes. The bill was defeated at second reading on 7 October 2026. The federal government has since announced its intention to introduce legislation maintaining an indefinite exclusion. As of 14 October 2026, that proposed legislation has not become law, and the existing statutory exclusion remains in force, with its scheduled expiry on 17 March 2027 unless Parliament intervenes.
The arguments supporting permanent exclusion are substantial. Psychiatric conditions may fluctuate, treatment responses can be delayed, and a person who has not benefited from several treatments may nevertheless improve. Depression and other illnesses can affect perceptions of the future, personal worth and the possibility of recovery. The concern is not that every person with a mental illness lacks decision-making capacity. Such a presumption would be inconsistent with equality and respect for persons with disabilities. Rather, it is that clinicians may face exceptional difficulty determining whether a request represents a stable, informed and autonomous judgment or is materially influenced by the condition prompting the request.
The counterargument is equally important. Some people endure severe psychiatric illness for decades, experience repeated treatment failures and continue to suffer despite extensive clinical intervention. To tell them that their suffering cannot qualify as irremediable simply because it is psychiatric may make legal recognition depend upon the diagnostic category through which suffering is described. Advocates of access argue that eligibility should be assessed individually rather than determined by a categorical rule.
Yet individualized assessment does not automatically eliminate uncertainty. The question is whether clinicians can reliably evaluate prognosis, treatment possibilities, capacity, the stability of the request and the possibility that the individual’s circumstances may change. The law frequently requires decisions under conditions of uncertainty, but the permissible degree of uncertainty may reasonably be different when the consequence is irreversible.
There is also a profound social dimension. If a person requests MAiD because appropriate psychiatric care is unavailable, because poverty has deprived them of stable housing, or because disability has produced isolation and inadequate support, society must ask whether the apparent choice is being made in circumstances it has a responsibility to improve. Formal voluntariness does not necessarily mean that meaningful alternatives exist. Conversely, the existence of social disadvantage does not establish that every request is invalid. The challenge is to distinguish individual autonomy from circumstances in which the failure of public institutions may narrow the choices available.
The Nuremberg Code
The Nuremberg Code, formulated in 1947 following the medical atrocities exposed during the Second World War, offers an important ethical perspective. Its first principle emphasizes the necessity of voluntary consent in human experimentation. Consent must be informed and freely given by a person capable of making an understanding decision, without force, fraud, deceit, duress or other forms of constraint. The Code emerged from a historical recognition that medical authority and state power can become instruments of wrongdoing when human beings are treated as objects rather than moral agents.
The analogy with MAiD must, however, be carefully drawn. The Nuremberg Code concerns human experimentation; it does not establish a right to assisted death or resolve the question of when such assistance should be lawful. Its enduring relevance lies in its insistence that professional expertise and state authorization cannot, by themselves, establish ethical legitimacy. A request for MAiD must be informed and voluntary, but consent alone cannot discharge every ethical obligation. The intervention must also be examined in the light of its purpose, consequences, applicable law and professional responsibilities.
Other Jurisdictions
Comparative law demonstrates that societies have adopted different approaches to the relationship between autonomy and the preservation of life. The Netherlands and Belgium permit euthanasia under statutory conditions that include a voluntary and well-considered request, serious suffering, appropriate medical assessment and procedural safeguards. Psychiatric suffering may qualify in certain circumstances, although eligibility is not automatic. Switzerland has a different legal framework, penalizing assistance in suicide when motivated by selfish reasons while distinguishing it from the direct administration of a lethal substance by another person. In the United States, state laws permitting medical aid in dying generally impose restrictions linked to terminal illness, prognosis, capacity and procedural requirements. Oregon’s Death with Dignity Act is an example. New Zealand’s End of Life Choice Act 2019, which came into force in 2021, establishes a framework centred upon terminal illness, advanced irreversible decline, unbearable suffering and decision-making capacity.
These models do not establish a universal legal principle. The fact that one jurisdiction permits assistance in dying in certain psychiatric cases does not prove that Canada is constitutionally obliged to do the same. Conversely, the existence of restrictive legislation elsewhere does not establish that a categorical exclusion in Canada is justified. Comparative experience is valuable because it reveals different methods of balancing competing interests, but constitutional validity must ultimately be determined by reference to Canada’s own legal framework.
Philosophy and Ethics
Philosophy provides another indispensable perspective. John Stuart Mill, in On Liberty (1859), defended individual freedom against unnecessary state interference. His philosophy invites the question whether a competent adult should be permitted to make deeply personal decisions without being subjected to the moral convictions of the majority. Yet Mill’s defence of liberty does not automatically resolve the question of an irreversible decision that eliminates the possibility of reconsideration. The state may claim that safeguards protect the conditions under which genuine autonomy can be exercised, rather than merely obstructing it.
Immanuel Kant offers a different conception of dignity. In the Groundwork of the Metaphysics of Morals (1785), he argues that humanity must always be treated as an end in itself and never merely as a means. Kant’s account of duties to oneself also condemns suicide. His philosophy supports the proposition that human worth cannot depend upon productivity, independence or freedom from suffering. A person whose life is marked by disability or psychological distress does not thereby lose intrinsic dignity. Nevertheless, contemporary medical ethics distinguishes between intentionally ending life, refusing disproportionate treatment and providing palliative care, and these distinctions require careful consideration.
Aristotle’s concept of eudaimonia, or human flourishing, further challenges the idea that life is merely biological persistence. Human welfare involves reason, relationships, virtue and participation in a community. A state that protects biological existence while neglecting healthcare, social inclusion and relief from preventable suffering may satisfy a narrow conception of preservation while failing a broader understanding of human flourishing.
Ronald Dworkin, in Life’s Dominion (1993), examined the relationship between autonomy, the sanctity of life and the different meanings individuals attach to the value of their existence. His analysis helps explain why the MAiD debate cannot be reduced to a contest between those who value life and those who do not. Both sides may regard life as profoundly important while disagreeing about what respect for its value requires under circumstances of extreme suffering.
The Scriptures
Religious traditions likewise illuminate the ethical dimensions of the controversy, although none should be treated as a direct statutory rule. The Bible presents human life as possessing profound significance. Genesis describes humanity as created in the image of God, while the commandment traditionally rendered as “Thou shalt not kill” has informed Christian opposition to the intentional taking of innocent human life. Yet the biblical narrative also confronts despair and suffering. In 1 Kings 19:4, Elijah asks that his life be taken, but the narrative responds with rest, nourishment and renewed purpose. This is not a direct ruling on MAiD; it nevertheless illustrates the possibility that despair, however genuine, may call for care rather than the immediate fulfilment of a wish to die.
The Buddhist Tripitaka approaches suffering through the Four Noble Truths and the concept of dukkha, which encompasses suffering, dissatisfaction and the instability of conditioned existence. The First Precept traditionally requires abstention from taking life, and many Buddhist interpretations oppose suicide and euthanasia. Buddhist ethics also emphasizes compassion and the significance of intention. Compassion requires that suffering be taken seriously and relieved where possible, but it does not necessarily require treating the wish to escape suffering as a final judgment that life should end.
The Upanishads explore the relationship between the individual self, ultimate reality and the apparent limitations of embodied existence. The Katha Upanishad, through the dialogue between Nachiketa and Yama, examines mortality, knowledge and the distinction between transient gratification and enduring spiritual understanding. These teachings are concerned with metaphysics and liberation rather than statutory eligibility for assisted dying. Their significance lies in challenging the assumption that human identity and worth are exhausted by transient physical or mental states.
The Bhagavad Gita similarly examines mortality through the dialogue between Arjuna and Krishna. Its teaching concerning the enduring nature of the self and the distinction between body and Atman cannot responsibly be interpreted as an endorsement of assisted dying. The text is concerned with duty, action and spiritual discipline, not with a modern medical entitlement to terminate life. Nevertheless, its insistence that action should be examined in the light of duty and moral understanding offers a useful caution against decisions governed solely by fear, despair or an unexamined desire to escape present circumstances.
These religious and philosophical traditions differ significantly in their understandings of life, death and moral duty. Their contribution is not to dictate a uniform legal answer, but to remind society that the value of human existence cannot be measured exclusively by comfort, utility or freedom from suffering. In a pluralistic democracy, however, the legitimacy of legislation must ultimately rest upon constitutional principles that can be examined and debated by citizens of different beliefs.
The controversy also raises the question of institutional authority. Parliament possesses democratic authority to establish the statutory conditions under which MAiD may be provided, but its legislation remains subject to the Constitution. Under section 52(1) of the Constitution Act, 1982, the Constitution is the supreme law of Canada, and an inconsistent law is, to the extent of the inconsistency, of no force or effect. Judicial review is therefore not an intrusion into an unlimited legislative domain; it is a mechanism through which constitutional limits are enforced.
The courts, however, do not possess unrestricted authority to substitute their personal moral convictions for those of elected representatives. Their responsibility is to interpret the constitutional text, apply precedent, examine evidence and determine whether restrictions on fundamental rights can be justified. In Carter, the Supreme Court concluded that protecting vulnerable persons did not justify the absolute prohibition before it. That judgment did not settle every future question of eligibility. The present dispute requires a distinct assessment of the evidence concerning mental illness, prognosis and safeguards.
The proper relationship between Parliament and the judiciary is therefore one of constitutional dialogue. Parliament may enact safeguards and reconsider eligibility criteria; the courts may determine whether those measures comply with constitutional guarantees. Neither institution should presume that disagreement itself establishes illegitimacy. The irreversible nature of the decision makes this dialogue particularly important. An erroneous decision permitting death cannot be remedied, but a prohibition that denies a competent person access to an option they regard as essential to their dignity may also impose a profound and irreversible burden.
My Take
Neither the right to life nor the principle of autonomy should be treated as an absolute trump card. The state must justify restrictions upon liberty and equality, while those advocating access to MAiD must confront the responsibilities that accompany an irreversible decision. The quality of the law should be judged by the seriousness with which it addresses both obligations.
Morality and legislation are related, but they are not identical. A practice may be legally permitted without being regarded as morally acceptable by every member of society. Conversely, a moral conviction, however sincerely held, does not automatically justify its compulsory imposition upon every individual. Ethics occupies the space between abstract moral belief and legal permission, asking what a person ought to do, what a professional owes another human being, and what responsibilities arise when an action cannot be reversed.
Human dignity must remain central to this inquiry. It cannot depend upon physical independence, economic productivity, psychological stability or freedom from suffering. A person whose existence is marked by disability, dependency or psychiatric distress does not lose their intrinsic worth. A society that allows people to conclude that their continued existence is an imposition upon others would fail to honour the very principle it claims to protect.
Yet dignity also includes respect for moral agency. To deny all significance to a competent adult’s considered judgment about their own suffering would diminish the person in another way. The challenge is to respect that agency without allowing autonomy to become a justification for neglect, abandonment or the premature closure of possibilities that appropriate care might preserve.
A durable legal settlement must therefore be accompanied by a serious commitment to mental healthcare, suicide prevention, palliative care, disability support and the social conditions that enable individuals to live with dignity. Access to treatment cannot be treated as a peripheral consideration. The protection of life should not be measured solely by the prohibition of an intervention, just as respect for autonomy should not be reduced to the fulfilment of every expressed preference.
The ultimate test is whether the law recognizes the human being in the full complexity of their existence: as an autonomous individual, a vulnerable person, a participant in a community and a human being whose dignity does not depend upon the judgment of others concerning the worth of their life.
The right to life cannot be understood merely as a command to remain alive, just as liberty cannot be understood merely as permission to choose death. Both principles demand a more searching inquiry into the responsibilities of the state and the moral limits of its power. The law must protect life without reducing the individual to an object of state protection; it must respect autonomy without treating every expressed preference as immune from ethical scrutiny.
Human dignity resides neither exclusively in the preservation of biological existence nor exclusively in the exercise of individual choice. It resides in the recognition that every person is entitled to be treated as a human being whose suffering matters, whose agency deserves respect, whose vulnerability must not be exploited and whose life must never be regarded as expendable. A constitutional democracy demonstrates its moral maturity not by eliminating the conflict between these principles, but by confronting it with intellectual honesty, institutional restraint and compassion. That is the enduring responsibility of morality, legislation, the courts and medical ethics alike.
