In Victoria, Australia, death by assisted suicide skyrocketed up thirty-one percent from June 2021 to June 2022. During that same time, evidence of a compromised health care system has raised alarm and questions about the inherently dangerous and discriminatory practice of assisted suicide.

As an example, assisted suicide advocates celebrating the Voluntary Assisted Dying Act as a success when life-extending medical care has yet to receive commensurate increases in funding, spotlights the gathering concerns of many in the disabled community; That what “equal access to health care” really means is the inevitable removal of safeguards first advertised as permanent provisions.  

“However, the chairman of the Voluntary Assisted Dying Review Board, Julian Gardner, was delighted with the results. ‘The number of people seeking to access voluntary assisted dying continues to increase,’ he wrote in an introduction to the Board’s annual report. ‘This is a further indicator of the success of the system.’ A steady increase in the number of deaths is a strange metric of success. Does this mean that, hypothetically, 100,000 deaths would constitute success beyond his wildest dreams?”

Other end-of-life decision-making options like palliative care have seen minor increases to funding over a five-year period. Would Victorians call an increase in funding and in the number of people who applied for assisted suicide a success while access to alternative end-of-life health care options diminishes because of underfunding? 

Assisted suicide proponents, “described the Act as ‘the safest scheme in the world, with the most rigorous checks and balances’ before it was passed. So, it is unsettling to read that Mr. Gardner parroted these reassurances before admitting that four deaths were technically non-compliant with the legislation, although he was confident that they were ‘clinically appropriate.’” 

But as Rosalind McDougall and Bridget Pratt of The University of Melbourne argued in 2020:

“While safety is undoubtedly ethically important, our analysis indicates that a legislative focus on maximizing safety comes at the expense of equal access.”

How can these assisted suicide laws be “the safest in the world” when its advocates argue, that for assisted suicide to be a success, the removal of safeguards is an acceptable cost? Moreover, that the removal of these safeguards is an anticipated loss. 

These four deaths raise the insuperable question of concern oft repeated by champions against assisted suicide legislation across similarly fragmenting American and Canadian health care systems: “What are the odds that safeguards will be relaxed even further…?” 

Coming in March of 2023, the Canadian government will have an answer and is expected to expand eligibility to people who are deemed mentally ill. A clear process map begun in 2015 that has seen protection after protection removed in the name of “providing” people with “equal access to health care” at breakneck speed. And all under the calculation of the Parliamentary Budget Office which determined in 2020 that it’s cheaper to provide assisted suicide to its most vulnerable rather than save them from completely treatable diseases and most recently, from poor housing conditions.

American insurers have fallen in lockstep with the idea that narrowing end-of-life health care options is the profitable path. A path where the most vulnerable, people with disabilities, and those living in poverty (often one and the same) are faced with a two-tier health care system with less choice than those with money and present good health. And where the best option is the cheapest and the cheapest option is assisted suicide.

It seems clear that patient agency and personal autonomy cannot be exercised without equal access to all healthcare options, including alternative end-of-life decisions. Clearer still, that where assisted suicide is made an option, it quickly becomes the only “option” for vulnerable people. 

And not by choice.