Laying my cards on the table for all to see, I oppose euthanasia. I’ve made that argument before, and will not repeat it here. The Canadian case is even thornier than the case in the U.S., for the incentive structure in a society with socialized medicine is downright perverse: Canadians do their country a financial favor by choosing to die, and they cannot realistically look to their government for assistance if they choose to live instead. The possibility of “gentle” coercion is rife, as many tales from Canadian citizens attest.
No wonder the number of Medical Aid in Dying, or MAiD, deaths increases every year in Canada. In 2016, when euthanasia was first introduced, 1,018 individuals died under MAiD, less than 1% of Canadian deaths. In 2021, 10,064 Canadians died through MAiD, more than 3% of all Canadian deaths. In 2025, over 16,500 died by MAiD, more than 5% of Canadian deaths. The list of those legally eligible for MAiD has also expanded over time, and with the inclusion of mental illness eligibility scheduled to go into effect in March 2027, a subsequent sharp rise in MAiD deaths is predicted.
One might be excused for thinking there is no way to make the Canadian euthanasia situation worse than it already is, but you’d be wrong. A trio of authors, two of them Canadian — Carter Winberg, a Canadian critical-care physician working on his master’s degree in bioethics at Harvard, and Ian Ball, another Canadian critical-care physician — have just published a stunning paper in the July 2026 issue of the New England Journal of Medicine.
In this seven-page opinion piece, the authors note that the concept of organ donation dramatically changes in the context of legal voluntary euthanasia. Since you have chosen to die, you can believe that your choice is a beneficent one by agreeing to donate your organs. So far, so relatively uncontroversial, and it is indeed the fact that Canadian MAiD deaths are increasingly accompanied by organ donation.
However, the authors point out that waiting until the donor is pronounced dead (the “dead donor rule,” or DDR) means that most organs to be harvested have been without blood circulation for many minutes. This impairs their viability for transplant. Given the long waiting lists for transplant in Canada, the authors see a problem for which there is an obvious solution.
Normally, the DDR functions also as a “do not kill” rule, as well. That is, the DDR in effect prohibits organ donation from causing death, because the patients must be declared dead before any harvesting can begin. There is to be a strict temporal sequence of death, and only then organ harvesting, for the procedure to be ethical. Indeed, there has been enormous scandal in the U.S. when that sequence has been tampered with. There’s a name for an alteration of the sequence, and it’s vivisection, which was tried as a war crime after Nazi atrocities in World War II, with seven doctors executed for the crime by the Allies.
This does not deter our doughty trio of authors. The “do not kill” aspect of the DDR makes no sense, they aver, when the patient is choosing of their own free, competent will to have medical doctors euthanize them. The patient has asked to be killed, and the doctors will kill them. That is precisely what the patient wants to have happen. What does it matter, then, if the doctor chooses to undertake this task through death-by-vivisection, assuming the patient is heavily sedated and presumably can feel nothing?
The authors assert:
“In the new context surrounding the DDR, requiring a formal declaration of death before procurement may become ethically arbitrary when death has been consensually chosen and is imminent. In this landscape, the moral significance of strict temporal sequencing is diminished. In death by organ donation, the patient’s authorization, experience, and outcome are not altered by whether death occurs moments before or during organ retrieval. Ethical focus should therefore shift away from identifying a precise moment of biologic death and toward respecting patients’ autonomous decisions, ensuring that safeguards against coercion and exploitation are robust, and advocating for a transparent and publicly accountable process.”
Indeed, they view death-by-vivisection as a win-win scenario: the patient’s choice to die is honored, the patient’s choice to donate their organs so that others may live is optimally followed, and presumably the recipients of those organs have a chance to live a full life. No one, they say, is worse off than if DDR were to be followed, and arguably all are better off if it is not. Of course, they do note that some clinicians might be opposed to performing a vivisection, but suggest that “a structured, candid, ethically rigorous, data-informed dialogue is essential” to, presumably, overcoming such objections.
The logic is impeccable, and I imagine will be persuasive to many. These flaxen cords of logic, however, must be seen for what they really are: the justification of vivisection. If I consent to be vivisected, it’s not bad, right? You’re just honoring my choice, correct?
Canada, o Canada! Your moral compass was shattered by the passage of the euthanasia law in 2016, and now you have no leg to stand on to oppose atrocity. You have sown the east wind, and now the whirlwind is coming.