Two years ago, a dear friend asked my husband and me to act as witnesses to his request for medically assisted death. We agreed without hesitation. Canada’s Medical Assistance in Dying (MAiD) law had been conceived for cases just like his. He was dying of respiratory failure and cancer. He was out of medical options, and his suffering was acute. The end was not far off. Through MAiD, he could either self-administer lethal medications, or have them administered intravenously by a medical professional. In either case, he could expect to drift into an unconscious state, from which he would never emerge.

We signed the form as his wife looked on, and tried not to cry. A few weeks later, he died in his sleep. Our friend never did use MAiD. But he was grateful and relieved that he had the choice of doing so. So were we.

In its original form, which was written into law in 2016, MAiD had widespread support from the general Canadian public. After all, we believe in personal autonomy. We do not believe in pointless suffering—including our own. Canada is, by now, a mostly secular country, unbeholden to religious ideas about the sanctity of each God-given soul. And so when Justin Trudeau’s government enacted MAiD seven years ago, it was presented as a progressive moral victory over regressive conservative medical hang-ups.

MAiD eligibility was restricted to Canadians with a “grievous and irremediable” medical condition, for whom “natural death has become reasonably foreseeable.” Applicants required two independent medical or nurse practitioners to sign off on their eligibility. Typical recipients were terminal cancer patients in their late 70s or older, whose dignified obits announced them as having died on their own terms, surrounded by loved ones.

The public was assured that the process was bioethically solid. Guardrails were in place to prevent abuse. Some Canadians warned of slippery slopes, but they were generally dismissed as doomsayers. Leading MAiD doctors such as Jean Marmoreo, widely celebrated in the media for their compassion and humanity, were quick to correct anyone who referred to their work as “assisted suicide.” Instead, we were told that this was a “medical procedure,” much like any other procedure (except to such extent that it’s guaranteed to be your last).

According to a government report published in July 2022, MAiD deaths represented about 3 percent of total Canadian deaths in 2021, up from about 0.3 percent in 2016. By now, a majority of my friends know someone who has died by MAiD, and many others who plan to do so when the time comes. For the most part, the availability of state-assisted suicide has become an accepted part of the Canadian social contract.

But thanks to recent legislative changes, MAiD has expanded in a way that many original supporters didn’t expect—or want. In 2021, following a successful court challenge by right-to-die litigants, the law was broadened to include patients with illnesses such as Parkinson’s disease or multiple sclerosis, who might live on with various degrees of impairment for many years. Specifically, the government removed the original eligibility requirement that a person’s natural death be “reasonably foreseeable.” (Such MAiD deaths are now tagged in the literature as “non-RFND”—i.e., no reasonably foreseeable natural death.) Aside from being over the age of 18 and of sound mind, applicants need only show that they are someone who has “a serious and incurable illness, disease, or disability, who is in an advanced state of irreversible decline in capability, who is experiencing enduring and intolerable suffering that cannot be relieved under conditions acceptable to them.”