In the UK Parliament’s recent Second Reading of the Terminally Ill Adults (End of Life) Bill, Canada was repeatedly referenced—often with unease. Several MPs were keen to distance the UK’s cautious legislative proposal from what they described as the more expansive and controversial Canadian framework for Medical Assistance in Dying (MAiD). These references framed Canada less as a model and more as a warning.
This blog post interrogates the UK Parliament’s selective use of Canada as a negative comparator and asks whether this reaction is grounded in a full understanding of what the Canadian experience actually entails. It also considers whether the UK’s current proposals are capable of meeting the kinds of ethical and legal imperatives that have shaped assisted dying reform elsewhere in the Commonwealth. More provocatively, it asks whether the UK’s Bill, by tightly restricting eligibility, avoids engaging with the deeper rights-based reasoning that shaped Canada’s Carter v Canada (Attorney General) 2015 SCC 5 decision which struck down the federal ban on assisted dying — and which was also present, if unresolved, in UK cases like Nicklinson.
The Second Reading and the Spectre of Canada
During the Second Reading debate on the Terminally Ill Adults (End of Life) Bill, Kim Leadbeater, who introduced the Bill, and other MPs repeatedly sought to distinguish the Bill from Canada’s broader MAiD framework. Members opposing the bill invoked Canada as a cautionary tale—pointing to the expansion of MAiD to those with disabilities, mental illness, and those not imminently dying. Labour MP Kim Leadbeater, in response, stressed that the UK’s Bill was nothing like the Canadian system: it was restricted to terminally ill adults expected to die within six months, with capacity, and under judicial and medical oversight.
This rhetorical move—differentiation by distancing—reveals a defensive posture in the UK debate. Canada becomes the straw man that makes the UK Bill appear both moderate and responsible. But this move conceals more than it reveals. In fact, the current Bill and the Canadian MAiD framework share a key philosophical foundation: both attempt to construct a regulated right to end life under conditions of suffering and decline. What differs is not the core logic but the depth and seriousness with which each jurisdiction engages with the implications of that logic.
What Canada Actually Did
Canada’s MAiD regime was established following Carter v Canada (Attorney General) 2015 SCC 5, where the Supreme Court struck down the prohibition on assisted suicide as unconstitutional. The Court held that the ban violated Section 7 of the Canadian Charter of Rights and Freedoms—protecting life, liberty and security of the person—by forcing people to end their lives prematurely out of fear they would lose the capacity to do so later.
Bill C-14 (2016) initially permitted MAiD only where death was “reasonably foreseeable.” This was later amended by Bill C-7 (2021) after Truchon v Attorney General of Canada 2019 QCCS 3792 ruled that criterion unconstitutional. Now, Canadian law distinguishes two tracks: one for those whose natural death is foreseeable and another for those whose death is not. The latter requires additional safeguards (e.g. 90-day assessment period, expert consultations). A separate exclusion for persons whose sole underlying condition is mental illness remains in place but is under active review.
Despite expansion, MAiD remains tightly regulated: written consent, capacity assessment, second medical opinion, and clear expression of enduring, voluntary, and informed consent are all mandatory. Contrary to fears, MAiD remains largely accessed by patients with terminal cancers and neurodegenerative diseases (as reported in the Annual Reports on MAiD in Canada). Structural concerns persist—particularly regarding access to care and poverty—but these critiques are context-specific and do not negate the logic of a rights-based framework.
Is the UK Bill So Different?
The UK’s Terminally Ill Adults (End of Life) Bill, introduced by Kim Leadbeater, includes a six-month terminal illness requirement, a two-doctor confirmation, and a High Court sign-off. Assistance must be self-administered. Safeguards are plentiful. But some of these provisions—particularly the prognosis requirement and the insistence on patient self-administration—carry symbolic and practical consequences that echo concerns previously raised in Canadian jurisprudence and policy.
In C Burt, ‘Assisted Dying Bill [HL]: Ignorance Within the House?’ (2023) 74(4) Northern Ireland Legal Quarterly 773, I argued that requiring patients to perform the final act themselves may reflect an unease with what assisted dying actually entails: the fear of crossing a medical “red line.” Yet, Canadian data show that almost all MAiD cases are practitioner-administered. Symbolically, Canada affirms patient control; practically, it recognises the limits of physical ability near the end of life. The UK Bill does the reverse.
More significantly, the UK’s six-month prognosis requirement may exclude the very individuals whose suffering most urgently demands relief. One such individual was Tony Nicklinson, who had locked-in syndrome—a condition that left him fully conscious but almost completely paralysed following a catastrophic stroke. In R (Nicklinson) v Ministry of Justice [2014] UKSC 38, he argued that the blanket prohibition on assisted dying violated his rights under Article 8 of the European Convention on Human Rights. While the Supreme Court ultimately declined to issue a declaration of incompatibility, it accepted that Article 8 was engaged and acknowledged that the case raised serious rights-based concerns—particularly about the adequacy of the current legal framework for those experiencing intolerable suffering. Under the proposed Bill, Nicklinson would not qualify despite the severity of his condition, his death was not reasonably foreseeable within six months. The Bill’s eligibility criteria therefore exclude not only claimants like Nicklinson, but also many of the real-life cases cited by MPs in support of the Bill—individuals suffering from unbearable symptoms but without a short-term prognosis.
What’s Really Being Feared?
When MPs say “we are not Canada,” what are they afraid of? It is not judicial overreach—UK courts have consistently deferred to Parliament. Nor is it a flood of MAiD applications from people with mental illness—Leadbeater’s Bill excludes such cases. Instead, the fear is regulatory evolution: that what begins as a tightly drawn law might later expand. But this is not an inevitability. Legislative design can and does set boundaries. And if safeguards are truly robust, why assume they will be discarded?
The invocation of Canada as a slippery slope reveals a deeper discomfort: the prospect that autonomy might require us to cede control. That Parliament, the judiciary, and the medical profession may have to accept that rational adults can choose death over suffering—and that such choices can be respected without moral collapse.
But what kind of autonomy is feared here? The parliamentary rhetoric presumes a hyper-individualistic model of decision-making, ignoring the fact that legal and ethical scholarship has long emphasised the relational nature of autonomy—particularly at the end of life. In Mortier v Belgium [2022] ECHR 764, the European Court of Human Rights recognised that autonomy is not exercised in a vacuum. Decisions about death are shaped by isolation, structural vulnerability, mental and physical decline, and the availability—or lack—of meaningful care. These are not peripheral concerns; they are central to any framework that claims to protect the vulnerable.
The fear of becoming Canada might also reflect a particular application of the precautionary principle—one that emphasises imagined risk over empirical evidence. In C Burt, ‘Assisted Dying Bill [HL]: Ignorance Within the House?’ (2023) 74(4) Northern Ireland Legal Quarterly 773 I have argued that the UK’s rejection of permissive frameworks often draws on precautionary logic taken to an extreme: where the mere possibility of abuse becomes sufficient to oppose reform, regardless of the strength of safeguards or the suffering caused by prohibition. Canada, for all its imperfections, demonstrates that systems can be iteratively improved. Waiting periods have been removed when they were found to prolong suffering without adding protection. Eligibility has expanded alongside strengthened assessments. Risk management, not risk aversion, has driven change.
There is also the symbolic dimension of regulation to consider. That the UK Bill requires the final act to be self-administered—despite evidence that many terminally ill people are physically incapable of doing so—suggests that Parliament is more comfortable with the appearance of autonomy than its practical realisation. By contrast, Canada’s practitioner-administered MAiD may appear more interventionist but is in fact more honest about the physical realities of dying and the human need for support. This preference for self-administration may also reflect a deeper anxiety about trust—specifically, trust in the medical profession to carry out assisted dying safely, ethically, and without abuse. In the wake of high-profile cases involving professional misconduct, such as the conviction of Lucy Letby, and amid broader concerns about overstretched hospitals and financial pressure on the NHS, it is perhaps unsurprising that legislators might err on the side of institutional distance. Yet sidestepping medical involvement does not eliminate ethical risk; it simply displaces responsibility onto the patient, even when they may be physically incapable of bearing it.
If the UK’s model is built primarily to avoid looking like Canada, rather than to respond to the actual needs and lived experiences of terminally ill people, then we risk creating law that speaks more to institutional anxieties than to human suffering.
Yet the Canadian model shows that legal evolution can be both responsive and responsible. The MAiD regime has grown more inclusive not because it was careless, but because constitutional and ethical reasoning demanded it. The UK, by contrast, has stagnated—mired in political caution and cultural ambivalence.
Towards a Comparative Imagination
The UK and Canada share not only a common law heritage but a political and cultural commitment to rights, dignity, and medical professionalism. If Canada has gone further, it is not because its values differ fundamentally from those of the UK, but because its courts took seriously the challenge of constitutional reasoning and recognised that a blanket prohibition on assisted dying—where it denied individuals autonomy, dignity, and equality—required legal accommodation. The moral and institutional challenge that followed was met not with deference, but with a deliberate effort to craft a regulatory framework responsive to rights-based claims at the end of life.
In Mortier v Belgium [2022] ECHR 764, the European Court of Human Rights emphasised the need for effective post-hoc oversight in euthanasia cases, as discussed in C Burt, ‘Mortier v Belgium [2022] ECHR 764: Warning Signs for Assisted Dying Regulation?’ (2023) 31(4) Medical Law Review 615. While Canada is not bound by European human rights jurisprudence, its regulatory framework has evolved in ways that reflect the kinds of safeguards affirmed in Mortier—embedding mandatory reporting, independent review, and accountability in its MAiD regime. The UK’s current proposals, by contrast, focus almost exclusively on ex ante safeguards—forestalling abuse before it occurs, but doing little to track outcomes or address structural inequality.
Understanding Canada’s legislative trajectory is not about admiring divergence, but about interrogating the consequences of a rights-driven model of regulation and asking whether it reflects principles the UK is willing to follow—or explicitly resist. It encourages a reflective humility: that others may have grappled with problems we are only beginning to face. Canada is not a perfect model—but nor is it the caricature invoked in Westminster. It is a jurisdiction that has confronted the complexity of suffering, autonomy, and legal responsibility with seriousness and transparency. That, at the very least, deserves engagement rather than dismissal.
Conclusion: The Choice Before Us
If Parliament truly wants to avoid Canada’s path, it must first understand it. Not through political soundbites, but through careful comparative analysis. The question is not whether the UK will “become Canada,” but whether it will allow fear to prevent reasoned reform. Assisted dying law, wherever it exists, reflects a society’s willingness to confront mortality and suffering as matters of public concern — and to do so with a particular conception of moral seriousness, one that privileges autonomy, compassion, and control. Other moral frameworks, of course, might reach different conclusions — emphasising care, endurance, or collective responsibility as central to dignity. To construct, however imperfectly, a legal space for compassion. The UK has that opportunity now. But it will not grasp it by pretending Canada has nothing to teach.
Posted by Mr. Chay Burt, PhD candidate, University of Sussex.
British Association of Comparative Law 
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