How MAiD Is Counted and Not Counted

Euthanasia, Cause of Death, and the Disappearance of the Act

The normalization of euthanasia rarely happens all at once. It usually advances by a series of softenings. First the language changes. Suicide becomes “physician-assisted death.” Then it becomes “medical assistance in dying.” Finally it becomes MAiD, an acronym so gentle and bureaucratic that the physician, the patient, and the lethal act almost disappear from view.

But there is another, less visible stage in this process: classification. A society does not only reveal its moral convictions by what it permits. It also reveals them by how it records what it permits. The question is not only whether euthanasia is legal, but whether society can still name truthfully what has happened when a patient dies by lethal medical intervention.

Canada offers an especially important case. Health Canada’s Sixth Annual Report on Medical Assistance in Dying in Canada states that 16,499 people received MAiD in 2024, representing 5.1 percent of all deaths in Canada that year. So the point is not that MAiD deaths are entirely unreported. The problem is subtler and more serious: MAiD is visible as a reported medical service, but it can become invisible as a cause of death.

Health Canada also explains that MAiD is not classified as a cause of death according to World Health Organization standards. Instead, for vital-statistics purposes, the underlying illness or condition is used. In the report’s own example, if a person with advanced cancer receives MAiD, cancer is treated as the cause of death for vital statistics.

This creates a peculiar public visibility. MAiD is counted and not counted. It is acknowledged and displaced. It appears in annual reports, but disappears into categories such as cancer, neurological disease, frailty, or another underlying condition. The act is recorded administratively, but hidden morally and statistically inside the language of illness and care.

That distinction matters. A patient’s illness may explain why death was requested. Cancer, disability, psychological suffering, isolation, fear of decline, or the feeling of being a burden may disclose the terrible conditions in which the request arose. These are not irrelevant. They deserve compassion, attention, and pastoral seriousness. But where a lethal drug is administered or prescribed precisely in order to bring about death, the illness is not the act by which death occurs. The underlying condition is the context. The lethal intervention is the chosen act.

Catholic moral theology has always insisted on this kind of clarity. St. Thomas Aquinas teaches that human acts must be judged according to their object, intention, and circumstances. Compassion, fear, pain, and a desire to relieve suffering may help explain why an act is chosen. They do not change the moral species of the act itself. To administer a lethal substance so that a patient will die is not the same act as relieving pain, withdrawing disproportionate treatment, or accompanying the dying.

This is why the Catholic tradition distinguishes carefully between killing and allowing to die. It is not wrong to refuse treatment that is extraordinary, disproportionate, excessively burdensome, or no longer reasonably beneficial. Nor is it wrong to give appropriate pain medication, even when death may be foreseen but not intended. But euthanasia and assisted suicide are different because death is chosen as the means or as the intended outcome.

Catholic bioethicists Patrick Lee and Jason Eberl help clarify this distinction. In “Personhood, Dignity, Suicide, and Euthanasia,” Lee argues that intentional mercy killing is wrong because it involves choosing against the intrinsic good of human life. Eberl, in “Aquinas on Euthanasia, Suffering, and Palliative Care,” clarifies the other side of the issue: Catholic morality does not demand useless prolongation of dying, nor does it reject palliative care. The line is crossed when death itself is selected as the solution to suffering.

That is why classification is not merely a technical matter. If a MAiD death is classified simply under the patient’s illness, the lethal act is absorbed into the disease narrative. Society can say, “the cancer killed him,” or “the neurological disease killed her,” when in fact a human act intervened in order to bring about death. The record may be medically useful in one respect, but morally misleading in another.

The problem belongs to a wider linguistic pattern. William Brennan, in his article “John Paul II on the Language Empowering the Culture of Death,” showed how the culture of death is empowered by language that masks violence against vulnerable persons. Manfred Spieker made a similar point in “The Legal Language of the Culture of Death in Europe”: words such as dignity, freedom, assistance, health, therapy, and self-determination can produce life-affirming associations while concealing acts directed against life.

MAiD belongs squarely within that pattern. It does not merely describe euthanasia; it educates the public to perceive euthanasia as assistance. The language softens the act. The legal framework permits the act. The clinical protocol administers the act. Then the classification system can displace the act under the illness that preceded it.

This is the threefold concealment now at work: euphemistic language conceals killing as care; administrative classification conceals the lethal act as disease; and institutional integration conceals euthanasia as ordinary medicine.

The last point is crucial. Once euthanasia is treated as a medical service, it does not remain isolated. It generates secondary practices and institutional pressures. Frans van Ittersum and Rev. Lambert Hendriks, writing on organ donation after euthanasia, have warned that an apparently charitable act can become closely connected to the prior act of killing. The National Catholic Bioethics Center has likewise raised concerns about Catholic hospitals in Canada being pressured to cooperate, directly or indirectly, with MAiD through transfer arrangements or nearby “clinical spaces.”

Classification and cooperation are two sides of the same normalization process. Classification hides the act in the record; cooperation embeds the act in the institution. In both cases, euthanasia becomes less visible as killing and more visible as a pathway within health care.

This is not only a problem for Catholic institutions. It is a problem for the whole common good. If lawmakers, physicians, families, and citizens cannot clearly see how often lethal medical acts occur, under what conditions they occur, and how they are being described, then public accountability is weakened. Safeguards depend on truth. A safeguard that cannot be verified is not much of a safeguard.

The Canadian experience also shows that MAiD is not simply an individual choice made in a vacuum. Many requests for assisted death arise amid loneliness, fear, disability, poverty, loss of meaning, or the feeling of being a burden. When a suffering person says, “I do not want to continue,” the first question should not be, “How do we facilitate that wish?” The first question should be, “Who is remaining with this person inside that suffering?”

This is why the offer of euthanasia is never neutral information. It says something to the patient. It says: your life now belongs to the category of lives for which death is a reasonable medical solution. For the elderly, disabled, chronically ill, depressed, or socially isolated, such an offer can confirm precisely the fear that already wounds them: that they are burdensome, inconvenient, expensive, or no longer fully wanted.

Charles De Koninck’s reflections on the common good help us see what is at stake. In La Confédération, rempart contre le Grand État, De Koninck warned against a political order in which public life is reduced to administration and citizens become abstract units to be managed. Public functions cease to be truly political and become merely bureaucratic. Prudence gives way to technique. Concrete communities are replaced by distant systems.

Something similar can happen in medicine. The suffering person is no longer first seen as someone embedded in family, friendship, parish, memory, and community. He appears instead as an isolated bearer of autonomous choice before a medical and legal apparatus. His request is processed. His eligibility is assessed. His death is scheduled. His case is classified. That is not communion. It is administration.

For De Koninck, the human person is not fulfilled by isolation, nor can his good be reduced to private preference detached from the community. He is ordered to goods shared with others: family, friendship, worship, civic life, and finally God Himself. The common good is not the enemy of personal dignity. It is the social space in which personal dignity is recognized, protected, and brought to fruition.

For this reason, euthanasia is not merely an individual act. It is a wound against the common good. It teaches the community that some dependencies are too costly, some sufferings too burdensome, some lives too diminished to be accompanied. But the vulnerable person is not outside the common good. He is one of its privileged tests. A community proves its humanity precisely by how it receives those who cannot repay, produce, or protect themselves.

Elio Cardinal Sgreccia’s Manuale di bioetica points in the same direction. Against utilitarian, contractualist, and purely procedural approaches, Sgreccia insists that bioethics must rest upon an adequate anthropology of the person, what he calls an “ontologically grounded personalism.” The patient is not simply an autonomous chooser, a biological organism, or a bearer of preferences. He is a person whose dignity is rooted in being, not in efficiency, independence, usefulness, or desire.

Once this personalist foundation is lost, medicine easily becomes either a technique for managing bodies or a service industry for satisfying choices. The physician is no longer primarily a servant of the patient’s integral good, but a technician of requested outcomes. The hospital becomes less a place of healing and more a site where biological suffering is managed according to legal options. In such a setting, death can begin to look like one more service.

The deeper issue, then, is anthropological. Modern culture increasingly treats the body not as a gift to be received, but as material to be managed. We see this at the beginning of life, where the unborn child can be rejected if he is unwanted, inconvenient, disabled, or poorly timed. We see it in the sexual revolution and gender ideology, where the body is treated as raw material for the sovereign self. And we see it at the end of life, where the suffering or dependent body is treated as a problem to be solved by control.

Abigail Favale’s The Genesis of Gender helps illuminate this pattern. Favale shows how modern gender theory often seeks liberation from the givenness of the body. Something similar occurs in the euthanasia regime. The dependent body, the suffering body, and the dying body are no longer received as places where love, patience, and accompaniment are demanded. They become conditions under which death may be chosen, administered, and then linguistically absorbed into the illness itself.

In both cases, language does not merely describe reality. It attempts to revise reality. Contraception taught modern culture to treat fertility as a malfunction; gender ideology treats sexed embodiment as a problem of self-definition; MAiD treats suffering and dependence as candidates for medical elimination. The common thread is not identical subject matter, but a shared anthropology: the body as material for control rather than gift.

Truthful classification serves the opposite witness. To name a MAiD death as a MAiD death is not to deny the patient’s illness. It is not to minimize suffering. It is simply to refuse to let the disease narrative swallow the chosen lethal act. A more honest system would distinguish among the underlying condition, the physiological mechanism, and the chosen lethal intervention. All three may be relevant. They are not interchangeable.

A society that cannot name the act will eventually lose sight of the person. At the beginning of life, abortion says that a dependent life may be rejected. At the end of life, euthanasia says that a dependent life may be removed. These acts are not identical, but they arise from a common temptation: the refusal to receive vulnerable life as gift.

Catholic bioethics must therefore resist both harshness and euphemism. It must never deny the anguish that leads some persons to request assisted death. But it must also refuse the false mercy that eliminates the sufferer in order to eliminate suffering. Compassion must not become concealment. Bureaucracy must not become moral anesthesia. Medicine must not be permitted to hide killing under the language of care.

The Christian answer is not technological maximalism. It is not the useless prolongation of dying. It is not indifference to pain. The Christian answer is accompaniment: palliative care, spiritual care, familial presence, sacramental life, and the refusal to let death appear as the obvious answer to dependence. When life becomes painful, the answer is not to shorten the road, but to walk it together.

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Editor’s Note: This article is part of a CE original series on Bioethics & Culture by Fr. Francesco Giordano, tackling the challenging moral issues of our day.

Photo by Felipe Queiroz Alves on Unsplash