“What I have never been able to get over, what I will never forgive them for, is that they took that from her.”
So, says tearfully my interviewee, whom I’ll call Joanna, a Brussels resident who watched stunned as her mother’s life was prematurely ended by euthanasia after a long battle with cancer. Her mother had recently undergone surgery that wouldn’t save her life, but that she hoped would offer crucial data for scientific research.
“It was a kind of ‘present’,” Joanna told me, that her mother had wanted to give the oncologists who had helped her. But soon after the operation, Joanna arrived at the hospital to find her siblings had gathered to begin a euthanasia that her mother, confused from the procedure, had never initiated.
The results of the surgery would never be used. “I strongly suspect it was because the summer holidays were coming and it was a more convenient time,” Joanna told me. “And they took that from her.”
Euthanasia has been expanding at an alarming rate in Belgium. In 2024, 3,991 people opted to die in this way, a 17% increase from the previous year, according to the Federal Control and Evaluation Commission on Euthanasia (FCEE).
This trend reflects a broader campaign across Europe, where euthanasia and assisted suicide are framed as matters of autonomy and choice. But read between the lines and it is about so much more — or less, depending on how you view our new macabre medical calculus.
In a new report for the think tank MCC Brussels, I warn of the creeping legalisation of euthanasia and assisted suicide across Europe — and the steady expansion of eligibility in places, like Belgium, where it is already legal.
Initially intended for terminally ill adults, Belgians have watched as euthanasia is increasingly extended to people with psychiatric conditions, as age restrictions have been removed, and as the disabled, old, and those with dementia, have become eligible under ever-broadening interpretations.
Elsewhere, legislation has also expanded so that for instance, in Canada, where I’m from, 1 in 20 deaths are now by euthanasia. In the province of Quebec alone, it is 1 in 14. In both Canada and Belgium, new proposals keep emerging to expand access further.
Canada is often perceived as an outlier, but Belgium’s laws are actually more permissive and have been gradually extended over two decades. In a majority of countries in the EU, legislation is being tabled or has already passed and been extended.
Bureaucratic process
We are told that euthanasia is about autonomy. But in reality, it becomes a bureaucratic process — one that transforms life and death decisions into a paper trail. Proponents claim that legalisation makes end of life decisions safer, that oversight prevents abuse. But it is precisely this transformation of momentous decisions into banal routine that Hannah Arendt famously identified as “the banality of evil.”
Death becomes a box-ticking exercise. All the forms have been filled out. No one can judge or be judged. Death, like birth before it, becomes medical, managed, scheduled. And this predictability has cost-saving implications. That’s why insurance companies are increasingly involved in euthanasia advocacy. Just last year, Belgian insurance executive Luc Van Gorp publicly called for the expansion of euthanasia to “prevent a crisis in social care.”
It’s difficult to avoid the conclusion that this is what it’s really about. In most areas of public life, autonomy is regarded with suspicion. Policymakers have embraced faddish theories like “nudge” (which advocates shoving people toward better choices) that presume people don’t know what’s best for them.
Yet here, suddenly, in this unique circumstance, autonomy is paramount and sacrosanct — when expensive citizens “choose” to die. It is highly suspicious that we suddenly and uniquely believe in the autonomy of those groups that in darker times were seen as intolerable “burdens” to society.
This selective faith in choice is telling. It is not a stretch to say that the legalisation and expansion of euthanasia across Europe is being driven, in part, by an unwillingness to bear the costs of caring for those who require the most.
Last March, Times columnist Matthew Parris looked forward to the day when euthanasia would come to be “seen as the normal road for many to take, and considered socially responsible — and even, finally, urged upon people.”
Cost-benefit analysis
A 2023 Canadian poll showed that a third of Canadians supported euthanasia for those whose only “disease” is poverty. An expert committee last October revealed what many had already suspected: That euthanasia was being used where the real affliction was unmet social need.
In public debates, people often describe euthanasia as preferable to the “indignities” of death like incontinence or immobility — forgetting these are everyday realities for many disabled people. The implication is that these lives are unworthy and undignified. Framing these conditions as obvious reasons for euthanasia marks a serious retreat from decades of disability rights advocacy.
Roger Foley, a Canadian man with a degenerative condition who says he was pressured into euthanasia, told me: “It was hard to come to terms with my disability. But now we’re taking people at their most vulnerable moment and saying, ‘Yes, that’s right. Your life really isn’t worth living.’”
At the end of the 18th century, Enlightenment thinkers like French philosopher and mathematician, Marquis de Condorcet, imagined a future where the human lifespan would have “no assignable limit.” In the twentieth century that light of optimism began to blink.
By the 1970s, Susan Sontag commented that doctors were becoming weary at people’s hubristic expectations for indefinite medical progress. And now, in our current moment, that weariness has hardened into something colder: a cost-benefit calculation that treats the old, the sick, and the disabled as far too demanding a burden for society to bear.
This was driven home to me in Brussels recently. After speaking at an event, I shared with a colleague how a family member in Canada had been offered no choice but death in response to a cancer diagnosis. A man at a nearby table interrupted: “You must accept it,” he said. “All this treatment is too costly.” He worked in health policy, he added. He would know.
This is the logic we must reject. I would like that learned health policy professional to know that, after much research and pushing, my family member did receive costly treatments, and is alive today because of it.
For Joanna’s mother, no treatment would have saved her life. But she had wanted to care for her until her last breath. While I am not a religious person, her sentiments reminded me of Giles Fraser, Vicar of St Anne’s, Kew, who said, “I want to be a burden on my family as I die, and for them to be a burden on me. It’s called love.”
We must resist the creeping normalisation of euthanasia. We must stop building societies that see lives as meaningless inefficiencies, that see dependence as a problem to be managed out of existence. Some lives are not worth less simply because they ask more of us.
