Built to Coerce: Canada’s Living Laboratory of Euthanasia and the Call to Catholic Witness

October 14, 2025

By Yuriko Ryan, DBe, MA, HEC-C

One summer morning my husband and I stepped into a Catholic hospital through a main entrance we both knew well. It was where he was born, where he practiced almost daily as a family physician for 35 years, where we returned to countless specialist visits, outpatient appointments, palliative care meetings with dear friends, and the joy of welcoming babies in the maternity ward. For us, the hospital was a constant holy presence, an unwavering witness to the dignity of life. 

But this visit brought something unexpected into view. On the left wall, a new mural of muted mountains and shoreline scenes quietly caught our attention. There were no familiar reminders – no mission statement and no donor plaques. The absence felt unsettling and eerie. Beside the mural was a locked door, labeled not with Providence or St. Paul’s Hospital but with the name of the regional health authority and Shoreline Space. Outside it, elderly patients unsuspectingly sat in wheelchairs, on walkers, or on chairs, waiting for their ride in a handicapped-accessible van. This was the wall and the door to the euthanasia clinic, conjoined to our Catholic hospital. The mural and the doorway together became more than décor – they became a map of contested moral space.   

Canada – Laboratory of Euthanasia

Canada has transformed into a real-world testing ground for euthanasia – what the law calls medical assistance in dying (MAiD). Initially permitted only in cases of suffering with terminal illness, [i] MAiD has rapidly expanded through court challenges framed as rights. Law makers and healthcare systems have responded with unexpected enthusiasm by widening eligibility to include patients with chronic conditions, disabilities, mental illness, frailty, and various perceived sufferings.

By the end of 2024, around 90,000 Canadians had died by MAiD since it became legal in 2016.[ii] In 2023, MAiD deaths accounted for 4.7% of all Canadian deaths,^[iii] making it the fifth leading cause of death nationwide. The pace of growth is nearly the same proportion the Netherlands reached after twenty years.[iv] Today, MAiD requests are rarely denied. [v]

Spatial Ethics

Spatial ethics, despite their significance to environmental and behavioral psychology,[vi] [vii] [viii] [ix] and moral theology, including principles such as cooperation with evil,[x] have received scant attention. Yet the arrangement of care spaces profoundly shapes our moral imagination and our moral discourse. Hospitals and hospices are not the only ones facing spatial ethics issues. Risks to patients or individuals residing in long-term care homes and other congregate housing settings may be elevated due to the shared use of common areas and, frequently, rooms among clients. They may not be able to express their concerns adequately due to their cognitive decline, serious chronic illness and comorbidities, lack of care advocates, language barriers, and loneliness and isolation. For patients with disabilities, frequently, the limited access to home care, disability support and services in their own communities result in unwanted hospitalization. And MAiD assessments are more readily available in hospitals. These care spaces may implicitly communicate to vulnerable populations that their lives are burdensome.

Built To Coerce

When my poster Built to Coerce: Ethics of Imposed Euthanasia (MAiD) Provision in a Catholic Hospital Space received recognition at the Catholic Medical Association conference, the moment was bittersweet. The award affirmed the urgency of examining how legal and healthcare structures can pressure Catholic and other mission-driven organizations, medical professionals, and patients toward euthanasia through spatial arrangements. Yet the recognition could not erase the grief that such coercion exists, nor the weight of knowing that euthanasia clinics are being embedded in contested care settings across the country, reshaping not only the geography of care but the very meaning of healthcare itself.

Meanings of Healthcare Space

Traditionally, healthcare spaces served as operational, missional, and moral actors. The euthanasia clinic I described is located immediately inside a main entrance of our Catholic hospital. Its placement – on the main floor, adjacent to high-volume outpatient specialty clinics and diagnostic labs and visible along corridor sightlines – functions as an operational and missional signal for the regional health authority and the government. It implicitly states who matters and who is deemed peripheral. Despite a pre-existing agreement signed two decades earlier, denominational healthcare organizations now face human-rights legal challenges and mounting pressure to provide euthanasia onsite in exchange for a license to operate and receive public funding. This forced presence demands collective moral reflection and renewed missional rigor – not only for Catholic healthcare organizations but for any organization striving to remain a witness to the dignity of life.    

On the Ground

British Columbia – our province – has the second-highest per capita rate of MAiD deaths across the country.[xi] By 2023, MAiD deaths had already surpassed deaths from illicit drug overdoses.[xii]In 2024, MAiD accounted for 6.7% of all deaths in BC.[xiii] [xiv] Of the 3,000 MAiD deaths in 2024, nearly 90 % were seniors aged 65 and over. 35% died by MAiD for “Other Conditions” – not cancer or cardiovascular diseases –, with frailty being the leading cause under the “Other” category. MAiD has become a solution to old age. In 2024, approximately 40% of all MAiD deaths in BC occurred in private residences.[xv] Their last breaths in the air of family spaces risk shared memories being tainted. Spatial ethics issues surrounding MAiD now touch every care and housing setting.[xvi]

It is not difficult to imagine how frail seniors reach such decisions, surrounded by cues embedded in care spaces. In hospitals, they overhear conversations about MAiD in multi-occupancy rooms or find pamphlets left at their bedside. In hospices, if MAiD is openly celebrated next door, the space begins to speak to the minds of the dying. Standalone MAiD suites are also appearing in business complexes, without clear signage, mission statements, or donor plaques – eerily similar to Shoreline Space. One is built in direct view of a community dialysis clinic, remains unmarked with smoky windows, passed daily by unsuspecting patients and office workers.

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