New York State assisted dying was signed into law in February, and by the end of September, an estimated 20 patients had already received prescriptions for life-ending treatment.

New York is the 14th state, including Washington, D.C., to legalize some form of the controversial procedure, with advocates arguing on moral grounds to ease suffering. Yet the debate is not about compelling anyone to endure agony. The real concern is institutional, and Britain and Canada demonstrate how assisted dying incentivizes state-sponsored death.

In Britain, MPs voted 286 to 270 against the Terminally Ill Adults (End of Life) Bill last month, halting the legislation at its second reading. The proposal would have permitted mentally competent adults in England and Wales with less than six months to live to request assistance ending their lives.

As healthcare resources run short and social care drains budgets, palliative care needs more people. Likewise, disability support needs funding, housing adaptations need builders, and families need financial and emotional support. Death can be signed off on with a stroke of a pen, while long-term care devours public money without end.

This creates an institutional problem that no legislative safeguard can resolve. The core question is whether society has truly done all it can to ensure death is not just the least-worst choice, left standing only because every other path has deteriorated.

Britain’s own parliamentary evidence makes that tension difficult to dismiss.

A House of Commons Health and Social Care Committee report highlighted inadequate palliative and end-of-life care, including a “postcode lottery” for access, workforce pressures, weaknesses in social care, and an unsustainable funding model.

Those in their final months of life make up just 1% of the population but consume over 20% of healthcare spending. Care homes now average £1,300 a week (£67,000 a year), and nursing or dementia care is climbing past £1,500 to £1,600 a week (£80,000+ a year). Death would conveniently balance the ledger.

But Canada’s experience shows why Britain’s refusal was wise. Canada’s Medical Assistance in Dying (MAID) regime began in 2016, and in 2021, Parliament removed the requirement that a natural death be reasonably foreseeable. The floodgates were opened. Now, lawmakers debate whether mental illness should qualify.

Against this backdrop, Canada’s Parliamentary Budget Officer calculated that MAID reduced annual provincial healthcare spending by $86.9 million (CAD), with expansions saving an additional $62 million (CAD) annually. Meanwhile, direct administrative execution costs remain minimal, creating a powerful systemic incentive towards death.

As the qualifications for death continue to expand, we see the “slippery slope” in action — and the creation of a new permanent institution. Once the state accepts assisted death as a legitimate response to suffering, lawmakers are forced to endlessly decide why an exception applies here and not there.

The most striking example is Christine Gauthier, a disabled Canadian veteran and former Paralympian. In 2022, she told a parliamentary committee that after spending years seeking assistance from Veterans Affairs to install a wheelchair ramp at her home, an employee instead offered her information about MAID.

While the government described it as individual misconduct rather than official policy, the episode is nonetheless telling. She asked the state to make her life more accessible, so a state employee raised the possibility of ending it.

The solution is not to give the state more power over death, but to break its monopoly over health. A humane alternative begins by removing the bureaucrat from the bedside.

By shifting from nationalized monopolies to market-driven medicine powered by Direct Primary Care, Health Savings Accounts, and unencumbered competition, we can lower care costs through innovation rather than state-sponsored rationing.

Furthermore, the chronic shortage of care beds, builders, and mobility adaptations is not a market failure, but the result of state planning. Restrictive zoning, aggressive licensing, and heavy compliance make simple home modifications scarce and expensive. Deregulation would let private builders and local providers deliver practical solutions quickly and affordably.

American lawmakers should heed these warning signs. The U.S. has mostly resisted Europe’s unsustainable healthcare model, as well as its assisted dying programs. But liberal activists and policymakers have long been advocating for both. Policies like Medicare for All not only threaten the exceptional care and access Americans receive, but also make inhumane assisted dying programs all the more practical, if not inevitable.

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Anne Struffmann is a Young Voices contributor.

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Albany’s New Assisted Dying Law Follows Canada’s Deadly Cost-Cutting Playbook