In Q&A at a 2021 training session by the Canada Association of MAiD Assessors and Providers, a physician asked Dr. Kevin Reel—the president of the Canadian Bioethics Society—what a doctor should do if a patient sought MAiD “because of socioeconomic reasons.” Dr. Reel replied that of course the physician didn’t have to administer MAiD, but he would “have to refer the person onto somebody else, who may hopefully fulfill the request in the end.” I shudder for those who, unlike my grandpa, lack loved ones to advocate for even basic social assistance and are instead funneled through a bureaucracy of death. The conversation around MAiD puts front and center the questions of what makes life worth living and, by implication, in what circumstances a life might no longer be worth living.

My Grandfather died last October. In some sense, his death wasn’t a surprise—at almost ninety, he’d dealt with increasing health issues and not-infrequent hospital visits for years. What was surprising and traumatic was that, just earlier in the week, he’d seemed to be entering a relatively healthy period. But what started as a check-in for his heart arrythmia rapidly turned into the last news we wanted to hear: he had contracted pneumonia (which required restricting fluids) but also a blood infection (which required increasing his fluids to allow antibiotics to be effective). Two fatal conditions that were impossible to treat concurrently, and sepsis soon set in. Within hours of feeling unwell, Grandpa Tom had deteriorated until it was clear his last hours had come. I drove as fast as I could to be by his side in the hospital.

Grandpa Tom and I shared a special connection whose severance has left a hole I doubt will ever be filled on this side of eternity. When I was a child, he made up songs for me and my brothers, built us toys and a treehouse, and always bought us a happy meal after play time at the park. No matter how small my part, he was there to see my high school plays. In my college years, I had the privilege of worshiping with him and my grandmother in church. He was there when I proposed to the woman I’d marry, and to this day I wear the wedding band, once his own, that Grandpa Tom passed to me. At every major milestone of my life, he was there to cheer me on and show me love.

I now think that part of what made our relationship so special was that, as my mother’s stepfather, Grandpa Tom wasn’t even part of my biological family. His life was a picture of the gospel: after alcohol abuse led to a failed marriage that estranged him from his children, Grandpa Tom had a dramatic conversion experience and found deliverance from the anger and alcoholism that had so hardened his heart. He knew better than most of us that he wasn’t perfect and that he needed a savior—his faith seemed so real to me because he was open about the ways he’d struggled and failed. Never once in his life did I know a Grandpa Tom who boasted, “Thank the Lord that I am not like those other people.” Always his confession was, “Lord have mercy on me, a sinner.”

This redeemed Tom found a new family through meeting my grandmother—who herself had suffered divorce—and married her Christmas day of 1985. Here again, the gospel shines through. In Christ, God grafted the gentile nations’ wild branches onto the cultivated tree of Israel and created a new family with ties stronger than blood relation. Grandpa Tom’s marriage to my grandmother grafted him into my family, and his branch bore abundant fruit in the love he had for his grandchildren.

In the last years and months of his life, my grandfather had gradually become less and less able to care for himself. My grandmother was a nurse by training, and her tireless care for him was itself a testament to the tireless, sacrificial love of Christ, the Great Physician of our souls. My parents undertook to renovate their house to accommodate the mobility assistance he needed, and my mom sacrificed much of her own time and energy to ensure that he received the medical care he needed to hold onto life as long as he could. For all involved, that care was a heavy burden. To care for someone in decline is to devote more and more effort for less and less improvement, and the time to enjoy any improvement that does occur gets shorter and shorter with every bout of illness, every defibrillation to restore a regular heartbeat.

In the months since Grandpa Tom has passed, I have returned again and again to the question of what it means to die well. In recent decades in the West, most fiercely now in Canada and Northern Europe but with parts of the U.S. slouching in that direction, “Medical Assistance in Dying” (MAiD) has become more and more ubiquitous. A catchall term for euthanasia and physician-assisted suicide, MAiD has metastasized in recent years. From a narrow treatment offered those with imminently terminal conditions and in unbearable pain, MAiD is urged upon those whose primary care would be too expensive, who suffer from treatable mental illness, or who find themselves on the brink of homelessness. They are told by kind doctors, with excellent bedside manner and with the authority of the major medical associations and the approval of government health services, that MAiD will allow them the autonomy to die with dignity instead.

A recent medical journal article sounded a klaxon’s blare on Canada’s MAiD regime. It relates the true story of a man with “hearing and cognitive disability” who suffered from depression and was involuntarily admitted to a psychiatric hospital as a suicide risk.

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