Bioethics Blogs

Assisted Dying: A History of Ethical Principles

Stuart Chambers describes the ethical principles that have shaped the historical debates surrounding medical assistance in dying in Canada.


Canada’s proposed legislation on medical assistance in dying, (Bill C-14), is arguably the result of a transition or evolution of bioethical principles from sanctity of life, to qualified sanctity of life, to quality of life.

According to the sanctity of life principle, life is of intrinsic value. Grounded in mainstream Christian beliefs, this principle prohibits intentional killing—in both active and passive forms.  Life is considered a stewardship or loan from the Creator, and the power to live or die resides with the Creator alone.

According to the qualified sanctity of life principle, one cannot actively and intentionally hasten death; however, one can refrain from preventing natural death.  Treatment can, therefore, be omitted, allowing death to occur “naturally.”

The quality of life principle, in sharp contrast, permits intentionally hastening death using either acts of omission (withholding or withdrawing treatment) or commission (prescribing overdoses or administering lethal injections).  Although the quality of life principle is now the dominant ethos, its acceptance unfolded gradually over time. This occurred largely in response to shifting public attitudes towards intentional death, as reflected in legal documents and case law.

In1982, the Law Reform Commission of Canada shepherded the transition from the sanctity of life principle to the qualified sanctity of life principle. In its report, Aiding Suicide and Cessation of Treatment, the Commission concluded that a moral distinction between acts of omission and commission was legitimate. In other words, “letting die” was ethically distinct from “intending death.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.