Featuring fifteen chapters by fourteen different contributors from a variety of backgrounds, and spread over five hundred pages, Unravelling MAiD in Canada provides an extensive inquiry into the ethics and controversies that pertain to assisted suicide in Canada. The editors, Ramona Coelho, K. Sonu Gaind, and Trudo Lemmens, have done impressive work  gathering a variety of scholars from diverse backgrounds to tackle issues that are both specific to Canada – namely the introduction of Bill C-14, which legalized Medical Assistance in Dying and its subsequent eligibility extension through Bill C-17 –  as well as pieces that are relevant for other jurisdictions. 

This diversity in authors and approaches is reflected by that of the editors themselves: While Coelho and Gaind both have backgrounds in clinical practice, the former practicing family medicine and the latter trained in psychiatry and psycho-oncology, Lemmens is trained in health law and policy. As all familiar with the ethics of assisted suicide are well aware, diversity in approach is paramount to providing relevant and inclusive insight into the subject.

As the editors themselves acknowledge in the preface, their position is resolutely critical of MAiD, and that is reflected in the chapters. As such some of the topics addressed, while crucial to understanding the ins and outs of the ethical debate for the uninitiated, will be familiar to the reader who has previously engaged with the ethics of assisted dying. Subjects such as the relationship between MAiD and conscientious objection, disability and the slippery slope,  or the difficult relationship between MAiD and palliative care,  are staples of the debate. Other chapters address issues as varied as MAiD and mental illness, advance requests, and the current Canadian legal landscape concerning MAiD as well as its potential pitfalls.

 All chapters come together to provide a unified picture, but I believe it important to take some additional time on two topics that are highly relevant in  Canada, and have been given little attention in the philosophical and political literature: Indigenous peoples and mature minors. Throughout Chapter 9, Hon. Graydon Nicholas addresses the systemic health inequalities endured by Indigenous peoples due to colonialism and subsequent coercive uses of power against them, particularly through the medical system. This led to a climate of distrust towards the health system in Indigenous communities, which is only aggravated when said system starts providing suicide assistance. Furthermore, Nicholas argues that MAiD may be conceptually incompatible with non-Western holistic views on health, often overlooked in Western medical frameworks. 

Chapter 15 focuses on another emerging issue in the ethics of assisted dying: should adolescents deemed capable of consenting to medical procedures without parental approval or knowledge (usually referred to as “mature minors”) be granted access to MAiD? Coelho discusses how self-determination should be understood in the case of such minors requesting MAiD, and how theirs may be compromised by pressures such as bullying, exposure to domestic violence, or poverty – all elements that may thwart one’s ability to make a free and informed choice. She also hints at how extending MAiD for mature minors may deeply reshape parental dynamics by blurring the limit between parental authority and state power, and diminishing the weight of the former in favour of the latter. Whether one agrees or disagrees with Nicholas or Coelho, both their chapters raise challenges that neither side of the debate can ignore.

All in all, Unravelling MAiD is a timely and important book. The editors have done a fantastic job in curating this volume, and the works they have gathered should be of interest not only to those critical of MAiD.  Given the highly emotional and tense nature of the debate,    it is more crucial than ever to look at the controversies of assisted suicide through the eyes of the other. To that end, Unravelling MAiD provides a step in the right direction.mRb