The United Kingdom is moving toward legalizing medical assistance in dying, modeling its law in part on Canada’s Medical Assistance in Dying (MAiD) program. The Terminally Ill Adults (End of Life) Bill has drawn criticism similar to that faced by Canada’s policy, particularly concerns that poor and disabled people could be pushed toward assisted dying, not because they are terminally ill but as a result of state austerity and neglect.

Labour backbench member of Parliament Kim Leadbeater has emphasized the restrictive nature of the proposed UK law, which does indeed appear to be stricter than Canada’s. According to the BBC, those seeking an assisted death must be over eighteen years old, a resident of England or Wales, and registered with a family doctor for at least a year. Further qualifications include the requirements that applicants must face immediate death — within half a year — and have the mental capacity to decide to die or have clearly expressed such wishes ahead of time.

The process itself is highly regulated — it includes two official declarations, clearance with two doctors on two separate occasions, the sign-off of a High Court judge, and a waiting period post-approval before the patient administers the life-ending drug. These steps are intended to provide robust checks and balances, limiting eligibility to those in the final stages of terminal illness.

The bill has passed an initial vote in the House of Commons but faces further scrutiny in both the Commons and the House of Lords. It won’t be law anytime soon, and debates will continue to echo critiques from the Canadian case and beyond. Even with the proposed restrictions, critics worry that England and Wales’s MAiD program — separate from that of Scotland, which will decide on its own bill — raises serious social and ethical issues.

Baroness Tanni Grey-Thompson, a Paralympian and disability rights advocate, is a leading critic of the bill. Speaking to the Independent, she challenged assurances from the bill’s proponents, arguing that the reality “is very different.” She points to the ability of patients to engage in “doctor shopping” by seeking permission from a variety of physicians, should one refuse to sign off on assisted dying — a practice she notes is already happening in Canada.

Grey-Thompson also cites arguments against the measure familiar in Canada, including the risk that people will be pressured to end their lives because of disability or other factors, despite the law forbidding coercive control. She worries too that the parameters of inclusion for death will be loosened over time, as they have been in Canada, for instance, to include mental illness.

These are all genuine concerns that have proven worth the worry, as the Canadian experience has shown. UK justice minister Shabana Mahmood echoes these sentiments, calling the bill a “slippery slope to death on demand” in her opposition to it. Both she and health secretary Wes Streeting voted against the bill.

At the heart of concerns about coercion and abuse is the issue of austerity. A state that withholds necessary support from its poor and disabled isn’t the only reason one might be critical of an assisted dying program, but it’s an important one. The Canadian state is euthanizing its poor and disabled today, as physician-assisted death has increasingly become an option for those suffering under structural oppression — a grim reality disability rights advocates have warned about for years, tied to the failures of liberal democracy and its free-market underpinnings.

The UK’s National Health Service has endured years of neoliberal austerity, much like Canada’s single-payer health care system. This has led to a structural decline in the quality of care provided by the system, including long wait times for treatment. Under such conditions, it’s not hard to see how austerity and inadequate care could create direct or indirect pressure for people to end their lives — whether to avoid “burdening” their loved ones or to escape a system that neglects them.

A principal argument in favor of MAiD is autonomy — the right of individuals to make decisions about their own bodies and lives, including the choice to end their suffering, especially if death is imminent. It’s a compelling argument. However, its force diminishes when viewed through the lens of systemic inequality and neglect.

There is good reason to worry that poor, disabled, or elderly people may be coerced — directly or indirectly — into seeking assisted death, as has happened in Canada. That coercion — and the deaths that come from it — driven forward in no small part by a neglectful state, are prima facie violations of autonomy. In any society marked by austerity, ageism, and anti-disability bias, MAiD regimes risk sacrificing those left behind by state and society, ostensibly to protect the autonomy of others. This constitutes a profound violation of the very principle MAiD claims to uphold.

In such a context, it becomes nearly impossible to implement a MAiD program that doesn’t result in preventable deaths — ending lives that, under fairer social conditions and a more just distribution of resources, might have continued. MAiD, in these circumstances, becomes the fruit of a poisoned tree. Legislated limits, no matter how strict, cannot redeem it.

The UK should heed Canada’s hard lesson, learned at great human cost, as it considers its own law on assisted death.