When Miriam Lancaster arrived in the ED with back pain last year, she wasn’t expecting to spend a month in hospital while her fractured sacrum healed. But the 84-year-old got an even bigger shock while waiting for her prognosis. A doctor came to check on her and—“as casually as one might offer a cup of tea,” she recalled afterwards—asked if she wanted euthanasia.

Welcome to Canada, where 1 in 20 deaths are at the hands of a physician. The brief reel where Miriam first shared her story has gone viral, but not because her experience is rare. It’s because slipping our feet into her shoes is so surreal, some viewers aren’t convinced it happened. “I was stunned,” she said. “All I knew was that I was in tremendous pain and that a stranger had just suggested I might want to end my life.”

The reason New Zealand should pay attention to Miriam is that she’s living what we might face in future. The ACT Party has a private member’s bill that would allow doctors to offer euthanasia to patients. It would also make 25 other changes to our End of Life Choice Act. This would shift New Zealand’s legislation from where Canada was 10 years ago, when it legalised euthanasia, to where it is today. People suffering from chronic conditions could qualify, all places of care would be mandated to allow euthanasia onsite, doctors would be required to provide effective referrals, and—yes—they could offer it to their patients.

To block this expansion, the bill’s proponents argue, is to inflict unnecessary suffering.

But while they try to imitate Canada, one Canadian province is attempting to wind euthanasia legislation back to where NZ is now.

The reason? Canada has created new categories of unnecessary suffering.

Alberta’s Premier tabled the Safeguards for Last Resort Termination of Life Act mid-March with a public defence, referencing disturbing experiences that are now commonplace.

People with chronic conditions are offered euthanasia, even when they can’t access the support they need.

Young people dealing with depression and health problems can doctor-shop until someone supports their suicidal ideation.

Veterans Affairs officials have encouraged people with PTSD to consider euthanasia.

And next year, Canada intends to allow people to qualify for euthanasia based on mental illness alone. This is why Alberta’s Premier, Danielle Smith, is acting now.

We cannot follow Canada’s lead without listening to these warnings.

“Patient safety is, and must always be, our first concern,” she said. “Our government has been highly sceptical of federal moves to widen eligibility to those whose only medical condition is mental illness.”

Like New Zealand, Canada first legalised euthanasia only for those whose death was foreseeable. And like two-thirds of Kiwis, most Canadians saw it as a reasonable last resort for people who were both suffering and dying.

But five years ago, Canada’s courts decided that patients who weren’t near death were being discriminated against. The push to eliminate this type of “discrimination” has gone so far that Canadian hospices are being shut down and taken to court for not offering it on site.

Dr Ramona Coelho joined the Premier to say that she has seen patients approved for Medical Assistance in Dying (MAiD) “without a deep dive of their suffering or without offering evidence-based medicine that could offer them solutions to live well.” Her patients also report being offered MAiD repeatedly, with some feeling pressured to book assessments.

Far from supporting patient autonomy, embedding this choice in the health system tips the balance away from other—more costly—choices. A decade in, Canadians do not have what they signed up for.

The UN Human Rights Council has expressed “extreme concern” about Canada, and its Committee on the Rights of Persons with Disabilities has recommended exactly what Alberta is attempting. It notes that “Track 2 medical assistance in dying is disproportionately accessed by women with disabilities and persons with disabilities in marginalized situations.”

Following the bill’s release, Dr Coelho wrote, “For many disabled, elderly, and marginalized patients, trust in the system is fragile, and discrimination risks are real. MAiD-free spaces are not an attack on autonomy. They recognize that safety and trust matter, and that people have the right to access care in a facility and with a clinician they believe will value and protect their life and safety.”

We cannot follow Canada’s lead without listening to these warnings.

Fortunately for Miriam Lancaster, she was willing to face the time and cost of her recovery, and her daughter was there to back up her rejection of euthanasia. Since her recovery, Miriam has been travelling. In Cuba, she joined a music group and added Cuban music to her piano repertoire. In Guatemala, she rode up the Pacaya Volcano. She isn’t dwelling on how it felt to have someone offer to end her life, but she and her daughter support Alberta’s attempt to eliminate such experiences.

Inevitably, New Zealand will have to define who our euthanasia laws are written for. Alberta’s Minister of Justice, Mickey Amery, has seen what ACT’s private member’s bill would bring about here. “Hope,” he has concluded, “should always be easier to access than death.”