A minority of countries or parts of countries have thus far accepted the legal practice of Medical Assistance in Dying (MAiD) (euthanasia and assisted suicide), but legalising MAiD is expanding worldwide. More countries are debating legalisation of euthanasia or assisted suicide, but the nature of laws and legal practices vary greatly and both ethical and empirical assessments of current practices are the subject of much controversy. We examine the premises and evidence in the rhetoric of assisted suicide and euthanasia. We illustrate the trend with the rationale and political concerns that led to the legalisation of euthanasia in Quebec as “Medical Assistance in Dying” (MAiD), and its subsequent expansion in Canada to include persons who do not suffer from a terminal illness, including persons who suffer only from a mental illness. The values of autonomy, “dying with dignity“ and their ethical and legal bases for justifying MAiD are critically analysed. The implications of practicing euthanasia, as opposed to assisted suicide are discussed, as well as proposals for a duty to die in some circumstances. We conclude by proposing that besides debating the legal, moral and practical concerns with MAiD, we should also focus on the psychological roots of our fears and ways to reduce those fears in individuals and societies.

Having articulated the need for and benefits of culturally sensitive approaches to human rights implementation involving social institutions, Chapter 3 considers their permissibility under international law. It does this by analysing the obligations on states parties to implement international human rights treaties, focusing on their discretion to employ measures so long as they are effective. This includes enacting legislation or undertaking a variety of other measures of implementation. Despite this broad discretion, Chapter 3 discerns a preference for the domestic legal incorporation of treaties evinced by scholars and the UN treaty bodies. This preference is critiqued as part of the legalisation of human rights, which marginalises other effective implementation measures that may be more culturally sensitive. Analysing the human rights treaties, as well as the interpretations of their respective treaty bodies, Chapter 3 identifies the wide scope for UN human rights treaties to be implemented via measures other than legislation.

The introductory chapter frames the book in the contemporary setting of persistent human rights violations, increasing human rights contestation and shifting global dynamics. The chapter articulates the challenge of human rights implementation, highlighting the gap between international norms and local realities. It identifies several problematic factors in the effective domestic implementation of international human rights law. First, the chapter addresses the long-standing cultural critique of universal human rights, and their continued cultural disconnect in many societies today. It then addresses the state-centric and legalistic nature of human rights as problematic factors in implementation. This first chapter advocates an increased role for other (non-legal) measures and other (non-state) actors in the domestic implementation of human rights in order to overcome the problems identified. Specifically, a greater role for social institutions is advocated. Finally, the first chapter sets out the book’s research design, case study and structure.