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What has troubled me most as Canada moves to legalize physician-assisted death is the fatalism of those, including some senators, who argue for the broadest access possible to the "procedure."

That's fine for those who are certain in their choice of death. But who is ever really sure they want to die? Given the options available – intolerable physical or psychological pain, total dependence on others for care – it's understandable that some would choose to hasten death. The Supreme Court correctly decided that consenting adults in this situation should be able to do so with medical help. But that shouldn't mean the state should encourage it.

Yet that is what broadening access to physician-assisted death beyond the parameters outlined in Bill C-14 would amount to. It would send a message to the utterly hopeless or dependent that Canadian society might be better off without them. It would lead many to end their lives prematurely.

In the early 1990s, I watched several friends and a brother suffer through, and eventually die from, the devastating effects of AIDS. As one opportunistic infection after another ravaged their immune-suppressed bodies, many of them might have chosen doctor-assisted death, had it been legally available, rather than endure the cruelty with which the disease was destroying their young lives. But they died with dignity, the old-fashioned way.

Another group of HIV-infected friends and acquaintances was luckier. Despite what was then considered a fatal diagnosis, they managed to live long enough to see the introduction of a so-called triple-cocktail drug therapy in 1996. Almost overnight, they went from being emaciated skeletons near death to becoming healthy and productive citizens. This "Lazarus effect" was the result of highly active antiretroviral therapy that turned HIV infection into a chronic but manageable condition. No one saw that dramatic development coming, certainly not as quickly as it did.

I am left wondering how many in this cohort of survivors, wasting away only months earlier, would have chosen to end their lives with the help of a physician had it been legal. That would have been stacking one tragedy on top of another. Imagine the pain their loved ones would have felt knowing that, had they held on a bit longer, they would have got their lives back.

Around the same time that AIDS drug cocktails were enabling the HIV-infected to snatch life from the jaws of death, a new class of antidepressants was turning previously hopeless and dysfunctional sufferers of depression, anxiety and obsessive compulsive disorder into happy and productive members of society. The introduction and popularization of selective serotonin reuptake inhibitors, such as Prozac, Paxil and Zoloft, ended the unbearable suffering of mental illness for millions of people. Again, it happened almost overnight. Had doctor-assisted death been available, many depression sufferers wouldn't have made it that far.

Most times, of course, a fatal diagnosis means just that. A panoply of diseases remain "grievous and irremediable" and inflict "intolerable suffering" on those afflicted with them. Far be it for anyone but the individuals concerned to decide whether they want to live or not. Just as Canada decided long ago that women should have access to safe and legal abortions, we must now recognize the right to safe and legal doctor-assisted death.

Let's not, however, lose sight of just how momentous this shift really is. It represents not just an evolution in societal values – like recognizing gay marriage or transgender rights – but also an extension of the concept of health care to include ending the life of the patient. While it appears most physicians will never be able to bring themselves to perform the procedure, there remains a subset who believe strongly in helping anyone who says they're suffering intolerably (including so-called mature minors, whatever that means) to end their lives, whether they face a "reasonably foreseeable" death or not. They would banalize physician-assisted death. But there is nothing banal about dying, nor should there ever be.

I'm with Justice Minister Jody Wilson-Raybould and Health Minister Jane Philpott: Let's go slow on this. In upholding the rights of those determined to die on their own terms, the Supreme Court may have inadvertently encouraged some people suffering from grievous and irremediable conditions to opt for physician-assisted death out of hopelessness or because they no longer want to burden their caregivers. Allowing that to happen would be a sad statement on Canadian society.

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