What does it mean to make a choice?

I'm drawn to this question: What does it mean to make a choice? We often assume that when someone chooses MAiD, they are exercising autonomy; that this decision is the result of a rational process based on unbearable suffering. But is this true autonomy, or is it simply the brain braining, following conditioned thoughts like a river follows its course?Viktor Frankl, who observed that between a stimulus and response, there exists a space; a space where choice, awareness, and true freedom reside. This space, however, is not always accessible. Many live in a state of reactivity, where thoughts appear and are identified with, resulting in a chain of conditioned reactions.Alan Watts, the philosopher and spiritual comedian, once said, “the most important decision a person can make is whether or not to kill themselves.” He wasn’t being morbid; he was pointing to the fundamental reality that life itself is not something we are forced to continue. Yet, paradoxically, by deeply realizing that we can choose not to exist, we may come to a new understanding of why we continue to live. Watts often spoke about how recognizing the illusory nature of control can actually bring about a deeper ease with life itself.Similarly, Eckhart Tolle, long before he became known as the author of The Power of Now, spent years in depression, sitting on park benches, overwhelmed by thoughts of ending his life. One day, in a moment of deep despair, he heard a voice in his mind say, 'I can’t live with myself any longer.' And then, the question arose: 'Who is the one that cannot live with myself?' This inquiry shattered his perception of self and led to a profound transformation, what he later described as an experience of presence so deep that suffering simply lost its grip. His suffering was not removed through external means, but through a shift in awareness.This shift is something I have witnessed in my own work with presence therapy; it provides a space for people to simply sit, still and present. And in that stillness, many come to a startling realization: that they are not their thoughts. That the brain is just braining, all on its own. That choice, as we commonly understand it, is not really choice at all; it is simply the unfolding of conditioned patterns. When people experience this firsthand, not as an intellectual idea but as a direct observation, something profound happens. The grip of suffering begins to loosen.I do not bring this up as an argument against MAiD. Rather, I offer it as a reflection on suffering itself, and the ways in which we frame mental distress. In medicine, we tend to view suffering as something to be treated, fixed or eliminated; whether through therapy, medication or, in the case of MAiD, through the removal of the sufferer themselves. But what if suffering, particularly the kind that drives people toward MAiD, is not merely a problem to be solved, but an invitation?I don’t mean to suggest that suffering should be prolonged or that people should be denied their right to relief. We live in a world where suffering is real, and where inequities, illnesses and circumstances create unbearable conditions for many. What I mean is that, for some, suffering may contain within it the seed of transformation.We often describe mental health crises as disorders, pathologies or failures of brain chemistry. But what if, instead, they could be seen as thresholds of potential doorways into a deeper understanding of self? Eckhart Tolle’s crisis was not a disorder; it was the moment before awakening. The mind, spiraling into despair, reached a breaking point, and on the other side of that breaking point was presence, the discovery of the space of which Frankl spoke.Could it be that those who seek MAiD due to mental distress have not yet found this space? And if that’s the case, what is our responsibility as healthcare providers—not just in terms of assessing suffering, but in ensuring that patients have had the opportunity to explore the depth of their own awareness before making such a final choice. I also recognize that this idea may be uncomfortable for many. Medicine is not traditionally concerned with existential inquiries; it deals with the tangible, the treatable, the biological. But the reality is that suffering is not merely physical; it is deeply intertwined with our perception of self, time and reality. We see this in palliative care, where some patients, even in great pain, find peace not through medical interventions but through a shift in perspectives; whether through spirituality, meditation or simple acceptance.What if, in our conversations about MAiD, we made room for this perspective? Not as a way to deny suffering, but as a way to ensure that every person considering MAiD has had access to that space before making their decision?I offer these reflections not as conclusions, but as open-ended questions; questions that I continue to sit with, just as I sit with participants in my acupuncture sessions, watching them as they begin to notice that thoughts simply arise and pass, that the self they were so identified with is not quite what they assumed it to be.On a personal note, my own perspective on death has been shaped by my father’s decision to end his life at age 89, believing he had COVID and wanting to protect my mother. His action, while deeply personal, reflects the complex decisions we all face as we grow older and confront our mortality. I do not judge his choice, but I do reflect on it. Was there space for another possibility? If he had the chance to observe his thoughts, rather than being swept away by them, would he have made the same decision?Dr. Carlos Yu is a family doctor in Ajax, Ont.

What does it mean to make a choice?

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