The growing toll of euthanasia in Canada – from zero to more than 10,000 in five years – is upsetting settled ideological allegiances. How could a progressive policy like the right-to-die for a few terminally ill patients evolve into a euthanasia juggernaut?

Writing in The Atlantic, New York Times columnist David Brooks confesses that he is perplexed. Euthanasia or, as it is called in Canada, medical assistance in dying (MAiD), appears to be the ineluctable consequence of John Stuart Mills’s vision of autonomy, which is the pillar of modern liberalism. “If individual autonomy is the highest value, then when somebody comes to you and declares, “It’s my body. I can do what I want with it,” whether they are near death or not, painfully ill or not, doesn’t really matter. Autonomy rules.”

Brooks finds this unpalatable. Shouldn’t we help people who want to die, not just help them die? But “If you start with autonomy-based liberalism, MAID is where you wind up.”

And autonomy-based liberalism is the dominant ideology of Western society at the moment.

So he backs a different kind of liberalism, which he calls “gifts-based liberalism”. This appears to be his own invention – a way to harvest all the fruits of liberalism without uprooting the tree. What does this look like? Not much like Mills’s liberalism.

He bases it on “four truths that gifts-based liberalism embraces and autonomy-based liberalism subverts”:

• you didn’t create your life.
• you didn’t create your dignity.
• you don’t control your mind.
• you did not create your deepest bonds.

He concludes that society is based, not on social contracts between autonomous individuals, but covenants – enduring personal relationships. “If autonomy-based liberals believe that society works best when it opens up individual options, gifts-based liberals believe that society works best when it creates ecologies of care that help people address difficulties all along the path of life.”

No doubt some steely-minded bioethicists will not find Brooks’s analysis of liberalism and his critique of Mill convincing. In fact, gifts-based liberalism sounds more like Christianity than traditional liberalism. But Brooks is an astute cultural chronicler rather than a bioethicist. His essay is a sign of a deep discontent with MAiD.