Wiebe and Mullin, Choosing Death in Unjust Conditions

Abstract

• The essay explores the ethical implications of Medical Assistance in Dying (MAiD) in contexts where individuals request it due to unjust social conditions.

• Two primary questions are considered:

  • Autonomy: Can decisions made under unjust social circumstances be meaningfully autonomous?

  • Accessibility: Should MAiD be available to individuals in these unjust conditions?

• Key Definitions:

  • Unjust social circumstances: Situations where individuals lack meaningful access to options they are entitled to.

  • Autonomy: Self-governance aimed at achieving personally meaningful goals.

Introduction

• Recent legal changes in Canada regarding MAiD have raised concerns that people might seek this option not strictly due to medical conditions but due to social injustices (e.g., financial issues, poor housing conditions).

• The authors argue against the premise that autonomy is inherently diminished in individuals choosing death due to unjust circumstances.

Analysis

Background on MAiD Legislation

• MAiD was expanded in Canada through Bill C-7 (2021), removing the requirement for death to be reasonably foreseeable, thus increasing eligibility significantly.

• Concerns exist that individuals with disabilities may opt for MAiD due to lack of social support rather than purely medical reasons.

• Notable example: A 2022 case where a man suffering from chemical sensitivities chose MAiD mainly due to housing issues rather than his medical condition.

Arguments Against Restricting MAiD

1. Autonomy and Restricted Choices:

• Some argue that restricting options undermines autonomy.

• Counter-argument: Individuals can maintain autonomy despite oppressive conditions that limit their choices.

2. Internalized Oppression:

• Oppression may shape individuals’ self-perceptions leading them to internalize negative attitudes.

• Effective assessment of autonomy should focus on capacities for self-trust and decision-making rather than just social context.

3. Engaged Hope:

• Autonomy requires hope and the perceived possibility of a better future.

• Many individuals seeking MAiD do so from a position of engaged hope rather than complete despair.

Harm Reduction Perspective

• The essay advocates for a harm reduction approach, suggesting that even though having MAiD available is tragic, it constitutes the least harmful option under current socio-economic conditions.

• Refusal of MAiD could exacerbate suffering for individuals facing intolerable situations (medical and psychosocial).

Ethical Considerations

• The essay emphasizes that individuals living in unjust circumstances making decisions regarding MAiD, despite facing oppression, may still possess the necessary capacities for autonomy.

• Critique against paternalism: It argues against the tendency to discredit choices made by individuals under duress caused by systemic injustices.

Conclusion

• Individuals with disabilities need improved access to healthcare and social support systems to prevent reliance on MAiD.

• The authors argue against blanket restriction of MAiD based on situational injustices, advocating that such decisions stem from a place of agency rather than a loss of autonomy.

• Ethical care and support systems must be developed to address injustices leading individuals to consider MAiD as a viable option.

Key Takeaways

• Autonomous choices can exist within unjust conditions; not all restricted choices indicate diminished agency.

• The application of harm reduction in the context of MAiD highlights the need for a compassionate approach to complex ethical dilemmas surrounding end-of-life decisions.