MAID Revisited: Choosing death in unjust conditions
Plus, the future of fertility, and involuntary care for addiction
This past weekend, I helped supervise the final exam for some of my undergraduate students. Anyone who has done so at a university knows that the official invigilators responsible for keeping time are often students themselves, and the shared responsibility creates an ideal environment for hushed, friendly conversation.
The exam given to my Health Care Ethics class centered around MAID and the proposed expansion to include mental illness in Canada. My new invigilator friend passed the time by reading over the exam. He looked up at me, eyebrows raised, and loudly whispered,
“Is this for real? Is this going to be legal in Canada?”
“I guess we’ll see!”
At the very least, while the chatter on MAID has slightly quieted down since the extension to 2024 was announced, I think it’s important we don’t procrastinate our thinking on this. The issue is still very real, and 2024 will arrive in no time.
This is why I feel it’s important to share my dear friend Kayla Wiebe’s new publication out in the Journal of Medical Ethics entitled Choosing death in unjust conditions: hope, autonomy, and harm reduction. While I usually don’t share academic papers, Kayla and her co-author Amy Mullin have a special talent for clear, accessible writing.
When I had the privilege of reading a draft a couple of months ago, I was relieved there were people much more articulate and intelligent than me having this conversation about ‘unjust social conditions’. Remember Mr. Amir Farsoud?
Here is the abstract for the paper. If you are interested in the full text and do not have access, reply to this email or send us an email at cafebioethics@gmail.com.
In this essay, we consider questions arising from cases in which people request medical assistance in dying (MAiD) in unjust social circumstances. We develop our argument by asking two questions. First, can decisions made in the context of unjust social circumstance be meaningfully autonomous? We understand ‘unjust social circumstances’ to be circumstances in which people do not have meaningful access to the range of options to which they are entitled and ‘autonomy’ as self-governance in the service of personally meaningful goals, values and commitments. People in these circumstances would choose otherwise, were conditions more just. We consider and reject arguments that the autonomy of people choosing death in the context of injustice is necessarily reduced, either by restricting their options for self-determination, through their internalisation of oppressive attitudes or by undermining their hope to the point that they despair.
Second, should MAiD be available to people in such circumstances, even when a sound argument can be made that the agents in question are autonomous? In response, we use a harm reduction approach, arguing that even though such decisions are tragic, MAiD should be available. Our argument engages with relational theories of autonomy as well as recent criticism raised against them and is intended to be general in application, although it emerges in response to the Canadian legal regimen around MAiD, with a focus on recent changes in Canada’s eligibility criteria to qualify for MAiD.
Wiebe K, Mullin A. J Med Ethics 2023;0:1–6. doi:10.1136/jme-2022-108871
From The New Yorker
Last week, I mused at the end of the newsletter about the future of health care, and how bioethics might fit into this future. The New Yorker seems to be thinking about the same thing…
An excerpt:
Piraye Yurttas Beim, the C.E.O. of a biotech company called Celmatix, which is focussed on developing therapies to slow ovarian aging, told me that the excitement around I.V.G. could be misleading. “It feels like: we can go to Mars, so why can’t we make eggs?” she said. “But I think making eggs that have transgenerational reproductive potential—I think it’s probably, like, one hundred times as complex to do that as to go to Mars.”
The article explore emerging fertility treatments and their social, ethical, and economic implications. The author Emily Witt argues that while these technologies offer exciting possibilities, they also raise complex ethical questions that require careful consideration and regulation to ensure equitable and respectful use. Highly recommend this read - as a reproductive ethicist, I can see the companies named within this article becoming massive over the coming years.
From The Globe and Mail
A few months ago, we wrote about the debate over expanding mandatory treatment for mental health and addiction in British Columbia. This past Wednesday, Anna Mehler Paperny, the author of Hello I Want to Die Please Fix Me: Depression in the First Person published an opinion piece centred around this issue.
Here is an excerpt from the article:
Does coercive care work? It depends on who you ask, and what you mean by “work.” Yes, it can keep you safe from yourself and others for a period of time; it can give you a chance to access care, at least in the short- to medium-term. (Granted, Canadians with severe mental illness are often discharged into a treatment abyss; one can be sick enough to warrant coercion, but apparently not sick enough to warrant continuing care that could prevent future deterioration.)
But involuntary care can also set people up for relapse and drug poisoning, if they use substances and lose tolerance. And traumatizing experiences in such care can seed a deep mistrust of the medical system, making it less likely that they ever seek out care on their own.
I’ve been there. I’ve spent weeks locked in psych wards because I was deemed a suicide risk; I know how awful and disempowering it is to lose agency behind those auto-locking doors. But I got lucky: The doctor who ordered the extension of my first involuntary stay, a decision I cursed him for at the time, became my outpatient psychiatrist and a lifesaver.
An important and incredibly well written read - makes me want to read her book!
Thank you for reading! Do let me know your takes on these articles, I love hearing from you!
Wishing you a wonderful weekend. :)
-Nipa
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