Article Text

Download PDFPDF
Medical Assistance in Dying at a paediatric hospital
  1. Carey DeMichelis1,
  2. Randi Zlotnik Shaul2,3,
  3. Adam Rapoport4,5,6
  1. 1Applied Psychology and Human Development, Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
  2. 2Bioethics Department, The Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
  4. 4Paediatric Advanced Care Team, The Hospital for Sick Children, Toronto, Ontario, Canada
  5. 5Emily’s House Children’s Hospice, Toronto, Ontario, Canada
  6. 6Departments of Paediatrics and Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Carey DeMichelis, Applied Psychology and Human Development, Joint Centre for Bieothics, University of Toronto, Toronto, ON M5S 1V6, Canada; carey.demichelis{at}


This article explores the ethical challenges of providing Medical Assistance in Dying (MAID) in a paediatric setting. More specifically, we focus on the theoretical questions that came to light when we were asked to develop a policy for responding to MAID requests at our tertiary paediatric institution. We illuminate a central point of conceptual confusion about the nature of MAID that emerges at the level of practice, and explore the various entailments for clinicians and patients that would flow from different understandings. Finally, we consider the ethical challenges of building policy on what is still an extremely controversial social practice. While MAID is currently available to capable patients in Canada who are 18 years or older—a small but important subsection of the population our hospital serves—we write our policy with an eye to the near future when capable young people may gain access to MAID. We propose that an opportunity exists for MAID-providing institutions to reduce social stigma surrounding this practice, but not without potentially serious consequences for practitioners and institutions themselves. Thus, this paper is intended as a road map through the still-emerging legal and ethical landscape of paediatric MAID. We offer a view of the roads taken and considered along the way, and our justifications for travelling the paths we chose. By providing a record of our in-progress thinking, we hope to stimulate wider discussion about the issues and questions encountered in this work.

  • suicide/assisted suicide
  • children
  • capacity
  • care of dying minors
  • paediatrics

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors RZS, Director of the Department of Bioethics, and AR, Medical Director of Palliative Care/Paediatric Advanced Care Team, were asked to assemble and co-chair an interdisciplinary working group that would develop a policy for responding to requests for MAID at The Hospital for Sick Children in Toronto, Ontario. They invited CD, a PhD Candidate at the University of Toronto’s Joint Centre for Bioethics, to participate in the working group and to draft the hospital’s policy. Conversations with the interdisciplinary MAID Working Group brought important normative questions to light. These theoretical questions and their practical entailments were drafted into the present paper by CD. All authors provided substantial contributions to the conception of the article. While CD drafted, RZS and AR revised critically for important intellectual content, and all provided final approval of the version being published and agreed to be accountable for all aspects of the work.

  • Funding Funding for this project was provided by The Hospital for Sick Children.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There is no additional unpublished data from the study.

Linked Articles

Other content recommended for you