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Continuing the conversation about medical assistance in dying
  1. Carey DeMichelis1,
  2. Randi Zlotnik Shaul1,2,3,
  3. Adam Rapoport3,4,5
  1. 1 Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
  2. 2 Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3 Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
  4. 4 Department of Palliative Care, The Hospital for Sick Children, Toronto, Ontario, Canada
  5. 5 Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
  1. Correspondence to Dr Carey DeMichelis, Joint Centre for Bioethics, University of Toronto, Toronto, ON M5T 3M7, Canada; carey.demichelis{at}


In their summary and critique, Gamble, Gamble, and Pruski mischaracterise both the central arguments and the primary objectives of our original paper. Our paper does not provide an ethical justification for paediatric Medical Assistance in Dying (MAID) by comparing it with other end of life care options. In fact, it does not offer arguments about the permissibility of MAID for capable young people at all. Instead, our paper focuses on the ethical questions that emerged as we worked to develop a policy for responding to MAID requests at our tertiary paediatric institution. Following the Supreme Court of Canada’s recent decriminalisation of MAID, our hospital needed to answer immediate on-the-ground questions such as: ‘What are we going to do if an 18-year-old patient in our care requested MAID today, as is now their legal right? How should we protect their privacy? What is the best way to ensure patients are informed when making these decisions?’ On these important questions, Gamble, Gamble, and Pruskiare silent.

  • ethics
  • informed consent
  • euthanasia
  • pediatrics
  • policy development

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  • 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, then 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. This work resulted in our 2018 paper. CD: drafted the present manuscript as a commentary response. RZS and AR: revised critically for important intellectual content. All authors provided substantial contributions to the conception of the article; provided final approval of the version being published and agreed to be accountable for all aspects of the work.

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

  • Competing interests None declared.

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

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