• health personnel
• health promotion
• health workforce

Canada’s new medical assistance in dying (MAiD) law is ethically superior to the previous version. I agree with Udo Shuklenk and Jocelyn Downie1 that both social determinants of health and slippery slope objections to the recent amendments are unsuccessful.[1] Despite this broad agreement, I worry that the authors’ argument against the slippery slope objection is too focused on the current amendments at the expense of future changes.

Before I address that argument, I have one point about the social determinants of health. Any treatment that goes against a patient’s values is wrong. Critics of expanding MAiD criteria are concerned that expanded access will mean that persons with disabilities, among others, will be more likely to be pressured into getting an assisted death. Were there is evidence for this worry, it ought to be taken seriously.

However, in my work as a clinical ethicist, it is overwhelmingly more common for me to be consulted about clinical situations where patient values are disregarded for the sake of invasive life-sustaining treatment, rather than concerns about hastened death. This takes different forms. In some cases, a healthcare provider or a family member will pressure a patient who has decision-making capacity. This is why patients occasionally ask that their request for MAiD be kept private from their family: the patient is worried about being pressured out of it (or of dealing with the other effects of MAiD’s stigma). In non-MAiD cases, a patient’s substitute decision-maker will request treatment with the aim of maximising length of life, despite knowledge that the patient did not want life-sustaining treatment …