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Choosing death in unjust conditions: hope, autonomy and harm reduction
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  1. Kayla Wiebe,
  2. Amy Mullin
  1. Philosophy, University of Toronto Faculty of Arts and Science, Toronto, Ontario, Canada
  1. Correspondence to Kayla Wiebe, Philosophy, University of Toronto Faculty of Arts and Science, Toronto, ON M5G 1X8, Canada; kayla.wiebe{at}mail.utoronto.ca

Abstract

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.

  • Death
  • Ethics- Medical
  • Euthanasia
  • Right to Die
  • Legislation

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable.

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Footnotes

  • X @KaylaJWiebe

  • Contributors We jointly worked on the paper from the inception of the idea, through development, revision, and to completion. We both contributed equally to and are jointly responsible for the content in this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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