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Autonomy is not a sufficient basis for analysing the choice for medical assistance in dying in unjust conditions: in favour of a dignity-based approach
  1. Maria DiDanieli1,2
  1. 1Burlington Family Health Team, Burlington Ontario Health Team, Burlington, Ontario, Canada
  2. 2Edinburgh School of Law, The University of Edinburgh, Edinburgh, UK
  1. Correspondence to Ms Maria DiDanieli, Burlington Ontario Health Team, Burlington, Ontario, Canada; M.S.Didanieli{at}


In their paper titled Choosing death in unjust conditions: hope, autonomy and harm reduction, Wiebe and Mullin argue against the stance of diminished autonomy in chronically ill, disabled patients living in unjust sociopolitical environments who pursue medical assistance in dying (MAiD). They suggest that it would be paternalistic to deny these people this choice and conclude that MAiD should actually be seen as a form of harm reduction for them.

This response to their article argues that basing discussions surrounding this important topic on a single bioethical concept does not address the needs of this cohort and is restrictively siloed. The discussion should include considerations of human rights and the need for legislative reforms to address social conditions, in addition to traditional bioethical principles. Work in this area needs to become interdisciplinary and collaborative as well as integrate input from the patients themselves. The concept of the dignity of these patients, in its broadest sense, needs to be infused into the discussion in order to optimise the exploration for solutions for this cohort.

The stance of MAiD as harm reduction, in this context, does not meet the definition of harm reduction, nor does it represent a commitment to the best interests of these patients.

  • ethics- medical
  • human rights
  • paternalism
  • right to health
  • disabled persons

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  • Contributors I am the sole contributor to this article.

  • 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; internally peer reviewed.

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