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Beyond coercion: reframing the influencing other in medically assisted death
  1. Mara Buchbinder1,
  2. Noah Berens2
  1. 1Department of Social Medicine and Center for Bioethics, University of North Carolina, Chapel Hill, North Carolina, USA
  2. 2Office of Graduate Medical Education, University of North Carolina, Chapel Hill, North Carolina, USA
  1. Correspondence to Professor Mara Buchbinder, Department of Social Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA; mara_buchbinder{at}


This essay considers how we are to understand the decision to end one’s life under medical aid-in-dying (MAID) statutes and the role of influencing others. Bioethical concerns about the potential for abuse in MAID have focused predominantly on the risk of coercion and other forms of undue influence. Most bioethical analyses of relational influences in MAID have been made by opponents of MAID, who argue that MAID is unethical, in part, because it cannot cleanly accommodate relational influences. In contrast, proponents of MAID have downplayed the role of relational influences because they may threaten the pillars of autonomy and voluntariness on which the ethics of MAID rest. Drawing on a case study collected as part of an ethnographic study of MAID in Vermont, we show how relations of care are central to MAID decision-making. Such relations may muddle motives for assisted death, exposing the limits of conventional bioethics thinking on MAID and relational influence. Here, we argue that ethical frameworks for MAID should account for the role of relational influences in decision-making, and acknowledge that relational influences may support, as well as undermine, a decision for MAID. We then outline an evaluative framework for determining whether relational influences are undue that identifies six key domains for consideration: mental competence, authenticity, relationship context, having an adequate range options, financial considerations and irremediability. We conclude by suggesting that social relationships may constitute an important source of value in end-of-life decision-making and not only a liability.

  • Coercion
  • Suicide
  • Decision Making
  • Death
  • Ethics- Medical

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  • Contributors MB designed and conceptualised the research, drafted the manuscript, revised it for scholarly content, and is responsible for the overall content of the manuscript. NB contributed to literature review and drafted sections of the manuscript.

  • Funding Mara Buchbinder's work on this study was funded by the Greenwall Foundation (no grant number) and the National Science Foundation (1630010). Noah Berens' work on this study was funded by the National Institutes of Health (T35-DK007386).

  • Competing interests None declared.

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

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