The Way Forward for Medical Aid in Dying: Protecting Deliberative Autonomy is Not Enough

Abstract

Mainstream public and legal debates, decisions, and norms about medical aid in dying (MAiD) have focused primarily on the deliberative facets of autonomy and have paid far less attention to its social components. As a result, safeguards may fail to properly protect the autonomy of vulnerable persons.

After introducing the factual and theoretical background of this problem (Section I), I will explain the distinction between deliberative and social dimensions of autonomy, and why a right to autonomy might entail not only protecting an agent’s decisional capacities, but also certain conditions enabling the realization of such capacities (Section II). In Section III, I will explain that legal and bioethical discourses about autonomy have traditionally focused on its deliberative dimensions. This explains, in part, why one should not be surprised that the judicial interpretation of the right to liberty in the Carter decision focused on deliberative capacities (Section IV) and that the legal and regulatory MAiD frameworks set up by our federal and provincial governments similarly focus on deliberative autonomy (Section V). Section VI outlines an alternative interpretation of the right to autonomy that recognizes the necessity of social resources and proposes a principled way of constraining that right. Section VII maps the kinds of social determinants of autonomy in the context of MAiD that our government should monitor and analyze in order to enact proper safeguards to protect socially vulnerable people in the future.

Keywords: Medical Aid in Dying, Autonomy, Vulnerability

JEL Classification: K32, Z18, I31, I18