When It Comes to Medical Aid-in-Dying, We Must Protect the Vulnerable

“Many such persons will have internalized the idea that they constitute an inconvenient and expensive burden on loved ones, as well as the healthcare system. Legalizing MAID risks reinforcing that message.”

Medical aid-in-dying (MAID) laws are increasingly being enacted across Europe, North America, and Australia. It is easy to see the appeal of these laws. They comport with our Western emphasis on autonomy and self-determination. “Death with dignity” is a compelling catchphrase. The rhetorical questions one encounters in Facebook threads and letters to the editor (“Who are we to control someone else’s death,” “If we put our pets to sleep, why won’t we do the same for  human beings,” and so on) carry considerable weight. One could be forgiven for assuming that anyone not in thrall to rigid religious fundamentalism or an abstract and arid vitalism must be a supporter of MAID.

Let us gently challenge that assumption. There are no “knockdown” arguments against MAID—just reasonable people on both sides of the debate. This issue, however, is more complex than it might initially appear, especially for those who stress social justice, societal progress, and support for the marginalized.

First, one need not share the view that all acts of suicide, assisting a suicide, and mercy killing are morally wrong to have concerns about MAID. The debate does not turn on whether such acts are invariably wrong but whether legalizing them under certain conditions would be prudent public policy. There is wisdom in the old maxim that “Hard cases make bad law.”

Second, while individual autonomy is undoubtedly a cardinal value, it should not be wielded like a trump card in discussions of MAID. The ongoing Coronavirus (COVID-19) pandemic usefully illustrates the limits of autonomy. Throughout the pandemic, governments have restricted autonomy to safeguard life and health. Legalizing MAID would surely advance autonomy, but if it conflicts with other crucial values–such as protecting the vulnerable and preserving human life–it is not necessarily obvious that claims of autonomy should carry the day.