Medical Assistance in Dying (MAID) Quiz

Health Care & Bioethics - Medical Assistance in Dying (MAID)

• MAID involves using medical means to end a person's life when natural death is expected
• The primary intention is to relieve immense pain and suffering
• MAID includes physician-assisted suicide (PAS), voluntary active euthanasia (VAE), and withholding/removal of life support
• There are distinctions between passive euthanasia (withholding or removing life support) and active euthanasia (directly administering a lethal dose)

Online Mini Lecture Instructions

• Discussion board questions appear during the lecture
• Pausing the lecture and reflecting on the topics is encouraged
• Participation in the online discussion boards on Nexus is recommended
• Answering questions on the discussion boards earns bonus marks (4+ = 2 marks, 2 = 1 mark, 1 = 0.5 marks)
• Encouraging respectful dialogue between students is highlighted

Puzzles About Justice in Emergencies

• COVID-19 vaccine distribution is discussed, specifically the ethical and philosophical issues of equitable distribution
• Vaccine distribution according to need vs. wealth is questioned — arguments for prioritizing need in poorer countries vs. wealthier countries' greater capacity for aid
• Poorer countries' need for vaccines due to healthcare limitations and wealthier countries' aid capacity are debated

Argument for Distributing to Poorer Regions First

• Poorer regions have less access to healthcare than wealthier regions
• Need for vaccines is greater in poorer regions due to limited healthcare access
• Resources should be distributed based on need, specifically in this context, healthcare need

Discussion Board Questions 1 and 2

• Students are asked to identify the least plausible premise in the argument presented, justifying the reasoning
• Students are prompted to discuss potential ethical problems arising from prioritizing poorer regions in vaccine distribution, such as global inequality and its effect on healthcare access

Argument for Distributing to Wealthier Regions First

• Wealthier regions have better healthcare access generally
• Wealthier nations are better equipped to help those in need due to resources and infrastructure, thus enabling wider distribution
• Their capability to distribute should prioritize the initial vaccine access

Discussion Board Questions 3 and 4

• Students are asked to critique a premise from a wealthier-first argument, justifying their reasoning
• Students are prompted to discuss potential ethical issues stemming from vaccinating wealthier regions first, such as the impact of unequal resource distribution on global health

Medical Assistance in Dying (MAID) - Overview

• MAID is using medical means to end a life when natural death is expected
• The main goal is pain and suffering relief, not necessarily hastening death
• MAID includes physician-assisted suicide (PAS), voluntary active euthanasia (VAE), and the withholding/removal of life support

Passive Euthanasia

• Passive euthanasia involves withholding or removing life support
• Withholding allows a patient to die naturally even if some life extension might be possible with support
• Removal of life support removes artificial measures preventing natural death

Active Euthanasia

• Active euthanasia is directly administering a lethal dose via a physician
• PAS (Physician-assisted suicide) differs from VAE (Voluntary active euthanasia) by the patient self-administering the lethal dose after a physician provides it

Are Active and Passive Euthanasia Morally Distinct? Arguments

• Different arguments address the moral distinction between active and passive euthanasia
• One argument states that taking an innocent life is wrong, thereby making active euthanasia wrong but passive euthanasia permissible, by focusing on the intent behind the act
• A second argument emphasizes both active and passive euthanasia aims to relieve suffering, making them equally permissible, by highlighting the intent to reduce suffering

Are Active and Passive Euthanasia Morally Distinct? Thought Experiment

• The thought experiment involves a father on life support where a son pulls the plug for inheritance, raising questions about the son's motivations.
• The scenario highlights the complexities of intent behind actions related to life and death decisions, and whether allowing natural death is fundamentally different from actively ending a life.

Discussion Board Questions 4 and 5

• Students are encouraged to debate the moral equality or inequality between active and passive euthanasia, considering factors like patient autonomy and intent
• The question of which argument is most compelling should be evaluated critically, citing specific aspects that contributed to a particular argument's persuasiveness.

MAID in Canada - A Brief History

• Physician-assisted suicide (PAS) and voluntary active euthanasia (VAE) were legalized in Canada in 2016
• The legalization followed a court ruling that deemed prohibiting MAID unconstitutional, emphasizing the right to end suffering
• Kay Carter's case (Carter v. Canada) was pivotal in the ruling, leading to the eventual legalization of MAID

Updates to Legislation

• Initial MAID criteria included a "reasonably foreseeable" death, subsequently adjusted to broader eligibility
• This criterion was subsequently removed to extend eligibility, particularly in the Truchon and Gladu cases in Quebec, reflecting a shift towards broader access
• There are still restrictions on access for those with mental illnesses, with a determined timeframe for review.

Safeguards

• Existing rules and protocols aim to ensure that MAID is performed safely, adhering to ethical and legal standards
• A two-track approach exists to cater to cases of foreseeable and non-foreseeable deaths, ensuring diverse patient needs are considered while maintaining patient safety
• Clear guidelines are needed to ensure the procedure respects the patient and is morally justifiable, considering potential ethical issues involved

MAID in Canada - Eligibility Criteria

• As of March 17, 2021, eligibility criteria for MAID in Canada include being 18 years or older, having decision-making capacity, and meeting specific health standards

Arguments in Favour of Active Euthanasia

• Prohibiting MAID for competent patients is a violation of personal autonomy
• MAID is morally permissible (and sometimes required) when requested by a competent individual, addressing the suffering relief aspect
• Relieving suffering sometimes requires MAID due to the severity of circumstances

Killing is Always Wrong - Against MAID

• PAS and VAE are forms of killing, violating a duty against killing, arguing against moral permissibility — the act itself is considered morally wrong
• Both practices should, therefore, be prohibited on moral grounds.

Arguments in Favour of Active Euthanasia (revisited)

• Allowing competent patients to access MAID can be the most effective way to alleviate suffering, placing it as a necessary response to severe suffering
• Denying the option of relieving suffering is morally wrong, due to its impact on a person's autonomy and well-being
• So, MAID is morally acceptable under conditions where it is intended for the relief of suffering.

A Slippery Slope - Against PAS & VAE

• Legalizing PAS and VAE might incentivize doctors to encourage vulnerable groups to choose MAID over life-prolonging treatments, due to concerns about coercion and abuse, which raise ethical considerations.

Discussion Board Questions 6 and 7

• Reflect on the moral permissibility of active euthanasia, considering various viewpoints and supporting ideas using justification and reasoning
• Critically analyze various arguments, focusing on logical flaws, assumptions, and counterarguments related to MAID

Competent Under-Aged Patients?

• The case involves a 15-year-old with severe cancer, who is competent but not eligible under current MAID laws due to age.
• Poses the question of whether the minimum age requirement for MAID should be lowered, considering the patient's capacity for autonomous decision-making

Discussion Board Questions 8 and 10

• Discusses whether psychological suffering warrants MAID in the absence of physical illness
• Explores the various ethical implications of providing MAID to those with mental illnesses, highlighting the safeguards that should be in place
• Questions whether 15-year-olds who meet other criteria should be allowed MAID, considering the complexities of the issue and various counterarguments related to minors' capacity of decision-making and access to medical aid