Medical Aid in Dying: Leaving the Choice to the Patient

Is precluding the option of MAID against a competent patient’s wishes an exercise of paternalistic control and decision-making for the patient?

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This article is in response to the From Our Readers article, “Finding Meaning in Suffering: The Value of Helping Patients” by John R. Peteet, MD.

While maintaining that first principles derived from religious traditions constitute the primary basis for categorical opposition to MAID, I also acknowledged a potential role for other transcendental beliefs or cultural traditions. However, these typically are also embedded in religion-derived assumptions as to humanity’s distinct status, requiring a different definition of dignity than that which we apply to other intelligent species. The point is that humans are not likely to give up such first principles based on logical arguments.

Attitudes toward same-sex relationships actually make the point. To the extent that attitudes have shifted among the religious—and for many they have not—it has primarily been the result of gradual and insidious cultural shifts over decades, rather than logical debate changing basic convictions. In contrast, metaphysical first principles that are not “God-given” but must be defended, such as the role of individual autonomy in the nature of moral reality, can be productively discussed.

There are, of course, other possible arguments not based on fundamental principles for opposing MAID. I address some of them—such as concerns of the disability community and the impact on others and on social policy—in Parts 2 and 3 of my series. Here I will only comment on Sulmasy’s concern that physicians should not take on the “role of deciding problems of living” for patients. How does MAID imply this, as it leaves the choice to the patient? The physician can provide information about the patient’s medical situation and prognosis and, if the patient elects, provide a humane means to implement MAID; whereas precluding this option against a competent patient’s wishes truly is an exercise of paternalistic control and decision-making for the patient. What qualifies us physicians—or ethicists for that matter—for that role?

Dr Heinrichs is a psychiatrist in Ellicott City, Maryland.

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