When the decision to die interferes with the duty to heal

TL;DR

A patient's decision to pursue medical assistance in dying raises ethical and policy questions about how healthcare providers should respond.

Contribution

The paper proposes a four-pronged approach to address ethical challenges when medical assistance in dying intersects with life expectancy decisions.

Findings

Current policies may inadvertently discriminate against patients seeking MAiD for mental health conditions.

Collaborative decision-making between physicians and patients is essential to align care with patient goals.

Guidelines, ethics training, education, and research are needed to address these ethical challenges.

Abstract

This commentary was inspired by an encounter M. M. experienced while shadowing a physician in 2024. The physician referred an otherwise healthy patient between 64 and 74 years old for a routine colonoscopy due to relevant risk factors. However, instead of the anticipated report, they received a letter from the specialist stating their refusal to complete the procedure. The reason cited for refusal: medical assistance in dying (MAiD). In the meeting with the specialist, the patient mentioned that they were considering pursuing MAiD for depression in 2026 - a choice that, notably, would not be available for solely mental health conditions until March 17, 2027.

Here, we consider multiple angles centred around how we should treat MAiD, particularly when it intersects with decisions related to life expectancy. Policy reform is necessary to address this potential form of discrimination across all subspecialties in medicine, advocating instead for collaborative, case-by-case decision-making between physicians and patients to discuss their goals of care and risks. To this end, we propose a four-pronged approach, including guidelines, medical ethics training, patient-targeted education, and further research.