Drawing the line: advance requests for medical assistance in dying: broad considerations with a special focus on dementia

Abstract

This thesis considers the issue of whether to expand Medical Assistance in Dying (MAiD) legislation to include advance requests (ARs) broadly, with particular consideration for the dementia condition. The goal is to provide a deeper understanding of the value tensions involved in a decision of if and how ARs for MAiD should be extended to the Canadian population. To date, much of the discussion of the ethics of advance requests for MAiD focuses on those with dementia. This condition poses particular challenges in that it will, at some point, certainly cause a loss of capacity and living with such loss of capacity may be considered unbearable suffering to some individuals. The question of whether to legalize ARs for MAiD hinges on notions of the self and the nature of autonomy, both of which are affected by dementia. This thesis aims to address some of these challenges with a view to understanding whether and under what circumstances an AR for MAiD might be justified. This thesis provides suggestions and arguments aimed specifically at whether ARs for MAiD ought to be legalized and does not suggest whether MAiD ought to be legalized for individuals with mental illness as a sole underlying condition. Further, the scope of this thesis focuses on the moral and ethical considerations and implication that ought to be considered in potential expansion of legislation, not the resulting implications of actually expanding such legislation. Overall, the thesis focuses on the ethics of the potential legalization of ARs for MAiD in general, with a sub-focus on dementia, as the condition poses unique challenges as mentioned above.