The DOI matches its Crossref record; 22 of the 22 references it cites were found in a registry or an index.
Choosing death in unjust conditions: hope, autonomy and harm reduction
Open accessAbstract
In this essay, we consider questions arising from cases in which people request medical assistance in dying (MAiD) in unjust social circumstances. We develop our argument by asking two questions. First, can decisions made in the context of unjust social circumstance be meaningfully autonomous? We understand ‘unjust social circumstances’ to be circumstances in which people do not have meaningful access to the range of options to which they are entitled and ‘autonomy’ as self-governance in the service of personally meaningful goals, values and commitments. People in these circumstances would choose otherwise, were conditions more just. We consider and reject arguments that the autonomy of people choosing death in the context of injustice is necessarily reduced, either by restricting their options for self-determination, through their internalisation of oppressive attitudes or by undermining their hope to the point that they despair. Second, should MAiD be available to people in such circumstances, even when a sound argument can be made that the agents in question are autonomous? In response, we use a harm reduction approach, arguing that even though such decisions are tragic, MAiD should be available. Our argument engages with relational theories of autonomy as well as recent criticism raised against them and is intended to be general in application, although it emerges in response to the Canadian legal regimen around MAiD, with a focus on recent changes in Canada’s eligibility criteria to qualify for MAiD.
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“Notably, several study participants viewed suicidal ideation as a reason to grant, rather than refuse MAiD MI-SUMC, considering it a better, more dignified option to the painful and uncertain death by suicide for those intent on ending their life [62, 63].”
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Cited by
Sorted by citations
The realities of Medical Assistance in Dying in Canada
Coelho, R., Maher, J., Gaind, K. S., & Lemmens, T. (2023) · Palliative and Supportive Care · doi:10.1017/s1478951523001025 · Cited by 70
“Others have defended MAiD as a fully autonomous choice to avoid suffering in oppressed people who cannot access adequate socioeconomic resources (Wiebe and Mullin 2023).”
Stergiopoulos, V., Bastidas-Bilbao, H., Gupta, M., Buchman, D. Z., Stewart, D. E., Rajji, T., Simpson, A. I. F., van Kesteren, M. R., Cappe, V., Castle, D., et al. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05541-5 · Cited by 5
Metadata
- Authors
- Wiebe, K., & Mullin, A.
- Affiliations
- University of Toronto (CA)
- Corresponding author
- Wiebe, Kayla
- Venue
- Journal of Medical Ethics
- Publisher
- BMJ
- Published
- 2023-04-26
- Volume
- 50
- Issue
- 6
- Pages
- 407-412
- ISSN
- 0306-6800 (ISSN-L)
- 1473-4257
- OpenAlex
- W4367048460
- Cited by
- 49
- References
- 22
- Citations by year
- 2026: 12 · 2025: 17 · 2024: 13 · 2023: 7
- FWCI
- 12.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Medical Ethics (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- medical assistance in dying, autonomy, injustice, harm reduction, hope, despair, self-determination
- MeSH terms
- Decision Making, Humans, Social Justice, Suicide, Assisted, Personal Autonomy, Harm Reduction, Hope
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