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Comment & Response
January 2018

Medical Assistance in Dying—Unanswered Questions

Author Affiliations
  • 1Department of Physical Medicine & Rehabilitation, Mayo Clinic, Scottsdale, Arizona
  • 2Department of Critical Care Medicine, Mayo Clinic Hospital, Phoenix, Arizona
JAMA Intern Med. 2018;178(1):155-156. doi:10.1001/jamainternmed.2017.7313

To the Editor Medical Assistance in Dying (MAID) became Canadian law after Royal Assent on June 17, 2016. In their Perspective published in a recent issue of JAMA Internal Medicine, Quinn and Detsky1 described MAID in a patient with cancer who was “fading away…[and] wanted to be in control of his death.”1(p1251) Both authors and a palliative care physician participated in MAID, and the authors concluded that “in this circumstance it was the right care, for the right patient, at the right time.”1(p1252) They justified MAID by appealing to arguably an unrestricted legal interpretation of individual autonomy. Quinn and Detsky1 buttressed their position stating that MAID is not only congruent with patients’ right to self-determination but also reduces family’s distress levels by avoiding the need for having to make agonizing end-of-life decisions. However, disagreements exist in the ethics literature on: (1) the interplay between patient right to autonomy (positive freedom right) vs physician right to nonparticipation in MAID (negative freedom right); and (2) the claim that MAID offers a convenient resolution of family distress associated with “uncertainty and agonized end-of-life decision-making”1(p1252) about withdrawal of life-saving care interventions. Despite a paucity of research, the psychological sequels (anxiety, depression, and posttraumatic stress disorders) of MAID on families are unlikely to be less than of those whose loved ones die naturally.2

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