Unrestricted MAID: A thought experiment

ABSTRACT: If you slide far enough down the slippery slope envisaged by opponents of medical assistance-in-dying (MAiD), you eventually land in an ostensibly ghastly society where life has been devalued, suicide is rampant, and physicians have industrialized euthanasia. But what if the slippery slope lead us somewhere completely different? 

This paper aims to explore and evaluate some overlooked public health benefits from the full legalization of MAiD, with the elimination of all prohibitions and regulations on the practice. We instead anticipate positive effects for public health in three domains: 1. Expanded access to those who currently do not qualify for MAiD through the removal of onerous and ineffective access criteria with a sharpened focus on horizontal equity; 2. Heightened safety through preventing complications from suicide attempts and rerouting of potential private suicides into alternate forms of care; and 3. Aggregate benefits to the health system as a whole through lowered healthcare costs at the end-of-life, increased organ supplies, and sharpened patient activation in their end-of-life wishes. 

We then explore and rebut a number of worst case scenarios of widespread MAiD legalization to address criticisms of such a large policy shift. These include concerns over non-persistent requests, coercion by families and financial systems, and the decay of the physician-patient relationship. We find all to be driven by fear, rather than data, and dangerously myopic. 

Finally, we seat these benefits in the larger context, introducing a new model for weighing these unexamined benefits against the potential harms that may arise, hoping to shift the conversation on MAiD (and other controversial bioethics issues) away from only observing negative effects toward a more inclusive and holistic approach.

Author Bio: Sean Riley is a Project Coordinator in the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. Holding a MA in Bioethics & Science Policy from Duke University and an MSc in Health Sciences from Erasmus University in the Netherlands, he has extensive experience with research on the ethical and policy aspects of end-of-life care, specifically in regards to voluntary euthanasia and capital punishment. Professionally, he works as a health services researcher on behavioral health issues. Recent projects include conducting a systematic review on eating disorders for the United States Preventive Services Task Force and implementing a screening protocol for unhealthy alcohol use in primary care across North Carolina. Personally (and primarily), he continues his bioethical research into medical assistance-in-dying and bioethical theory. He hopes to eventually marry the empirical and normative aspects of his professional and personal research. Twitter: @S_R_Riley Email: srr31@email.unc.edu