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Social determinants of health and slippery slopes in assisted dying debates: lessons from Canada

The question of whether problems with the social determinants of health that might impact decision-making justify denying eligibility for assisted dying has recently come to the fore in debates about the legalisation of assisted dying. For example, it was central to critiques of the 2021 amendments...

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Autores principales: Downie, Jocelyn, Schuklenk, Udo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8479744/
https://www.ncbi.nlm.nih.gov/pubmed/34349029
http://dx.doi.org/10.1136/medethics-2021-107493
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author Downie, Jocelyn
Schuklenk, Udo
author_facet Downie, Jocelyn
Schuklenk, Udo
author_sort Downie, Jocelyn
collection PubMed
description The question of whether problems with the social determinants of health that might impact decision-making justify denying eligibility for assisted dying has recently come to the fore in debates about the legalisation of assisted dying. For example, it was central to critiques of the 2021 amendments made to Canada’s assisted dying law. The question of whether changes to a country’s assisted dying legislation lead to descents down slippery slopes has also come to the fore—as it does any time a jurisdiction changes its laws. We explore these two questions through the lens of Canada’s experience both to inform Canada’s ongoing discussions and because other countries will confront the same questions if they contemplate changing their assisted dying law. Canada’s Medical Assistance in Dying (MAiD) law has evolved through a journey from the courts to Parliament, back to the courts, and then back to Parliament. Along this journey the eligibility criteria, the procedural safeguards, and the monitoring regime have changed. In this article, we focus on the eligibility criteria. First, we explain the evolution of the law and what the eligibility criteria were at the various stops along the way. We then explore the ethical justifications for Canada’s new criteria by looking at two elements of the often-corrosive debate. First, we ask whether problems with the social determinants of health that might impact decision-making justify denying eligibility for assisted dying of decisionally capable people with mental illnesses and people with disabilities as their sole underlying medical conditions. Second, we ask whether Canada’s journey supports slippery slope arguments against permitting assisted dying.
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spelling pubmed-84797442021-10-08 Social determinants of health and slippery slopes in assisted dying debates: lessons from Canada Downie, Jocelyn Schuklenk, Udo J Med Ethics Feature Article The question of whether problems with the social determinants of health that might impact decision-making justify denying eligibility for assisted dying has recently come to the fore in debates about the legalisation of assisted dying. For example, it was central to critiques of the 2021 amendments made to Canada’s assisted dying law. The question of whether changes to a country’s assisted dying legislation lead to descents down slippery slopes has also come to the fore—as it does any time a jurisdiction changes its laws. We explore these two questions through the lens of Canada’s experience both to inform Canada’s ongoing discussions and because other countries will confront the same questions if they contemplate changing their assisted dying law. Canada’s Medical Assistance in Dying (MAiD) law has evolved through a journey from the courts to Parliament, back to the courts, and then back to Parliament. Along this journey the eligibility criteria, the procedural safeguards, and the monitoring regime have changed. In this article, we focus on the eligibility criteria. First, we explain the evolution of the law and what the eligibility criteria were at the various stops along the way. We then explore the ethical justifications for Canada’s new criteria by looking at two elements of the often-corrosive debate. First, we ask whether problems with the social determinants of health that might impact decision-making justify denying eligibility for assisted dying of decisionally capable people with mental illnesses and people with disabilities as their sole underlying medical conditions. Second, we ask whether Canada’s journey supports slippery slope arguments against permitting assisted dying. BMJ Publishing Group 2021-10 2021-08-04 /pmc/articles/PMC8479744/ /pubmed/34349029 http://dx.doi.org/10.1136/medethics-2021-107493 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Feature Article
Downie, Jocelyn
Schuklenk, Udo
Social determinants of health and slippery slopes in assisted dying debates: lessons from Canada
title Social determinants of health and slippery slopes in assisted dying debates: lessons from Canada
title_full Social determinants of health and slippery slopes in assisted dying debates: lessons from Canada
title_fullStr Social determinants of health and slippery slopes in assisted dying debates: lessons from Canada
title_full_unstemmed Social determinants of health and slippery slopes in assisted dying debates: lessons from Canada
title_short Social determinants of health and slippery slopes in assisted dying debates: lessons from Canada
title_sort social determinants of health and slippery slopes in assisted dying debates: lessons from canada
topic Feature Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8479744/
https://www.ncbi.nlm.nih.gov/pubmed/34349029
http://dx.doi.org/10.1136/medethics-2021-107493
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