Minimizing the Risk of Limited Patient Autonomy

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This article is in response to the From Our Readers article, “Medical Aid in Dying: Not a Medical Choice, but a Personal One” by Susan Stefan, JD.

I agree with Susan Stefan, JD, that the goal should be to optimize the patient’s autonomy in making all medical and end-of-life decisions, including electing medical aid in dying (MAID). Toward that end, legislation for MAID should make the medical criteria for qualifying as explicit and objective as possible. The physician’s role should be limited to making those medical judgments, rather than passing moral or ethical judgment about the legitimacy of MAID for a specific patient or patients in general. Physicians who object to MAID based on their own ethical or religious convictions should be explicit about that and have the patient work with another physician to determine their medical eligibility for MAID.

Obviously no medical judgment is completely objective or unambiguous. But with reasonable safeguards, it should be possible to minimize the risk of arbitrary or nonmedical judgments by a physician that would limit the patient’s autonomy. The presumption should be to respect the patient’s wishes, in the absence of compelling circumstances that argue otherwise.

Surely the fact that this process will never be perfect is not a valid basis for rejecting MAID legislation. Should we jettison our judiciary system because in a given case one judge might say yes, and another say no? Rather, we make every attempt to make the legal code sufficiently explicit that a judge knows the specific points of law and precedents they should consider in rendering a judgment.

Besides, what is the alternative? Dr Stefan is concerned that in a given case one doctor might say yes, and another doctor might say no to a patient’s request for MAID, giving undue power to “a stranger with a medical degree.” But to oppose MAID legislation based on this concern is to support giving the power to the strangers in their state legislature to say no to everyone.

Dr Heinrichs is a psychiatrist in Ellicott City, Maryland.