The Moderate Approach to Advance Requests for Medical Assistance in Dying in Advanced Dementia

Abstract

The purpose of this thesis is to provide an approach to advance requests for MAiD in the setting of advanced dementia. Development of such an approach will require facing important ethical questions and metaphysical challenges. A small number of international jurisdictions permit advance requests for MAiD but there is no universal standard approach. Canada permits advance requests for MAiD in the very limited capacity of the Final Waiver of Consent and Advance Consent. However, advance directives for other life-or-death decisions such as withholding therapies or withdrawing interventions are permitted much more broadly – even when the intention is to hasten the patient’s death. Many authors argue that advance requests for MAiD and advance directives for other life-or-death decisions ought to be seen as ethically equivalent. There are several approaches to advance directives for life-or-death decisions in the setting of advanced dementia. The most prominent approaches attempt to prioritize the apparent tension between autonomy and beneficence while prioritizing self-determination. I will argue that the most prominent approaches fail due to underlying issues with their metaphysical foundations. I propose a Moderate Approach to advance requests for MAiD that I argue will provide sufficient ethical consideration to the apparent tension while maintaining sound metaphysical footing. Under this Moderate Approach, we ought to maximize the psychological connectedness and anticipate potential tensions between the person creating the advance request and the person who will be the subject of the advance request. If this tension occurs, we ought to resolve this tension by determining if the opposition is due to a change within the person themselves, or due to an unwanted influence from the disease process.