Introduction
Medical Aid in Dying (MAID) in Canada is subject to moral and ethical controversy, especially regarding its applicability to mature minors. The Mature Minor Doctrine, adopted in Canada, is the legal rule ensuring the right of a non-emancipated patient to refuse treatment (Tunick, 2021). However, this doctrine applies to all medical decisions except MAID (Patton & Dobson, 2021). I believe the law needs to be amended so that mature minors, subject to strict conditions, can have access to MAID.
Utilitarian Perspective
Ensuring that mature minors have access to MAID is consistent with popular moral and ethical concepts. From utilitarian ethics, the moral value of an act is determined from the point of view of benefit, which consists in achieving the satisfaction of the greatest number of people (Amer, 2019). In the case of MAID, maximum utility is achieved in relation to the mature minor, the decision-maker, society, and the healthcare system as a whole.
The utilitarian benefit of increased access to MAID is improving the healthcare system by reducing costs and increasing patient self-awareness (Riley & Sarbey, 2022). A mature minor can realize their desire and end their suffering, the healthcare system achieves the goals of fulfilling the will of the patient, and society becomes fairer through ensuring equal access to medical services.
Deontological Perspective
Deontological ethics may also decide that the access of mature minors to MAID is morally justified. Deontological ethics is often used in medicine because it is associated with the concept of duty, so a decision is considered justified if it complies with a set of established rules (Dillon, 2021). The medical worker must take into account the wishes of the patient during treatment or refusal of it (Singh & Moodley, 2020). Deontological ethics places great importance on duty in the actions of medical personnel; if the duty to the patient is to end suffering, this action can be justified (Gupta, C., & Sachdev, 2020). This principle should have no exceptions and should be applied to mature minors.
Principles of Medical Ethics
Autonomy
The principle of autonomy in medicine states that the patient has the right to make independent decisions regarding their health. According to this principle, the doctor’s responsibility is to provide complete information to the patient, after which the doctor is obliged to follow their decision (Molina-Mula & Gallo-Estrada, 2020). The basic principle of medical care is a respectful attitude towards the individual, which includes autonomous decision-making, including voluntary death (Pesut et al., 2020).
In the case of MAID, the doctor’s responsibility is to inform the patient about the possibility or impossibility of a cure and the prognosis for health outcomes, after which the patient must independently decide the acceptability of this step. Mature minors are also subject to the principle of autonomy and should, therefore, be allowed to have access to MAID.
Beneficence
For mature minors, this principle of beneficence should also be implemented if the patient wishes to resort to MAID. The principle of beneficence is realized in actions that result in the good of the patient, which implies the elimination of harm and the advantage of benefit over harm (Spoljar et al., 2020). Subject to all conditions and the obvious benefit to the patient, if otherwise it is impossible to avoid harm, mature minors should have access to MAID.
Self-Determination
Preventing euthanasia from a beneficial personal choice is a violation of the patient’s right to self-determination (Pesut et al., 2020). There is no benefit in continuing treatment against the will of the patient, the process of which brings moral and physical suffering. Equitable access and doctrinal compliance are essential to equitable healthcare.
Conclusion
In conclusion, the question of using the doctrine of mature minors in relation to MAID is morally and ethically complex. However, from the point of view of utilitarianism, deontology, and the principles of beneficence and autonomy, this procedure should be allowed for the group of patients in question. The Mature Minor Doctrine is designed to provide fair healthcare without age-based exceptions. Therefore, subject to strict eligibility criteria, mature minors should be allowed to use MAID.
References
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Dillon, J. (2021). Utilitarian vs deontological ethics in medicine and dentistry. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 132(6), 617-618. Web.
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Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health, 17(3), 835-859. Web.
Patton, M., & Dobson, K. (2021). Proposal for the extension of rights to medical assistance in dying (MAID) to mature minors in Canada. Canadian Psychology, 62(3), 318–325. Web.
Pesut, B., Greig, M., Thorne, S., Storch, J., Burgess, M., Tishelman, C., & Janke, R. (2020). Nursing and euthanasia: A narrative review of the nursing ethics literature. Nursing ethics, 27(1), 152-167. Web.
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Singh, J. A., & Moodley, K. (2020). Critical care triaging in the shadow of COVID-19: Ethics considerations. South African Medical Journal, 110(5), 355-359. Web.
Spoljar, D., Curkovic, M., Gastmans, C., Gordijn, B., Vrkic, D., Jozepovic, A., & Borovecki, A. (2020). Ethical content of expert recommendations for end-of-life decision-making in intensive care units: A systematic review. Journal of Critical Care, 58(1), 10-19. Web.
Tunick, M. (2021). State authority, parental authority, and the rights of mature minors. The Journal of Ethics, 27(1), 1-23. Web.