Mature Minor Eligibility for Medical Assistance in Dying (MAiD): An Ethical Analysis

Abstract

Medical Assistance in Dying (MAiD) was legalized in Canada on June 17, 2016, following a landmark Supreme Court of Canada decision, Carter v. Canada (2015). Currently, the law controversially denies three groups access to MAiD: mature minors (capable children under 18), persons making advance directives, and persons with mental illness as a sole underlying condition. All three populations are excluded from access to MAiD on the grounds that they may lack the capacity to autonomously request and consent to the procedure.

This Applied Philosophy Dissertation examines the prospect of extending MAiD eligibility to one of these vulnerable populations, mature minors. The question of MAiD presents conflicting legal and ethical obligations to children. One obligation is to child welfare. We have stronger duties – including legal duties – to protect children’s interests than those of adults, and we organize society such that children are treated differently to shield them as a vulnerable group. Yet we also have obligations to child self-determination. Children have a legal right to decision-making autonomy corresponding to their level of maturity. This tension between welfare and self-determination hinges in part on whether children can make genuinely autonomous choices, a source of considerable debate among child development experts.

The dissertation argues that eligibility for MAiD should be calibrated according to maturity rather than age. It develops three key arguments for this conclusion. One is that an age criterion in Bill C-14 is an unjustifiable act of age discrimination. Children who are otherwise eligible for MAiD suffer to the same extent as adults, and are disadvantaged compared to adults where they cannot end this suffering on their own terms. Secondly, prohibiting mature minors from accessing MAiD does not protect their welfare, and may be harmful in cases where requests are motivated by severe pain and suffering, a low quality of life, and an unwillingness to endure continued indignities. Thirdly, the law treats mature minors inconsistently by permitting minors to refuse life-sustaining treatment, for example, a blood transfusion on religious grounds, yet prohibiting them from consenting to MAiD. This legal inconsistency is also an ethical inconsistency: mature minors are able to choose to die when they could otherwise live, yet they are unable to control how they die when their death is unavoidable.