This document provides an outline for a presentation on medically assisted dying (MAiD) in Ireland. It aims to establish an ethical framework for conceptual discussion of MAiD by considering: the decision, the decision makers, and the outcome. It does not endorse any viewpoint. The presentation raises several ethical questions around patient autonomy and consent, concepts of life and death, the role of healthcare providers, and impacts on community and public trust. Examples are provided from Canada, where MAiD is legal, to illustrate challenges in practice. The document stresses the need for evidence from all stakeholders and learning from other jurisdictions' experiences before legalizing MAiD in Ireland.

1. M E D I C A L L Y A S S I S T E D
D Y I N G I N D Y I N G ( M A i D )
I RE L A N D : M A P P I N G T H E
E T H I C A L T E RRA I N
Ghaiath Hussein, MBBS, MHSc, PhD
Assistant Prof. in Medical Ethics & Law,
Trinity College Dublin
@GhaiathHussein

2. OUTL I NE : WHAT MY PRESENTATION IS(NOT)
• Provide an ethically-oriented logical framework to guide a
conceptual discussion on MAiD, following this categorization:
▪ The decision
▪ The decisionmakers
▪ The outcome
• Using examples from some countries that legalized MAiD, with
focus on Canada.
• NOT an attempt to explain or endorse any ethical theory or
approach or any official or religious viewpoint

3. W H AT I S
E T H I C A L LY
R E L E VA N T / U N I Q U E
A B O U T M A I D ?
Irreversible decision
Contradicting morally-equivalent
values and duties
Death as a value-laden concept
(spiritual vs. clinical)
Death is a process not an event
Similarities and differences to other
EOL care decisions
Option, right or duty?

4. W HO IS W HO IN MAID?
MAiD
Patient
Family
HCPs
Public
W HICH E THICAL PATH?
Theories
as
lenses
Deontological
Teleological
Principlism
Contractarian

5. ETHICAL QUESTIONS ABOUT THE PATIE NTS?
Autonomy (& Informed Consent)
• How to define capacity to consent? How informed/manipulated/coerced they are?
• What are the limits of autonomy? Do they apply to MAiD?
• Does MAiD dignify autonomous choices or limit view to self?
• Can consent be delegated (children, unconscientious, etc.)?
• Why should 'autonomy' be privileged above other principles of medical ethics?
Concepts of life, death, suffering
• How about non-pain-related reason (loss of autonomy, losing dignity and the
intolerability of not being able to enjoy one’s life)?
• How to assess the impact of COVID-19 and the like on MAiD eligibility and choices?
Option, right or duty?
• Is there a duty to die? avoid burdening others (what is the role of family?)
• MAiD with(out) request: who decides? Blurring of criteria
• Is it ok to change my mind?
• Can MAiD candidate choose what happens after her death?

6. E T H I C A L Q U E S T I O N S A B O U T T H E H C P s ?
Conflicts of duties and roles
• Conflicting duties of not to harm, care, do good, alleviate pain?
• What are the limits of autonomy? Do they apply to MAiD? How about ‘Principle of Double Effect’?
• Role in MAiD? Consultant, assessor, informer, advocate, decisionmaker, implementer
• How would each of these roles affect the main duty to care?
Conscious-based objections
• On what basis can HCPs refuse to be involved (personal, religious, etc.)?
• Can faith-based healthcare facilities be ‘exempted’?
• How to manage uncertainties about the patient’s condition or the outcome of MAiD itself?
Moral habituation and erosion
• What kind of emotional support is available?
• From reflection and guilt to a habit and business as usual
Legal arguments and implications
• How safeguarding are the safeguards? Example of ‘foreseeable death’, used ‘wrong combination’
• Patient choice or physicians’ assessment?

7. ETHICAL QUESTIONS RELATED TO THE
COMMUNITY & WIDER P UBL IC
• Would legalizing MAiD affect perception/trust in HCPs?
• How MAiD may reorientate the focus/roles & priorities?
• Will legalizing MAiD abolish self-committed or unregulated suicide?
Pubic view of healthcare facilities and providers
• Who gets the ‘service’?
• Who pays for it?
• Questions on eligibility, accessibility, and affordability
Justice and access
• How MAiD will affect the reallocation of resources?
• How MAiD lead to view some patients as ‘burden’?
Impact on disabled and persons with special needs?

8. M A I D I N A C T I O N :
C A N A D A
https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html#s1

9. TRYING THE TRIED?
The Spectator (UK) Dr Joel Zivot,

10. O N A F I N A L N O T E / T H O U G H T
• We need evidence. From, with, and about all the
stakeholders.
• ‘Others did it, why not us’ is not a good argument.We
may be similar but not the same.
• Others did it, so let’s learn from them and see how they
ended up is a better prologue
• The majority rules only in politics. In ethics, we need to
hear from the minorities first.