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Medical assistance in dying: the downside
  1. John Richard Attia1,2,
  2. Christine Jorm3 and
  3. Brian Kelly1
  1. 1 Division of Medicine, Hunter New England Local Health District, New Lambton, New South Wales, Australia
  2. 2 Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
  3. 3 NSW Regional Health Partners, Hunter New England Local Health Network - HNELHN, New Lambton, New South Wales, Australia
  1. Correspondence to Professor John Richard Attia, SMPH, The University of Newcastle, New Lambton Heights, NSW 2305, Australia; john.attia{at}

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Euthanasia is the deliberate administration of medications with the explicit intention of ending life, whereas physician assisted dying is the prescription or supply of drugs to enable the patient to end their own life.1 We use the term ‘medical assistance in dying’ (MAID) to refer to both. The rationale for MAID is usually based on two principles:

  • Compassion, that is, to relieve unbearable suffering.

  • Autonomy, that is, the right to self-determination.

Such individual rights however exist within a broader community, familial and societal context. Philosopher Daniel Callaghan stated: “Euthanasia is not a private matter of self-determination. It is an act that requires two people to make it possible and a complicit society to make it acceptable”.2 We present our perspective on the (often unacknowledged) implications of MAID for the family, physician and the healthcare system. A MEDLINE review was done with snowballing that is, following up reference lists from papers identified.

Why patients might request MAID

Several factors drive patient requests for MAID, including the fear of becoming a burden to others, depression and feelings of hopelessness, loss of identity or dignity, feeling isolated, being tired of existence, and fear of uncertainty; it is of interest that the fear of pain more than pain itself was also a driver.3–5 These studies explored the concerns of those with a terminal illness who usually did not have access to MAID and were considering a hypothetical situation. Initial experience from the Dying with Dignity programme in the USA6 and the Medical Assistance in Dying programme in Canada7 find that those dying through MAID are predominantly motivated by fear of the loss of control and autonomy. Interestingly, most were educated, higher socioeconomic level Caucasians (>90%).7 It has been suggested that ‘Being …

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  • Contributors JRA drafted the manuscript; CJ and BK critically reviewed it. All authors take responsibility for the content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.