Institutional non-participation in assisted dying: Changing the conversation

Area of Science:

• Bioethics
• Healthcare Law
• Medical Ethics

Background:

• The right of institutions to refuse participation in medical assistance in dying (MAID) is debated.
• Current discourse often frames institutional non-participation solely through the lens of religious conscience.
• This perspective assumes non-participating centers are religious and expects full participation otherwise.

Purpose of the Study:

• To reframe the discussion around institutional non-participation in MAID.
• To argue that institutional non-participation is primarily a matter of self-governance, not exclusively conscience.
• To identify legitimate reasons beyond conscience for healthcare centers not offering MAID.

Main Methods:

• Philosophical argumentation
• Ethical analysis
• Conceptual reframing of institutional rights and responsibilities

Main Results:

• Institutional non-participation in MAID is fundamentally an issue of institutional self-governance.
• Healthcare institutions possess a natural right to self-governance, including the decision to offer MAID.
• Legitimate reasons for non-participation exist beyond conscience, such as capacity, expertise, and palliative care considerations.

Conclusions:

• The debate on institutional MAID non-participation should move beyond a narrow focus on conscience.
• Institutional self-governance provides a valid framework for deciding on MAID provision.
• Acknowledging diverse reasons for non-participation, including non-religious ones, is crucial for a comprehensive discussion.