When the decision to die interferes with the duty to heal

This commentary was inspired by an encounter M. M. experienced while shadowing a physician in 2024. The physician referred an otherwise healthy patient between 64 and 74 years old for a routine colonoscopy due to relevant risk factors. However, instead of the anticipated report, they received a letter from the specialist stating their refusal to complete the procedure. The reason cited for refusal: medical assistance in dying (MAiD). In the meeting with the specialist, the patient mentioned that they were considering pursuing MAiD for depression in 2026 - a choice that, notably, would not be available for solely mental health conditions until March 17, 2027.

Here, we consider multiple angles centred around how we should treat MAiD, particularly when it intersects with decisions related to life expectancy. Policy reform is necessary to address this potential form of discrimination across all subspecialties in medicine, advocating instead for collaborative, case-by-case decision-making between physicians and patients to discuss their goals of care and risks. To this end, we propose a four-pronged approach, including guidelines, medical ethics training, patient-targeted education, and further research.