Abstract
This article examines several ethical, legal, and spiritual aspects of Medical Assistance in Dying (MAiD) in Canada, a practice that has been legalized in Canada since June 17, 2016. The article identifies the underlying ethical tension of patient autonomy, and the principle of care providers protecting vulnerable populations. The article reviews how the legal framework of MAiD has evolved in Canada, where now individuals with any irremediable medical condition have access to this program; and where the care community appears divided regarding MAiD options for people's mental health. The article looks at the ethical, legal impacts of MAiD for medical providers, with a specific focus on their moral conscience; mental health wellbeing; duty to “do no harm”. Spiritual care providers have a role to play in MAiD situations, as they act as a non-judgmental supportive presence who honor their own ethical limits, as well as the various belief systems of their patients. Utilizing a case example and ethical frameworks, the article advocates for compassionate care for individuals in serious and persistent suffering that is rooted in patient centered care, as honoring dignity and personhood with safeguards against potential abuse. The overall recommendation in this exploratory article is for equitable interdisciplinary care that includes considerations of ethics, spiritual care and legalities.
Issues Around Medically Assisted Dying (MAiD)
In our healthcare system today, medically assisted dying (MAiD) is a contentious topic. If certain requirements are met, it allows people to take their own lives through the assistance of a medical team. Euthanasia and physician-assisted suicide are the two techniques used in this situation. In euthanasia, a physician administers a medication directly to the patient to end their life (Knox & Wagg, 2023). While many practitioners may accept other scientific discoveries within the medical setting, they do not accept MAiD on the basis of personal conviction and their religious beliefs since it was legalized in Canada in 2016 (Brown, 2022). Because of the complication around MAiD, the government of Canada has set up eligibility criteria for requesting and administering MAiD to individuals (Government of Canada, Department of Justice, 2024). While “nurse practitioners, physicians, pharmacists, and “persons aiding practitioners” (including nurses) are permitted to help those who have explicitly requested MAID,” (Medical Assistance in Dying) concerns about transparency and lack of data continue to pose a challenge to the administration of MAiD. The same sources (Canadian Association of Nurses) highlighted some challenges as “regulations from the federal health minister, in cooperation with the provinces and territories, on data collection for monitoring and analyzing MAID…” and the “independent review on MAID in reference to advance directives, mature minors, and solely psychiatric illnesses” (Nurses Association, n.d.). Another study found significant variability in the implementation of MAiD in nurses’ work contexts and practice supports. The study found that influential leadership largely manipulated the development of MAiD systems. The study funder found that workplaces supporting nurses’ moral responses were most effective in promoting well-being (Pesut et al., 2020). This suggests that MAiD may also be affecting the mental health of practitioners in one way or the other.
Since it was made legal in 2016, medically assisted dying, or MAiD, has become a hot topic in Canada's healthcare system. Euthanasia and physician-assisted suicide are the two primary strategies involved. The problem is that a lot of medical professionals are opposed to MAiD, and this is frequently due to their personal convictions. This problem comes with several difficulties. One major issue is data transparency. Regulatory obstacles can further complicate matters. Not to mention the impact all of this has on the mental health of the participating healthcare professionals.
The Legality of the Practice of MAiD
Upon its legalization in 2015 in Quebec and 2016 in Canada, legalization of MAiD was for individuals with terminal illnesses. However, in March 2021, the law was amended to include people with grievous and irremediable medical conditions (Government of Canada, 2023). In March 2023, people with complicated mental health conditions were added to be eligible for MAiD. However, due to the opposition that came with this legislation, the government was compelled to hold on to the implementation of MAiD for mental health patients. The major reason for holding on to the implementation for mental health patients was simply because it appears not to reflect the values of Canadians in general (Cardus, 2023). While the law also allows prisoners access to MAiD on other conditions than being mentally ill, terminally ill, or grievously and irremediably ill, some scholars believe that “prisoners have a high prevalence of psychiatric conditions, with approximately 14% of inmates having major mood disorders or psychosis and high comorbidities of substance use disorder contributing to increased risk of suicidality” (Simpson et al., 2022). Hence, allowing inmates access to MAiD might be highly questionable, as this may become the new way of being suicidal.
This is why William suggested that MAiD requires that the decision-making process undergo ethical and legal scrutiny to prevent abuses and maintain public trust in the medical community (Nielsen, 2021). Patty identifies that people are more likely to choose MAiD if they are under severe health stress and calls for intentionality when considering a patient's request for MAiD. Patty concluded with this quote: “Despite Canada's health-care challenges, there are innovative ways to ensure those applying for MAID have access to care providers, including nurses, who can work alongside them to ensure their choice is for the right person, at the right time, and for the right reasons” (Wellborn, 2025).
The Canadian government has persistently enacted legislation to assist those seeking MAiD and to safeguard those administering it, while continuously striving to determine what they deem the greatest interest of Canadians.
Tension Between Autonomy and Protection
Autonomy
In discussing the autonomy of patients, Beauchamp and Childress see the patient's decision as a fundamental principle in medical ethics. Hence, they see the making of decisions on one's life as autonomy. This can apply to one's choices regarding life and death, such as involving Medical Assistance in Dying (MAiD) (Beauchamp & Childress, 2013). Therefore, in relation to ethical foundation, autonomy of a patient is fundamentally respected because of the patient's self-determination. Flanders argues that out of the array of dreadful options available to unbearable patients, one should be extracted, and that is the option of death to reclaim dignity and control over one's life. This is done rigorously with informed consent (Flanders, 2021).
Protection
In discussing the risk to the vulnerable population, Moller and co. identify that patients may opt for MAiD due to unbearable pain, loss of dignity, or terminal illness. According to them, protection describes the responsibility of caregivers as healthcare professionals and society to vulnerable individuals to assist them in evading avoidable harm and death. There is now and has always been tension between this duty and the freedom for an individual to choose to undergo MAiD (Konder and Christie, 2019). In identifying the ethical concerns, some scholars stated that unity is widely considered an extremely difficult issue with MAiD. According to them, undesired and unqualified pressure to undergo MAiD might be placed on some individuals, such as mentally disabled and socioeconomically challenged persons who are labeled as having disabilities (Mroz et al., 2021).
The Collision of Autonomy and Protection
In their study about how doctor-patient relationships can influence the balance between autonomy and protection, Emanuel and Emanuel suggested that informed consent can mean ensuring that patients are making decisions free of coercion. This, according to them, is because there is a worry that some patients may not comprehend the options available to them or the consequences of MAiD. Concerning vulnerability, they stated that there seems to be a discussion concerning the degree to which the most vulnerable patients experiencing hardships (mental, social, financial) should be helped regarding these choices. According to them, there are those who consider that too much attention to autonomy could be detrimental to these individuals (Emanuel & Emanuel, 1992).
Healthcare Providers’ Responsibilities: As for the case of other providers of healthcare, their responsibility is more complex; they must observe the autonomy of the patients, but, at the same time, they have ethical duties to provide care that involves safeguarding the patient by preventing harm (Dworkin, 1993).
The Duty of Caregiver: The Ethical Principle of Practitioners’ Duty to “Do No Harm,” and How It Intersects with the Practice of MAiD
The idea of “do no harm,” also known by the Latin phrase “Primum non nocere,” is a key rule in healthcare ethics. This principle guides doctors, nurses, and other caregivers, especially those involved in MAiD. It is important to understand the duty of care, which is about taking good care of patients and not causing harm, a concept known as non-maleficence (Magueta et al., 2024).
The Duty of Care
Duty of care is a rule for healthcare workers. It means they must always do what's best for patients and give care that is skilled, kind, and respectful. This rule ensures that caregivers do not cause physical harm, emotional pain, or mental distress to patients. Healthcare workers must pay attention to how they treat patients, making sure their actions do not hurt them in any way. They need to be careful, thoughtful, and caring in their work, always keeping the well-being of the patient in mind (McCoy, 2025). MAiD raises difficult questions about ethics because it involves looking after people while trying not to cause them harm.
When a patient requests MAiD, healthcare workers face tough decisions. On one hand, MAiD respects the patient's right to make their own choice and can help stop their suffering. On the other side, it goes against the idea of not causing harm. In these situations, healthcare providers need to consider whether helping with MAiD is causing harm or is stopping the person's suffering. Or whether the goal of MAiD is to end suffering, which might be a caring thing to do, but also whether the end of the suffering is worth the ending of a life.
Spiritual Care an Essential Component
Some healthcare as well as spiritual care practitioners have held strong opposition to MAiD due to their beliefs. For instance, the Archdiocese of Edmonton recently reaffirmed the Catholic Church's position on MAiD with this statement: The guide instructs that it is the teaching of the Church that no Catholic is permitted to take part in MAiD, be it for themselves or for another person. This is because all forms of “euthanasia and assisted suicide are gravely contrary to the dignity of the human person and to the respect due to the living God, our Creator (Canada Archdiocese Gives Guidance on MAiD, 2024).
Similar to the Catholic position, the Seventh-day Adventist Church admits that death is a part of our destiny and that we can find comfort in the thought of eternity through Jesus Christ. The church encourages the show of concern in the treatment of the seriously ill - some of whom need physical, emotional, and also spiritual help. This also backs up the decision-making process in medical care where intervention is involved, the wishes of the respective patients being the first priority in case they are capable of making their own decisions. However, the church also rejects MAiD and “mercy killing” and puts forward the idea of reducing pain in a less violent way (Atwood, 2017). These churches have taken this stand based on their understanding of such Bible texts that specially invite adherents not to take life. It is one of the Ten Commandments in Exodus 20:13, explicitly stated: “You shall not kill.” In Deuteronomy 32:39, God claims the prerogative to allow anyone to live or to die. This theological disposition is rooted in their understanding of Genesis 1:27, which says, “God created mankind in his own image, in the image of God he created them; male and female he created them.” Having this information will help non-adherents understand why some Christian traditions disapprove of MAiD.
Case Study
This case study is between a student (me - a spiritual care provider) whose faith tradition does not allow him to support MAiD and a woman whose faith tradition also does not support MAiD. The student received a notification to go visit the family and provide support as her husband was dying. The student entered the room and introduced himself and his role. She quickly responded with joy. She explained how her faith does not support MAiD, but her husband's family had requested MAiD. She was not simply struggling with the procedure; rather, her struggles were from her religion, which does not support MAiD. The spiritual care student, who also did not believe in MAiD, simply listened to the woman without making any mention of his disposition about MAiD. He was just there to listen and validate her feelings without judging her experience or even letting her know that he also did not believe in MAiD.
While the tension and controversies around MAiD still have a long way to go, spiritual care practitioners can stand in the gap by providing compassionate presence. Their roles as companions enable them to journey with patients without controlling the wheel. Just being with sufferers does not bring any compromise on the spiritual care practitioner. The same way spiritual care practitioners are always there for people who may be in the hospital due to their bad choices is the same way they can be there for people who have chosen MAiD. Spiritual care practice does not infringe on their personal belief system because while a practitioner may choose to not be a part of a patient's decision for MAiD, they can simply provide support as they would with other health conditions.
Spiritual care facilitates meaningful conversations with patients. It is a part of spiritual care practitioners’ routine to hold profound discussions about meaning and suffering alongside a patient. These discussions enable patients to consider life-and-death decisions in an articulative manner without leading them to a specific conclusion. This model honors the varying beliefs in relation to MAiD.
Spiritual care focuses on holistic aspects of health, which encompasses emotional and even spiritual suffering. Discussing suffering in its multifaceted nature can shape surrounding discussions about MAiD. By journeying with patients in their suffering to explore all options, spiritual caregivers can offer support and aid by employing other means, such as palliative care, without having to take a stance on MAiD. However, practitioners must be careful to only explore in a way that does not invade the autonomy of the patient. This is because respecting individual beliefs is a core competency that spiritual care students need to acquire to become practitioners. It is medically criminal to impede the voice of a patient's belief. Different religions/patients hold diverse beliefs about dying and death. Through spiritual care, these beliefs can be respected by allowing patients to safely navigate their feelings regarding MAiD without stigmatic oppression. Such an empowering approach enables patients to appreciate the subtle complexities of personal worldviews concerning death, life, and even autonomy.
In caring for patients, spiritual care seems to be one of the first disciplines concerned with defending patients’ discretion and dignity, an intersection that comes with health decision-making. In the context of discussions surrounding MAiD, spiritual caregivers should understand their boundaries and stay within their scope of practice.
Conclusion
This paper deals with the ethical dilemma of medically assisted dying (MAiD) in Canada, focusing on the conflict between patient autonomy and the safeguarding of weak persons, especially the case of doctors who conducted this type of practice without the patient giving consent. The paper begins with the statement of the fact that MAiD has been a moot point of countless arguments among the medical community since its official recognition in 2016. It has been the case that those opposing the practice are driven by individual beliefs and moral issues. The paper covers the transformation of the legal base, which has broadened the qualifying standards to include those with intolerable and irremediable conditions, and it indicates the possibility of ending the life of a person who has mental illness or is a prisoner.
The paper went on to discuss the ethical principles of autonomy while it also laid great emphasis on the significance of informed consent and patients’ rights to the self-choice. Nonetheless, the paper spoke to the caregiver's protective function to avert injury, especially for those people who are more susceptible and may be influenced to look for MAiD. The article, at the same time, makes an appeal for an equitable stance that can at the same time give full weight to patient autonomy and at the same time, prevent any possible going overboard with it.
Spiritual care practitioners in these cases offer support very gently, without insisting on their own views. They are the ones who bring compassionate presence to patients/people in their pain and decisions till the last minute, and this gives patients the chance to go through their feelings about MAiD in a manner that caused no harm to diverse faiths. The paper comes down on the side of an all-round approach to care that empathizes with the patient's respect for human dignity and the right to self-determine in the face of the many forces of MAiD.
Footnotes
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.