The Role of Choice in Death and Dying

I attended this symposium this morning, which featured speakers talking about who can access choice at the end of life and what choice might actually mean in this situation. Although the speakers did not appear to specifically support MAID, it is important to think critically about these issues. A summary from my notes is provided below.

Dr. Allan Kellehear talked about disproportionate access to basic medical care and end-of-life care among various populations around the world. He talked about how our policies around end-of-life consider only a fraction of the dying process and can be accessed primarily by affluent people. He said the reality of dying, sociologically, demographically and epidemiologically, is not reflected in policies about choice in death.

Dr. Moyse talked about the nature of choice, such as if you are choosing one pair of pants over another, and mentioned what factors one might consider with typical choices such as this. When facing death, choice includes different considerations and may lead individuals to lean toward something like MAID due to a feeling of despair.

Dr. Berlinger advocated for supporting aging services to ensure that older adults and their caregivers are really making “choices” at the end of life. When people imagine what it might be like to live with dementia and then create policy around that without considering the voices of people with dementia or their caregivers, they do a disservice to people living with dementia. My takeaway was basically that we can’t know whether people are really exercising appropriate choices when they have limited alternative options. If we had funding and social support for patients and caregivers to manage dangerous behaviors, such as “wandering,” we might not conclude that MAID really is the best choice. Dr. Berlinger mentioned Momentia in her talk.

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