Dr Marija Kirjanenko1, Dr James Cordeiro2
1Eastern Health, Victorian Dept. Health, Plunkett Center (ACU), Melbourne, Australia, 2SUNY Brockport, Romanell Center for Clinical Ethics and Phil of Medicine (SUNY Buffalo), Oxford Universtiy, Brockport, United States
Biography:
Dr. Marija Kirjanenko is an emergency physician and medical specialist at Eastern Health and Victorian Health Department as well as lecturer in philosophical bioethics at the Plunkett Center, Australian Catholic University.
Abstract:
In addition to her training in medicine, she holds a MSt in Practical Ethics from Oxford University. Her research in bioethics has been recently published in AJOB Neuroscience and related journals.
Health professionals must often negotiate between respecting the autonomy of persons with mental illness while simultaneously attending to the demands of justice and the constraints of non-maleficence. A prominent recent example is the case of requests for Medical Assistance in Dying (MAiD) by the homeless, notably in Canada. Writing about this issue, Liebe and Mullin (2024) recently raised the question of whether MAiD requests in socially unjust contexts are meaningfully autonomous.
On the view that a patient’s autonomy is predicated on her possession of adequate competence and authenticity (Mackenzie, 2008), we argue that health professionals may reasonably resist MAiD requests on moral grounds if the physical and especially mentally debilitating effects of sustained homelessness sufficiently undermine the authenticity condition. We make the case that this occurs if mental privation alters the patient’s mental state in a manner that leads the provider to question the MAiD request as an expression of the authentic self, thus calling into question the patient’s meaningful autonomy.
While our treatment here does not take a stand on the ethics of MAiD per se, we believe our argument would helps healthcare professionals in religious healthcare institutions minimize the moral distress that will arise from caring for patients who request MAiD, particularly in the context of social injustice.