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J Med Ethics. 2019 Jan;45(1):60-67. doi: 10.1136/medethics-2018-104896. Epub 2018 Sep 21.

Medical Assistance in Dying at a paediatric hospital.

Author information

Applied Psychology and Human Development, Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada.
Bioethics Department, The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
Paediatric Advanced Care Team, The Hospital for Sick Children, Toronto, Ontario, Canada.
Emily's House Children's Hospice, Toronto, Ontario, Canada.
Departments of Paediatrics and Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada.


This article explores the ethical challenges of providing Medical Assistance in Dying (MAID) in a paediatric setting. More specifically, we focus on the theoretical questions that came to light when we were asked to develop a policy for responding to MAID requests at our tertiary paediatric institution. We illuminate a central point of conceptual confusion about the nature of MAID that emerges at the level of practice, and explore the various entailments for clinicians and patients that would flow from different understandings. Finally, we consider the ethical challenges of building policy on what is still an extremely controversial social practice. While MAID is currently available to capable patients in Canada who are 18 years or older-a small but important subsection of the population our hospital serves-we write our policy with an eye to the near future when capable young people may gain access to MAID. We propose that an opportunity exists for MAID-providing institutions to reduce social stigma surrounding this practice, but not without potentially serious consequences for practitioners and institutions themselves. Thus, this paper is intended as a road map through the still-emerging legal and ethical landscape of paediatric MAID. We offer a view of the roads taken and considered along the way, and our justifications for travelling the paths we chose. By providing a record of our in-progress thinking, we hope to stimulate wider discussion about the issues and questions encountered in this work.


capacity; care of dying minors; children; paediatrics; suicide/assisted suicide

Conflict of interest statement

Competing interests: None declared.

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