Medical Aid in Dying, Somatic Oppression and Relational Autonomy

Principal Investigator: Jonas-Sébastien Beaudry
Funding: Fonds de Recherche du Québec - Société et Culture


Beautiful sunset photo taken by Jonas Sebastien BeaudryMedical Aid in Dying (MAiD) has become part of the medical and legal Canadian landscape, through successive judicial and legislative steps, starting with Quebec’s Act respecting end-of-life care in 2014 and culminating with the amendment to the Criminal Code in 2016. Two main positions have emerged regarding access to MAiD in public and academic discourses: (1) a restrictionist one, advocating a ban or more stringent measures of safeguards and (2) an expansionist one, advocating broader access to MAiD. The restrictionist position is articulated around the importance of protecting vulnerable lives, and the expansionist one is predicated on the value of autonomy.

While proponents of both positions acknowledge the impact of oppression (especially “ableism”) on autonomy, they lack a relational conceptualization of (1) the dimensions of autonomy at play (currently, the language is focused on “consent”); (2) the threats that weigh on autonomy (currently limited to notions that can vitiate consent, such as undue influence); (3) the wrongness of this threat (currently, impermissible paternalism or violation of physical integrity); and (4) the remedies it calls for (currently, access or non-access to MAiD).

As a result, a number of issues, such as internalized oppression and paucity of social options have not received enough attention. Such problems would be better captured if legal discussions incorporated the notions of somatic oppression (body-related discrimination and stigmatization) from disability studies and the notion of relational autonomy from feminist theory. The concept of relational autonomy has been gaining traction in philosophical and legal circles over the last thirty years. Its proponents consider autonomy to be a capacity that is exercised socially, in the process of constructing a “relational self”. Feminist bioethicists have used “relational autonomy” to criticize the limits of what the doctrine of “free and informed consent” can accomplish in the healthcare context. It is surprising that, in the midst of polemics polarizing the disability community within both the public and academia, theorists of relational autonomy have not paid enough attention to the kinds of oppression that may affect the autonomy of socially vulnerable populations in the context of MAiD. 

This interdisciplinary project proposes to bring feminist theory and disability studies  together to better capture and begin to address this important oversight. More specifically, it proposes to develop a workable conception of “somatic oppression” and “relational autonomy” to be used in the legal analysis of liberty rights.

This conceptual apparatus will benefit disability activists and legal scholars engaged in government consultations and strategic litigation, for example, by advocating for the development of necessary social support structures for patients contemplating MAiD. If my research suggests that somatic oppression poses a credible threat to the autonomy of MAiD patients, my findings can serve as a conceptual basis for subsequent empirical research that would test which social factors connected to suicidality have a statistically significant impact on a patient’s decision to seek MAiD and whether these harmful factors can be assuaged through social measures.

Early publications from this project:

J.-S. Beaudry, “Somatic Oppression and Relational Autonomy: Revisiting Medical Aid in Dying Through a Feminist Lens”, forthcoming in (2020) 53:2 UBC Law Review 241.

J.-S. Beaudry, “The Way Forward for Medical Aid in Dying: Protecting Deliberative Autonomy is Not Enough”, Supreme Court Law Review, Second Series, Vol. 85: 335-385.

Policy outreach connected to this project:

Senate testimony on Bill C7:

“Bill C-7 and Lives Not Worth Living”, Policy Options (December 14, 2020)

What’s missing from the Conversation about assisted death”, Policy Options (October 16, 2019).

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