Assisted dying, disability and voluntariness under social injustice

Recent reports from Canada have sparked debate about cases in which people with disabilities request assisted dying not primarily because of their medical conditions, but because of poverty, inadequate housing or insufficient care. Some argue that although such situations are tragic and unjust, such requests are autonomous and should be acceded to.

In this paper, I instead argue that requests motivated by suffering that is caused by remediable social injustice for which the state is responsible should not be regarded as sufficiently voluntary. Hence, they do not fulfil the high standards for autonomy usually required in the context of assisted dying. Drawing on baseline theories of coercion, I show that proposals can be coercive when made by an agent who is simultaneously subjecting the recipient to ongoing injustice. I compare standard cases of such forms of coercion to the context of assisted dying, focusing on the role of the state as a collective agent. I argue that when the state unjustly fails to provide adequate resources to people with disabilities while simultaneously making the option of assisted dying available, this can create coercive pressure to choose assisted dying.

To avoid creating such pressure, states that make assisted dying available should urgently ensure that people with disabilities have access to adequate resources and support. In addition, assessments of the voluntariness of individual requests should consider the potential influence of unjust social conditions.