Preprint / Version 1

Subjectivity, Suffering, and Epistemic Injustice in MAID

##article.authors##

  • Lindsay Fu Polygence

DOI:

https://doi.org/10.58445/rars.3262

Keywords:

Medical Assistance in Dying (MAID), Mental health ethics, Epistemic injustice

Abstract

The expansion of MAID (Medical Assistance in Dying) to Canadian patients suffering primarily from mental health conditions raises many practical and ethical challenges. This paper examines the potential threat of epistemic injustice in the accurate assessment of mental health patients seeking MAID. The MAID assessment process relies heavily on medical practitioner knowledge of patient suffering, which is difficult when the suffering is primarily psychological. These difficulties are compounded by the threat of epistemic injustice: the injustice to one’s status as a knower, including one’s knowledge of their own suffering. By using Miranda Fricker’s (2007) framework of epistemic injustice, this paper identifies areas where testimonial and hermeneutical injustices may negatively impact the assessment process. It concludes by suggesting a number of ameliorative interventions.

References

References

Aphasia. Johns Hopkins Medicine. (n.d.). https://www.hopkinsmedicine.org/health/conditions-and-diseases/aphasia

Canada, H. (2025, August 27). Medical assistance in dying: Overview [Education and awareness]. https://www.canada.ca/en/health-canada/services/health-services-benefits/medical-assistance-dying.html

Canada, H. (2023, March 27). Advice to the Profession: Medical Assistance in Dying (MAID) [Transparency - other]. https://www.canada.ca/en/health-canada/services/publications/health-system-services/advice-profession-medical-assistance-dying.html

Carel, H., & Kidd, I. J. (2014). Epistemic injustice in healthcare: A philosophical analysis. Medicine, Health Care and Philosophy, 17(4), 529–540. https://doi.org/10.1007/s11019-014-9560-2

Davis, J., & Mathison, E. (2020). The Case for an Autonomy-Centred View of Physician-Assisted Death. Journal of bioethical inquiry, 17(3), 345–356. https://doi.org/10.1007/s11673-020-09977-8

Dotson, K. (2011). Tracking Epistemic Violence, Tracking Practices of Silencing. Hypatia, 26(2), 236–257. https://doi.org/10.1111/j.1527-2001.2011.01177.x

Fricker, M. (2007). Epistemic Injustice: Power and the Ethics of Knowing. Oxford University Press.

Department of Justice Canada. (2024, July 31). Canada’s medical assistance in dying (MAID) law. https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html

Department of Justice Canada. (2025, July 14). Section 7 – life, liberty and security of the person. Charterpedia. https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/check/art7.html

Gupta, M., & Blouin, S. (2022). Ethical judgment in assessing requests for medical assistance in dying in Canada and Quebec: What can we learn from other jurisdictions? Death Studies, 46(7), 1608–1620. https://doi.org/10.1080/07481187.2021.1926636

Health Canada. (2024b, December 11). Fifth annual report on medical assistance in dying in Canada, 2023. https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-medical-assistance-dying-2023.html

Henry, M., Alias, A., Bisson, G. V., Liu, J. Y., Dargis, L., Gauthier, L., Tapp, D., Greenfield, B., & Mishara, B. (2023). Medical assistance in dying in Canada: A scoping review on the concept of suffering. Psycho-Oncology, 32(9), 1339–1347. https://doi.org/10.1002/pon.6196

Kendell R. E. (2001). The distinction between mental and physical illness. The British journal of psychiatry : the journal of mental science, 178(6), 490–493. https://doi.org/10.1192/bjp.178.6.490

Kidd, I. J., & Carel, H. (2018). Healthcare Practice, Epistemic Injustice, and Naturalism. In S. Barker, C. Crerar, & T. S. Goetze (Eds.), Harms and Wrongs in Epistemic Practice. Cambridge University Press. http://www.ncbi.nlm.nih.gov/books/NBK562587/

Lund, D. E. (2018). “I would rather die than have a blood transfusion”: A dialogue about life, death, and freedom of conscience. The Journal of Educational Thought (JET) / Revue de La Pensée Éducative, 51(1), 57–78.

Dying With Dignity Canada. Maid for Mental Illness. (2025, July 3). https://www.dyingwithdignity.ca/advocacy/maid-for-mental-illness/

McDougall, R. J., & Ko, D. (2021). Eligibility and access to voluntary assisted dying: a view from Victoria, Australia. Journal of Medical Ethics, 47(10), 676–677. https://www.jstor.org/stable/27350568

McKinnon, R. (2016). Epistemic Injustice. Philosophy Compass, 11(8), 437–446. https://doi.org/10.1111/phc3.12336

Centre for Addiction and Mental Health. Medical assistance in dying (maid) and mental illness – faqs. (2024, November). https://www.camh.ca/en/camh-news-and-stories/maid-and-mental-illness-faqs

Rinaldi, L. (2025, February 24). They’re Suing the Government for the Right to Die. Maclean’s. https://macleans.ca/longforms/canada-maid-mental-illness/

Medical Protection. The challenges of treating Jehovah’s witnesses. (n.d.). https://www.medicalprotection.org/southafrica/casebook/casebook-may-2014/the-challenges-of-treating-jehovahs-witnesses

Varelius, J. (2014). Medical expertise, existential suffering and ending life. Journal of Medical Ethics, 40(2), 104–107.

Downloads

Posted

2025-12-21