Evaluating Autonomy and Structural Vulnerability in Legislative Expansion
Proponents of expanding Medical Assistance in Dying (MAID) often assert that individual autonomy and self-determination must remain the paramount principles governing end-of-life choices, arguing that denying access to individuals with chronic disabilities or non-terminal conditions infringes upon their bodily liberty. From this perspective, legislative constraints derived from broader social critiques unnecessarily paternalize capable adults who seek relief from grievous and irremediable suffering. However, this libertarian framing presumes an idealized context of uncoerced decision-making that fails to reflect the lived realities of marginalized populations. As critical scholarship indicates, the interaction between disability and MAID eligibility operates within pervasive systemic inequities, where inadequate social services, poverty, and inaccessible care severely constrain genuine choice (Disability and Medical Assistance in Dying, 2026). Furthermore, international human rights frameworks emphasize that a state's legal expansion of assisted dying must not compromise fundamental guarantees regarding the right to life and substantive equality (Canada’s Medical Assistance in Dying Law, 2023). When systemic deprivation transforms assisted death into a substitute for comprehensive social support, expanding access under the banner of negative liberty actively reinforces existing discrimination. Therefore, constraining MAID expansion through robust disability rights protections does not undermine legitimate autonomy; rather, it ensures that state-sanctioned mortality does not become the default remedy for unresolved structural injustice.