Medical Aid In Dying: Physician Beliefs, Practices, And Respect For Autonomy

Author

Caitlin M. Cassady, Wayne State University

Access Type

Open Access Embargo

Date of Award

January 2025

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Social Work

First Advisor

Faith P. Hopp

Second Advisor

Andrea Sankar

Abstract

Medical aid in dying (MAiD) consists of clinicians helping terminally ill persons seek, and if eligible, complete a medically assisted death. It is increasingly legal across the United States with two states eliminating residency requirements. Although opinion polls often show most Americans believe MAiD should be legal, the practice remains stigmatized. Opponents of it worry about abuse, coercion, and a change in culture that could lead to further devaluing disabled lives, while proponents hail MAiD as providing autonomy and choice. The bioethical value of respect for autonomy is closely related to the social work profession’s duty to respect and promote clients’ self-determination. Anthropologists studying MAiD have joined others in complicating the notion of the dying person’s independent autonomy in lived experiences of MAiD. With this complication in mind, this dissertation sought to explore MAiD physicians’ experiences (n = 20), practices, beliefs using ethnographic methods of narrative and semi-structured interview, participant-observation, and archival review. Interviews were also conducted with one caregiver and two advocates. Analyses are presented herein in three stand-alone chapters: The first chapter is a previously published excerpt (chapter and appendix entry) from a trade text serving as a guide to family caregivers for someone dying at home (Sankar & Cassady, 2024). This material incorporates the case study of a MAiD caregiver into difficult decisions and situations surrounding end-of-life. It puts MAiD situations and decisions alongside other treatment decisions and difficult situations, providing information and resources for those considering MAiD. The second chapter features an analysis of data regarding times from ingestion to death in MAiD. Here, physicians describe good care as shortening clock times or subjective times to death by identifying and re-placing agencies; capacities to act, rather than identifying individual autonomy. Physicians use clinical agency to manipulate pharmaceutical, biological, clinical, patient and family agencies in attempts to reduce uncertainty and suffering for family during the death vigil. Looking at cases that fit within the theme and then that don’t fit, this chapter asks important questions about what clinical practices reduce suffering and how the ability to do something is valued in death vigils in MAiD and beyond. The third chapter presents physician practice themes and discusses overlap with social work end-of-life roles. Practice guidance for social workers in the United States focuses primarily on ethical issues perceived in MAiD. Given that MAiD is likely discussed and considered widely beyond those completing a MAiD death, this article marshals practice data addressing goals MAiD discussions, hospice support, and family needs during the death vigil to show that social work professionals, leaders, and researchers need to move beyond the focus of ethics and towards what MAiD practice looks like. Finally, the implications for this research are discussed and future research topics relevant to both anthropology and social work are proposed.

Recommended Citation

Cassady, Caitlin M., "Medical Aid In Dying: Physician Beliefs, Practices, And Respect For Autonomy" (2025). Wayne State University Dissertations. 4176.
https://digitalcommons.wayne.edu/oa_dissertations/4176