Udo Schüklenk

As more jurisdictions permit a medically assisted death (MAiD)—and none of the jurisdictions that introduced MAiD has seen any serious attempts at reversing it—the focus of debate has turned to the question of what is a morally defensible access threshold for MAiD. This permits us to rethink the moral reasons for the legalization or decriminalization of assisted dying. Unlike what is assumed in many legislative frameworks, unbearable suffering caused by terminal illness is not what oftentimes motivates decisionally capable people to request MAiD. This matters when access thresholds are considered. The argument advanced in this essay is that because MAiD is less destructive to people’s relationships and less harmful than medically unsupervised suicide, access to medical assistance in dying should be open to anyone who is legally capacitated and who persistently requests such assistance.

The COVID-19 pandemic brought about at least two normative challenges on unprecedented scale for liberal democracies. One concerned prioritization decisions when health care resources were constrained. The other, which arguably led to lasting damage to social cohesion and citizens’ trust in government and government public health institutions, concerned policies introduced with the aim of reducing the spread of SARS-CoV2, some of which turned out to be mistaken. I discuss in this essay a few examples of misguided, liberty-limiting public health policies and describe how public health and public health ethics principlism provided cover for such policies. Citizens had reasons to be concerned about the duration of such liberty-infringing policies, the absence of predictable government policies, and the absence of transparent justifications for the policies that were implemented.

The opinion of the American Medical Association (AMA) Council on Ethical and Judicial Affairs (CEJA) on the accommodation of conscientious objectors among medical doctors aims to balance fairly patients’ rights of access to care and accommodating doctors’ deeply held personal beliefs. Like similar documents, it fails. Patients will not find it persuasive, and neither should they. The lines drawn aim at a reasonable compromise between positions that are not amenable to compromise. They are also largely arbitrary. This article explains why that is the case. The view that conscientious objection accommodation has no place in modern medicine is defended.