Timothy Holland

In this same, May‐June 2026, issue of the Hastings Center Report, Brendon Saloner suggests that mandated drug treatment can expand freedom and promote egalitarian social justice so long as three criteria are met. Drawing on our clinical experience in addiction medicine and a critical appraisal of the available evidence, we challenge this claim. We argue that Saloner's three criteria are unlikely to be met within jurisdictions that criminalize drug use and lack supports for people who use drugs. The criterion that mandated treatment be “likely to be beneficial” is undermined by the coercive nature of such interventions and the lack of evidence supporting their effectiveness when compared to voluntary care. Further, the application of mandated treatment risks extending carceral oversight to individuals charged with minor offenses, disproportionately affecting equity‐denied populations. Finally, we question whether infringements on liberty through legal oversight can genuinely expand freedom, particularly when such measures exacerbate social instability and undermine the potential for voluntary engagement with care. We contend that meaningful expansion of freedom for people who use drugs is better achieved through voluntary, community‐based treatment models supported by robust social infrastructure. A radical reorientation of drug policy—away from coercion and toward supportive, person‐centered care—is necessary to achieve the ethical aims of reducing harm, promoting autonomy, and advancing egalitarian social justice.

This paper presents an Ethics Framework for MAiD (Medical Assistance in Dying) to support the integration of evidence‐informed, values‐based, inclusive and transparent ethical decision‐making into everyday MAiD practice. As with other areas of clinical practice, ethical decision‐making is an intrinsic part of MAiD. While clinicians connected to academic medical centers or large hospitals may have access to the expertise of an ethicist, those working independently, or in community‐based, rural or remote settings may wrestle with ethical issues alone. Without a process to guide ethical reflection and analysis, clinicians navigating complex MAiD cases risk moral distress and uncertainty, and may inadvertently make decisions that are biased, narrow or ill‐informed. The proposed Ethics Framework for MAiD includes a description of core values and principles relevant to the delivery of MAiD and a process guide to support the application of values and principles to cases. Use of the framework is illustrated through a simplified complex MAiD case. This Ethics Framework for MAiD is applicable to both clinical patient cases and organizational ethics issues, and adaptable to any jurisdiction and any legal or practice context. It may also be used by ethicists when conducting formal ethics case consultations involving MAiD. The goal of the paper is to empower MAiD assessors, providers, health professionals, program managers and ethicists to address ethical issues arising in everyday practice through the introduction of a pragmatic ethics framework specifically tailored to assisted dying.