Abstract

The Special Joint Committee on Physician Assisted Dying has recommended the extension of current medical assistance in dying legislation in Canada to include mature minors. A mature minor is anyone under the age of 18 demonstrating sufficient capacity to understand their medical condition, and the risks and benefits of available treatments. Although mature minors are the only minors being considered under the current recommendations regarding future legislation, Canadian health care professionals are already being approached with inquiries about MAID for minors who do not meet mature minor criteria. Current eligibility criteria for MAID include a requirement of informed consent, and that of intolerable suffering. Most minors are presumed, by the law and in health care practice, not to have the capacity to consent. Parents/guardians would therefore have to act as surrogate decision makers. Reliance on parents/guardians as surrogate decision makers increases the risk of inaccurately assessing the more subjective eligibility criteria for MAID, particularly suffering intolerably, by excluding the subjective perspective of the minor regarding her own intolerable suffering. Health care professionals' accounts of a minor's intolerable suffering also increase this risk. When factored into determinations of a minor's eligibility for MAID, inaccurate assessments of intolerable suffering raise concern about justice in the context of MAID for minors. This research began with a hypothesis that the subjectivity of suffering makes it important to incorporate the sufferers' own voice in an accurate assessment of intolerable suffering. This thesis explores how the child's voice, as representative of the child's experience, can be useful in adequately assessing that a minor is suffering intolerably, and thus factor into determinations of that child's eligibility for MAID. The conceptual framework of children's agency from the New Sociology of Childhood literature provides a theoretical foundation for elicitation of the child's voice, and hence a plausible means of assessing the intolerable suffering of a minor. The 'child's voice' refers to communication from the child using words, illustration, actions, assistive devices, or silence, that serves as a metaphor for children's perspectives, and may provide epistemological access to a child's experience. This thesis demonstrates that children's voices can provide valuable information for decision-making pertaining to MAID for a minor; however, it is not clear whether the insight that children's voices can provide in assessing intolerable suffering is sufficient for the context of MAID for minors. This thesis identifies this matter as something that would have to be considered in greater detail if considering an extension of MAID legislation to all minors in the future.