The Right to Die: Autonomy, Ethics, and Medical Aid In Dying (MAID)

On February 11, 2025 during a panel titled How We Die: A Panel Investigating the Ethics of Medical Aid in Dying (MAID), legal scholar Thaddeus Pope highlighted the importance of personal autonomy in end-of-life decisions. Pope emphasized that many individuals seek to control the manner and timing of their death due to suffering—both physical and existential. Patients often feel that their quality of life has deteriorated to the point where the burdens of living outweigh its benefits. Loss of independence, despair, and fear of prolonged suffering are significant motivators for those considering MAID. 

Currently in Virginia, patients already exercise considerable control over their end-of-life decisions through three main actions. Through advanced directives, patients can refuse life-sustaining treatment or request its withdrawal. High-dose opiates and palliative sedation are also ways patients express their autonomy in end-of-life decisions. Finally, patients also voluntarily stop eating and drinking (VSED), which hastens death. Pope presented MAID as an additional end-of-life option, which is not yet legal in Virginia but exists in 11 other states. 

MAID remains a highly regulated process in every state where it is legal. It is only available to terminally ill adults with decision-making capacity who fully understand the consequences of their request. Patients must self-administer the medication, which leads to a painless and controlled death. Other states’ experience with MAID shows that most users are older, well-educated, insured individuals, often already in hospice care. Notably, many patients who receive a MAID prescription (~33%) never actually use it, finding comfort in simply having the option as a safeguard. 

Pope heavily emphasized the extensive safeguards surrounding MAID. Multiple requests and evaluations are required to ensure voluntariness and information understanding. Over a century of combined experience in the eleven authorized states shows no evidence of abuse or coercion. Thus, participation is strictly optional for patients, clinicians, and facilities, ensuring it is voluntary. 

The future of MAID in Virginia remains uncertain but promising. Some Virginia residents already travel to other states or even Switzerland to access MAID and legislative efforts have been ongoing for six years. Legal barriers such as residency requirements are weakening, making access easier. Public support is strong, particularly among younger demographics who consider MAID a moral and civil right. 

Pope’s arguments are compelling because they reinforce the fundamental principle of autonomy. Individuals facing terminal illness should have the right to determine their end-of-life path. The suffering that some patients endure, both physical and existential, is unimaginable. If existing palliative measures fail to provide personal relief, denying a terminally ill patient the choice of MAID seems unjust. Only they know what they are experiencing, and only they should decide how they want to face that pain. Moreover, Pope’s data suggests that MAID is not widely abused and remains a last resort for those who need it most. The fact that many patients obtain a prescription but never use it emphasizes its value as a psychological safety net rather than a coercive measure. Given these considerations, Virginia should legalize MAID, aligning itself with states that prioritize compassion, dignity, and self-determination at the end of life. 

An objection could be raised on the grounds that MAID is not a right; it is a restriction on life rather than an exemplification of dignity. It could be argued that prioritizing the ability to end one’s life undermines the value of life itself. However, we believe Pope would possibly respond that this perspective fails to acknowledge that dignity is inherently subjective and varies from person to person. For many, the loss of autonomy, extreme suffering, and existential distress constitute something far worse than death. MAID does not impose death on anyone; it provides a choice for those who, by their own judgment, find continued life unsustainable. 

Thaddeus Pope’s emphasis on the legality of MAID raised a particularly interesting dilemma. One of the main reasons for instituting MAID in the first place, as stated in the panel, is to alleviate suffering. Legally speaking, this decision can only be made by the person who wants to undergo the procedure. But if MAID is intended to alleviate suffering, what of those who can no longer communicate their will due to advanced illness or cognitive decline? Are we then resigned to preserving an autonomy that no longer exists? This seems tragically paradoxical because those most in need of relief may be precisely those who are unable to request it. 

The most striking aspect of the presentation, however, was how social the entire MAID process is. And in hindsight, it seems glaringly obvious. Human life is never isolated. We are deeply enmeshed in family, culture, and community. Mara Buchbinder, one of the panelists and a professor of social medicine, highlighted how people who pursue MAID want their loved ones present, revealing a tapestry of social, familial, and emotional considerations that shape one’s final days.