Organ Donation and Medical Assistance in Dying (MAID): Ethical and Legal Issues Facing Canada

In June 2016 the Government of Canada enacted legislation to regulate the practice of voluntary euthanasia and assisted suicide (together termed medical assistance in dying or MAID) in response to the Supreme Court’s 2015 decision in which it struck down the Criminal Code provisions prohibiting assisted dying in particular circumstances. One issue that has not been addressed in depth in the Canadian debate is whether those accessing MAID would be eligible to donate organs and tissues, and the ethico-legal issues this may pose. This is a challenging question that brings together the controversial introduction of MAID with the ethically sensitive practice of organ donation. This paper analyzes the ethico-legal issues raised in four possible scenarios for donation to occur in the context of MAID: living donation of non-vital organs before MAID, extended living donation of vital organs in anticipation of MAID, deceased donation following MAID, and MAID by removal of organs. Extended living donation of vital organs and MAID by removal of organs are unlikely to be accepted, and indeed we recommend against them. However, these possibilities have been raised in the medical ethics literature and we address them as part of a full review of this topic. In conclusion, we provide recommendations to address the combination of organ donation and MAID within what we believe to be acceptable ethical parameters.