The Role of Medical Ethics in Voluntary Assisted Dying: A Regulatory Space Analysis

This article reflects on the role of medical ethics in voluntary assisted dying (VAD) practice from the perspective of the field of regulation. Through employing Regulatory Space Theory, which seeks to understand how individual and institutional behaviour is guided by competing and conflicting sources of normative guidance, the article will make three arguments. First, medical ethics, along with the institutions and individuals that employ medical ethics through various tools in VAD practice (e.g., ethical practice guidelines or ethical advice), are involved in the exercise of regulation. This is the case even if those institutions and individuals employing medical ethics do not necessarily perceive themselves as 'regulatory actors'. Second, drawing on Regulatory Space Theory, the actors and tools that employ medical ethics to undertake regulation are only part of a wider 'regulatory space' that includes other regulatory forces such as law, policy, and system design. Hence, the role of medical ethics in VAD practice cannot be properly understood in isolation. Third, this article maps medical ethics across VAD regulation, showing the breadth of roles that medical ethics plays in VAD practice, including the macro (i.e., State) level, meso (i.e., institutional) level, and micro level (i.e., clinical coalface). This mapping highlights the significant use of medical ethics even by regulatory actors without specific medical ethics expertise and in regulatory tools that are not focused on medical ethics. The article concludes by considering the practical implications of how medical ethics is used in regulating VAD practice.