Voluntary Assisted Dying for Grief: Medicalisation, a Proposed Autonomy—Only Approach, and Lessons From Prepubescent Gender Care

Abstract

The recent addition of the diagnostic criteria for prolonged grief disorder has attracted criticism and concern about the undue medicalisation of grief and other existentially distressing yet normal life events. However, prolonged grief disorder currently forms the only pathway to VAD access for those suffering from extremely prolonged or unrelenting grief in the Netherlands, as this satisfies the requirement that the request must be due to a medical condition, and these criticisms of the disorder could jeopardise that access. A potential solution to this tension could be the currently debated autonomy—only approach to VAD, which circumvents issues of medicalisation by removing VAD from the medical domain. However, this approach raises other problems that require investigation in the context of grief specifically. In this article, I will first consider how VAD for grief is currently treated within Dutch VAD policy. This will involve an examination of prolonged grief disorder as a diagnosable condition, and how it relates to the general concern of undue medicalisation. Following this, I will consider possible ways in which persistence of a death wish due to grief can be established without the use of a medical diagnosis, as would be the case according to the autonomy-only framework for VAD. Ultimately, I will borrow some guidelines from the field of prepubescent gender care as an area that shares many morally relevant features with the question of VAD for grief and propose what I will be calling the “watchful grief affirming waiting” model.