Self-determination and its limits: Reply to Di Paula and Klonsky (2026), Nock (2026), and O’Connor and Sinyor (2026).

Medical assistance in dying is a deeply polarizing issue, raising difficult questions about self-determination and the circumstances under which facilitating death may be justified. Three commentaries, written by Di Paula and Klonsky, Nock, and O'Connor and Sinyor, respectively, approach these questions from distinct perspectives. Di Paula and Klonsky (2026) consider the interests of the future self, Nock (2026) examines the obligations of the healer, and O'Connor and Sinyor (2026) emphasize society's responsibility to address suffering. Despite these differing points of emphasis, all three commentaries converge on a fundamental question concerning the limits of self-determination in decisions about death. In particular, the arguments raised across the commentaries share an underlying assumption that a desire for death, even in the face of great suffering, is not sufficient to justify facilitating death. This response considers the distinct arguments advanced by each commentary while examining this common thread and its implications for the broader debate surrounding medical assistance in dying. (PsycInfo Database Record (c) 2026 APA, all rights reserved).