On the epistemology of case studies of social phenomena in healthcare

Winnington and MacLeod recently reported in NZMJ a case study related to voluntary assisted dying (VAD).1 In this study, the authors used a semi-structured interview of a single participant's experience of VAD in a family member, in a foreign country. This was analysed and reported in the form of a case study, with the stated intent to explore the individual's experience of VAD in this foreign country and their perception of how this may relate to the upcoming End of Life Choice Act (EoLCA) referendum, scheduled for September 2020. There are significant challenges with the study from a methodological and analytical perspective. What follows is an evaluation of these challenges and a reflection on the nature of this research. In the introduction, the authors state, "medicine (in collaboration with law) has maintained an unwavering stance that the right-to-die produces a 'slippery slope' effect, whereby some patients may be obligated to terminate their lives prematurely". Using the current state of law as support for this claim is circular logic and unhelpful for addressing the current issues of whether VAD should be legalised in New Zealand, how health and social outcomes can be maximised, nor do the authors present evidence that supports law being maintained specifically to address the 'slippery slope' premise. Similarly, the data cited on uptake in the Netherlands do not support the assertion of a 'duty to die' premise, they reflect uptake.