When patients’ requests for medical assistance in dying (MAiD) are made primarily for social or economic reasons (ie, reasons that have to do with the unjust conditions they are living in), there is ambiguity over whether injustice has undermined their autonomy. In this paper, I suggest that patients who meet the eligibility criteria but who request MAiD primarily due to the unjust social conditions in which they live can exercise autonomy. Exploring evidence that supports this claim, I show that autonomy skills are exercised through the form of hope I defend. I maintain that patients requesting MAiD under unjust circumstances can engage in this form of hope, and this is a reliable indicator of autonomy.