By Chris Haring
A recent story from The Guardian briefly looked at the state of play of medical aid in dying worldwide, highlighting the variations in laws across the globe.
When Esther Rantzen, a presenter on the popular BBC program That’s Life! from 1973 to 1994, said in a recent interview that she joined the Swiss medical aid-in-dying organization Dignitas, her frank-but-accurate assessment of her circumstances has renewed debate in the United Kingdom about the legality of the practice.
“I [think] if the next scan says nothing’s working, I might buzz off” to Dignitas’ Zurich location, she said. “But it puts my family and friends in a difficult position because… the police might prosecute them. So we’ve got to do something.”
Unfortunately, Rantzen – who has Stage IV lung cancer – will almost certainly choose her end-of-life option under the existing muddy legal framework in her home country of England. And, as Daniel Boffey recently wrote for The Guardian, there is no global consensus on how to legislate: governments from Canada to Australia to Japan have widely varying laws on assisted dying and/or suicide (which are related but distinct practices).
The countries whose policies Boffey briefly explored generally fall into three categories: they explicitly allow medical aid in dying – and in some cases, even assisted suicide or euthanasia – for most, if not all, residents; they permit assisted death provided a patient meets specific requirements; or, they generally ban both assisted dying and suicide under any circumstances.
Countries Where Assisted Dying Is Permitted:
Switzerland has permitted assisted suicide for adults without restrictions along with aid in dying since 1942. The only stipulation included within the Swiss Criminal Code is that the motive is not “selfish.”
More recently, Belgium has allowed physician-assisted death for individuals with “incurable illnesses who experience constant, intolerable suffering” for the past two decades. Notably, euthanasia for non-terminally ill individuals, including those with psychiatric disorders or dementia, is also legally permitted in the country.
Similarly, the Netherlands established provisions for assisted death under the Termination of Life on Request and Assisted Suicide Act 2001. This law permits doctors to prescribe drugs either for self-administration or to administer to individuals who “experience unbearable suffering and make an informed choice to die.”
Meanwhile, following a 2015 Supreme Court ruling, medical aid in dying (MAID) is allowed in Canada for individuals with “grievous and irremediable” medical conditions. Canadian doctors are empowered to prescribe life-ending drugs for self-administration, and since 2021, they can also administer them.
Countries with Complicated or Evolving Laws:
In the U.S., Death with Dignity is legal in ten states and Washington D.C. Nearly three decades ago, Oregon became the first to allow doctors to prescribe life-ending medication to terminally ill adults for self-administration. Multiple other states will be considering proposed legislation in 2024.
Germany is attempting to establish new laws following a 2020 federal constitutional court ruling that overturned a “business”-based ban on assisted dying. A recent Associated Press story from July noted that although “active assistance” remains explicitly illegal, “passive help” – the more common method available in other countries – currently exists within a legal gray area on a federal level.
In most Australian states, doctors can prescribe drugs to adults for self-administration and, when an individual is physically incapable, even administer them. However, although the Australian Capital Territory legislative assembly introduced an assisted-dying bill in October, medical aid in dying remains illegal there and in the Northern Territory.
Countries Where Assisted Dying Is Not Allowed:
Following the instruction of President Emmanuel Macron, France is currently exploring the possibility of permitting assisted death. The existing law allows medical personnel to place people experiencing “intolerable pain” who are close to dying under permanent sedation but does not authorize them to hasten the end of life.
Lastly, while Japan explicitly prohibits all forms of assisted suicide, voluntary assisted dying (and the distinction between it and euthanasia) is unaddressed in its legislative codes.
Although these laws (or lack thereof) represent only a portion of the diversity in views on assisted death, the efforts of the global aid-in-dying movement continue to expand access to a dignified, peaceful end of life for millions of people worldwide.
(Disclaimer: As they appear in the following story, the terms “assisted suicide” and “euthanasia” are explicitly different procedures than “medical aid in dying” or “physician-assisted dying/death.” Additionally, in all U.S. jurisdictions with codified Death with Dignity laws, each specifies that medical aid in dying is, in fact, not suicide, nor a means to assist in suicide.)
Read the full article below:
Assisted dying around the world: where and when it is allowed
By: Daniel Boffey
Published: December 19, 2023
The broadcaster and Silver Line founder Esther Rantzen has said she has considered the option of assisted dying if her ongoing lung cancer treatment does not improve her condition, adding that she had joined the Swiss organisation Dignitas, which offers physician-assisted suicide. Here we take a look at the policies of other countries.
Doctors are permitted to prescribe drugs for self-administration and they have been able to administer them since 2021 to those who ask to die and have a grievous and irremediable medical condition. A ban on assisted dying was liberalised after a 2015 supreme court ruling that prohibiting a physician’s assistance in terminating life infringed on the constitutional right to life, liberty and the security of the person who required such help.
The Termination of Life on Request and Assisted Suicide Act 2001 permits doctors to prescribe drugs for self-administration and to administer where it can be shown that the individual concerned is experiencing unbearable suffering and is making an informed choice to die. The individual involved must be at least 12 years old and parental consent is required for those aged 12-16.
The Swiss Criminal Code of 1942 permitted adults to assist in another’s suicide as long as the motive for doing so was not “selfish”. Doctors are permitted to prescribe drugs for self-administration and to administer. Organisations providing assisted suicide have been providing services under certain regulations since 1985. Assisted suicide is lawful irrespective of the condition of the person who requests it.
Lawmakers are struggling to agree on new legislation after a 2020 federal constitutional court ruling that a ban on assisted suicide violated the rights of citizens to determine the circumstances of their death by restricting their ability to seek assistance from a third party.
Medically assisted dying for adults is legal in 11 of the 50 states. In Washington DC, the Death With Dignity Act 2016 permits doctors to prescribe drugs for self-administration. Legislation was passed this year to allow more types of healthcare providers in the district to sign off on requests for a medically assisted death, and allow the drugs to be mailed to patients instead of collected in person.
In Victoria, Western Australia, Tasmania, South Australia, Queensland, and New South Wales, doctors are able to prescribe drugs to adults for self-administration and, in cases where an individual is physically unable to self-administer, to administer the drugs. Assisted dying remains illegal in the Northern Territory and the Australian Capital Territory (ACT). A bill to legalise voluntary assisted dying in the ACT was introduced to the legislative assembly in October.
For the past 20 years under Belgian law, patients have qualified for medically assisted dying if they have an incurable illness and experience constant and intolerable suffering that cannot be alleviated. Unlike in many other countries with liberal legal systems, euthanasia for people who are not terminally ill, such as those with psychiatric disorders or dementia, is also legal. Since 2014 there have been no age restrictions; parental consent is required for under-18s.
This year, President Emmanuel Macron instructed the government to look at whether euthanasia or assisted dying should be permitted in France. The law, in effect since 2016, allows medical personnel to place someone close to death and in intolerable pain under permanent sedation but stops short of authorising them to administer or supply a lethal substance.
According to Japan’s penal code, solicitation of suicide (the act of intentionally killing oneself), assistance in suicide, commissioned murder and consensual homicide are illegal. No laws or official guidelines govern voluntary assisted dying.