Executive Summary – Medical Assistance in Dying: The Law in Selected Jurisdictions Outside Canada

(Disponible en français : Résumé – Aide médicale à mourir : la législation dans certains États à l’extérieur du Canada)

Over the last decades, movements have arisen in several jurisdictions around the world to legalize medical assistance in dying. Until recently, only a few jurisdictions permitted medical assistance in dying, including Oregon, Washington State, Vermont, the Benelux countries (Belgium, the Netherlands and Luxembourg) and Switzerland. In the last five years, six United States (U.S.) jurisdictions have legalized the practice, as have the Australian state of Victoria and Canada. In other countries, such as Germany, Spain, Italy and New Zealand, legislative proposals and court decisions on the issue are increasingly common. At the same time, there continues to be vocal opposition to the elimination of criminal sanctions for individuals who either assist in or cause the death of persons who have requested that their life be terminated.

In Canada, the term “medical assistance in dying” includes both assisted suicide (the patient self-administers a substance) and euthanasia (someone else, usually a medical practitioner, administers the substance). Some jurisdictions around the world allow one of these options, while others allow for both.

According to available statistics, the general trend in the countries that have legalized assisted dying has been for year-to-year increases in deaths by assisted dying. Such deaths, however, remain a small percentage of total deaths, and there have been some recent year-to-year decreases. Regardless of jurisdiction, most patients who receive medical assistance in dying have cancer.

Broadly speaking, Australian and North American jurisdictions have more restrictive rules in place for assistance in dying than the European jurisdictions that permit the practice. The nine U.S. jurisdictions where it is legal, for example, generally require a prognosis of six months or less to live and permit only assisted suicide. Only adults are eligible. The Australian state of Victoria has similar criteria, though with some notable differences. For example, Victoria allows both euthanasia and assisted suicide.

In contrast, in the Benelux countries there is no requirement that a patient have a terminal illness. A psychiatric illness may be enough to qualify for assistance in dying if other conditions are met. In addition, euthanasia is permitted in those jurisdictions and is far more common than assisted suicide.

The three Benelux countries allow advance directives, meaning that the patient need not have the capacity to make the decision at the time of death. However, the scope for advance directives is much broader in the Netherlands, where they can be used in situations of dementia, for example. In Belgium and Luxembourg, advance directives can only be relied upon where the individual is unconscious at the time of the procedure.

Though the rules are not exactly the same, both the Netherlands and Belgium allow some minors to receive assistance in dying. As in the U.S. jurisdictions that have legalized assisted suicide, Luxembourg only allows adults to receive assistance in dying.

Switzerland’s Criminal Code allows assisted suicide, as long as the assistance is provided for unselfish reasons. However, that country does not have a regulatory regime with specific criteria like the other countries noted above. This means that non-residents can receive assistance in dying in Switzerland and the practice is not limited to physicians.

Constitutional Court decisions have legalized euthanasia in Colombia, but it remains rare. While the court called for legislation, no legislative efforts have been successful to date, as the issue is quite contentious. The government was required by the court to create a regulatory framework for medical assistance in dying to fill the void created by the lack of legislation.

Assistance in dying is being discussed in many legislatures, particularly in North America and Europe. If current trends continue, legalization of assistance in dying in other jurisdictions is likely.

Read the full text of the Background Paper: Medical Assistance in Dying: The Law in Selected Jurisdictions Outside Canada

Author: Julia Nicol, Library of Parliament

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