Over the last few 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. Since 2015, seven more United States (U.S.) jurisdictions have legalized the practice, as have five Australian states, Canada and other countries. 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 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, U.S. jurisdictions, the five Australian states that allow assisted dying and New Zealand have more restrictive rules in place for assistance in dying than the European jurisdictions that permit the practice. The 10 U.S. jurisdictions where legislation exists generally require a prognosis of six months or less to live and permit only assisted suicide. Only adults are eligible. The Australian states and New Zealand have similar criteria, although with some notable differences, for example, allowing both euthanasia and assisted suicide.
In contrast, in the Benelux countries, and now in Colombia and Spain, 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 these countries and is far more common than assisted suicide.
The three Benelux countries, and now Colombia and Spain, 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, the Netherlands, Belgium and Colombia allow some minors to receive assistance in dying. As in the U.S. jurisdictions that have legalized assisted suicide, Luxembourg, five Australian states New Zealand and Spain only allow 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.
Court decisions have legalized euthanasia in Colombia, Italy, Germany and Peru, but no legislation has been adopted to regulate the practice in those countries.
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 HillStudy: Medical Assistance in Dying: The Law in Selected Jurisdictions Outside Canada
Author: Julia Nicol, Library of Parliament