Assisted dying, also known as physician-assisted suicide (PAS) or euthanasia, is a deeply controversial issue with different legal frameworks, cultural attitudes, and ethical considerations around the world. Countries vary widely in their approaches, with some allowing it under strict conditions, while others strictly prohibit it. The UK has recently began the process to debate it in parliament. Here’s a look at how assisted dying is regulated and practiced in different parts of the world:
Europe
- Netherlands: The Netherlands was one of the first countries to legalize both euthanasia and physician-assisted suicide under the Dutch Termination of Life on Request and Assisted Suicide (Review Procedures) Act in 2002. It allows these practices for patients experiencing unbearable suffering with no prospect of improvement, and who make a voluntary, well-considered request. The decision requires the involvement of a physician and is subject to strict legal criteria and oversight.
- Belgium: Belgium legalized euthanasia in 2002 and has one of the most permissive euthanasia laws in the world. It allows euthanasia for adults and, since 2014, for minors in specific circumstances. There is no requirement for a terminal illness, but patients must be in a state of unbearable physical or psychological suffering with no prospect of relief. The patient’s request must be voluntary, well-considered, and repeated.
- Switzerland: Switzerland has a unique approach to assisted suicide, which is legal but not euthanasia (where the doctor administers the lethal dose). Assisted suicide in Switzerland does not require the involvement of a physician, as long as the individual administering the assistance does not have a selfish motive. This has led to the establishment of organizations like Dignitas and Exit, which help terminally ill patients from around the world access assisted dying.
- Germany: Germany’s approach to assisted dying has been subject to legal and ethical debates. In 2020, the German Constitutional Court ruled that the right to a self-determined death includes the right to seek help from third parties, effectively decriminalizing assisted suicide. However, the details of how this ruling will be implemented remain under legislative consideration.
North America
- Canada: In Canada, medical assistance in dying (MAID) has been legal since 2016 under Bill C-14, which was later expanded in 2021 under Bill C-7. It permits euthanasia and assisted suicide for patients with a grievous and irremediable medical condition causing intolerable suffering. The recent amendments have expanded eligibility to include people whose natural death is not reasonably foreseeable, under stricter safeguards.
- United States: In the U.S., assisted dying laws are state-specific. States like Oregon, Washington, California, Colorado, Hawaii, Vermont, Maine, New Jersey, New Mexico, and Montana have legalized physician-assisted suicide through legislation or court rulings. The laws typically require that patients must be terminally ill with a prognosis of six months or less to live and be mentally capable of making the decision. Euthanasia (where a doctor directly administers the lethal dose) is illegal in all U.S. states.
3. Oceania
- Australia: Assisted dying laws in Australia vary by state. Victoria became the first Australian state to legalize voluntary assisted dying (VAD) in 2019, followed by Western Australia, Tasmania, South Australia, Queensland, and New South Wales. The laws are generally restrictive, requiring that patients have a terminal illness with less than six months to live (or twelve months for neurodegenerative conditions) and that they meet other criteria, including mental competence and residency requirements.
- New Zealand: New Zealand legalized euthanasia in 2020 through a public referendum, and the End of Life Choice Act came into effect in November 2021. It allows terminally ill adults with less than six months to live to choose assisted dying, provided they meet strict eligibility criteria, including making a fully informed and voluntary decision.
Asia
- Japan: In Japan, there are no specific laws regarding euthanasia or assisted suicide, but both practices are generally prohibited under criminal law. However, there have been isolated cases where passive euthanasia (withdrawing life support) has been accepted under strict conditions, such as when a patient’s suffering is unbearable and all parties agree.
- India: In 2018, the Indian Supreme Court legalized passive euthanasia, allowing the withdrawal of life-support systems for terminally ill patients in specific circumstances. Active euthanasia and assisted suicide remain illegal, but the court also recognized living wills, allowing individuals to state their wishes regarding end-of-life care.
Africa and the Middle East
- South Africa: Assisted dying is currently illegal in South Africa, but there have been legal cases and debates seeking to change this status. In 2015, a court ruling in favor of assisted suicide for a terminally ill patient sparked national discussion, although the judgment was limited to that specific case.
- Other Countries in the Region: In the broader Middle East and Africa, assisted dying is largely illegal and often strictly prohibited due to religious, cultural, and ethical beliefs that consider it incompatible with the sanctity of life. Predominantly Muslim countries tend to oppose euthanasia and assisted suicide based on Islamic principles.
Global Trends and Ethical Debates
- Ethical Considerations: The debate over assisted dying revolves around complex ethical issues, including the value of human life, the right to die with dignity, the potential for abuse, and concerns about vulnerable populations. Supporters argue for personal autonomy and relief from suffering, while opponents worry about the slippery slope effect and the societal implications of normalizing assisted death.
- Cultural and Religious Influences: Cultural and religious values play a significant role in shaping attitudes toward assisted dying. In many countries where Christianity, Islam, or other religions have a strong influence, there is significant resistance to legalizing euthanasia or physician-assisted suicide.
- Increasing Legalization: There is a growing trend toward legalizing some form of assisted dying, particularly in Europe and North America. However, the extent and conditions under which it is allowed vary greatly, and it remains a highly debated topic around the world.