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Euthanasia Essay Wikipedia

This article is about the legality of euthanasia of humans. For mercy killings performed on other animals, see Animal euthanasia.

Efforts to change government policies on euthanasia of human lives in the 20th and 21st centuries have met limited success in Western countries. Human euthanasia policies have also been developed by a variety of NGOs, most notably medical associations and advocacy organizations. As of March 2018[update], human euthanasia is legal in the Netherlands, Belgium, Colombia,[1]Luxembourg, Canada[2] and India[3]. Assisted suicide is legal in Switzerland, Germany, Japan, and in the US states of Washington, Oregon, Colorado, Vermont, Montana, Washington DC,[4] and California.[5]South Korea is also set to join as a euthanasia-legal country starting from February 2018, both active and passive. An assisted dying scheme in the Australian state of Victoria will come into effect in mid-2019.

Euthanasia law by country[edit]

Australia[edit]

Main article: Euthanasia in Australia

Euthanasia is illegal in Australia, though a law to allow voluntary assisted dying in the Australian state of Victoria will come into effect in mid-2019.[6] Although rare, charges have been laid for 'aiding and abetting' the suicide of others.[7] It once was legal in the Northern Territory, by the Rights of the Terminally Ill Act 1995. In 1997, the Australian Federal Government overrode the Northern Territory legislation through the introduction of the Euthanasia Laws Act 1997.[8] Unlike the states, legislation in the Northern Territory is not guaranteed by the Australian constitution. During the brief period in which euthanasia was legal in the Northern Territory, Dr. Philip Nitschke helped three people end their lives through assisted suicide using his Deliverance machine. Organizations such as Exit International want the government to bring back euthanasia rights to Australia. Exit made TV commercials which were banned before they made it to air in September 2010.[9] Australia however gives patients an Advanced Care Directive option.[clarification needed]

Belgium[edit]

The Belgian parliament legalised euthanasia on 28 May 2002.[10][11]

A survey published in 2010 reported that those who died from euthanasia (compared with other deaths) were more often younger, male, cancer patients and more often died in their homes. In almost all cases, unbearable physical suffering were reported. Euthanasia for nonterminal patients was rare.[12][13] There have been about 1,400 cases a year since the law was introduced, and a record 1,807 cases were recorded in 2013.[14][15]

In December 2013, the Belgian Senate voted in favour of extending its euthanasia law to terminally ill children. Conditions imposed on children seeking euthanasia are that "the patient must be conscious of their decision and understand the meaning of euthanasia", "the request must have been approved by the child's parents and medical team", "their illness must be terminal" and "they must be in great pain, with no available treatment to alleviate their distress".[16] A psychologist must also determine the patient's maturity to make the decision. The amendment emphasizes that the patient's request be voluntary.[17] The first minor to be euthanized under these new regulations occurred in September 2016.[18]

In September 2014, the Federal Euthanasia Commission gave convicted rapist and murderer Frank Van Den Bleeken the right to assisted suicide. Van Den Bleeken had served decades in prison for a 1989 crime and no longer wished to live. Over a dozen other inmates filed similar petitions.[19] In January 2015, the Justice Ministry acknowledged that Van Den Bleeken's doctors recommended against euthanasia and that alternative psychological care would be sought for him.[20]

Canada[edit]

Main article: Euthanasia in Canada

Voluntary active euthanasia, called "physician assisted dying", is legal in Canada for all people over the age of 18 who have a terminal illness that has progressed to the point where natural death is "reasonably foreseeable." To prevent suicide tourism, only people eligible to claim Canadian health insurance may use it. Legalization of the practice came in 2015/2016 as a result of a series of Supreme Court rulings striking down Canada's ban on medically assisted suicide. Below is a timeline of events:

On 6 February 2015, the Supreme Court of Canada unanimously ruled in Carter v Canada (AG) that Canadian adults who are mentally competent and suffering intolerably and permanently have the right to a doctor's help in dying. The court however suspended its ruling for 12 months to give the government an opportunity to write legislation and draft new laws and policies around assisted dying.[21][22] In January 2016 the court granted an additional 4-month extension to its ruling suspension to allow time for the newly elected Liberal government to consult with Canadians on drafting a law to comply with the ruling. As an interim measure, it also ruled that provincial courts can now begin approving applications for euthanasia until the new law passes.[23]

A parliamentary committee report tasked with studying the issue in light of the Supreme Court of Canada's ruling recommended that anyone experiencing “intolerable suffering” should be able to seek a doctor’s help to die. On April 14, 2016, Canada's federal Liberal government introduced legislation to legalize assisted dying under more restrictive conditions than recommended by the committee, allowing access to only those with terminal illnesses for whom death is “reasonably foreseeable”.[24] The British Columbia Civil Liberties Association argues that the government's assisted dying law is unconstitutional, because it limits access to only those whose death is "reasonably foreseeable", rather than provide access to anybody suffering from a "grievous and irremediable" condition, the definition used by the Supreme Court of Canada in their court ruling that the BCCLA argues would include non-terminal conditions.[25]

The bill received considerable multi-partisan opposition within the Senate, where it was criticized as being drafted too quickly, and being too restrictive compared with the Supreme Court decision.[26] As a result, the Senate made a series of amendments to the bill. The House of Commons accepted all of the amendments made by the Senate except one, which removed the requirement that death be "reasonably foreseeable."

On 17 June 2016, a bill to legally allow assisted suicide within Canada became law after it passed both houses of the Parliament of Canada and received Royal Assent.[27]

Colombia[edit]

In a 6–3 decision, Colombia's Constitutional Court ruled in 1997 that "no person can be held criminally responsible for taking the life of a terminally ill patient who has given clear authorization to do so," according to the Washington Post.[28] The court defined "terminally ill" person as those with diseases such as "cancer, AIDS, and kidney or liver failure if they are terminal and the cause of extreme suffering," the Post reported. The ruling specifically refused to authorize euthanasia for people with degenerative diseases such as Alzheimer's, Parkinson's, or Lou Gehrig's disease. On 15 December 2014, the Constitutional Court had given the Ministry of Health and Social Protection 30 days to publish guidelines for the healthcare sector to use in order to guarantee terminated ill patients, with the wish to undergo euthanasia, their right to a dignified death.[29]

Denmark[edit]

Parliament has assigned ethics panels over the years that have advised against legalisation each time[30] however it is still not specifically outlawed[31] and a study published in 2003 showed 41% of deaths under medical supervision involved doctors taking "end-of-life" decisions to help ease their patients' suffering before death (about 1% of which were via prescription drugs).[32][33]

Finland[edit]

Active euthanasia is not legal in Finland. Passive euthanasia, however, is legal.[34]

France[edit]

In July 2013, French President François Hollande stated his personal support for decriminalisation of voluntary euthanasia in France, which had been one of his presidential campaign promises ("introduction of the right to die with dignity"), despite objections from France's National Consultative Ethics Committee/ Comité national consultatif d'éthique, which alleged "abuses" in adjacent jurisdictions that have decriminalised and regulated either voluntary euthanasia or physician-assisted suicide (Belgium, Switzerland, the Netherlands and Luxembourg). It remains to be seen whether President Hollande will be successful in his objectives, given that the Catholic Church in France and other religious social conservatives have announced that after forthright opposition to the introduction of same-sex marriage in France, their next target may be any such decriminalisation of voluntary euthanasia.[35]

In January 2016 both parts of France's parliament approved a measure that, while stopping short of euthanasia, would allow doctors to keep terminal patients sedated until death.[36]

India[edit]

Main article: Euthanasia in India

Passive euthanasia is legal in India.[37] On 7 March 2011 the Supreme Court of India legalised passive euthanasia by means of the withdrawal of life support to patients in a permanent vegetative state.[38][39] Forms of Active euthanasia, including the administration of lethal compounds, are illegal.[40]

Ireland[edit]

In Ireland, it is illegal for a doctor (or anyone) to actively contribute to someone's death. It is not, however, illegal to remove life support and other treatment (the "right to die") should a person (or their next of kin) request it. A September 2010 Irish Times poll showed that a majority, 57% of adults, believed that doctor-assisted suicide should be legal for terminally ill patients who request it.[41]Doctors can stop giving a patient life sustaining treatments such as ventilators, feeding tube etc. after being sedated, allowing the patient to die peacefully in their sleep.This only occurs in certain circumstances.[42]

Israel[edit]

The Israeli Penal Law forbids causing the death of another and specifically forbids shortening the life of another. Active euthanasia is forbidden by both Israeli law and Jewish law. Passive euthanasia is forbidden by Jewish law but has been accepted in some cases under Israeli law.[43] In 2005, proposals were put forward to allow passive euthanasia to be administered using a switch mechanism similar to Sabbath clocks.[44] In 2006, the Steinberg Commission was set up to look into whether life and death issues could be rethought in the context of Jewish law, which suggested that hospitals could set up committees to determine whether patients would be given passive euthanasia.[45]

Japan[edit]

The Japanese government has no official laws on the status of euthanasia and the Supreme Court of Japan has never ruled on the matter. Rather, to date, Japan's euthanasia policy has been decided by two local court cases, one in Nagoya in 1962, and another after an incident at Tokai University in 1995. The first case involved "passive euthanasia" (消極的安楽死,shōkyokuteki anrakushi) (i.e., allowing a patient to die by turning off life support) and the latter case involved "active euthanasia" (積極的安楽死,sekkyokuteki anrakushi) (e.g., through injection). The judgments in these cases set forth a legal framework and a set of conditions within which both passive and active euthanasia could be legal. Nevertheless, in both of these particular cases the doctors were found guilty of violating these conditions when taking the lives of their patients. Further, because the findings of these courts have yet to be upheld at the national level, these precedents are not necessarily binding. Nevertheless, at present, there is a tentative legal framework for implementing euthanasia in Japan.[46]

In the case of passive euthanasia, three conditions must be met:

  1. the patient must be suffering from an incurable disease, and in the final stages of the disease from which he/she is unlikely to make a recovery;
  2. the patient must give express consent to stopping treatment, and this consent must be obtained and preserved prior to death. If the patient is not able to give clear consent, their consent may be determined from a pre-written document such as a living will or the testimony of the family;
  3. the patient may be passively euthanized by stopping medical treatment, chemotherapy, dialysis, artificial respiration, blood transfusion, IV drip, etc.

For active euthanasia, four conditions must be met:

  1. the patient must be suffering from unbearable physical pain;
  2. death must be inevitable and drawing near;
  3. the patient must give consent. (Unlike passive euthanasia, living wills and family consent will not suffice.)
  4. the physician must have (ineffectively) exhausted all other measures of pain relief.

The problems that arose from this, in addition to the problem faced by many other families in the country, has led to the creation of "bioethics SWAT teams".[47] These teams will be made available to the families of terminally ill patients in order to help them, along with the doctors, come to a decision based on the personal facts of the case. Though in its early stages and relying on "subsidies from the Ministry of Health, Labor and Welfare" there are plans to create a nonprofit organization to "allow this effort to continue."[48]

Latvia[edit]

Euthanasia is not legal in Latvia.[49] However a doctor may refuse further treatment of a patient if they believe it is the best course of action. [50]

Lithuania[edit]

Euthanasia is not legal in Lithuania.[citation needed]However as of 2016 a draft of a law about the right to die has been produced.[51]

Luxembourg[edit]

The country's parliament passed a bill legalizing euthanasia on 20 February 2008 in the first reading with 30 of 59 votes in favour. On 19 March 2009, the bill passed the second reading, making Luxembourg the third European Union country, after the Netherlands and Belgium, to decriminalise euthanasia. Terminally ill patients will have the option of euthanasia after receiving the approval of two doctors and a panel of experts.[52]

Mexico[edit]

Main article: Euthanasia in Mexico

In Mexico, active euthanasia is illegal but since 7 January 2008 the law allows the terminally ill —or closest relatives, if unconscious— to refuse medication or further medical treatment to extend life (also known as passive euthanasia) in Mexico City,[53] in the central state of Aguascalientes (since 6 April 2009)[54] and, since 1 September 2009, in the Western state of Michoacán.[55] A similar law extending the same provisions at the national level has been approved by the senate[56] and an initiative decriminalizing active euthanasia has entered the same legislative chamber on 13 April 2007.[57]

Netherlands[edit]

Main article: Euthanasia in the Netherlands

In the 1973 "Postma case" a physician was convicted for having facilitated the death of her mother following repeated explicit requests for euthanasia.[58] While upholding the conviction, the court's judgment set out criteria when a doctor would not be required to keep a patient alive contrary to their will. This set of criteria was formalized in the course of a number of court cases during the 1980s.

In 2002, the Netherlands passed a law legalizing euthanasia including physician-assisted suicide.[59] This law codifies the twenty-year-old convention of not prosecuting doctors who have committed euthanasia in very specific cases, under very specific circumstances. The Ministry of Public Health, Wellbeing and Sports claims that this practice "allows a person to end their life in dignity after having received every available type of palliative care."[60] The United Nations has reviewed and commented on the Netherlands euthanasia law.[citation needed]

In September 2004 the Groningen Protocol was developed, which sets out criteria to be met for carrying out child euthanasia without the physician being prosecuted.[61]

New Zealand[edit]

Main article: Euthanasia in New Zealand

Assisted suicide and voluntary euthanasia remain illegal in New Zealand under Section 179 of the New Zealand Crimes Act 1961, which renders it a criminal offence to "aid and abet suicide." There have been two prior decriminalisation attempts- the Death With Dignity Bill 1995 and the Death With Dignity Bill 2003. Both failed, although the latter only did so by a three-vote margin within the New Zealand Parliament. In May 2012, Labour Party of New Zealand MP Maryan Street introduced a private member's bill into the ballot box, the End of Life Choices Bill, which was taken over by MP Iain Lees-Galloway when she failed to get re-elected in the 2014 General Election. The bill was dropped in Dec 2014 under the request of Labour Party of New Zealand leader Andrew Little as the issue was deemed to be distracting from bigger issues that concerns the party.[62] In December 2017, ACT MP David Seymour's End of Life Choice Bill, which will legalise assisted suicide for a select group of people if successful, passed its first reading in Parliament in a 76-44 personal vote.

Norway[edit]

Euthanasia remains illegal, though a caregiver may receive a reduced punishment for taking the life of someone who consents to it.[63]

Peru[edit]

Euthanasia is a delict under the laws of Peru, although there have been some attempts to reform them.

In October 2009, the Reviser Special Commission of the Penal Code of the Parliament expressed its support of a proposal that tried to amend article 112 of the Penal Code, but it did not succeed.

However, at the beginning of 2015, the case of the Chilean woman young Valentina Maureira, who suffered from cystic fibrosis, an incurable disease, and who asked that euthanasia be allowed in her country, attracted the interest of the press of Chile and also of foreign media.[64]

On March 4 of the same year, the Peruvian legislator Roberto Angulo Álvarez, membership of Dignity and Democracy parliamentary group, motivated by this case, presented a bill that proposed to allow assisted death in case of terminal or degenerative disease, with the objective of "avoid the physical and psychological pains of the patient, as well the unnecessary expenses for the family members and the State". Angulo Álvarez also argued that his legislative project "would contribute to respect for individual freedom and human dignity".[65][66]

South Korea[edit]

The National Assembly and The Ministry of Health and Welfare voted in favor of active euthanasia starting from February of 2018, and has announced to issue a "Well-Dying" Bill[67]. However, the topic and debate of euthanasia in South Korea sparked for a long time, starting back in December 4, 1997 when a doctor was sent to prison for a major duration for voluntarily cutting life support of a braindead patient who injured himself from a head trauma upon the request of his wife. This incident is well known in Korea as 'Boramae Hospital Incident' (보라매병원 사건). Another incident that sparked further debate was from the imprisonment of a father who plugged off a respirator for his braindead son.[68] Reports indicate that South Korea has previously legalized passive euthanasia, but maintained the illegality of active suicide as of December 2015, under the name "Death with Dignity" Bill[69].

Patients who qualify for active or passive euthanasia in South Korea are reserved for the terminally ill with a nonexistent chance of recovery. Patients who have a beneficial reaction to any medications, or is not in a rapidly deteriorating state of health leading to imminent death may not be qualified. Patients must have a confirmation of a registered physician and a doctor to die under dignity, and comatose patients must have the approval of both guardians.[70]

Philippines[edit]

Euthanasia is illegal in the Philippines. In 1997, the Philippine Senate considered passing a bill legalizing passive euthanasia. The bill met strong opposition from the country's Catholic Church. If legalized the Philippines would have been the first country to legalize euthanasia. Under current laws, doctors assisting a patient to die can be imprisoned and charged with malpractice.[71]

Switzerland[edit]

Main article: Euthanasia in Switzerland

In Switzerland, deadly drugs may be prescribed to a Swiss person or to a foreigner, where the recipient takes an active role in the drug administration.[72] More generally, article 115 of the Swiss penal code, which came into effect in 1942 (having been written in 1918), considers assisting suicide a crime if and only if the motive is selfish.

Sweden[edit]

Passive euthanasia was deemed legal after a landmark court ruling in 2010. This means a health care professional can legally cease life support upon request from a patient if they understand the consequences stated by their health care provider, however administering a lethal substance is illegal.[73]

Turkey[edit]

Euthanasia is strictly forbidden in Turkey. The aide who helped a person to suicide or other ways to kill oneself will be punished for assisting and encouraging suicide under the stipulation of article 84 of the Turkish Criminal Law. In condition of active euthanasia, article 81 of the same law sets forth that any person who carries out this act will be judged and punished for life imprisonnement just like a simple murder.

United Kingdom[edit]

Main article: Euthanasia in the United Kingdom

Euthanasia is illegal in the United Kingdom. Any person found to be assisting suicide is breaking the law and can be convicted of assisting suicide or attempting to do so.[74][75] However, the Director of Public Prosecutions has issued guidelines setting out when a prosecution is, or is not, likely to happen.[76] Between 2003 and 2006 Lord Joffe made four attempts to introduce bills that would have legalised voluntary euthanasia – all were rejected by the UK Parliament.[77] Currently, Dr Nigel Cox is the only British doctor to have been convicted of attempted euthanasia. He was given a 12-month suspended sentence in 1992.[78]

In regard to the principle of double effect, in 1957 Judge Devlin in the trial of Dr John Bodkin Adams ruled that causing death through the administration of lethal drugs to a patient, if the intention is solely to alleviate pain, is not considered murder even if death is a potential or even likely outcome.[79]

United States[edit]

Main article: Euthanasia in the United States

See also: Assisted suicide in the United States

Active euthanasia is illegal throughout the United States. Patients retain the rights to refuse medical treatment and to receive appropriate management of pain at their request (passive euthanasia), even if the patients' choices hasten their deaths. Additionally, futile or disproportionately burdensome treatments, such as life-support machines, may be withdrawn under specified circumstances and, under federal law and most state laws only with the informed consent of the patient or, in the event of the incompetence of the patient, with the informed consent of the legal surrogate. The Supreme Court of the United States has not dealt with "quality of life issues" or "futility issues" and appears to only condone active or passive "euthanasia" (not legally defined) when there is clear and convincing evidence that informed consent to the euthanasia, passive or active, has been obtained from the competent patient or the legal surrogate of the incompetent patient.

While active euthanasia is illegal throughout the US, assisted suicide is legal in Washington DC,[80]Colorado, Oregon, Washington, Vermont, California,[81] one county in New Mexico, and is de facto legal in Montana.[82][83]

Uruguay[edit]

Main article: Euthanasia in Uruguay

Since 1933 the Penal Code of Uruguay, article 37, accept Compassionate Homicide, the first legal document that include euthanasia. It's important to say that this legal document didn't use this denomination. In another article, 127, the judge could waive the doctor, if this action was made by patient pledge and the doctor had an honorable reputation.[84] The main source of this Penal Code was Jimenéz de Asúa, a Spanish penalist, that introduce this concept in his book "Libertad de amar y derecho a morir: ensayos de un criminalista sobre eugenesia, eutanasia, endocrinología", published in Madrid/Spain, in 1928.[85] The first proposal to understand Euthanasia as homicide was made by Ruy Santos in his MD thesis, "Da resistencia dos estados mórbidos à therapeutica e da incurabilidade perante a euthanásia", at Faculdade de Medicina da Bahia/Brazil, in 1928. He made a difference between Euthanasia as homicide and Euthanasia as suicide, probably the first citation about Assisted Suicide.[86]

Non-governmental organizations[edit]

Further information: Assisted suicide § Organizations in support of assisted suicide

There are a number of historical studies about the thorough euthanasia-related policies of professional associations. In their analysis, Brody et al. found it necessary to distinguish such topics as euthanasia, physician-assisted suicide, informed consent and refusal, advance directives, pregnant patients, surrogate decision-making (including neonates), DNR orders, irreversible loss of consciousness, quality of life (as a criterion for limiting end-of-life care), withholding and withdrawing intervention, and futility.[87] Similar distinctions presumably are found outside the U.S., as with the highly contested statements of the British Medical Association.[88][89]

On euthanasia (narrowly defined here as directly causing death), Brody sums up the U.S. medical NGO arena:

The debate in the ethics literature on euthanasia is just as divided as the debate on physician-assisted suicide, perhaps more so. Slippery-slope arguments are often made, supported by claims about abuse of voluntary euthanasia in the Netherlands.... Arguments against it are based on the integrity of medicine as a profession. In response, autonomy and quality-of-life-base arguments are made in support of euthanasia, underscored by claims that when the only way to relieve a dying patient's pain or suffering is terminal sedation with loss of consciousness, death is a preferable alternative – an argument also made in support of physician-assisted suicide.[90]

Other NGOs that advocate for and against various euthanasia-related policies are found throughout the world. Among proponents, perhaps the leading NGO is the UK's Dignity in Dying, the successor to the (Voluntary) Euthanasia Society.[91] In addition to professional and religious groups, there are NGOs opposed to euthanasia[92] found in various countries.

See also[edit]

References[edit]

  1. ^"Minsalud deja en firme la resolución con protocolo de eutanasia". April 2015. 
  2. ^"Medical Assistance in Dying Bill". Canada's Justice Laws Website. 2016. 
  3. ^https://m.economictimes.com/news/politics-and-nation/in-landmark-decision-supreme-court-allows-passive-euthanasia-living-will/videoshow/63229586.cms
  4. ^[1]
  5. ^http://www.nwfdailynews.com/news/20160419/canadian-catholic-group-speaks-out-against-proposed-assisted-suicide-bill
  6. ^"Euthanasia: Victoria becomes the first Australian state to legalise voluntary assisted dying". ABC News. 29 November 2017. 
  7. ^R v Shirley Justins [2011] NSWSC 568 AustLII
  8. ^"Inquiry into the Rights of the Terminally Ill (Euthanasia Laws Repeal) Bill 2008". Law Council of Australia. April 2008. Archived from the original on 4 March 2011. Retrieved 21 April 2011. 
  9. ^Alexander, Cathy (13 September 2010). "Pro-euthanasia TV ad ban 'a violation of free speech'". The Age. Melbourne. 
  10. ^http://www.ejustice.just.fgov.be/cgi/article_body.pl?language=nl&pub_date=2002-06-22&numac=2002009590&caller=summary
  11. ^Adams M, Nys H (2003). "Comparative reflections on the Belgian Euthanasia Act 2002". Med Law Rev. 11 (3): 353–76. doi:10.1093/medlaw/11.3.353. PMID 16733879. 
  12. ^Smets T, Bilsen J, Cohen J, Rurup ML, Deliens L (February 2010). "Legal euthanasia in Belgium: characteristics of all reported euthanasia cases". Med Care. 48 (2): 187–92. doi:10.1097/MLR.0b013e3181bd4dde. PMID 19890220. 
  13. ^Aviv, Rachel (22 June 2015). "The Death Treatment". The New Yorker. Retrieved 19 June 2015. 
  14. ^AP (16 September 2014). "Belgian convicted killer with 'incurable' psychiatric condition granted right to die". The Guardian. Retrieved 3 January 2015. 
  15. ^Tim Porter (3 January 2015). "Belgian serial rapist and murderer Frank Van Den Bleeken 'to be euthanised' in January". International Business Times. Retrieved 3 January 2015. 
  16. ^"Belgian Senate votes to extend euthanasia to children". BBC News. 13 December 2013. 
  17. ^Higgins, Andrew (12 December 2013). "Belgian Senate Votes to Allow Euthanasia for Terminally Ill Children". The New York Times. 
  18. ^"Belgium minor first to be granted euthanasia". BBC News. Retrieved 17 September 2016. 
  19. ^"Brussels: Murderer may kill himself". The Week (page 6). 26 September 2014. 
  20. ^"Belgian rapist Van Den Bleeken refused 'right to die'". BBC News. 6 January 2015. Retrieved 31 January 2018. 
  21. ^Fine, Sean (6 February 2015). "Canadians have right to doctor-assisted suicide, Supreme Court rules". The Globe and Mail. 
  22. ^Carter v. Canada (Attorney General), 2015 SCC 5, online at: http://scc-csc.lexum.com/scc-csc/scc-csc/en/item/14637/index.do
  23. ^"Supreme court gives Parliament 4-month extension on doctor-assisted dying law". January 15, 2016. Retrieved 28 February 2016. 
  24. ^https://www.economist.com/news/international/21697129-seeking-consensus-where-none-exists-canadas-new-doctor-assisted-dying-law-takes-shape
  25. ^http://www.ctvnews.ca/politics/children-of-assisted-death-advocate-kay-carter-urge-amendments-to-liberal-bill-1.2869585
  26. ^Tasker, John Paul (May 28, 2016). "'Rushed' assisted-dying legislation to face strong opposition in the Senate". CBC News. Retrieved 1 June 2016. 
  27. ^[2]
  28. ^http://www.highbeam.com/doc/1P2-738421.html
  29. ^Redacción Salud (19 February 2015). "Los principios para regular la eutanasia" (in sp). ElEspectador.com. 
  30. ^Cook, Michael. "Denmark quietly debates euthanasia". BioEdge. Retrieved 11 October 2014. 
  31. ^Humphry, Derek (2005). The Good Euthanasia Guide: Where, What, and Who in Choices in Dying. Junction City, Oregon, U.S.A.: Norris Lane Press. p. 4. ISBN 978-0-9768283-1-0. Retrieved 11 October 2014. 
  32. ^"Doctor-assisted euthanasia common in Europe". Australian Broadcasting Commission. Agençe France-Presse. 4 August 2003. Retrieved 11 October 2014. 
  33. ^van der Heide, Agnes; Deliens, Luc; Faisst, Karin; Nilstun, Tore; Norup, Michael; Paci, Eugenio; van der Wal, Gerrit; van der Maas, Paul J (17 June 2003). "End-of-life decision-making in six European countries: descriptive study"(PDF). The Lancet. 362: 345–350. doi:10.1016/s0140-6736(03)14019-6. PMID 12907005. Retrieved 11 October 2014. 
  34. ^Silvoniemi, M.; Vasankari, T.; Vahlberg, T.; Clemens, KE; Salminen, E. (2010). "Physicians' attitudes towards euthanasia in Finland: would training in palliative care make a difference?". Palliative Medicine. 24: 744–746. doi:10.1177/0269216310376556. 
  35. ^"France aims to allow euthanasia despite ethics doubts": TVNZ News: 02.07.2013: "Archived copy". Archived from the original on 2013-07-02. Retrieved 2013-07-02. 
  36. ^Press, Associated (2016-01-27). "France adopts sedated dying law as compromise on euthanasia". The Guardian. ISSN 0261-3077. Retrieved 2016-12-06. 
  37. ^"India joins select nations in legalising "passive euthanasia"". Chennai, India: The Hindu. 7 March 2011. Retrieved 8 March 2011. 
  38. ^Venkatesan, J. (7 March 2011). "Supreme Court disallows friend's plea for mercy killing of vegetative Aruna". Chennai, India: The Hindu. Retrieved 7 March 2011. 
  39. ^"Aruna Shanbaug case: SC allows passive euthanasia in path-breaking judgment". The Times of India. 7 March 2011. Retrieved 7 March 2011. 
  40. ^Magnier, Mark (8 March 2011). "India's Supreme Court lays out euthanasia guidelines". LA Times. Retrieved 8 March 2011. 
  41. ^
Current status of euthanasia around the world:

  Active euthanasia is legal

  Passive euthanasia is legal

  Euthanasia laws vary by administrative division

  Euthanasia is illegal

  Unknown

Current status of euthanasia in Europe:

  Active euthanasia is legal

  Passive euthanasia is legal

  Assisted suicide is allowed

  Euthanasia is illegal

  Ambiguous legal situation

  Unknown

Assisted suicide is suicide committed with the aid of another person, sometimes a physician.[1] The term is often used interchangeably with physician-assisted suicide (PAS), which involves a doctor "knowingly and intentionally providing a person with the knowledge or means or both required to commit suicide, including counseling about lethal doses of drugs, prescribing such lethal doses or supplying the drugs."[2]

Canada, Belgium, the Netherlands, Luxembourg, and Switzerland allow physicians to physically assist in the death of patients. In the United States, six states allow medical aid in dying, a legal practice in which a person who has been diagnosed as terminally ill with 6 months or less to live can request a lethal dose of a medication to self-administer in order to end their life. This option is designated a legal form of assisted suicide by distinct state laws. Non-medical assisted suicide is unlawful by common law or criminal statute in the vast majority of the United States (with some states having no definitive law or statute).[3]

Physician-assisted suicide is often confused with euthanasia. In cases of euthanasia the physician administers the means of death, usually a lethal drug. In physician-assisted suicide, it is required that a person of sound mind voluntarily expresses his or her wish to die and requests a dose of medication that will end his or her life. The distinguishing aspect is that physician-assisted suicide requires the patient to self-administer the medication.[4][5]

Support[edit]

Reducing suffering[edit]

One argument for medical aid in dying is that it reduces prolonged suffering in those with terminal illnesses. When death is imminent (half a year or less) patients can choose to have aid in dying as a medical option to shorten an unbearable dying process. Pain is mostly not reported as the primary motivation for seeking physician aid in dying in the United States;[6] the three most frequently mentioned end‐of‐life concerns reported by Oregon residents who took advantage of the Death With Dignity Act in 2015 were: decreasing ability to participate in activities that made life enjoyable (96.2%), loss of autonomy (92.4%), and loss of dignity (78.4%).[7]

Oregon Statistics[edit]

A study of hospice nurses and social workers in Oregon reported that symptoms of pain, depression, anxiety, extreme air hunger and fear of the process of dying were more pronounced among hospice patients who did not request aid-in-dying medication.[8]

A Journal of Palliative Medicine report on patterns of hospice use noted that Oregon was in both the highest quartile of hospice use and the lowest quartile of potentially concerning patterns of hospice use. A similar trend was found in Vermont, where AiD was authorized in 2013.[9]

In Oregon, in hospital death rates are at the lowest in the nation, at home death rates are at the highest in the nation, and violent suicide among hospice patients has been reduced significantly.[9]

In February 2016, Oregon released a report on their 2015 numbers. During 2015, there were 218 people in the state who were approved and received the lethal prescription medicines to end their own life. Of that 218, 132 terminally ill patients ultimately made the decision to ingest the medication, resulting in their death. According to the state of Oregon Public Health Division’s survey, the majority of the participants, 78%, where 65 years of age or older and predominately Caucasian, 93.1%. 72% of the terminally ill patients who opted for ending their own lives had been diagnosed with some form of cancer. In the state of Oregon’s 2015 survey, they asked the terminally ill who were participating in medical aid in dying, what their biggest end-of-life concerns were: 96.2 percent of those people mentioned the loss of the ability to participate in activities that once made them enjoy life, 92.4 percent mentioned the loss of autonomy, or their independence of their own thoughts or actions, and 75.4% percent stated loss of their dignity (Oregon Death With Dignity Act).

Washington State Statistics[edit]

An increasing trend in deaths caused from ingesting lethal doses of medications prescribed by physicians was also noted in Washington: from 64 deaths in 2009 to 202 deaths in 2015.[10] Among the deceased, 72% had terminal cancer and 8% had neurodegenerative diseases (including ALS).[10]

U.S. Polls[edit]

Polls conducted by Gallup dating back to 1947 positing the question, "When a person has a disease that cannot be cured, do you think doctors should be allowed to end the patient's life by some painless means if the patient and his family request it?" show support for the practice increasing from 37% in 1947 to a plateau of approximately 75% lasting from approximately 1990 to 2005. When the polling question was modified as such so the question posits "severe pain" as opposed to an incurable disease, "legalization" as opposed to generally allowing doctors, and "patient suicide" rather than physician administered euthanasia, public support was substantially lower, by approximately 10% to 15%.[11]

A poll conducted by National Journal and Regence Foundation found that both Oregonians and Washingtonians were more familiar with the terminology "end-of-life care" than the rest of the country and residents of both states are slightly more aware of the terms palliative and hospice care.[12]

A survey from the Journal of Palliative Medicine found that family caregivers of patients who chose medical AiD were more likely to find positive meaning in caring for a patient and were more prepared for accepting a patient's death than the family caregivers of patients who didn’t request AiD.[13]

Safeguards to protect vulnerable populations[edit]

Many current aid in dying laws contain oversight and investigative processes to ensure that the law is used only in eligible scenarios and within the confines of the law.

This includes stringent eligibility and qualification processes, mandatory state reporting by the medical team, and medical board oversight. In Oregon and other states, two doctors and two witnesses must attest that a person's request for aid in dying medication wasn’t coerced or under undue influence.

These safeguards include proving your residency and eligibility. You must meet with two physicians and they must confirm your diagnoses before you can continue, in some cases, they do include a psychiatric evaluation as well to determine whether or not the patient is making this decision on his/her own. The next steps are two oral requests, a waiting period of a minimum of 15 days before making your next request. A written request which must be witnessed by two different people, one of which cannot be a family member, and then another waiting period by your doctor in which they either say you're eligible for the drugs or not ("Death with Dignity").

"Slippery slope" fears not realized[edit]

The state of Oregon provides nearly two decades of data on their Death with Dignity Act.

An October 2007 study, published in the Journal of Medical Ethics, found that "rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS."[14]

Support organizations[edit]

Listed below are some major organizations that support medical aid in dying:

Death with Dignity National Center[edit]

The Death with Dignity National Center is a nonprofit organization that has been in existence since 1993. This organization is most notably associated with the original writing and continued advocating of the Oregon Death with Dignity Law that was enacted on October 27, 1997.[15][third-party source needed] Oregon, Washington, and Vermont laws state that mentally competent, and terminally ill adult patients can determine if they want to receive prescription medication so they can die in a humane and peaceful way.[16]

Dignitas (Switzerland)[edit]

Dignitas helps Swiss nationals and foreigners to die by providing advice and lethal drugs. The legal pre-requisites are that a person must have either a terminal illness, an unendurable incapacitating disability or unbearable and uncontrollable pain.[17] However, in practice they also accept mentally ill patients[18] or those without a medical diagnosis. 25% of people in Switzerland who take advantage of assisted suicide do not have a terminal illness but are "tired of life",[19] for example the retired British art teacher who killed herself on 27 March 2014 "in part because she had become fed up with the modern world of emails, TVs, computers and supermarket ready meals."[20]

Dignity in Dying[edit]

Dignity in Dying Is a United Kingdom based campaign group for the right to die, supporting members with advice and information[21].[22][23]

Disabled Activists for Dignity in Dying[edit]

DADID[24] is a campaign group in the UK for disabled people in association with Dignity in Dying, led by disabled people who support a change in the law to allow terminally ill, mentally competent adults the choice of an assisted death within upfront safeguards. Disability is an issue claimed both by activists and opponents in support of their arguments. Most court cases appealing for medical aid in dying have been brought by disabled persons. A Yougov poll[25] in the U.K. suggested that 80% of disabled persons support a change in the law, such as Lord Falconer's Bill[26] to allow some form of medical aid in dying.

Exit[edit]

Exit is a Scottish organization that supports a permissive model of right-to-die legislation[27] based on published research and recommendations from Glasgow University using an 'exceptions to the rule' (against euthanasia) format to facilitate transparency and open safeguards.[28] Exit published the world's first guide on medical aid in dying, called How to Die With Dignity (1980); followed by Departing Drugs (1993), and the Five Last Acts series.[29][30] Exit also publishes a Blog with broad-ranging analysis of assisted-suicide related issues.[31]

Exit International[edit]

Exit International is the publisher of the assisted dying guidebook The Peaceful Pill Handbook by Dr. Philip Nitschke and Dr. Fiona Stewart.[32] Founded in 2006 by Nitschke and based in Bellingham, Washington,[33] Exit International is a pro-choice assisted dying organization with an online membership of around 18,000 internationally. The organization holds meetings and workshops in the US, Canada, the UK and Ireland, Australia and New Zealand.

Final Exit Network[edit]

Final Exit Network, Inc. is a nonprofit organization founded in 2004 for the purpose of serving as a resource to individuals seeking information and emotional support in dying medically as a means to end suffering from chronically painful—though not necessarily terminal—illness.

World Federation of Right to Die Societies[edit]

The World Federation of Right to Die Societies was founded in 1980 and encompasses thirty-eight right to die organizations in twenty-three different countries.[34][third-party source needed]

Opposition[edit]

Medical ethics[edit]

Code of Ethics[edit]

The most current version of the American Medical Association’s Code of Ethics clearly states that physician-assisted suicide is prohibited. It prohibits physician-assisted suicide because it is “fundamentally incompatible with the physician’s role as healer” and because it would be “difficult or impossible to control, and would pose serious societal risks”. [35]

Hippocratic Oath[edit]

Some doctors[36] remind that physician-assisted suicide is contrary to the Hippocratic Oath of 400 BCE, which is the oath historically taken by physicians. It states "I will give no deadly medicine to anyone if asked, nor suggest any such counsel".[37][38] The original oath however has been modified many times and, contrary to popular belief, is not required by most modern medical schools.[39]

The Declaration of Geneva[edit]

The Declaration of Geneva is a revision of the Hippocratic Oath, first drafted in 1948 by the World Medical Association in response to forced euthanasia, eugenics and other medical crimes performed in Nazi Germany. It contains, "I will maintain the utmost respect for human life."[40]

The International Code of Medical Ethics[edit]

The International Code of Medical Ethics, last revised in 2006, includes "A physician shall always bear in mind the obligation to respect human life" in the section "Duties of physicians to patients".[41]

The Statement of Marbella[edit]

The Statement of Marbella was adopted by the 44th World Medical Assembly in Marbella, Spain, in 1992. It provides that "physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession."[42]

"Slippery slope" argument[edit]

Main article: Euthanasia and the slippery slope

There are many health care professionals[who?], especially those concerned with bioethics, who are opposed to PAS due to the detrimental effects that the procedure can have with regard to vulnerable populations. This argument is known as the "slippery slope".[43] This argument encompasses the apprehension that once PAS is initiated for the terminally ill it will progress to other vulnerable communities, namely the disabled, and may begin to be used by those who feel less worthy based on their demographic or socioeconomic status. In addition, vulnerable populations are more at risk of untimely deaths because, "patients might be subjected to PAS without their genuine consent".[44]

Religious stances[edit]

Buddhism[edit]

See also: Buddhism and euthanasia

According to Buddhist thought, assisted suicide and euthanasia constitute deliberate killing of another person. These practices contradict the fundamental Buddhist principle of refraining from killing a living being. Suicide is considered an uncompassionate act as it causes grief to others and is believed to deprive them of spiritual development. Buddhism also says that assisted suicide is uncompassionate because death will not relieve the killed person of suffering, and is instead thought to postpone the suffering to their next life. The perpetrator is also believed to experience negative karma and suffering in the next life, as killing another person, no matter the reason, is seen as a negative act.[citation needed]

Catholicism[edit]

The Roman Catholic Church acknowledges the fact that moral decisions regarding a person's life must be made according to one's own conscience and faith.[45] Catholic tradition has said that one's concern for the suffering of another is not a sufficient reason to decide whether it is appropriate to act upon euthanasia. According to the Catechism of the Catholic Church, "God is the creator and author of all life." In this belief system God created human life, therefore God is the judge when to end life.[45] From the Roman Catholic Church’s perspective, deliberately ending one’s life or the life of another is morally wrong and defies the Catholic doctrine. Furthermore, ending one’s life deprives that person and his or her loved ones of the time left in life and causes enormous grief and sorrow for those left behind.[46]

Pope Francis[47] is the current dominant figure of the Catholic Church. He affirms that death is a glorious event and should not be decided for by anyone other than God. Pope Francis insinuates that defending life means defending its sacredness.[48] The Roman Catholic Church teaches its followers that the act of euthanasia is unacceptable because it is perceived as a sin, as it goes against the Ten Commandments, "Thou shalt not kill. (You shall not kill)" As implied by the fifth commandment, the act of assisted suicide contradicts the dignity of human life as well as the respect one has for God.[49]

The Roman Catholic Church also recognizes the story of the Good Samaritan. It uses the story to call earnestly upon the Good Samaritan's actions and his love for his neighbor. In this tradition, the act of assisted suicide negates the respect and love we should have for our neighbors, as it mistakenly places the love God has for his followers in the hands of physicians.

As an alternative to the Physician-Assisted Suicide and in order to alleviate pain, the Catholic Church proposes that terminally ill patients focus on religion and making peace with the Creator while receiving the love and mercy of their families and caregivers.[50] Additionally, the Roman Catholic Church recommends that terminally ill patients should receive palliative care, which deals with physical pain while treating psychological and spiritual suffering as well, instead of Physician-Assisted Suicide.[51]

Judaism[edit]

While preservation of life is one of the greatest values in Judaism, there are rare instances of suicide and assisted suicide appearing in the Bible and Rabbinic literature.[52] The medieval authorities debate the legitimacy of those measures and in what limited circumstances they might apply. The conclusion of the majority of later rabbinic authorities, and accepted normative practice within Judaism, is that suicide and assisted suicide can not be sanctioned even for a terminal patient in intractable pain.[53]

Unitarian Universalism[edit]

According to a 1988 General Resolution, "Unitarian Universalists advocate the right to self-determination in dying, and the release from civil or criminal penalties of those who, under proper safeguards, act to honor the right of terminally ill patients to select the time of their own deaths".[54]

Mormonism[edit]

The Church of Jesus Christ of Latter-day Saints is against euthanasia. Anyone who takes part in euthanasia, including "assisted suicide", is regarded as having violated the commandments of God.[55] However the Church recognizes that when a person is in the final stages of terminal illness there may be difficult decisions to be taken. The Church states that 'When dying becomes inevitable, death should be looked upon as a blessing and a purposeful part of an eternal existence. Members should not feel obligated to extend mortal life by means that are unreasonable.[56]

Organizations opposed to assisted suicide[edit]

  • ADAPT – the American Disabled for Attendant Programs Today is a United States organisation that is active in the disability rights movement. They oppose the legalization of physician-assisted suicide, arguing that it is a "violation of the equal protection guaranteed by the Americans with Disabilities Act."[57]
  • Agudath Israel of America[58]
  • Autistic Self Advocacy Network
  • British Medical Association
  • Care Not Killing is a group based in the United Kingdom that combines a number of organisations opposed to assisted suicide under a common banner.[59]
  • Christian Medical Fellowship
  • Disability Rights Education and Defense Fund[60]
  • The Euthanasia Prevention Coalition International, founded in 1998 in Canada, is an international organisation opposed to euthanasia and assisted suicide.
  • Family First New Zealand[61]
  • Family Institute of Connecticut[62]
  • National Council on Disability
  • National Spinal Cord Injury Association
  • Not Dead Yet is a United States disability rights group that opposes assisted suicide and euthanasia for people with disabilities.[63]
  • Orthodox Union is one of the oldest Orthodox Jewish organizations in the United States.[64]
  • Patients' Rights Action Fund
  • Royal College of General Practitioners
  • Royal College of Physicians[65]
  • TASH is an international advocacy association of people with disabilities, their family members, other advocates, and people who work in the disability field. The mission of TASH is to promote the full inclusion and participation of children and adults with significant disabilities in every aspect of their community, and to eliminate the social injustices that diminish human rights.
  • The Russian Orthodox Church Canons consider any form of suicide, except suicides committed out of mental disturbances (insanity), a grave sin and a human fault: "A perpetrator of calculated suicide, who 'did it out of human resentment or other incident of faintheartedness' shall not be granted Christian burial or liturgical commemoration (Timothy of Alexandria, Canon 14).[66]
  • The United States Conference of Catholic Bishops has stated its opposition to assisted suicide.[67]
  • Voice for Life[68]
  • The World Medical Association's official position is: "Physicians-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient."[69]

Attitudes of physicians and healthcare professionals[edit]

It is widely acknowledged that physicians must play some role in the process of assisted suicide and euthanasia (as evident in the name "physician assisted suicide"), often putting them at the forefront of the issue. Decades of opinion research shows that physicians in the US and several European countries are less supportive of legalization of PAS than the general public.[70] In the US, although "about two-thirds of the American public since the 1970s" have supported legalization, surveys of physicians "rarely show as much as half supporting a move."[70] However, physician and other healthcare professional opinions vary widely on the issue of assisted suicide, as shown in the following tables.

StudyPopulationWilling to Assist PASNot Willing to Assist PAS
Canadian Medical Association, 2011[71]Canadian Medical Association (n=2,125)16%44%
Cohen, 1994 (NEJM)[72]Washington state doctors (n=938)40%49%
Lee, 1996 (NEJM)[73]Oregon state doctors (n=2,761)46%31%
StudyPopulationIn favor of PAS being legalNot in favor of PAS being legal
Medscape Ethics Report, 2014[74]U.S.-based doctors54%31%
Seale, 2009[70]United Kingdom physicians (n=3,733)35%62.2%
Cohen, 1994 (NEJM)[72]Washington state doctors (n=938)53%39%

Attitudes toward PAS vary by health profession as well; an extensive survey of 3733 medical physicians was sponsored by the National Council for Palliative Care, Age Concern, Help the Hospices, Macmillan Cancer Support, the Motor Neurone Disease Association, the MS Society and Sue Ryder Care showed that opposition to euthanasia and PAS was highest among Palliative Care and Care of the Elderly specialists, with more than 90% of palliative care specialists against a change in the law.[70]

In a 1997 study by Glasgow University's Institute of Law & Ethics in Medicine found pharmacists (72%) and anaesthetists (56%) to be generally in favor of legalizing PAS. Pharmacists were twice as likely as medical GPs to endorse the view that "if a patient has decided to end their own life then doctors should be allowed in law to assist".[75] A report published in January 2017 by NPR suggests that the thoroughness of protections that allow physicians to refrain from participating in the municipalities that legalized assisted suicide within the United States presently creates a lack of access by those who would otherwise be eligible for the practice.[76]

Legality by country[edit]

See also: Legality of euthanasia

Voluntary euthanasia was legalized in Colombia (in 1997),[77] the Netherlands (in 2002), Belgium (in 2002), Luxembourg (in 2008),[78] and Canada (in 2016).[79] Assisted suicide, where the patient has to take the final action themselves (unlike voluntary euthanasia), is legal in Canada, the Netherlands, Luxembourg, Switzerland and parts of the United States. In the United States there are assisted dying laws restricted to terminally ill and mentally competent adults in Oregon, Montana, Washington, Vermont, California, Colorado and Washington D.C.[80] Oregon was the first United States state to legalize assisted suicide, which was achieved through popular vote. The Act was a citizens' initiative passed twice by Oregon voters. The first time was in a general election in November 1994 when it passed by a margin of 51% to 49%. An injunction delayed implementation of the Act until it was lifted on October 27, 1997. In November 1997, a measure was placed on the general election ballot to repeal the Act. Voters chose to retain the Act by a margin of 60% to 40%.[81]

Australia[edit]

Main article: Euthanasia in Australia

Assisted suicide is currently illegal throughout Australia with the exception of Victoria where the Voluntary Assisted Dying Act 2017 (Victoria) was passed on 29 November 2017. It was legal in the Northern Territory for a short time under the Rights of the Terminally Ill Act 1995.

Belgium[edit]

The "Euthanasia Act" legalized euthanasia in Belgium in 2002,[82][83] but it didn't cover assisted suicide.[84]

In 2006, Belgium partially legalized euthanasia with certain regulations:

  • The patient must be an adult and in a "futile medical condition of constant and unbearable physical or mental suffering that cannot be alleviated".[85]
  • The patient must have a long-term history with the doctor, with euthanasia/physician assisted suicide only allowed for permanent residents.
  • There need to be several requests that are reviewed by a commission and approved by two doctors.[86]

As of November 2015, Belgium had the most liberal assisted suicide laws in the world.[87]

In 2014, Belgium became the first country to authorize euthanasia for children, on request, if they have a terminal illness and understand the repercussions of their act.[88]

Canada[edit]

Main article: Euthanasia in Canada

Suicide was considered a criminal offence in Canada until 1972. Physician-assisted suicide has been legal in the Province of Quebec since June 5, 2014.[89] It was declared legal across the country because of the Supreme Court of Canada decision Carter v Canada (AG), of February 6, 2015. After a lengthy delay, the House of Commons passed a Bill (C-14) in mid June 2016 that allows for doctor-assisted suicide. Between December 10, 2015 and June 30, 2017, since the passing of Bill C-14, over 2,149 medically assisted deaths were documented in Canada. Research published by Health Canada illustrates physician preference for physician administered euthanasia, citing concerns of effective administration and prevention of the potential complications of self-administration by patients.[90]

China[edit]

In China, assisted suicide is illegal under Articles 232 and 233 of the Criminal Law of the People's Republic of China.[91]

An article in People's Daily reported that "Nine people from Xi'an City in China made news when they 'jointly wrote to local media asking for euthanasia, or mercy killings'.[84] These people had uremia, a disease due to the failure of the kidneys, and expressed their "unbearable suffering and [an unwillingness] to burden their families any more".[85] In China, suicide or neglect is considered homicide and can be punished by three to seven years in prison.[92] Zhong’s[citation needed] case rejected the legality of assisted suicide.

Colombia[edit]

In May 1997 the Colombian Constitutional Court allowed for the euthanasia of sick patients who requested to end their lives, by passing Article 326 of the 1980 Penal Code.[86] This ruling owes its success to the efforts of a group that strongly opposed euthanasia. When one of its members brought a lawsuit to the Colombian Supreme Court against it, the court issued a 6 to 3 decision that "spelled out the rights of a terminally ill person to engage in voluntary euthanasia."[93]

In February 2015, the Supreme Court gave the government 30 days to create a comprehensive set of guidelines for doctors, to assist them in avoiding breaches of the law, as although technically legal, many physicians face lawsuits where they must prove that all legal requirements were met prior to the procedure. This fear of legal action has led many doctors to refuse to perform the procedure, in spite of its legality.[94]

Denmark[edit]

In Denmark, passive euthanasia, or the refusal to accept treatment is not illegal. But voluntary euthanasia when a patient actively tries to kill themselves is illegal. 71% of Denmark's population is in favor of legalizing assisted suicide.[95]

France[edit]

The controversy over legalising euthanasia and physician assisted suicide is not as big as in the United States because of the country's "well developed hospice care programme".[96] However, in 2000 the controversy over the topic was ignited with Vincent Humbert. After a car crash that left him "unable to 'walk, see, speak, smell or taste'", he used the movement of his right thumb to write a book, I Ask the Right to Die (Je vous demande le droit de mourir) in which he voiced his desire to "die legally".[96] After his appeal was denied, his mother assisted in killing him by injecting him with an overdose of barbiturates that put him into a coma, killing him 2 days later. Though his mother was arrested for aiding in her son's death and later acquitted, the case did jump-start new legislation which states that when medicine serves "no other purpose than the artificial support of life" it can be "suspended or not undertaken".[97]

In 2013 President Francois Hollande said that France should hold a national debate on the issue, and stated his intention to introduce a bill to parliament before the end of the year. Opinion polls in France show that the majority of the public are in favor of an assisted suicide law,[98] however France's national ethics committee has advised against any change in the law.[99]

Germany[edit]

Killing somebody in accordance with his demands is always illegal under the German criminal code (Paragraph 216, "Killing at the request of the victim; mercy killing").[100]

Assisting with suicide by, for example, providing poison or a weapon, is generally legal. Since suicide itself is legal, assistance or encouragement is not punishable by the usual legal mechanisms dealing with complicity and incitement (German criminal law follows the idea of "accessories of complicity" which states that "the motives of a person who incites another person to commit suicide, or who assists in its commission, are irrelevant").[101] Nor is assisting with suicide explicitly outlawed by the criminal code. There can however be legal repercussions under certain conditions for a number of reasons. Aside from laws regulating firearms, the trade and handling of controlled substances and the like (e.g. when acquiring poison for the suicidal person), this concerns three points:

Free vs. manipulated will[edit]

If the suicidal person is not acting out of his own free will, then assistance is punishable by any of a number of homicide offences that the criminal code provides for, as having "acted through another person" (§25, section 1 of the German criminal code,[102] usually called "mittelbare Täterschaft"). Action out of free will is not ruled out by the decision to end one's life in itself; it can be assumed as long as a suicidal person "decides on his own fate up to the end [...] and is in control of the situation."[101]

Free will cannot be assumed, however, if someone is manipulated or deceived. A classic textbook example for this, in German law, is the so-called Sirius case on which the Federal Court of Justice ruled in 1983: The accused had convinced an acquaintance that she would be re-incarnated into a better life if she killed herself. She unsuccessfully attempted suicide, leading the accused to be charged with, and eventually convicted of attempted murder.[103] (The accused had also convinced the acquaintance that he hailed from the star Sirius, hence the name of the case).

Apart from manipulation, the criminal code states three conditions under which a person is not acting under his own free will:

  1. if the person is under 14
  2. if the person has "one of the mental diseases listed in §20 of the German Criminal Code"[104]
  3. a person that is acting under a state of emergency.

Under these circumstances, even if colloquially speaking one might say a person is acting of his own free will, a conviction of murder is possible.

Neglected duty to rescue[edit]

German criminal law obliges everybody to come to the rescue of others in an emergency, within certain limits (§323c of the German criminal code, "Omission to effect an easy rescue").[105] This is also known as a duty to rescue in English. Under this rule, the party assisting in the suicide can be convicted if, in finding the suicidal person in a state of unconsciousness, he does not do everything in his power to revive him.[106] In other words, if someone assists a person in committing suicide, leaves, but comes back and finds the person unconscious, he must try to revive him.[107]

This reasoning is disputed by legal scholars, citing that a life-threatening condition that is part, so to speak, of a suicide underway, is not an emergency. For those who would rely on that defence, the Federal Court of Justice has considered it an emergency in the past.

Homicide by omission[edit]

German law puts certain people in the position of a warrantor (Garantenstellung) for the well-being of another, e.g. parents, spouses, doctors and police officers. Such people might find themselves legally bound to do what they can to prevent a suicide; if they do not, they are guilty of homicide by omission.

Iceland[edit]

Assisted suicide is illegal. "At the current time, there are no initiatives in Iceland that seek the legalization of euthanasia or assisted suicide. The discussion on euthanasia has never received any interest in Iceland, and both lay people and health care professionals seem to have little interest in the topic. A few articles have appeared in newspapers but gained little attention."[108]

Ireland[edit]

Assisted suicide is illegal." Both euthanasia and assisted suicide are illegal under Irish law. Depending on the circumstances, euthanasia is regarded as either manslaughter or murder and is punishable by up to life imprisonment." [109]

Luxembourg[edit]

In March 2003, a vote to legalise assisted suicide was lost by a single vote (at the time, assisted suicide was not illegal, as suicide was permitted under the criminal code, but a person assisting someone to take their own life could face prosecution).[110] After again failing to get royal assent for legalizing euthanasia and assisted suicide, in December 2008 Luxembourg's parliament amended the country's constitution to take this power away from the monarch, the Grand Duke of Luxembourg.[111] Euthanasia and assisted suicide were legalized in the country in April, 2009.[112]

The Netherlands[edit]

Main article: Euthanasia in the Netherlands

Physician-assisted suicide is legal under the same conditions as euthanasia. Physician-assisted suicide became allowed under the Act of 2001 which states the specific procedures and requirements needed in order to provide such assistance. Assisted suicide in the Netherlands follows a medical model which means that only doctors of terminally ill patients are allowed to grant a request for an assisted suicide. The Netherlands only allows people over the age of 12 to pursue an assisted suicide when deemed necessary.

New Zealand[edit]

Main article: Euthanasia in New Zealand

Assisted suicide is illegal in New Zealand. Under Section 179 of the Crimes Act 1961, it is illegal to 'aid and abet suicide.'

South Africa[edit]

South Africa is struggling with the debate over legalizing euthanasia. Owing to the underdeveloped health care system that pervades the majority of the country, Willem Landman, "a member of the South African Law Commission, at a symposium on euthanasia at the World Congress of Family Doctors" stated that many South African doctors would be willing to perform acts of euthanasia when it became legalized in the country.[113] He feels that because of the lack of doctors in the country, "[legalizing] euthanasia in South Africa would be premature and difficult to put into practice [...]".[113]

On 30 April 2015 the High Court in Pretoria granted Advocate Robin Stransham-Ford an order that would allow a doctor to assist him in taking his own life without the threat of prosecution. On 6 December 2016 the Supreme Court of Appeal overturned the High Court ruling.[114]

Switzerland[edit]

Main article: Euthanasia in Switzerland

Though it is illegal to assist a patient in dying in some circumstances, there are others where there is no offence committed.[115] The relevant provision of the Swiss Criminal Code[116] refers to "a person who, for selfish reasons, incites someone to commit suicide or who assists that person in doing so will, if the suicide was carried out or attempted, be sentenced to a term of imprisonment (Zuchthaus) of up to 5 years or a term of imprisonment (Gefängnis)."

A person brought to court on a charge could presumably avoid conviction by proving that they were "motivated by the good intentions of bringing about a requested death for the purposes of relieving "suffering" rather than for "selfish" reasons.[117] In order to avoid conviction, the person has to prove that the deceased knew what he or she was doing, had capacity to make the decision, and had made an "earnest" request, meaning he/she asked for death several times. The person helping also has to avoid actually doing the act that leads to death, lest they be convicted under Article 114: Killing on request (Tötung auf Verlangen) - A person who, for decent reasons, especially compassion, kills a person on the basis of his or her serious and insistent request, will be sentenced to a term of imprisonment (Gefängnis). For instance, it should be the suicide subject who actually presses the syringe or takes the pill, after the helper had prepared the setup.[118] This way the country can criminalise certain controversial acts, which many of its people would oppose, while legalising a narrow range of assistive acts for some of those seeking help to end their lives.

In July 2009, British conductor Sir Edward Downes and his wife Joan died together at a suicide clinic outside Zürich "under circumstances of their own choosing". Sir Edward was not terminally ill, but his wife was diagnosed with rapidly developing cancer.[119]

In March 2010, the PBS FRONTLINE TV program in the United States showed a documentary called "The Suicide Tourist" which told the story of Professor Craig Ewert, his family, and Dignitas, and their decision to commit assisted suicide using sodium pentobarbital in Switzerland after he was diagnosed and suffering with ALS (Lou Gehrig's disease).[120]

In May 2011, Zurich held a referendum that asked voters whether (i) assisted suicide should be prohibited outright; and (ii) whether Dignitas and other assisted suicide providers should not admit overseas users. Zurich voters heavily rejected both bans, despite anti-euthanasia lobbying from two Swiss social conservative political parties, the Evangelical People's Party of Switzerland and Federal Democratic Union. The outright ban proposal was rejected by eighty four percent of voters, while seventy eight percent voted to keep services open should overseas users require them.[121]

In June 2011, The BBC televised the assisted suicide of Peter Smedley, a canning factory owner, who was suffering from motor neurone disease. The programme – Sir Terry Pratchett's Choosing To Die – told the story of Peter's journey to the end where he used The Dignitas Clinic, a euthanasia clinic in Switzerland, to assist him in carrying out the taking of his own life. The programme shows Peter eating chocolates to counter the unpalatable taste of the liquid he drinks to end his own life. Moments after drinking the liquid, Peter begged for water, gasped for breath and became red, he then fell into a deep sleep where he snored heavily while holding his wife's hand. Minutes later, Peter stopped breathing and his heart stopped beating.

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