Global Overview of Assisted Dying Laws and Their Variations

For the first time in nearly a decade, Members of Parliament are scheduled to vote on Friday on legislation that would grant terminally ill adults in England and Wales the option of an assisted death. While this practice remains prohibited in the majority of nations, over 300 million individuals now reside in countries where assisted dying has been legalized. Since 2015—the year UK MPs last addressed this matter—Canada, Australia, New Zealand, Spain, and Austria have all enacted assisted dying legislation, with some provisions extending to individuals who are not terminally ill. The proposed bill for England and Wales incorporates safeguards that proponents assert would establish the most stringent regulations globally, necessitating a High Court judge’s approval for patients. Conversely, opponents contend that altering the law would constitute a perilous move, endangering vulnerable individuals. They maintain that efforts should instead concentrate on enhancing inconsistent access to palliative care services. In anticipation of Friday’s vote, an examination of assisted dying legislation across North America, Europe, and Australasia is presented. Within the United States, assisted dying—a practice some detractors refer to as assisted suicide—is permissible in 10 states and Washington DC. Oregon pioneered offering assistance to die for certain patients in 1997, accumulating over 25 years of experience, and has served as the blueprint for subsequent US assisted dying statutes. In Oregon, assisted dying is available to mentally competent adults who are terminally ill and projected to die within six months, requiring endorsement from two physicians. Since 1997, 4,274 individuals have been prescribed a lethal dose of medication, resulting in 2,847 (67%) deaths. Last year, cancer affected two-thirds of patients in Oregon who sought assistance to die. Approximately one in ten had a neurological condition, and a similar percentage suffered from heart disease. Among the 367 patients who ingested a lethal dose of medication last year, the overwhelming majority (91.6%) identified loss of autonomy as a primary concern, while other reasons included: In Oregon, mirroring other US states where assisted dying is allowed, the lethal medication must be self-administered—a requirement also proposed for England and Wales. Approximately one-third of individuals who receive a prescription for a lethal dose ultimately do not proceed with it. Oregon holds significance for proponents of assisted dying in England and Wales, who highlight that its provisions have consistently been limited to terminally ill adults since inception. Nevertheless, opponents assert that certain regulations have been loosened. A residency stipulation has been removed, thereby making it accessible to individuals from outside the state. Furthermore, the volume of assisted deaths has seen a considerable increase over time. Canada is frequently referenced by opponents of assisted dying as an illustration of the so-called “slippery slope” phenomenon—a jurisdiction where assisted dying has been broadened and made accessible to a wider demographic since its initial implementation. Medical assistance in dying (Maid) was established in 2016, initially exclusively for the terminally ill. This was revised in 2021, expanding eligibility to individuals enduring “unbearable suffering” from an irreversible illness or disability. Despite postponements, it is still slated to become available to those with a mental illness in three years. Critics argue that further expansion of the law will increasingly jeopardize disabled and vulnerable individuals. A significant increase in the number of people utilizing Maid has also been observed. Currently, four out of every 100 deaths in Canada are medically assisted, in contrast to approximately one in 100 in Oregon. Kim Leadbeater, the Member of Parliament who introduced the assisted dying bill in Westminster, states that the Canadian framework is distinct from what is under consideration for England and Wales, where eligibility would be confined to the terminally ill. In Europe, six nations permit some form of legalized assisted dying: Switzerland, the Netherlands, Belgium, Luxembourg, Spain, and Austria. In each of these countries—in contrast to the proposals for England and Wales—the option of assistance to die is not limited to the terminally ill. Switzerland became the first nation globally to establish a “right to die” when it legalized assisted suicide in 1942. It stands as one of the few countries that grants foreigners access to assistance in dying through organizations such as Dignitas, located in Zurich. Over the past two decades, more than 500 Britons have died at Dignitas, with 40 occurring last year. The lethal medication must be self-administered. The Netherlands and Belgium both legalized assisted dying over two decades ago for patients enduring unbearable suffering from an incurable illness, encompassing mental health conditions. This provision has since been expanded to include children, making them the sole European nations to permit this. Both countries sanction euthanasia, or physician-assisted dying. More recently, Spain and Austria have legalized assisted dying for cases involving both terminal illness and intolerable suffering. In Austria, the medications must be self-administered, while in Spain, a medical professional is permitted to administer them. Notwithstanding these differences, it is evident that the criteria for assisted dying are considerably broader across Europe compared to what is being proposed anywhere within the British Isles. Members of the Scottish Parliament (MSPs) at Holyrood are scheduled to discuss a bill for Scotland that mirrors the one being voted on at Westminster. In the Isle of Man parliament, a bill permitting terminally ill adult patients with 12 months or less to live to die has almost completed all legislative stages. This legislation is anticipated to receive Royal Assent next year, with the first assisted death on the island potentially occurring in 2027. A five-year residency requirement is included. Jersey has also pledged to amend its laws to permit assisted dying for the terminally ill. Over the last several years, voluntary assisted dying has been legalized throughout the majority of Australia. In New Zealand, however, patients must be terminally ill and have a life expectancy of six months or less. This timeframe is extended to 12 months for individuals with a neurodegenerative condition in specific regions of Australia. In both nations, patients have the option to self-administer the lethal medication, though it can also be administered by a doctor or nurse, typically through an intravenous injection. Further reporting was contributed by Anthony Reuben and Gerry Georgieva. Copyright 2024 BBC. All rights reserved. The BBC disclaims responsibility for the content found on external websites. Information regarding our policy on external linking is available.