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Assisted suicide

May 13, 2023

For other uses, see Assisted dying (disambiguation).

Assisted suicide is suicide undertaken with the aid of another person.[1] The term usually refers to physician-assisted suicide (PAS), which is suicide that is assisted by a physician or another healthcare provider. Once it is determined that the person's situation qualifies under the physician-assisted suicide laws for that location, the physician's assistance is usually limited to writing a prescription for a lethal dose of drugs.

Current status of assisted suicide around the world:
  Physician-assisted suicide is legal
  Legalized by court ruling, but not legislated or regulated
  Physician-assisted suicide is illegal

In many jurisdictions, helping a person die by suicide is a crime.[2] People who support legalizing physician-assisted suicide want the people who assist in a voluntary death to be exempt from criminal prosecution for manslaughter or similar crimes. Physician-assisted suicide is legal in some countries, under certain circumstances, including Austria, Belgium, Canada, Germany, Luxembourg, the Netherlands, New Zealand, Spain, Switzerland, parts of the United States and all six states of Australia. The constitutional courts of Colombia, Germany and Italy legalized assisted suicide, but their governments have not legislated or regulated the practice yet.

In most of those states or countries, to qualify for legal assistance, individuals who seek a physician-assisted suicide must meet certain criteria, including: having a terminal illness, proving they are of sound mind, voluntarily and repeatedly expressing their wish to die, and taking the specified, lethal dose by their own hand. The laws vary in scope from place to place. In the United States, PAS is limited to those who have a prognosis of six months or less to live. In other countries such as Germany, Canada, Switzerland, Spain, Italy, Austria, Belgium and the Netherlands, a terminal diagnosis is not a requirement and voluntary euthanasia is additionally allowed.[3]

Terminology

 
Secobarbital is one of the most commonly prescribed drugs for physician-assisted suicide in the United States.[4]

Suicide is the act of killing oneself. Assisted suicide is when another person materially helps an individual person die by suicide, such as providing tools or equipment, while physician-assisted suicide involves a physician (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".[5]

Assisted suicide is contrasted to euthanasia, sometimes referred to as mercy killing, where the person dying does not directly bring about their own death, but is killed in order to stop the person from experiencing further suffering. Euthanasia can occur with or without consent, and can be classified as voluntary, non-voluntary or involuntary. Killing a person who is suffering and who consents is called voluntary euthanasia. This is currently legal in some regions.[6] If the person is unable to provide consent it is referred to as non-voluntary euthanasia. Killing a person who does not want to die, or who is capable of giving consent and whose consent has not been solicited, is the crime of involuntary euthanasia, and is regarded as murder.

Right to die is the belief that people have a right to die, either through various forms of suicide, euthanasia, or refusing life-saving medical treatment.

Suicidism can be defined as "the quality or state of being suicidal"[7] or as "... an oppressive system (stemming from non-suicidal perspectives) functioning at the normative, discursive, medical, legal, social, political, economic, and epistemic levels in which suicidal people experience multiple forms of injustice and violence..."[8]

Assisted dying versus assisted suicide

Some advocates for assisted suicide strongly oppose the use of "assisted suicide" and "suicide" when referring to physician-assisted suicide, and prefer phrases like "medical aid in dying" or "assisted dying". The motivation for this is to distance the debate from the suicides commonly performed by those not terminally ill and not eligible for assistance where it is legal. They feel those cases have negatively impacted the word "suicide" to the point that it should not be used to refer to the practice of a physician prescribing lethal drugs to a person with a terminal illness.[9][10] However, in certain jurisdictions, like Canada, "aid in dying" does not require a person's natural death to be reasonably foreseeable in order to be eligible for MAiD. Moreover, the term "assisted dying" is also used to refer to other practices like voluntary euthanasia and terminal sedation.[11][12]

Physician-assisted suicide

Support

Arguments for

Arguments in support of assisted death include respect for patient autonomy, equal treatment of terminally ill patients on and off life support, compassion, personal liberty, transparency[13] and ethics of responsibility.[8] When death is imminent (half a year or less) patients can choose to have assisted death as a medical option to shorten what the person perceives to be an unbearable dying process.

Death With Dignity is coined as the United States national leader in end of life advocacy and policy reform. The organization has been advocating for physician-assisted suicide and euthanasia since 1994. [14]

Pain is mostly not reported as the primary motivation for seeking physician-assisted suicide in the United States;[15] 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 (75.4%).[16]

Oregon statistics

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 a lethal prescription for barbiturates, the drug used for physician-assisted death.[17]

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-in-dying (AiD) was authorized in 2013.[18]

In February 2016, Oregon released a report on its 2015 numbers. In 2015, there were 218 people in the state who were approved and received the lethal drugs to end their own life. Of that 218, 132 terminally ill patients ultimately decided to ingest drugs, resulting in their death. According to the state of Oregon Public Health Division's survey, the majority of the participants, 78%, were 65 years of age or older and predominantly white, 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% of those people mentioned the loss of the ability to participate in activities that once made them enjoy life, 92.4% mentioned the loss of autonomy, or the independence of their own thoughts or actions, and 75.4% stated loss of their dignity.[19]

Washington State statistics

An increasing trend in deaths caused by ingesting lethal doses of medications prescribed by physicians was also noted in Washington: from 64 deaths in 2009 to 202 deaths in 2015.[20] Among the deceased, 72% had terminal cancer and 8% had neurodegenerative diseases (including ALS).[20]

U.S. polls

Polls conducted by Gallup dating back to 1947 posit 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 voluntary euthanasia, public support was substantially lower, by approximately 10% to 15%.[15]

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.[21]

A survey from the Journal of Palliative Medicine found that family caregivers of patients who chose assisted death 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 did not request assisted death.[22]

Safeguards

Many current assisted death laws contain provisions that are intended to provide oversight and investigative processes to prevent abuse. This includes 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 assert that a person's request for a lethal prescription was not coerced or under undue influence.

These safeguards include proving one's residency and eligibility. The patient must meet with two physicians and they must confirm the diagnoses before one can continue the procedure; in some cases, they do include a psychiatric evaluation as well to determine whether or not the patient is making this decision on their own. The next steps are two oral requests, a waiting period of a minimum of 15 days before making the 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 the patient's doctor in which they say whether they are eligible for the drugs or not ("Death with Dignity").

The debate about whether these safeguards work is debated between opponents and proponents.

A 1996 survey of Oregon emergency physicians found that "Only 37% indicated that the Oregon initiative has enough safeguards to protect vulnerable persons." 83% agreed that patients "Might feel pressure because of burden to others" and 70% agreed that patients "Might feel pressure because of financial concerns".[23]

Religious stances in favor

Unitarian Universalism

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".[24]

Opposition

Medical ethics

Hippocratic Oath

Some doctors[25] remind that physician-assisted suicide is contrary to the Hippocratic Oath, which is the oath historically taken by physicians. It states "I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan.".[26][27] The original oath however has been modified many times and, contrary to popular belief, is not required by most modern medical schools, nor confers any legal obligations on individuals who choose to take it.[28] There are also procedures forbidden by the Hippocratic Oath which are in common practice today, such as abortion and execution.[29]

Declaration of Geneva

The Declaration of Geneva is a revision of the Hippocratic Oath, first drafted in 1948 by the World Medical Association in response to forced (involuntary) euthanasia, eugenics and other medical crimes performed in Nazi Germany. It contains, "I will maintain the utmost respect for human life."[30]

International Code of Medical Ethics

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".[31]

Statement of Marbella

The Statement of Marbella was adopted by the 44th World Medical Assembly in Marbella, Spain, in 1992. It provides that "physician-assisted suicide, like voluntary euthanasia, is unethical and must be condemned by the medical profession."[32]

Concerns of expansion to people with chronic disorders

Main article: Euthanasia and the slippery slope

A concern present among health care professionals who are opposed to PAS, are the detrimental effects that the procedure can have with regard to vulnerable populations. This argument is known as the "slippery slope".[33] This argument encompasses the apprehension that once PAS is initiated for the terminally ill it will progress to other vulnerable communities, namely disabled people, 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".[34]

Religious stances in opposition

Catholicism

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.[35] 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 voluntary 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 of when to end life.[35] 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 grief and sorrow for those left behind.[36]

Pope Francis[37] 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.[38] 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 one of the Ten Commandments. As implied by the sixth commandment, "Thou shalt not kill (You shall not kill)," the act of assisted suicide contradicts the dignity of human life as well as the respect one has for God.[39][36] 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.[40]

Judaism

While preservation of life is one of the greatest values in Judaism, there are instances of suicide and assisted suicide appearing in the Bible and Rabbinic literature.[41] 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.[42]

The Church of Jesus Christ of Latter-day Saints

The Church of Jesus Christ of Latter-day Saints (LDS Church) is against assisted suicide and euthanasia, and anyone who takes part in either is regarded as having violated the commandments of God.[43] 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".[44]

Neutrality

There have been calls for organisations representing medical professionals to take a neutral stance on PAS, rather than a position of opposition. The reasoning is that this supposedly would better reflect the views of medical professionals and that of wider society, and prevent those bodies from exerting undue influence over the debate.[45][46][47]

The UK Royal College of Nursing voted in July 2009 to move to a neutral position on PAS.[48]

The California Medical Association dropped its long-standing opposition in 2015 during the debate over whether a Physician Assisted Suicide bill should be introduced there, prompted in part by cancer sufferer Brittany Maynard.[49] The California End of Life Option Act was signed into law later that year.

In December 2017, the Massachusetts Medical Society (MMS) voted to repeal their opposition to physician-assisted suicide and adopt a position of neutrality.[50]

In October 2018, the American Academy of Family Physicians (AAFP) voted to adopt a position of neutrality from one of opposition. This is contrary to the position taken by the American Medical Association (AMA), which opposes it.[51]

In January 2019 the British Royal College of Physicians announced it would adopt a position of neutrality until two-thirds of its members think it should either support or oppose the legalization of PAS.[52]

In September 2021, the largest doctors union in the United Kingdom, the British Medical Association, adopted a neutral stance towards a change in the law on assisted dying, replacing their position of opposition which had been in place since 2006.[53]

American Medical Association Code of Ethics

The American Medical Association (AMA) opposes physician-assisted suicide. In response to the ongoing debate about PAS, the AMA has issued guidance for both those who support and oppose physician-assisted suicide. The AMA Code of Ethics Opinion 5.7 reads that "Physician-assisted suicide is fundamentally incompatible with the physician's role as healer" and that it would be "difficult or impossible to control, and would pose serious societal risks" but does not explicitly prohibit the practice. In the AMA Code of Ethics Opinion 1.1.7, which the AMA states "articulates the thoughtful moral basis for those who support assisted suicide", it is written that outside of specific situations in which physicians have clear obligations, such as emergency care or respect for civil rights, "physicians may be able to act (or refrain from acting) in accordance with the dictates of their conscience without violating their professional obligations."[54]

Attitudes of healthcare professionals

It is widely believed that physicians should play a significant role, usually expressed as "gatekeeper", in the process of assisted suicide and voluntary euthanasia (as evident in the name "physician-assisted suicide"), often putting them at the forefront of the issue. Decades of opinion research show that physicians in the US and several European countries are less supportive of the legalization of PAS than the general public.[55] 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".[55] However, physician and other healthcare professional opinions vary widely on the issue of physician-assisted suicide, as shown in the following tables.

Study Population Willing to Assist PAS Not Willing to Assist PAS
Canadian Medical Association, 2011[56] Canadian Medical Association (n=2,125) 16% 16
 
 44% 44
 
Cohen, 1994 (NEJM)[57] Washington state doctors (n=938) 40% 40
 
 49% 49
 
Lee, 1996 (NEJM)[58] Oregon state doctors (n=2,761) 46% 46
 
 31% 31
 
Study Population In favor of PAS being legal Not in favor of PAS being legal
Medscape Ethics Report, 2014[59] U.S.-based doctors 54% 54
 
 31% 31
 
Seale, 2009[55] United Kingdom physicians (n=3,733) 35% 35
 
 62.2% 62.2
 
Cohen, 1994 (NEJM)[57] Washington state doctors (n=938) 53% 53
 
 39% 39
 

A 2019 survey of US physicians found that 60% of physicians answered 'yes' to the question "Should PAS be legalized in your state?" The survey discovered that physicians are concerned about a possible "slippery slope". 30% agreed that "PAS/AID would lead to the legalization of euthanasia" and 46% agreed that "Health insurance companies would cover PAS/AID over more expensive, possibly life-saving treatments, like chemotherapy".[60] The survey also found that physicians generally misunderstand why patients seek PAS. 49% of physicians agreed that "Most patients who seek PAS/AID do so because of physical pain", whereas studies in Oregon found that "the three most frequently mentioned end-of-life concerns were loss of autonomy (89.5%), decreasing ability to participate in activities that made life enjoyable (89.5%), and loss of dignity (65.4%)."[61] In addition, the survey found uncertainty about the adequacy of safeguards. While 59% agreed that "Current PAS laws provide adequate safeguards", there was greater concern with respect to specific safeguards. 60% disagreed that "Physicians who are not psychiatrists are sufficiently trained to screen for depression in patients who are seeking PAS" and 60% disagreed that "Most physicians can predict with certainty whether a patient seeking PAS/AID has 6 months or less to live".[60] The concern about adequate safeguards is even greater among Oregon emergency physicians, among whom one study found that “Only 37% indicated that the Oregon initiative has enough safeguards to protect vulnerable persons."[23]

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 voluntary 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.[55]

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".[62] 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.[63]

A poll in the United Kingdom showed that 54% of General Practitioners are either supportive or neutral towards the introduction of assisted dying laws.[64] A similar poll on Doctors.net.uk published in the BMJ said that 55% of doctors would support it.[65] In contrast the BMA, which represents doctors in the UK, opposes it.[66]

An anonymous, confidential postal survey of all General Practitioners in Northern Ireland, conducted in the year 2000, found that over 70% of responding GPs were opposed to physician-assisted suicide and voluntary active euthanasia.[67]

Legality

 
Current status of assisted suicide around the world:
  Physician-assisted suicide is legal
  Legalized by court ruling, but not legislated or regulated
  Physician-assisted suicide is illegal

Physician-assisted suicide is legal in some countries, under certain circumstances, including Austria,[68][69] Belgium,[70] Canada,[71] Luxembourg,[72] the Netherlands,[73] New Zealand,[74] Spain,[75] Switzerland[76] and parts of the United States (California,[77] Colorado,[78] Hawaii,[79] Maine,[80] Montana,[note 1][81] New Jersey,[82] New Mexico,[83] Oregon,[84] Vermont,[85] Washington[86] and Washington DC[87]) and Australia (New South Wales,[88] Queensland,[89] South Australia,[90] Tasmania,[91] Victoria[92] and Western Australia[93]). The Constitutional Courts of Colombia,[94][95][96] Germany[97] and Italy[98] legalized assisted suicide, but their governments have not legislated or regulated the practice yet.

Australia

Main article: Euthanasia in Australia

Laws regarding assisted suicide in Australia are a matter for state and territory governments. Physician assisted suicide is currently legal in all Australian states: New South Wales,[88] Victoria,[99]South Australia, Western Australia,[100] Tasmania[101] and Queensland.[102] It remains illegal in all Australian territories.

Under Victorian law, patients can ask medical practitioners about voluntary assisted dying, and doctors, including conscientious objectors, should refer to appropriately trained colleagues who do not conscientiously object.[103] Health practitioners are restricted from initiating conversation or suggesting voluntary assisted dying to a patient unprompted.

Voluntary euthanasia was legal in the Northern Territory for a short time under the Rights of the Terminally Ill Act 1995, until this law was overturned by the Federal Government which also removed the ability for territories to pass legislation relating to assisted dying, however this was repealed in December 2022 with the passing of Restoring Territory Rights Act. The highly controversial 'Euthanasia Machine', the first invented voluntary assisted dying machine of its kind, created by Philip Nitschke, utilised during this period is presently held at London's Science Museum.[104]

Austria

 
Current status of assisted suicide in Europe:
  Physician-assisted suicide is legal
  Legalized by court ruling, but not legislated or regulated
  Assisted suicide is not legal

In December 2020, the Austrian Constitutional Court ruled that the prohibition of assisted suicide was unconstitutional.[105] In December 2021, the Austrian Parliament legalized assisted suicide for those who are terminally ill or have a permanent, debilitating condition.[106][107]

Belgium

The Euthanasia Act legalized voluntary euthanasia in Belgium in 2002,[108][109] but it did not cover physician-assisted suicide.[110]

Canada

Main article: Assisted suicide in Canada

In Canada, physician-assisted suicide was first legalized in the Province of Quebec on 5 June 2014.[111] It was declared nationally legal by the Supreme Court of Canada on 6 February 2015, in Carter v. Canada (Attorney General).[112]

National legislation formalizing physician-assisted suicide passed in mid-June 2016, for patients facing an estimated death within six months.[113] Eligibility criteria have been progressively expanded over time. As of March 2021, individuals no longer need to be terminally ill in order to qualify for assisted suicide.[114] Legislation allowing for assisted suicide for mental illness was expected to come into force on March 17 2023, but has since been postponed until 2024.[115]

Between 10 December 2015 and 30 June 2017, 2,149 medically assisted deaths were documented in Canada. Research published by Health Canada illustrates physician preference for physician-administered voluntary euthanasia, citing concerns about effective administration and prevention of the potential complications of self-administration by patients.[116]

China

In China, assisted suicide is illegal under Articles 232 and 233 of the Criminal Law of the People's Republic of China.[117] In China, suicide or neglect is considered homicide and can be punished by three to seven years in prison.[118] In May 2011, Zhong Yichun, a farmer, was sentenced to two years imprisonment by the People's Court of Longnan County, in China's Jiangxi Province for assisting Zeng Qianxiang to die by suicide. Zeng had a mental illness and repeatedly asked Zhong to help him die by suicide. In October 2010, Zeng took excessive sleeping pills and lay in a cave. As planned, Zhong called him 15 minutes later to confirm that he was dead and buried him. However, according to the autopsy report, the cause of death was from suffocation, not an overdose. Zhong was convicted of criminal negligence. In August 2011, Zhong appealed the court sentence, but it was rejected.[118]

In 1992, a physician was accused of murdering a patient with advanced cancer by lethal injection. He was eventually acquitted.[118]

Colombia

In May 1997 the Colombian Constitutional Court allowed for the voluntary euthanasia of sick patients who requested to end their lives, by passing Article 326 of the 1980 Penal Code.[119] This ruling owes its success to the efforts of a group that strongly opposed voluntary 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".[120]

Publicized cases

In January 2022 Victor Escobar became the first person in the Andean country with a non-terminal illness to die by legally regulated euthanasia. The 60-year-old Escobar had end-stage chronic obstructive pulmonary disease.[121]

Denmark

Assisted suicide is illegal in Denmark. Passive euthanasia, or the refusal to accept treatment, is not illegal. A survey from 2014 found that 71% of Denmark's population was in favor of legalizing voluntary euthanasia and physician-assisted suicide.[122]

France

Assisted suicide is not legal in France. The controversy over legalising voluntary euthanasia and physician-assisted suicide is not as big as in the United States because of the country's "well developed hospice care programme".[123] 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".[123] 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 two 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".[124]

Germany

Killing somebody in accordance with their demands is always illegal under the German criminal code (Paragraph 216, "Killing at the request of the victim").[125]

Assisting suicide is generally legal and the Federal Constitutional Court has ruled that it is generally protected under the Basic Law; in 2020, it overturned a ban on the commercialization of assisted suicide.[105] 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").[126]

Travel to Switzerland

Between 1998 and 2018 around 1250 German citizens (almost three times the number of any other nationality) travelled to Dignitas in Zurich, Switzerland, for an assisted suicide, where this has been legal since 1998.[127][unreliable source?][128] Switzerland is one of the few countries that permit assisted suicide for non-resident foreigners.[129]

Physician-assisted suicide

Physician-assisted suicide was formally legalised on 26 February 2020 when Germany's top court removed the prohibition of "professionally assisted suicide".[130]

Iceland

Assisted suicide is illegal.[131]

Ireland

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."[132]

Italy

On 25 September 2019, the Italian Constitutional Court ruling 242/2019 declared that article 580 of the criminal code was unconstitutional; the decriminalisation of assisted suicide in the case of those who aid people who suffer from an irreversible pathology to die, effectively legalised assisted suicide.[133] The Italian Parliament has not yet passed a law regulating assisted suicide. On 16 June 2022, the first assisted suicide was performed.[134][135]

Jersey

On 25 November 2021, the States Assembly voted to legalise assisted dying and a law legalising it will be drafted in due course.[136] The Channel Island is the first country in the British Islands to approve the measure.[137] The proposition, which was lodged by the Council of Ministers, proposes that a legal assisted dying service should be set up for residents over the age of 18 with a terminal illness or other incurable suffering. The service will be voluntary and methods are either physician-assisted suicide or euthanasia.[138]

This follows a campaign and overwhelming public support. Paul Gazzard and his late husband Alain du Chemin were key actors in the campaign in favour of legalising assisted dying. A citizen's jury was established, which recommended that assisted dying be legalised in the island.[137]

Luxembourg

After again failing to get royal assent for legalizing voluntary euthanasia and physician-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.[139] Voluntary euthanasia and physician-assisted suicide were legalized in the country in April 2009.[140]

Netherlands

Main article: Euthanasia in the Netherlands

The Netherlands was the first country in the world to formally legalise voluntary euthanasia.[141] Physician-assisted suicide is legal under the same conditions as voluntary 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 patients who are suffering "unbearably without hope"[142] are allowed to grant a request for an assisted suicide. The Netherlands allows people over the age of 12 to pursue an assisted suicide when deemed necessary.

New Zealand

Main article: Euthanasia in New Zealand

Assisted suicide was decriminalised after a binding referendum in 2020 on New Zealand's End of Life Choice Act 2019. The legislation provided for a year-long delay before it took effect on 6 November 2021.[143] Under Section 179 of the Crimes Act 1961, it is illegal to 'aid and abet suicide' and this will remain the case outside the framework established under the End of Life Choice Act.

Norway

Assisted suicide is illegal in Norway. It is considered murder and is punishable by up to 21 years imprisonment.

South Africa

South Africa is struggling with the debate over legalizing voluntary euthanasia and physician-assisted suicide. 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 voluntary euthanasia when it became legalized in the country.[144] 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 ...".[144]

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.[145]

Switzerland

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.[146] The relevant provision of the Swiss Criminal Code[147] 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.[148] In order to avoid conviction, the person has to prove that the deceased knew what he or she was doing, had the capacity to make the decision, and had made an "earnest" request, meaning they 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.[149] 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.

Switzerland is one of only a handful of countries in the world which permits assisted suicide for non-resident foreigners,[150][129] causing what some critics have described as suicide tourism. Between 1998 and 2018 around 1250 German citizens (almost three times the number of any other nationality) travelled to Dignitas in Zurich, Switzerland, for an assisted suicide. During the same period over 400 British citizens also opted to end their life at the same clinic.[127][128]

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 84% of voters, while 78% voted to keep services open should overseas users require them.[151]

In Switzerland non-physician-assisted suicide is legal, the assistance mostly being provided by volunteers, whereas in Belgium and the Netherlands, a physician must be present. In Switzerland, the doctors are primarily there to assess the patient's decision capacity and prescribe the lethal drugs. Additionally, unlike cases in the United States, a person is not required to have a terminal illness but only the capacity to make decisions. About 25% of people in Switzerland who take advantage of assisted suicide do not have a terminal illness but are simply old or "tired of life".[152]

Publicized cases

In January 2006 British doctor Anne Turner took her own life in a Zurich clinic having developed an incurable degenerative disease. Her story was reported by the BBC and later, in 2009, made into a TV film A Short Stay in Switzerland starring Julie Walters.

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.[153]

In March 2010, the American PBS TV program Frontline showed a documentary called The Suicide Tourist which told the story of Professor Craig Ewert, his family, and Dignitas, and his decision to die by assisted suicide using sodium pentobarbital in Switzerland after he was diagnosed and suffering with ALS (Lou Gehrig's disease).[154]

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 Smedley's journey to the end where he used The Dignitas Clinic, a voluntary euthanasia clinic in Switzerland, to assist him in carrying out his suicide. The programme shows Smedley eating chocolates to counter the unpalatable taste of the liquid he drinks to end his life. Moments after drinking the liquid, Smedley 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, Smedley stopped breathing and his heart stopped beating.

Uruguay

Main article: Euthanasia in Uruguay

Assisted suicide, while criminal, does not appear to have caused any convictions, as article 37 of the Penal Code (effective 1934) states: "The judges are authorized to forego punishment of a person whose previous life has been honorable where he commits a homicide motivated by compassion, induced by repeated requests of the victim."[155]

United Kingdom

Main article: Assisted suicide in the United Kingdom

England and Wales

Deliberately assisting a suicide is illegal.[156] Between 2003 and 2006, Lord Joffe made four attempts to introduce bills that would have legalised physician-assisted suicide in England and Wales. All were rejected by the UK Parliament.[157] In the meantime, the Director of Public Prosecutions has clarified the criteria under which an individual will be prosecuted in England and Wales for assisting in another person's suicide.[158] These have not been tested by an appellate court as yet.[159] In 2014, Lord Falconer of Thoroton tabled an Assisted Dying Bill in the House of Lords which passed its Second Reading but ran out of time before the General Election. During its passage peers voted down two amendments which were proposed by opponents of the Bill. In 2015, Labour MP Rob Marris introduced another Bill, based on the Falconer proposals, in the House of Commons. The Second Reading was the first time the House was able to vote on the issue since 1997. A Populus poll had found that 82% of the British public agreed with the proposals of Lord Falconer's Assisted Dying Bill.[160] However, in a free vote on 11 September 2015, only 118 MPs were in favour and 330 against, thus defeating the bill.[161]

Scotland

Unlike the other jurisdictions in the United Kingdom, suicide was not illegal in Scotland before 1961 (and still is not) thus no associated offences were created in imitation. Depending on the actual nature of any assistance given to a suicide, the offences of murder or culpable homicide might be committed or there might be no offence at all; the nearest modern prosecutions bearing comparison might be those where a culpable homicide conviction has been obtained when drug addicts have died unintentionally after being given "hands on" non-medical assistance with an injection. Modern law regarding the assistance of someone who intends to die has a lack of certainty as well as a lack of relevant case law; this has led to attempts to introduce statutes providing more certainty.

Independent MSP Margo MacDonald's "End of Life Assistance Bill" was brought before the Scottish Parliament to permit physician-assisted suicide in January 2010. The Catholic Church and the Church of Scotland, the largest denomination in Scotland, opposed the bill. The bill was rejected by a vote of 85–16 (with 2 abstentions) in December 2010.[162][163]

The Assisted Suicide (Scotland) Bill was introduced on 13 November 2013 by the late Margo MacDonald MSP and was taken up by Patrick Harvie MSP on Ms MacDonald's death. The Bill entered the main committee scrutiny stage in January 2015 and reached a vote in Parliament several months later; however the bill was again rejected.

Northern Ireland

Health is a devolved matter in the United Kingdom and as such it would be for the Northern Ireland Assembly to legislate for assisted dying as it sees fit. As of 2018, there has been no such bill tabled in the Assembly.

United States

Main article: Assisted suicide in the United States
 
State laws regarding assisted suicide in the United States
  Legal
  Legal under court ruling1
  Illegal
1 In its 2009 decision Baxter v. Montana, the Montana Supreme Court ruled that assisted suicide did not violate Montana legal precedent or state statutes, even though no Montana laws specifically allowed it.

Physician-assisted dying was first legalized by the 1994 Oregon Death with Dignity Act, with effect delayed by lawsuits until 1997.[164] The Montana Supreme Court ruled in Baxter v. Montana (2009) that it found no state law or public policy reason that would prohibit physician-assisted dying.[81]

It was legalized by Washington (state) in 2008,[165] Vermont in 2013,[166] California[167][168] and Washington, D.C.,[169] and Colorado[170] in 2016, Hawaii in 2018,[171] New Jersey in 2019,[172] Maine in 2020,[173][174] and New Mexico in 2021[175] It had also been briefly legal in New Mexico in 2014 and 2015 due to a court decision that was overturned.

Access to the procedure is generally restricted to people with a terminal illness and less than six months to live. Patients are generally required to be mentally healthy, to get approval from multiple doctors, and to affirm the request multiple times.

The punishment for participating in physician-assisted death varies throughout the other states. The state of Wyoming does not "recognize common law crimes and does not have a statute specifically prohibiting physician-assisted suicide". In Florida, "every person deliberately assisting another in the commission of self-murder shall be guilty of manslaughter, a felony of the second degree".[176]

See also

Explanatory notes

  1. ^ See Baxter v. Montana.

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  164. ^ . Archived from the original on 29 June 2009. Retrieved 2 July 2009.
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  166. ^ Patient Choice and Control at End of Life Act of 2013
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  169. ^ District of Columbia Death with Dignity Act of 2016
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Further reading

  • Asch DA, DeKay ML (September 1997). "Euthanasia among US critical care nurses. Practices, attitudes, and social and professional correlates". Medical Care. 35 (9): 890–900. doi:10.1097/00005650-199709000-00002. JSTOR 3767454. PMID 9298078.
  • Aviv R (22 June 2015). "Letter from Belgium: Who Has the Right to a Dignified Death?: The Death Treatment". The New Yorker.
  • Henig RM (17 May 2015). "The Last Day of Her Life". The New York Times Magazine.
  • McDougall JF, Gorman M (2008). Contemporary World Issues: Euthanasia. Santa Barbara, Calif.: ABC-CLIO.
  • . Northwestern University. 17 July 2014. Archived from the original on 11 July 2006. Retrieved 30 July 2014.

May 13, 2023
assisted, suicide, other, uses, assisted, dying, disambiguation, suicide, undertaken, with, another, person, term, usually, refers, physician, assisted, suicide, which, suicide, that, assisted, physician, another, healthcare, provider, once, determined, that, . For other uses see Assisted dying disambiguation Assisted suicide is suicide undertaken with the aid of another person 1 The term usually refers to physician assisted suicide PAS which is suicide that is assisted by a physician or another healthcare provider Once it is determined that the person s situation qualifies under the physician assisted suicide laws for that location the physician s assistance is usually limited to writing a prescription for a lethal dose of drugs Current status of assisted suicide around the world Physician assisted suicide is legal Legalized by court ruling but not legislated or regulated Physician assisted suicide is illegal In many jurisdictions helping a person die by suicide is a crime 2 People who support legalizing physician assisted suicide want the people who assist in a voluntary death to be exempt from criminal prosecution for manslaughter or similar crimes Physician assisted suicide is legal in some countries under certain circumstances including Austria Belgium Canada Germany Luxembourg the Netherlands New Zealand Spain Switzerland parts of the United States and all six states of Australia The constitutional courts of Colombia Germany and Italy legalized assisted suicide but their governments have not legislated or regulated the practice yet In most of those states or countries to qualify for legal assistance individuals who seek a physician assisted suicide must meet certain criteria including having a terminal illness proving they are of sound mind voluntarily and repeatedly expressing their wish to die and taking the specified lethal dose by their own hand The laws vary in scope from place to place In the United States PAS is limited to those who have a prognosis of six months or less to live In other countries such as Germany Canada Switzerland Spain Italy Austria Belgium and the Netherlands a terminal diagnosis is not a requirement and voluntary euthanasia is additionally allowed 3 Contents 1 Terminology 1 1 Assisted dying versus assisted suicide 2 Physician assisted suicide 2 1 Support 2 1 1 Arguments for 2 1 1 1 Oregon statistics 2 1 1 2 Washington State statistics 2 1 1 3 U S polls 2 1 2 Safeguards 2 1 3 Religious stances in favor 2 1 3 1 Unitarian Universalism 2 2 Opposition 2 2 1 Medical ethics 2 2 1 1 Hippocratic Oath 2 2 1 2 Declaration of Geneva 2 2 1 3 International Code of Medical Ethics 2 2 1 4 Statement of Marbella 2 2 2 Concerns of expansion to people with chronic disorders 2 2 3 Religious stances in opposition 2 2 3 1 Catholicism 2 2 3 2 Judaism 2 2 3 3 The Church of Jesus Christ of Latter day Saints 2 3 Neutrality 2 3 1 American Medical Association Code of Ethics 2 4 Attitudes of healthcare professionals 3 Legality 3 1 Australia 3 2 Austria 3 3 Belgium 3 4 Canada 3 5 China 3 6 Colombia 3 6 1 Publicized cases 3 7 Denmark 3 8 France 3 9 Germany 3 9 1 Travel to Switzerland 3 9 2 Physician assisted suicide 3 10 Iceland 3 11 Ireland 3 12 Italy 3 13 Jersey 3 14 Luxembourg 3 15 Netherlands 3 16 New Zealand 3 17 Norway 3 18 South Africa 3 19 Switzerland 3 19 1 Publicized cases 3 20 Uruguay 3 21 United Kingdom 3 21 1 England and Wales 3 21 2 Scotland 3 21 3 Northern Ireland 3 22 United States 4 See also 5 Explanatory notes 6 References 7 Further readingTerminology Edit Secobarbital is one of the most commonly prescribed drugs for physician assisted suicide in the United States 4 Suicide is the act of killing oneself Assisted suicide is when another person materially helps an individual person die by suicide such as providing tools or equipment while physician assisted suicide involves a physician 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 5 Assisted suicide is contrasted to euthanasia sometimes referred to as mercy killing where the person dying does not directly bring about their own death but is killed in order to stop the person from experiencing further suffering Euthanasia can occur with or without consent and can be classified as voluntary non voluntary or involuntary Killing a person who is suffering and who consents is called voluntary euthanasia This is currently legal in some regions 6 If the person is unable to provide consent it is referred to as non voluntary euthanasia Killing a person who does not want to die or who is capable of giving consent and whose consent has not been solicited is the crime of involuntary euthanasia and is regarded as murder Right to die is the belief that people have a right to die either through various forms of suicide euthanasia or refusing life saving medical treatment Suicidism can be defined as the quality or state of being suicidal 7 or as an oppressive system stemming from non suicidal perspectives functioning at the normative discursive medical legal social political economic and epistemic levels in which suicidal people experience multiple forms of injustice and violence 8 Assisted dying versus assisted suicide Edit Some advocates for assisted suicide strongly oppose the use of assisted suicide and suicide when referring to physician assisted suicide and prefer phrases like medical aid in dying or assisted dying The motivation for this is to distance the debate from the suicides commonly performed by those not terminally ill and not eligible for assistance where it is legal They feel those cases have negatively impacted the word suicide to the point that it should not be used to refer to the practice of a physician prescribing lethal drugs to a person with a terminal illness 9 10 However in certain jurisdictions like Canada aid in dying does not require a person s natural death to be reasonably foreseeable in order to be eligible for MAiD Moreover the term assisted dying is also used to refer to other practices like voluntary euthanasia and terminal sedation 11 12 Physician assisted suicide EditSupport Edit Arguments for Edit Arguments in support of assisted death include respect for patient autonomy equal treatment of terminally ill patients on and off life support compassion personal liberty transparency 13 and ethics of responsibility 8 When death is imminent half a year or less patients can choose to have assisted death as a medical option to shorten what the person perceives to be an unbearable dying process Death With Dignity is coined as the United States national leader in end of life advocacy and policy reform The organization has been advocating for physician assisted suicide and euthanasia since 1994 14 Pain is mostly not reported as the primary motivation for seeking physician assisted suicide in the United States 15 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 75 4 16 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 a lethal prescription for barbiturates the drug used for physician assisted death 17 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 in dying AiD was authorized in 2013 18 In February 2016 Oregon released a report on its 2015 numbers In 2015 there were 218 people in the state who were approved and received the lethal drugs to end their own life Of that 218 132 terminally ill patients ultimately decided to ingest drugs resulting in their death According to the state of Oregon Public Health Division s survey the majority of the participants 78 were 65 years of age or older and predominantly white 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 of those people mentioned the loss of the ability to participate in activities that once made them enjoy life 92 4 mentioned the loss of autonomy or the independence of their own thoughts or actions and 75 4 stated loss of their dignity 19 Washington State statistics Edit An increasing trend in deaths caused by ingesting lethal doses of medications prescribed by physicians was also noted in Washington from 64 deaths in 2009 to 202 deaths in 2015 20 Among the deceased 72 had terminal cancer and 8 had neurodegenerative diseases including ALS 20 U S polls Edit Polls conducted by Gallup dating back to 1947 posit 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 voluntary euthanasia public support was substantially lower by approximately 10 to 15 15 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 21 A survey from the Journal of Palliative Medicine found that family caregivers of patients who chose assisted death 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 did not request assisted death 22 Safeguards Edit Many current assisted death laws contain provisions that are intended to provide oversight and investigative processes to prevent abuse This includes 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 assert that a person s request for a lethal prescription was not coerced or under undue influence These safeguards include proving one s residency and eligibility The patient must meet with two physicians and they must confirm the diagnoses before one can continue the procedure in some cases they do include a psychiatric evaluation as well to determine whether or not the patient is making this decision on their own The next steps are two oral requests a waiting period of a minimum of 15 days before making the 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 the patient s doctor in which they say whether they are eligible for the drugs or not Death with Dignity The debate about whether these safeguards work is debated between opponents and proponents A 1996 survey of Oregon emergency physicians found that Only 37 indicated that the Oregon initiative has enough safeguards to protect vulnerable persons 83 agreed that patients Might feel pressure because of burden to others and 70 agreed that patients Might feel pressure because of financial concerns 23 Religious stances in favor Edit 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 24 Opposition Edit Medical ethics Edit Hippocratic Oath Edit Some doctors 25 remind that physician assisted suicide is contrary to the Hippocratic Oath which is the oath historically taken by physicians It states I will not give a lethal drug to anyone if I am asked nor will I advise such a plan 26 27 The original oath however has been modified many times and contrary to popular belief is not required by most modern medical schools nor confers any legal obligations on individuals who choose to take it 28 There are also procedures forbidden by the Hippocratic Oath which are in common practice today such as abortion and execution 29 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 involuntary euthanasia eugenics and other medical crimes performed in Nazi Germany It contains I will maintain the utmost respect for human life 30 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 31 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 voluntary euthanasia is unethical and must be condemned by the medical profession 32 Concerns of expansion to people with chronic disorders Edit Main article Euthanasia and the slippery slope A concern present among health care professionals who are opposed to PAS are the detrimental effects that the procedure can have with regard to vulnerable populations This argument is known as the slippery slope 33 This argument encompasses the apprehension that once PAS is initiated for the terminally ill it will progress to other vulnerable communities namely disabled people 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 34 Religious stances in opposition Edit 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 35 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 voluntary 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 of when to end life 35 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 grief and sorrow for those left behind 36 Pope Francis 37 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 38 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 one of the Ten Commandments As implied by the sixth commandment Thou shalt not kill You shall not kill the act of assisted suicide contradicts the dignity of human life as well as the respect one has for God 39 36 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 40 Judaism Edit While preservation of life is one of the greatest values in Judaism there are instances of suicide and assisted suicide appearing in the Bible and Rabbinic literature 41 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 42 The Church of Jesus Christ of Latter day Saints Edit The Church of Jesus Christ of Latter day Saints LDS Church is against assisted suicide and euthanasia and anyone who takes part in either is regarded as having violated the commandments of God 43 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 44 Neutrality Edit There have been calls for organisations representing medical professionals to take a neutral stance on PAS rather than a position of opposition The reasoning is that this supposedly would better reflect the views of medical professionals and that of wider society and prevent those bodies from exerting undue influence over the debate 45 46 47 The UK Royal College of Nursing voted in July 2009 to move to a neutral position on PAS 48 The California Medical Association dropped its long standing opposition in 2015 during the debate over whether a Physician Assisted Suicide bill should be introduced there prompted in part by cancer sufferer Brittany Maynard 49 The California End of Life Option Act was signed into law later that year In December 2017 the Massachusetts Medical Society MMS voted to repeal their opposition to physician assisted suicide and adopt a position of neutrality 50 In October 2018 the American Academy of Family Physicians AAFP voted to adopt a position of neutrality from one of opposition This is contrary to the position taken by the American Medical Association AMA which opposes it 51 In January 2019 the British Royal College of Physicians announced it would adopt a position of neutrality until two thirds of its members think it should either support or oppose the legalization of PAS 52 In September 2021 the largest doctors union in the United Kingdom the British Medical Association adopted a neutral stance towards a change in the law on assisted dying replacing their position of opposition which had been in place since 2006 53 American Medical Association Code of Ethics Edit The American Medical Association AMA opposes physician assisted suicide In response to the ongoing debate about PAS the AMA has issued guidance for both those who support and oppose physician assisted suicide The AMA Code of Ethics Opinion 5 7 reads that Physician assisted suicide is fundamentally incompatible with the physician s role as healer and that it would be difficult or impossible to control and would pose serious societal risks but does not explicitly prohibit the practice In the AMA Code of Ethics Opinion 1 1 7 which the AMA states articulates the thoughtful moral basis for those who support assisted suicide it is written that outside of specific situations in which physicians have clear obligations such as emergency care or respect for civil rights physicians may be able to act or refrain from acting in accordance with the dictates of their conscience without violating their professional obligations 54 Attitudes of healthcare professionals Edit It is widely believed that physicians should play a significant role usually expressed as gatekeeper in the process of assisted suicide and voluntary euthanasia as evident in the name physician assisted suicide often putting them at the forefront of the issue Decades of opinion research show that physicians in the US and several European countries are less supportive of the legalization of PAS than the general public 55 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 55 However physician and other healthcare professional opinions vary widely on the issue of physician assisted suicide as shown in the following tables Study Population Willing to Assist PAS Not Willing to Assist PASCanadian Medical Association 2011 56 Canadian Medical Association n 2 125 16 16 44 44 Cohen 1994 NEJM 57 Washington state doctors n 938 40 40 49 49 Lee 1996 NEJM 58 Oregon state doctors n 2 761 46 46 31 31 Study Population In favor of PAS being legal Not in favor of PAS being legalMedscape Ethics Report 2014 59 U S based doctors 54 54 31 31 Seale 2009 55 United Kingdom physicians n 3 733 35 35 62 2 62 2 Cohen 1994 NEJM 57 Washington state doctors n 938 53 53 39 39 A 2019 survey of US physicians found that 60 of physicians answered yes to the question Should PAS be legalized in your state The survey discovered that physicians are concerned about a possible slippery slope 30 agreed that PAS AID would lead to the legalization of euthanasia and 46 agreed that Health insurance companies would cover PAS AID over more expensive possibly life saving treatments like chemotherapy 60 The survey also found that physicians generally misunderstand why patients seek PAS 49 of physicians agreed that Most patients who seek PAS AID do so because of physical pain whereas studies in Oregon found that the three most frequently mentioned end of life concerns were loss of autonomy 89 5 decreasing ability to participate in activities that made life enjoyable 89 5 and loss of dignity 65 4 61 In addition the survey found uncertainty about the adequacy of safeguards While 59 agreed that Current PAS laws provide adequate safeguards there was greater concern with respect to specific safeguards 60 disagreed that Physicians who are not psychiatrists are sufficiently trained to screen for depression in patients who are seeking PAS and 60 disagreed that Most physicians can predict with certainty whether a patient seeking PAS AID has 6 months or less to live 60 The concern about adequate safeguards is even greater among Oregon emergency physicians among whom one study found that Only 37 indicated that the Oregon initiative has enough safeguards to protect vulnerable persons 23 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 voluntary 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 55 A 1997 study by Glasgow University s Institute of Law amp 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 62 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 63 A poll in the United Kingdom showed that 54 of General Practitioners are either supportive or neutral towards the introduction of assisted dying laws 64 A similar poll on Doctors net uk published in the BMJ said that 55 of doctors would support it 65 In contrast the BMA which represents doctors in the UK opposes it 66 An anonymous confidential postal survey of all General Practitioners in Northern Ireland conducted in the year 2000 found that over 70 of responding GPs were opposed to physician assisted suicide and voluntary active euthanasia 67 Legality Edit Current status of assisted suicide around the world Physician assisted suicide is legal Legalized by court ruling but not legislated or regulated Physician assisted suicide is illegal Physician assisted suicide is legal in some countries under certain circumstances including Austria 68 69 Belgium 70 Canada 71 Luxembourg 72 the Netherlands 73 New Zealand 74 Spain 75 Switzerland 76 and parts of the United States California 77 Colorado 78 Hawaii 79 Maine 80 Montana note 1 81 New Jersey 82 New Mexico 83 Oregon 84 Vermont 85 Washington 86 and Washington DC 87 and Australia New South Wales 88 Queensland 89 South Australia 90 Tasmania 91 Victoria 92 and Western Australia 93 The Constitutional Courts of Colombia 94 95 96 Germany 97 and Italy 98 legalized assisted suicide but their governments have not legislated or regulated the practice yet Australia Edit Main article Euthanasia in Australia Laws regarding assisted suicide in Australia are a matter for state and territory governments Physician assisted suicide is currently legal in all Australian states New South Wales 88 Victoria 99 South Australia Western Australia 100 Tasmania 101 and Queensland 102 It remains illegal in all Australian territories Under Victorian law patients can ask medical practitioners about voluntary assisted dying and doctors including conscientious objectors should refer to appropriately trained colleagues who do not conscientiously object 103 Health practitioners are restricted from initiating conversation or suggesting voluntary assisted dying to a patient unprompted Voluntary euthanasia was legal in the Northern Territory for a short time under the Rights of the Terminally Ill Act 1995 until this law was overturned by the Federal Government which also removed the ability for territories to pass legislation relating to assisted dying however this was repealed in December 2022 with the passing of Restoring Territory Rights Act The highly controversial Euthanasia Machine the first invented voluntary assisted dying machine of its kind created by Philip Nitschke utilised during this period is presently held at London s Science Museum 104 Austria Edit Current status of assisted suicide in Europe Physician assisted suicide is legal Legalized by court ruling but not legislated or regulated Assisted suicide is not legal In December 2020 the Austrian Constitutional Court ruled that the prohibition of assisted suicide was unconstitutional 105 In December 2021 the Austrian Parliament legalized assisted suicide for those who are terminally ill or have a permanent debilitating condition 106 107 Belgium Edit The Euthanasia Act legalized voluntary euthanasia in Belgium in 2002 108 109 but it did not cover physician assisted suicide 110 Canada Edit Main article Assisted suicide in Canada In Canada physician assisted suicide was first legalized in the Province of Quebec on 5 June 2014 111 It was declared nationally legal by the Supreme Court of Canada on 6 February 2015 in Carter v Canada Attorney General 112 National legislation formalizing physician assisted suicide passed in mid June 2016 for patients facing an estimated death within six months 113 Eligibility criteria have been progressively expanded over time As of March 2021 individuals no longer need to be terminally ill in order to qualify for assisted suicide 114 Legislation allowing for assisted suicide for mental illness was expected to come into force on March 17 2023 but has since been postponed until 2024 115 Between 10 December 2015 and 30 June 2017 2 149 medically assisted deaths were documented in Canada Research published by Health Canada illustrates physician preference for physician administered voluntary euthanasia citing concerns about effective administration and prevention of the potential complications of self administration by patients 116 China Edit In China assisted suicide is illegal under Articles 232 and 233 of the Criminal Law of the People s Republic of China 117 In China suicide or neglect is considered homicide and can be punished by three to seven years in prison 118 In May 2011 Zhong Yichun a farmer was sentenced to two years imprisonment by the People s Court of Longnan County in China s Jiangxi Province for assisting Zeng Qianxiang to die by suicide Zeng had a mental illness and repeatedly asked Zhong to help him die by suicide In October 2010 Zeng took excessive sleeping pills and lay in a cave As planned Zhong called him 15 minutes later to confirm that he was dead and buried him However according to the autopsy report the cause of death was from suffocation not an overdose Zhong was convicted of criminal negligence In August 2011 Zhong appealed the court sentence but it was rejected 118 In 1992 a physician was accused of murdering a patient with advanced cancer by lethal injection He was eventually acquitted 118 Colombia Edit In May 1997 the Colombian Constitutional Court allowed for the voluntary euthanasia of sick patients who requested to end their lives by passing Article 326 of the 1980 Penal Code 119 This ruling owes its success to the efforts of a group that strongly opposed voluntary 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 120 Publicized cases Edit In January 2022 Victor Escobar became the first person in the Andean country with a non terminal illness to die by legally regulated euthanasia The 60 year old Escobar had end stage chronic obstructive pulmonary disease 121 Denmark Edit Assisted suicide is illegal in Denmark Passive euthanasia or the refusal to accept treatment is not illegal A survey from 2014 found that 71 of Denmark s population was in favor of legalizing voluntary euthanasia and physician assisted suicide 122 France Edit Assisted suicide is not legal in France The controversy over legalising voluntary euthanasia and physician assisted suicide is not as big as in the United States because of the country s well developed hospice care programme 123 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 123 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 two 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 124 Germany Edit Killing somebody in accordance with their demands is always illegal under the German criminal code Paragraph 216 Killing at the request of the victim 125 Assisting suicide is generally legal and the Federal Constitutional Court has ruled that it is generally protected under the Basic Law in 2020 it overturned a ban on the commercialization of assisted suicide 105 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 126 Travel to Switzerland Edit Between 1998 and 2018 around 1250 German citizens almost three times the number of any other nationality travelled to Dignitas in Zurich Switzerland for an assisted suicide where this has been legal since 1998 127 unreliable source 128 Switzerland is one of the few countries that permit assisted suicide for non resident foreigners 129 Physician assisted suicide Edit Physician assisted suicide was formally legalised on 26 February 2020 when Germany s top court removed the prohibition of professionally assisted suicide 130 Iceland Edit Assisted suicide is illegal 131 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 132 Italy Edit On 25 September 2019 the Italian Constitutional Court ruling 242 2019 declared that article 580 of the criminal code was unconstitutional the decriminalisation of assisted suicide in the case of those who aid people who suffer from an irreversible pathology to die effectively legalised assisted suicide 133 The Italian Parliament has not yet passed a law regulating assisted suicide On 16 June 2022 the first assisted suicide was performed 134 135 Jersey Edit On 25 November 2021 the States Assembly voted to legalise assisted dying and a law legalising it will be drafted in due course 136 The Channel Island is the first country in the British Islands to approve the measure 137 The proposition which was lodged by the Council of Ministers proposes that a legal assisted dying service should be set up for residents over the age of 18 with a terminal illness or other incurable suffering The service will be voluntary and methods are either physician assisted suicide or euthanasia 138 This follows a campaign and overwhelming public support Paul Gazzard and his late husband Alain du Chemin were key actors in the campaign in favour of legalising assisted dying A citizen s jury was established which recommended that assisted dying be legalised in the island 137 Luxembourg Edit After again failing to get royal assent for legalizing voluntary euthanasia and physician 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 139 Voluntary euthanasia and physician assisted suicide were legalized in the country in April 2009 140 Netherlands Edit Main article Euthanasia in the Netherlands The Netherlands was the first country in the world to formally legalise voluntary euthanasia 141 Physician assisted suicide is legal under the same conditions as voluntary 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 patients who are suffering unbearably without hope 142 are allowed to grant a request for an assisted suicide The Netherlands 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 was decriminalised after a binding referendum in 2020 on New Zealand s End of Life Choice Act 2019 The legislation provided for a year long delay before it took effect on 6 November 2021 143 Under Section 179 of the Crimes Act 1961 it is illegal to aid and abet suicide and this will remain the case outside the framework established under the End of Life Choice Act Norway Edit Assisted suicide is illegal in Norway It is considered murder and is punishable by up to 21 years imprisonment South Africa Edit South Africa is struggling with the debate over legalizing voluntary euthanasia and physician assisted suicide 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 voluntary euthanasia when it became legalized in the country 144 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 144 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 145 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 146 The relevant provision of the Swiss Criminal Code 147 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 Gefangnis 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 148 In order to avoid conviction the person has to prove that the deceased knew what he or she was doing had the capacity to make the decision and had made an earnest request meaning they 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 Totung 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 Gefangnis For instance it should be the suicide subject who actually presses the syringe or takes the pill after the helper had prepared the setup 149 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 Switzerland is one of only a handful of countries in the world which permits assisted suicide for non resident foreigners 150 129 causing what some critics have described as suicide tourism Between 1998 and 2018 around 1250 German citizens almost three times the number of any other nationality travelled to Dignitas in Zurich Switzerland for an assisted suicide During the same period over 400 British citizens also opted to end their life at the same clinic 127 128 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 84 of voters while 78 voted to keep services open should overseas users require them 151 In Switzerland non physician assisted suicide is legal the assistance mostly being provided by volunteers whereas in Belgium and the Netherlands a physician must be present In Switzerland the doctors are primarily there to assess the patient s decision capacity and prescribe the lethal drugs Additionally unlike cases in the United States a person is not required to have a terminal illness but only the capacity to make decisions About 25 of people in Switzerland who take advantage of assisted suicide do not have a terminal illness but are simply old or tired of life 152 Publicized cases Edit In January 2006 British doctor Anne Turner took her own life in a Zurich clinic having developed an incurable degenerative disease Her story was reported by the BBC and later in 2009 made into a TV film A Short Stay in Switzerland starring Julie Walters In July 2009 British conductor Sir Edward Downes and his wife Joan died together at a suicide clinic outside Zurich under circumstances of their own choosing Sir Edward was not terminally ill but his wife was diagnosed with rapidly developing cancer 153 In March 2010 the American PBS TV program Frontline showed a documentary called The Suicide Tourist which told the story of Professor Craig Ewert his family and Dignitas and his decision to die by assisted suicide using sodium pentobarbital in Switzerland after he was diagnosed and suffering with ALS Lou Gehrig s disease 154 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 Smedley s journey to the end where he used The Dignitas Clinic a voluntary euthanasia clinic in Switzerland to assist him in carrying out his suicide The programme shows Smedley eating chocolates to counter the unpalatable taste of the liquid he drinks to end his life Moments after drinking the liquid Smedley 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 Smedley stopped breathing and his heart stopped beating Uruguay Edit Main article Euthanasia in Uruguay Assisted suicide while criminal does not appear to have caused any convictions as article 37 of the Penal Code effective 1934 states The judges are authorized to forego punishment of a person whose previous life has been honorable where he commits a homicide motivated by compassion induced by repeated requests of the victim 155 United Kingdom Edit Main article Assisted suicide in the United Kingdom England and Wales Edit Deliberately assisting a suicide is illegal 156 Between 2003 and 2006 Lord Joffe made four attempts to introduce bills that would have legalised physician assisted suicide in England and Wales All were rejected by the UK Parliament 157 In the meantime the Director of Public Prosecutions has clarified the criteria under which an individual will be prosecuted in England and Wales for assisting in another person s suicide 158 These have not been tested by an appellate court as yet 159 In 2014 Lord Falconer of Thoroton tabled an Assisted Dying Bill in the House of Lords which passed its Second Reading but ran out of time before the General Election During its passage peers voted down two amendments which were proposed by opponents of the Bill In 2015 Labour MP Rob Marris introduced another Bill based on the Falconer proposals in the House of Commons The Second Reading was the first time the House was able to vote on the issue since 1997 A Populus poll had found that 82 of the British public agreed with the proposals of Lord Falconer s Assisted Dying Bill 160 However in a free vote on 11 September 2015 only 118 MPs were in favour and 330 against thus defeating the bill 161 Scotland Edit Unlike the other jurisdictions in the United Kingdom suicide was not illegal in Scotland before 1961 and still is not thus no associated offences were created in imitation Depending on the actual nature of any assistance given to a suicide the offences of murder or culpable homicide might be committed or there might be no offence at all the nearest modern prosecutions bearing comparison might be those where a culpable homicide conviction has been obtained when drug addicts have died unintentionally after being given hands on non medical assistance with an injection Modern law regarding the assistance of someone who intends to die has a lack of certainty as well as a lack of relevant case law this has led to attempts to introduce statutes providing more certainty Independent MSP Margo MacDonald s End of Life Assistance Bill was brought before the Scottish Parliament to permit physician assisted suicide in January 2010 The Catholic Church and the Church of Scotland the largest denomination in Scotland opposed the bill The bill was rejected by a vote of 85 16 with 2 abstentions in December 2010 162 163 The Assisted Suicide Scotland Bill was introduced on 13 November 2013 by the late Margo MacDonald MSP and was taken up by Patrick Harvie MSP on Ms MacDonald s death The Bill entered the main committee scrutiny stage in January 2015 and reached a vote in Parliament several months later however the bill was again rejected Northern Ireland Edit Health is a devolved matter in the United Kingdom and as such it would be for the Northern Ireland Assembly to legislate for assisted dying as it sees fit As of 2018 there has been no such bill tabled in the Assembly United States Edit Main article Assisted suicide in the United States State laws regarding assisted suicide in the United States Legal Legal under court ruling1 Illegal 1 In its 2009 decision Baxter v Montana the Montana Supreme Court ruled that assisted suicide did not violate Montana legal precedent or state statutes even though no Montana laws specifically allowed it vte Physician assisted dying was first legalized by the 1994 Oregon Death with Dignity Act with effect delayed by lawsuits until 1997 164 The Montana Supreme Court ruled in Baxter v Montana 2009 that it found no state law or public policy reason that would prohibit physician assisted dying 81 It was legalized by Washington state in 2008 165 Vermont in 2013 166 California 167 168 and Washington D C 169 and Colorado 170 in 2016 Hawaii in 2018 171 New Jersey in 2019 172 Maine in 2020 173 174 and New Mexico in 2021 175 It had also been briefly legal in New Mexico in 2014 and 2015 due to a court decision that was overturned Access to the procedure is generally restricted to people with a terminal illness and less than six months to live Patients are generally required to be mentally healthy to get approval from multiple doctors and to affirm the request multiple times The punishment for participating in physician assisted death varies throughout the other states The state of Wyoming does not recognize common law crimes and does not have a statute specifically prohibiting physician assisted suicide In Florida every person deliberately assisting another in the commission of self murder shall be guilty of manslaughter a felony of the second degree 176 See also EditBioethics Betty and George Coumbias Consensual homicide Euthanasia device Jack Kevorkian Legality of euthanasia List of deaths from legal euthanasia and assisted suicide Brittany Maynard Philip Nitschke Right to Die 2008 film Senicide A Short Stay in Switzerland 2009 film Suicide by cop Suicide legislation Voluntary Assisted Dying Act 2017 Victoria You Don t Know Jack 2010 film Explanatory notes Edit See Baxter v Montana References Edit Davis N 15 July 2019 Euthanasia and assisted dying rates are soaring But where are they legal The Guardian Retrieved 7 February 2020 Patients Rights Council 6 January 2017 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1017 S0963180113000054 PMID 23632255 Lundin L 2 August 2009 YOUthanasia Criminal Brief Retrieved 9 July 2013 The Suicide Tourist FRONTLINE PBS pbs org Republica Oriental del Uruguay Penal Code of Uruguay Parliament of Uruguay Archived from the original on 30 July 2015 Retrieved 12 August 2015 Huxtable RichardHuxtable R 2007 Euthanasia Ethics and the Law From Conflict to Compromise Abingdon UK New York Routledge Cavendish ISBN 9781844721061 Assisted Dying Bill latest BBC News Online DPP publishes interim policy on prosecuting assisted suicide The Crown Prosecution Service cps gov uk 23 September 2009 Archived from the original on 27 September 2009 A Critical Consideration of the Director of Public Prosecutions Guidelines in Relation to Assisted Suicide Prosecutions and their Application to the Law halsburyslawexchange co uk Archived from the original on 6 March 2012 Retrieved 4 June 2012 Dignity in Dying Poll PDF Populus 2015 Archived from the original PDF on 17 June 2015 Gallagher J Roxby P 11 September 2015 Assisted Dying Bill MPs reject right to die law BBC News End of Life Assistance Scotland Bill SP Bill 38 The Scottish Parliament 21 January 2010 Retrieved 12 June 2011 Margo MacDonald s End of Life Assistance Bill rejected BBC News Online 1 December 2010 Death With Dignity Act Legislative Statute Archived from the original on 29 June 2009 Retrieved 2 July 2009 Washington Death with Dignity Act Patient Choice and Control at End of Life Act of 2013 California End of Life Option Act of 2015 enacted June 2016 Aliferis L 10 March 2016 California To Permit Medically Assisted Suicide As of 9 June NPR District of Columbia Death with Dignity Act of 2016 End of Life Options Act of 2016 Death with Dignity Act of 2018 New Jersey Dignity in Dying Bill of Rights Act of 2019 Maine Death With Dignity Retrieved 13 June 2019 effective 1 January 2020 Maine Death with Dignity Act of 2019 Elizabeth Whitefield End of Life Options Act 2021 Assisted Suicide Laws in the United States Patients Rights Council www patientsrightscouncil org Retrieved 17 October 2017 Further reading EditAsch DA DeKay ML September 1997 Euthanasia among US critical care nurses Practices attitudes and social and professional correlates Medical Care 35 9 890 900 doi 10 1097 00005650 199709000 00002 JSTOR 3767454 PMID 9298078 Aviv R 22 June 2015 Letter from Belgium Who Has the Right to a Dignified Death The Death Treatment The New Yorker Henig RM 17 May 2015 The Last Day of Her Life The New York Times Magazine McDougall JF Gorman M 2008 Contemporary World Issues Euthanasia Santa Barbara Calif ABC CLIO What Is Physician Assisted Suicide Northwestern University 17 July 2014 Archived from the original on 11 July 2006 Retrieved 30 July 2014 Retrieved from https en wikipedia org w index php title Assisted suicide amp oldid 1154500805, wikipedia, wiki, book, books, library,

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