Assisted dying around the world: a status quaestionis

Abstract

Assisted dying practices, which include euthanasia and physician-assisted suicide (PAS), have expanded significantly around the world over the past 20 years. Euthanasia refers to the act of intentionally ending the life of a patient by a health care practitioner through medical means at that patient's explicit request while PAS involves the provision or prescribing of drugs by a health care practitioner for a patient to end their own life. The growing global aging population accompanied by higher levels of chronic disease and protracted illnesses have sharpened the focus on end of life issues and societal and legislative debates continue to address related moral and ethical complexities. Assisted dying practices are now legal in 18 jurisdictions, increasing the number of people with access to euthanasia and/or physician-assisted suicide (PAS) to over 200 million. New legislation is being crafted or considered in Portugal, Spain and 16 US states. Germany has recently overturned a ban on assisted dying services and New Zealand will put legalization of euthanasia to a vote in 2020. Assisted dying practice characteristics differ and there is also considerable variation in the terminology and labels used for assisted dying, which can add to the confusion and controversy around the practices. Frequency of use also varies greatly by jurisdiction, though a consistent increase has been seen in European countries including Belgium, the Netherlands and Switzerland as well as some jurisdictions with long-standing physician assisted dying laws, such as Oregon and Washington. All assisted dying legislation includes substantive and procedural requirements, such as minimum age, waiting period, health condition, physician consultation and reporting procedure, however, some are extensive and detailed while others are more limited. As access to assisted dying expands in new and existing jurisdictions, research must also expand to diligently examine the impact on patients, specifically among vulnerable populations, as well as on health care practitioners, health care systems and communities. This article will provide a thorough investigation, or 'status quaestionis' of the terminology, evolution and current legislative picture of assisted dying practices around the globe and contribute to the ongoing ethical, regulatory and practice debate, which have become increasingly important considerations for medical practice, end-of-life care and public health.

Trends in Swedish physicians’ attitudes towards physician-assisted suicide: a cross-sectional study

“…This number is quite a bit lower than the general public, where 73% were in favour of PAS in the same year [12], and a very recent opinion poll (2020) among the general public resulted in similar numbers in favour of PAS [13]. That healthcare professionals are more against PAS than the general public is a pattern that has been documented in many countries where PAS is not legal [1,2,9,10].…”

“…In recent years, there has been a lively public debate about physician-assisted suicide (PAS) both internationally and in Sweden [1][2][3][4][5][6][7][8][9][10][11]. California and other states in the US have followed Oregon in legalization of PAS; Canada has legalized euthanasia and PAS, and in 2020, New Zealand passed legislation laying the groundwork for the legalization of euthanasia and/or PAS in 2021.…”

Views of disability rights organisations on assisted dying legislation in England, Wales and Scotland: an analysis of position statements

“…Second, reach out to DROs and welcome their input into the debate, reassuring them that their insights add value even if they do not wish to commit to supporting either side of the issue. Third, DROs should be more willing to engage with this issue: cancer charities, for example, are notably silent given that cancer sufferers make up a substantial proportion of those opting for assisted dying 1. Fourth, learn from the experience of disabled people and DROs in countries where assisted dying has been introduced.…”

“…Euthanasia is where a physician intentionally ends a patient’s life, at their explicit request, by means of active drug administration. Physician-assisted suicide ‘is similar to euthanasia but involves the provision or prescribing of drugs by a physician for a patient to use to end their own life’ 1. Despite numerous legislative initiatives and judicial challenges, it remains unlawful to encourage or assist the suicide or attempted suicide of a person in England and Wales (as a result of section 2 of the Suicide Act 1961) while, in Scotland, it is illegal to do something knowing that it will be the immediate and direct cause of another person’s death 2 3…”

Medical Assistance in Dying (MAiD) in brain cancer: Whose autonomy are we respecting?

“…For some patients, the choice of an early death is preferable to the fear of suffering and loss of independence that a slightly longer life might present. Medical assistance in dying (MAiD), also known as physician assisted suicide (PAS) or voluntary assisted dying (VAD), may be self-administered or clinician administered, depending on legislation (1). The practice remains controversial, and some have expressed concern that MAiD may be primarily driven by inequity of access or failure to implement early and comprehensive palliative care as well as by potential social or financial vulnerability (2).…”