Legality of euthanasia

Current status of euthanasia around the world:

  Active euthanasia is legal

  Passive euthanasia is legal

  Euthanasia laws varies by administrative division

  Euthanasia is illegal

  Unknown

Efforts to change government policies on euthanasia of human lives in the 20th and 21st centuries have met limited success in Western countries. Human euthanasia policies have also been developed by a variety of NGOs, most notably medical associations and advocacy organizations. As of April 2016, human euthanasia is legal in the Netherlands, Belgium, Ireland, Colombia^[1] and Luxembourg. Assisted suicide is legal in Switzerland, Germany, Japan, Albania, Canada, and in the US states of Washington, Oregon, Vermont, New Mexico, Montana and California (effective June 2016).^[2]

Euthanasia law by country

Australia

Euthanasia is illegal in Australia. Although rare, charges have been laid for 'aiding and abetting' the suicide of others.^[3] It once was legal in the Northern Territory, by the Rights of the Terminally Ill Act 1995. In 1997, the Australian Federal Government overrode the Northern Territory legislation through the introduction of the Euthanasia Laws Act 1997.^[4] Unlike the states, legislation in the Northern Territory is not guaranteed by the Australian constitution. Before this law was passed by the Australian Government, Dr. Philip Nitschke helped three people by them using his Deliverance machine. Organizations such as Exit International (founded by Nitschke himself), want the government to bring back euthanasia rights to Australia. Exit made TV commercials which were banned before they made it to air in September 2010.^[5] Australia however gives patients an Advanced Care Directive option.

Belgium

The Belgian parliament legalised euthanasia on 28 May 2002.^[6][7]

A survey published in 2010 reported that those who died from euthanasia (compared with other deaths) were more often younger, male, cancer patients and more often died in their homes. In almost all cases, unbearable physical suffering were reported. Euthanasia for nonterminal patients was rare.^[8][9] There have been about 1,400 cases a year since the law was introduced, and a record 1,807 cases were recorded in 2013.^[10][11]

In December 2013, the Belgian Senate voted in favour of extending its euthanasia law to terminally ill children. Conditions imposed on children seeking euthanasia are that "the patient must be conscious of their decision and understand the meaning of euthanasia", "the request must have been approved by the child's parents and medical team", "their illness must be terminal" and "they must be in great pain, with no available treatment to alleviate their distress".^[12] A psychologist must also determine the patient's maturity to make the decision. The amendment emphasizes that the patient's request be voluntary.^[13]

Canada

While it was illegal to "aid and abet suicide" under Section 241(b) of the Criminal Code of Canada, which states that this is an indictable offence with a potential fourteen-year sentence if the appellant is found guilty, British Columbia's Supreme Court struck down the section, arguing that it imposed unconscionably discriminatory burdens on severely disabled individuals that were not valid under Sections 7 and 15 of the Charter of Rights and Freedoms on June 15, 2012. Thus, Canadian euthanasia and assisted suicide law are currently in legal limbo, although Canada's federal Parliament had until June 2013 to deal with the consequences of this decision.^[14] The Canadian Medical Association has declared neutrality on the issue.

On 6 February 2015, the Supreme Court of Canada unanimously ruled in Carter v Canada (AG) that Canadian adults who are mentally competent and suffering intolerably and permanently have the right to a doctor's help in dying. The court however suspended its ruling for 12 months to give the government an opportunity to write legislation and draft new laws and policies around assisted dying.^[15][16] In January 2016 the court granted an additional 4-month extension to its ruling suspension to allow time for the newly elected Liberal government to consult with Canadians on drafting a law to comply with the ruling. As an interim measure, it also ruled that provincial courts can now begin approving applications for euthanasia until the new law passes.^[17]

Colombia

In a 6-3 decision, Colombia's Constitutional Court ruled in 1997 that "no person can be held criminally responsible for taking the life of a terminally ill patient who has given clear authorization to do so," according to the Washington Post.^[18] The court defined "terminally ill" person as those with diseases such as "cancer, AIDS, and kidney or liver failure if they are terminal and the cause of extreme suffering," the Post reported. The ruling specifically refused to authorize euthanasia for people with degenerative diseases such as Alzheimer's, Parkinson's, or Lou Gehrig's disease. Finally in March 2015 euthanasia was made legal by the government.

Denmark

Parliament has assigned ethics panels over the years that have advised against legalisation each time^[19] however it is still not specifically outlawed^[20] and a study published in 2003 showed 41% of deaths under medical supervision involved doctors taking "end-of-life" decisions to help ease their patients' suffering before death (about 1% of which were via prescription drugs).^[21][22]

Finland

There is a grey area because of no mention in any criminal code and so it is tolerated amongst friends when done discreetly. Doctors do not formally perform it.^[23][24]

France

In July 2013, French President François Hollande stated his personal support for decriminalisation of voluntary euthanasia in France, which had been one of his presidential campaign promises ("introduction of the right to die with dignity"), despite objections from France's National Consultative Ethics Committee/ Comité national consultatif d'éthique, which alleged "abuses" in adjacent jurisdictions that have decriminalised and regulated either voluntary euthanasia or physician-assisted suicide (Belgium, Switzerland, the Netherlands and Luxembourg). It remains to be seen whether President Hollande will be successful in his objectives, given that the Catholic Church in France and other religious social conservatives have announced that after forthright opposition to the introduction of same-sex marriage in France, their next target may be any such decriminalisation of voluntary euthanasia.^[25]

India

Passive euthanasia is legal in India.^[26] On 7 March 2011 the Supreme Court of India legalised passive euthanasia by means of the withdrawal of life support to patients in a permanent vegetative state.^[27][28] Forms of Active euthanasia, including the administration of lethal compounds, are illegal.^[29]

Ireland

In Ireland, it is illegal for a doctor (or anyone) to actively contribute to someone's death. It is not, however, illegal to remove life support and other treatment (the "right to die") should a person (or their next of kin) request it. A September 2010 Irish Times poll showed that a majority, 57% of adults, believed that doctor-assisted suicide should be legal for terminally ill patients who request it.^[30]

Israel

The Israeli Penal Law forbids causing the death of another and specifically forbids shortening the life of another. Active euthanasia is forbidden by both Israeli law and Jewish law. Passive euthanasia is forbidden by Jewish law but has been accepted in some cases under Israeli law.^[31] In 2005, proposals were put forward to allow passive euthanasia to be administered using a switch mechanism similar to Sabbath clocks.^[32] In 2006, the Steinberg Commission was set up to look into whether life and death issues could be rethought in the context of Jewish law, which suggested that hospitals could set up committees to determine whether patients would be given passive euthanasia.^[33]

Japan

The Japanese government has no official laws on the status of euthanasia and the Supreme Court of Japan has never ruled on the matter. Rather, to date, Japan's euthanasia policy has been decided by two local court cases, one in Nagoya in 1962, and another after an incident at Tokai University in 1995. The first case involved "passive euthanasia" (消極的安楽死 shōkyokuteki anrakushi) (i.e., allowing a patient to die by turning off life support) and the latter case involved "active euthanasia" (積極的安楽死 sekkyokuteki anrakushi) (e.g., through injection). The judgments in these cases set forth a legal framework and a set of conditions within which both passive and active euthanasia could be legal. Nevertheless, in both of these particular cases the doctors were found guilty of violating these conditions when taking the lives of their patients. Further, because the findings of these courts have yet to be upheld at the national level, these precedents are not necessarily binding. Nevertheless, at present, there is a tentative legal framework for implementing euthanasia in Japan.^[34]

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

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

For active euthanasia, four conditions must be met:

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

The problems that arose from this, in addition to the problem faced by many other families in the country, has led to the creation of "bioethics SWAT teams".^[35] These teams will be made available to the families of terminally ill patients in order to help them, along with the doctors, come to a decision based on the personal facts of the case. Though in its early stages and relying on "subsidies from the Ministry of Health, Labor and Welfare" there are plans to create a nonprofit organization to "allow this effort to continue."^[36]

Luxembourg

The country's parliament passed a bill legalizing euthanasia on 20 February 2008 in the first reading with 30 of 59 votes in favour. On 19 March 2009, the bill passed the second reading, making Luxembourg the third European Union country, after the Netherlands and Belgium, to decriminalise euthanasia. Terminally ill patients will have the option of euthanasia after receiving the approval of two doctors and a panel of experts.^[37]

Mexico

In Mexico, active euthanasia is illegal but since 7 January 2008 the law allows the terminally ill —or closest relatives, if unconscious— to refuse medication or further medical treatment to extend life (also known as passive euthanasia) in Mexico City,^[38] in the central state of Aguascalientes (since 6 April 2009)^[39] and, since 1 September 2009, in the Western state of Michoacán.^[40] A similar law extending the same provisions at the national level has been approved by the senate^[41] and an initiative decriminalizing active euthanasia has entered the same legislative chamber on 13 April 2007.^[42]

Netherlands

In the 1973 "Postma case" a physician was convicted for having facilitated the death of her mother following repeated explicit requests for euthanasia.^[43] While upholding the conviction, the court's judgment set out criteria when a doctor would not be required to keep a patient alive contrary to their will. This set of criteria was formalized in the course of a number of court cases during the 1980s.

In 2002, the Netherlands passed a law legalizing euthanasia including physician-assisted suicide.^[44] This law codifies the twenty-year-old convention of not prosecuting doctors who have committed euthanasia in very specific cases, under very specific circumstances. The Ministry of Public Health, Wellbeing and Sports claims that this practice "allows a person to end their life in dignity after having received every available type of palliative care."^[45] The United Nations has reviewed and commented on the Netherlands euthanasia law.^[46]

In September 2004 the Groningen Protocol was developed, which sets out criteria to be met for carrying out child euthanasia without the physician being prosecuted.^[47]

New Zealand

Assisted suicide and voluntary euthanasia remain illegal in New Zealand under Section 179 of the New Zealand Crimes Act 1961, which renders it a criminal offence to "aid and abet suicide." There have been two prior decriminalisation attempts- the Death With Dignity Bill 1995 and the Death With Dignity Bill 2003. Both failed, although the latter only did so by a three-vote margin within the New Zealand Parliament. In May 2012, Labour Party of New Zealand MP Maryan Street introduced a private member's bill into the ballot box, the End of Life Choices Bill, which was taken over by MP Iain Lees-Galloway when she failed to get re-elected in the 2014 General Election. The bill was dropped in Dec 2014 under the request of Labour Party of New Zealand leader Andrew Little as the issue was deemed to be distracting from bigger issues that concerns the party.^[48]

Norway

Euthanasia remains illegal, though a caregiver may receive a reduced punishment for taking the life of someone who consents to it.^[49]

Philippines

Euthanasia is illegal in the Philippines. In 1997, the Philippine Senate considered passing a bill legalizing passive euthanasia. The bill met strong opposition from the country's Catholic Church. If legalized the Philippines would have been the first country to legalize euthanasia. Under current laws, doctors assisting a patient to die can be imprisoned and charged with malpractice.^[50]

Switzerland

In Switzerland, deadly drugs may be prescribed to a Swiss person or to a foreigner, where the recipient takes an active role in the drug administration.^[51] More generally, article 115 of the Swiss penal code, which came into effect in 1942 (having been written in 1918), considers assisting suicide a crime if and only if the motive is selfish.

Sweden

Passive euthanasia was deemed legal after a landmark court ruling in 2010. This means a health care professional can legally cease life support upon request from a patient, however administering a lethal substance is illegal.^[52]

Turkey

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

United Kingdom

Euthanasia is illegal in the United Kingdom. Any person found to be assisting suicide is breaking the law and can be convicted of assisting suicide or attempting to do so.^[53][54] However, the Director of Public Prosecutions has issued guidelines setting out when a prosecution is, or is not, likely to happen.^[55] Between 2003 and 2006 Lord Joffe made four attempts to introduce bills that would have legalised voluntary euthanasia – all were rejected by the UK Parliament.^[56] Currently, Dr Nigel Cox is the only British doctor to have been convicted of attempted euthanasia. He was given a 12-month suspended sentence in 1992.^[57]

In regard to the principle of double effect, in 1957 Judge Devlin in the trial of Dr John Bodkin Adams ruled that causing death through the administration of lethal drugs to a patient, if the intention is solely to alleviate pain, is not considered murder even if death is a potential or even likely outcome.^[58]

United States

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

While active euthanasia is illegal throughout the US, assisted suicide is legal in Oregon, Washington, Vermont, California (effective from mid-2016), one county in New Mexico, and is de facto legal in Montana.^[59][60]

Uruguay

Since 1933 the Penal Code of Uruguay, article 37, accept Compassionate Homicide, the first legal document that include euthanasia. It's important to say that this legal document didn't use this denomination. In another article, 127, the judge could waive the doctor, if this action was made by patient pledge and the doctor had an honorable reputation.^[61] The main source of this Penal Code was Jimenéz de Asúa, a Spanish penalist, that introduce this concept in his book "Libertad de amar y derecho a morir: ensayos de un criminalista sobre eugenesia, eutanasia, endocrinología", published in Madrid/Spain, in 1928.^[62] The first proposal to understand Euthanasia as homicide was made by Ruy Santos in his MD thesis, "Da resistencia dos estados mórbidos à therapeutica e da incurabilidade perante a euthanásia", at Faculdade de Medicina da Bahia/Brazil, in 1928. He made a difference between Euthanasia as homicide and Euthanasia as suicide, probably the first citation about Assisted Suicide.^[63]

Non-governmental organizations

There are a number of historical studies about the thorough euthanasia-related policies of professional associations. In their analysis, Brody et al. found it necessary to distinguish such topics as euthanasia, physician-assisted suicide, informed consent and refusal, advance directives, pregnant patients, surrogate decision-making (including neonates), DNR orders, irreversible loss of consciousness, quality of life (as a criterion for limiting end-of-life care), withholding and withdrawing intervention, and futility.^[64] Similar distinctions presumably are found outside the U.S., as with the highly contested statements of the British Medical Association.^[65][66]

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

The debate in the ethics literature on euthanasia is just as divided as the debate on physician-assisted suicide, perhaps more so. Slippery-slope arguments are often made, supported by claims about abuse of voluntary euthanasia in the Netherlands.... Arguments against it are based on the integrity of medicine as a profession. In response, autonomy and quality-of-life-base arguments are made in support of euthanasia, underscored by claims that when the only way to relieve a dying patient's pain or suffering is terminal sedation with loss of consciousness, death is a preferable alternative -- an argument also made in support of physician-assisted suicide.^[67]

Other NGOs that advocate for and against various euthanasia-related policies are found throughout the world. Among proponents, perhaps the leading NGO is the UK's Dignity in Dying, the successor to the (Voluntary) Euthanasia Society.^[68] In addition to professional and religious groups, there are NGOs opposed to euthanasia^[69] found in various countries.

References

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37. Loi du 16 mars 2009 sur l’euthanasie et l’assistance au suicide
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46. Observations of the UN human rights committee
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53. Suicide Act 1961 s.2
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60. Eckholm, Erik (7 February 2014). "‘Aid in Dying' Movement Takes Hold in Some States". The New York Times.
61. Reta A, Grezzi O. Código penal de la República Oriental del Uruguay. 4th ed. Montevideo: Fundación de Cultura Universitaria; 1996.
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64. Brody, Baruch, McCullough, Rothstein and Bobinski. Medical Ethics: Analysis of the Issues Raised by the Codes, Opinions and Statements. BNA Books, 2001
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66. For professional policies in the English-speaking world, see this selection by an advocacy NGO.
67. Brody et al., p.283
68. Dignity in Dying. In an unsympathetic account, the International Task Force on Euthanasia and Assisted Suicide has detailed the ebb and flow of euthanasia proponents. http://www.internationaltaskforce.org/rpt2005_I.htm#204
69. Euthanasia suicide mercy-killing right-to-die physician assisted suicide living wills research

External links

• Focarelli, Carlo. Euthanasia, Max Planck Encyclopedia of Public International Law
• Downie J, Chambaere K, Bernheim JL (2012). "Pereira's attack on legalizing euthanasia or assisted suicide: Smoke and mirrors". Current Oncology 19 (3): 133–8. doi:10.3747/co.19.1063. PMC 3364762. PMID 22670091.

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