Australia will, from mid-2019, once again join the list of countries that have legalised a person’s right to die if he or she is suffering unbearably. This comes after Victoria became the first state in the country to legalise voluntary assisted dying in November 2017 – more than two decades after the federal parliament struck down the Northern Territory’s short-lived euthanasia act.
The Victorian bill provides a model for physician-assisted suicide, where a patient can request and receive help to source the drugs necessary to bring about their own death. This is different to voluntary euthanasia, which typically requires another person such as a doctor to actively cause the death of the patient at the patient’s request.
Under the Victorian model, there is scope for a doctor to administer the drugs if the patient is physically incapable of doing so themselves. To access the scheme, the patient must meet strict criteria. They must have an illness likely to end their life within six months (12 months for neurodegenerative conditions such as motor neuron disease) and be experiencing suffering that can’t be managed in a way tolerable to the patient. They must be over the age of 18 and a resident of Victoria.
Victoria’s model is pretty conservative compared to other jurisdictions. Some broaden eligibility to minors, non-residents and people suffering non-terminal conditions and disabilities. Others include access to both voluntary euthanasia and physician-assisted dying.
Here is a roundup of the laws around the world that permit assisted dying or euthanasia and ways in which they differ.
Outcomes of the Oregon model have influenced debate in many jurisdictions, including Australia. Oregon passed its Death with Dignity Act in 1994. Finally taking effect in 1997, it is one of the longest-standing legislative schemes for physician-assisted suicide.
Oregon’s eligibility requirements are similar to those in Victoria. Assisted dying is available to adults over 18 who are capable of making decisions, have a terminal diagnosis with a life expectancy of six months and are Oregon residents.
The initial process for seeking assistance to die is also similar: a series of requests and evaluations over a period of time. Unlike the Victorian bill, though, the Oregon law doesn’t require patients or doctors to seek a licence or permit from the state prior to taking or allowing the medication. But doctors are required to report deaths to the state for evaluation purposes.
As of January 2017, 1,749 people had received prescriptions under the Oregon law since it came into force in 1997. Around 1,127 patients had died from ingesting the medications provided, 133 of these in 2016. Most participants (70%) were 65 years or older, and most (77.4%) had cancer.
The Oregon law has been remarkably stable. There was an unsuccessful attempt in 2015 to extend the eligibility period from six to 12 months. But the regulatory and eligibility criteria remain unchanged since 2006, when the law’s validity was last challenged in the courts.
Netherlands, Belgium and Luxembourg
In the Netherlands, Belgium and Luxembourg, both voluntary assisted dying and euthanasia are legal. There are no specific diagnostic requirements for access to the scheme for adults. The patient only needs to be experiencing unbearable suffering without prospect of a cure.
Patients accessing assisted dying and euthanasia in these jurisdictions have done so not only for terminal conditions but also non-terminal ones too. These include dementia, alcohol and drug addiction, mental illness and disability.
Both Belgium and the Netherlands have reduced or removed age eligibility criteria to include minors. Since 2014, minors of any age who are terminally ill have been able to access assisted dying or euthanasia in Belgium, after a psychiatric assessment. In the Netherlands, children from 12 years can access the laws.
In the Netherlands, 6,672 people died as a result of euthanasia and 150 of assisted suicide in 2015 – or 4.6% of all deaths. This is consistent with estimates that assisted suicide or euthanasia accounts for between 0.3% and 4.6% of all deaths in jurisdictions where it is legal. Thus it remains relatively rare.
Despite being recognised as the first “euthanasia” jurisdiction, the Swiss system is somewhat of a legal irregularity, as the laws don’t expressly authorise physician-assisted suicide. Rather, while the Swiss Penal Code 1942 makes voluntary euthanasia and assisted suicide an offence in the case of “selfish” motives, it is silent on the status of assisted suicide for “non-selfish” motives.
As the system rests on an omission rather than an express scheme, there are no mandated eligibility requirements relating to age, residency, condition or prognosis.
Since the 1980s, not-for-profit organisations have interpreted this law as permitting them to provide assisted suicide services.
In the 2015 case of Carter v Canada, the Canadian Supreme Court ruled that a terminally ill patient has a right to a physician’s assistance in dying under the Canadian Charter of Rights and Freedoms. The case resulted in Bill C-14, which excludes from Canadian criminal laws those who provide assistance in dying to Canadian residents over the age of 18, with capacity to make decisions, who are suffering from a “grievous and irremediable” medical condition rendering the end of their life reasonably foreseeable.
Bill C-14 has been challenged because of the “reasonably foreseeable” requirement. The British Columbia Civil Liberties Association has argued it is more restrictive than the finding of the Canadian Supreme Court in Carter, which required only that the plaintiff be experiencing intolerable suffering. That court challenge is continuing, while the law remains valid.
Quebec, a province of Canada, has also legislated a form of euthanasia. Under Quebecois law, doctors must administer assistance personally and remain with the patient until they die. This imposes a greater burden on doctors than assisted dying models.
Colombia permits both voluntary euthanasia and physician-assisted suicide to terminally ill adults. The practice is regulated by a set of guidelines published in 2015 by the Colombian Ministry of Health and Social Protection. The guidelines came some 20 years after the Constitutional Court ruled no person could be criminally liable for taking the life of a terminally ill patient who had consented.
In common with the Victorian model, the Colombian guidelines require prior external authorisation. However this is obtained from an external review committee in Colombia, rather the Secretary of the Department of Health, as in the case of the Victorian model.
Authors: Wendy Bonython, Associate professor, University of Canberra