- 1950-1979
MAID: Medical Aid in Dying
Medical aid in dying (MAID) is also called medical assistance in dying, physician-assisted suicide (PAS), physician-assisted death/dying (PAD), and self-determination in dying. The New York State Bar Association defined MAID as “when a terminally ill, mentally competent adult patient, who is likely to die within six months, takes prescribed medicines, which must be self-administered, to end suffering and achieve a peaceful death.” [1]
MAID differs from euthanasia, which is when a healthcare provider administers a fatal drug, and from passive euthanasia, which is when artificial life support is withheld or stopped (such as feeding tubes and ventilators). Euthanasia is illegal in the United States but legal in some countries, including Belgium, Canada, Luxembourg, the Netherlands, and Spain. [2]
As of January 2023, MAID is legal in 10 U.S. states and D.C. as well as several countries around the world, including Austria, Canada, and Finland. In the United States, the laws are frequently referred to as Death with Dignity laws. Oregon originated the phrase with the state statute legalizing MAID in Oct. 1997, the first in the US and the law most subsequent American laws and bills have been modeled upon. [3][4]
Some 30 U.S. states have considered legalizing MAID beyond the 10 states and D.C. in which the practice is legal. At least 11 states actively considered legalization legislation in the 2021-2022 legislative session. Nine states have never actively considered MAID legislation and at least three of those states passed legislation to make the specific practice illegal (versus classifying it broadly as homicide). [4]
The American Medical Association (AMA), American College of Physicians, and World Medical Association are officially opposed to the practice. The AMA stated that MAID is “fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.” However, at least 10 state chapters of the AMA, primarily in states where MAID is legal, have dropped opposition to the practice. [3][5][6][7]
On the other hand, the American Public Health Association, the American College of Legal Medicine, and the American Medical Women’s Association (AMWA) support the legalization of MAID. The AMWA says it “supports the right of mentally capable terminally ill patients to advance the time of death that might otherwise be a protracted, undignified, or extremely painful death.” [8][9][10]
Other medical organizations, including the British Medical Association and the Canadian Medical Association, have adopted a neutral stance on MAID. [11][12]
A 2018 Gallup poll found “65% of Americans think doctors should be legally allowed to assist a patient in dying by suicide” and 30% oppose legal MAID. 54% of respondents stated the practice was “morally acceptable,” while 42% believe MAID is “morally wrong.” [13]
An Aug. 8, 2024, Gallup poll found that 71% of Americans agree that doctors should be “allowed by law to end the patient’s life by some painless means if the patient and his or her family request it” (which is also known as euthanasia) and 66% agree that doctors should “be allowed by law to assist the [terminal] patient [in severe pain] to commit suicide” if requested by the patient. (which is also known as MAID). [43]
(This article first appeared on ProCon.org and was last updated on Dec. 19, 2022.)
| PROS | CONS |
|---|---|
| Pro 1: MAID allows terminally ill people to choose a “good death. Read More. | Con 1: MAID dangerously normalizes suicide. Read More. |
| Pro 2: MAID is a matter of bodily autonomy, a right everyone should have. Read More. | Con 2: MAID endangers vulnerable groups, including people with disabilities, the elderly, and people of color. Read More. |
| Pro 3: MAID ensures thoughtful regulation of the practice. Read More. | Con 3: MAID is a slippery slope to legal euthanasia and worse. Read More. |
Pro Arguments
(Go to Con Arguments)Pro 1: MAID allows terminally ill people to choose a “good death.
” The word “euthanasia” comes from the Greek word euthanatos, which means “easy death” or “good death.” [14]
In English, “euthanasia” has meant a good death since Francis Bacon described it as “after the fashion and semblance of a kindly & pleasant sleepe” in the early 17th century. The phrase “good death” has been associated with medical aid in dying ever since. [14]
While individual definitions of a “good death” may vary, a literature review found 94% of reports about what makes for a good death placed “preferences for dying process (94% of reports), pain-free status (81%), and emotional well-being (64%)” at the top of the lists from patients, family members, and healthcare providers. [15]
Many opponents of MAID define the practice as suicide, and thus not a good death. However, the American Association of Suicidology asserted that “suicide and physician aid in dying are conceptually, medically, and legally different phenomena.” [16]
Anita Hannig, associate professor of anthropology at Brandeis University, also distinguishes MAID from suicide: “Terminally ill patients who seek an assisted death aren’t suicidal. Absent a terminal prognosis, they have no independent desire to end their life…. Patients who pursue medical aid in dying are no longer looking at an open-ended life span either. To qualify for an assisted death in states with these laws they must already be on the verge of dying – that is, within six months of the end of their life. These patients don’t face a meaningful decision between living and dying, but between one kind of death and another.” [17]
Moreover, because of the waiting periods enforced by MAID laws, the patients have had time to carefully consider their choices for medical care and their own moral or spiritual obligations. Patients who choose medical aid in dying are typically surrounded by family, friends, and other loved ones when they die in a peaceful and comfortable environment. The patients have had time to say goodbye to other people in their lives. [16][18]
Medical anthropologist Mara Buchbinder has amplified on the benefits of MAID, especially for patients facing a drawn-out physical and mental decline punctuated by incessant medical interventions and a painful and heavily sedated death: “MAID renders not only the time of death but also the broader landscape of death open to human control. MAID allows terminally ill patients to choreograph their own deaths, deciding not only when but where and how and with whom. Part of the appeal is that one must go on living right up until the moment of death. It takes work to engage in all the planning; it keeps one vibrant and busy. There are people to call, papers to file, and scenes to set [turning]… dying into an active extension of life.” [18]
Pro 2: MAID is a matter of bodily autonomy, a right everyone should have.
Autonomy is “the state or condition of self-governance, or leading one’s life according to reasons, values, or desires that are authentically one’s own.” Bodily autonomy, in turn, is control over one’s physical being. [19]
MAID laws are written “to offer agency and autonomy at the end of life in lieu of suffering, indignity, and shame.” [20]
We should protect the “personal autonomy people should have to decide that they don’t want to continue living to the end of a condition from which they will die after many months, weeks, or days of suffering, both physically and existentially–that is, when there is no longer purpose in their lives,” according to lawyer Lamar W. Hawkins. [21]
“Our own [U.S.] Supreme Court, nearly 30 years ago, found that we all have the right to decide what medical care we are willing to accept,” adds Hawkins. “We should also have a right to decide what suffering we are willing to endure and receive medical assistance necessary to avoid the suffering we want to avoid. Our essential right to take our own lives when faced with unwanted suffering is undeniable–no state prohibits it. What we don’t yet have everywhere is the right to receive assistance in doing so, an omission that discriminates against the too feeble, the too ill, and the too disabled, who nevertheless know their own minds and deserve the assistance necessary to exercise that essential right.” [21]
For many terminally ill patients who are interested in MAID and go through the process to qualify and obtain a prescription, just having the lethal medication on hand relieves anxieties and fears about not only their potentially excruciating deaths but the lives and good moments they have left. [22]
Many find support from family, friends, and medical professionals to continue their lives for a while longer. In fact, many do not take the prescription medication and instead die from the terminal illness itself, but they die more peacefully having had the option of ending their lives and suffering on their own terms. [22]
Pro 3: MAID ensures thoughtful regulation of the practice.
American death with dignity laws are based on Oregon’s 1994 law, which was the first such American law enacted. The laws all have “stringent eligibility requirements” and “safeguards that [d]ata and studies show… work as intended, protecting patients and preventing misuse.” The safeguards include but are not limited to: being an adult with a terminal illness and fewer than six months to live, mentally competent, and able to self-administer the drugs. Each state requires the patient to make several requests to several doctors in person with witnesses and waiting periods between requests. And the patient may stop the process at any time before taking the lethal medication. [3][23]
Healthcare providers are under no obligation to participate in MAID but, if they do, they have to stop the process for mental health evaluations if needed or if coercion is suspected. Each state also has strict reporting protocols. [3][23]
Even Catholic priests have recognized the need for regulated death without agreeing morally with MAID. “And of the two possibilities, assisted suicide is the one [versus euthanasia] that most restricts abuses…. [So] it is a question of seeing which law can limit evil,” argues Father Renzo Pegoraro, Chancellor of the Pontifical Academy for Life. [24]
Many consider medical aid in dying laws a slippery slope to the abuse of vulnerable groups. But as journalist George Will pointed out, “Life is lived on a slippery slope: Taxation can become confiscation, police can become instruments of tyranny, laws can metastasize suffocatingly. However, taxation, police and laws are indispensable. The challenge is to minimize dangers that cannot be entirely eliminated from society…. MAID, enveloped in proper protocols, can and should be a dignity-enhancing response to especially harrowing rendezvous with the inevitable.” [25]
Rather than denying terminally ill people the grace of a good death because the law might go awry, society should work to strengthen protections for vulnerable groups and enforce laws that already make actions such as elder abuse illegal.
Con Arguments
(Go to Pro Arguments)Con 1: MAID dangerously normalizes suicide.
Suicide is “the act of intentionally taking one’s own life.” Medical aid in dying is the act of taking a fatal dose of medication to end one’s own life. [1]f[26]
“The more a society becomes pro some suicides, the more normalized suicide will become. Indeed, unless we recognize that the proper answer to suicide ideation is suicide prevention—for everyone, not just some—the ‘right’ to commit suicide could become as fundamental as the right to life,” according to Wesley J. Smith, Chair and Senior Fellow at the Center on Human Exceptionalism. [27]
Legalizing some suicides via medical aid in dying sends the message to those who are not terminally ill but who may be struggling with mental or physical illness, drug addiction, or other hardships that suicide is an acceptable solution available for them. [28]
According to the World Health Organization (WHO), 700,000 people die from suicide every year globally. [29]
In 2020, suicide was the twelfth leading cause of death in the United States, bumped down from the number 10 spot held in 2019 due to COVID-19 deaths and an increase in chronic liver disease and cirrhosis deaths. The overall rate of suicide increased 30% between 2000 and 2020. [30][31]
Suicide was the second leading cause of death for people aged 10-34 and the fifth for people aged 35-54, making suicide “a major contributor to premature mortality,” according to the Centers for Disease Control (CDC). [30][31]
In addition to the 45,900 Americans who died by suicide in 2020, some 12.2 million other adults reported serious thoughts of suicide, 3.2 million adults made plans to die by suicide, and 1.2 million adults actually died by suicide. [30]
Steven Wade, Executive Director of the Brain Injury Association of New Hampshire, highlights as well the many “populations, including veterans, teens, people with disabilities, brain injury survivors and the elderly who are ‘pre-disposed’ to suicide for reasons including depression, lack of autonomy and inability to engage in activities that make life enjoyable.” Those populations, he argues, are especially endangered by the “dangerous precedent” of legalizing some suicides, as well as by others who could exploit MAID laws “to steer vulnerable members of our society — who are not necessarily dying — in the direction of death instead of care.” [28]
“A taboo (not stigma) against suicide is an instrumental piece of suicide prevention,” according to psychiatrist Mark Komrad. Thus, instead of promoting any kind of suicide, governments should focus on suicide prevention, effective healthcare, and compassionate palliative care. [32]
Con 2: MAID endangers vulnerable groups, including people with disabilities, the elderly, and people of color.
Among the dangers of legalizing medical aid in dying is the potential to exploit the laws to kill vulnerable people.
The Center for Disability Rights points to the troubling reality that many disabled people are at the mercy of unscrupulous caregivers, medical providers, and insurance companies. Legal MAID endangers a community “at grave risk of coercion and abuse while creating an opportunity for insurance companies to enhance their bottom line.” [33]
Legalizing MAID “invites coercion,” according to attorney Margaret Dore, because abusive or impatient heirs and caregivers can shepherd the elderly toward suicide by helping them complete the necessary steps, picking up their medication, and potentially even administering the lethal drug because no witnesses are required at the time of death. [34][42]
“BIPOC [Black Indigenous and People of Color] Disabled people are at greater risk from assisted suicide laws because of racial disparities in health care,” says Ayishetu Salifu Mamudu, Deaf Systems Advocate at the Regional Center for Independent Living. “Although privileged white people present this as a rights issue, the reality is that BIPOC are in the cross hairs of this bad policy. I urge policy makers to recognize that and understand that in establishing this rights [sic] for some people, BIPOC individuals – and others – will die before their time. That is unacceptable.” [33]
Instead of facilitating suicide, palliative care is an effective, compassionate solution that does not imperil vulnerable groups. Zach Garafalo, Manager of Government Affairs at the Center for Disability Rights, points out that “anyone dying in discomfort that is not otherwise relievable, already may legally receive palliative sedation, wherein the patient is sedated to the point that the discomfort is relieved while the dying process takes place. We already have a legal solution to any uncomfortable deaths that does not endanger others the way an assisted suicide law does.” Legal hospice organizations already provide this end-of-life care and comfort. [33]
Con 3: MAID is a slippery slope to legal euthanasia and worse.
Describing legal MAID as a “moral cliff” rather than a slippery slope, John Stonestreet and Shane Morris, both of the Colson Center for Christian Worldview, highlight the fact that the “patient may request to die, but the doctor is still the one who determines whether the patient is competent and eligible. Small wonder that wherever medical aid in dying has been legalized, doctors and lawmakers have quickly begun asking why they need [a] patient’s permission before exercising ‘compassion’…. Once death is a treatment option, patients can no longer trust their doctors, their insurance companies, or even their families to have their best interests at heart. ‘Terminal illness’ quickly broadens to include ‘intolerable suffering’ which soon broadens to include ‘mental suffering.’” [35]
While the laws may be written with good intent, time chips away at the restrictions that might protect people. For example, in 2022, Oregon eliminated the requirement that patients requesting MAID be state residents. [36]
In 2021, Canada, which legalized MAID and euthanasia simultaneously, removed the criterion that the patient be dying or have a terminal illness; now any patient with a “grievous and irremediable medical condition” may request MAID or euthanasia. [37]
In 2002, Belgium extended euthanasia to children over 12, and recent health ministers have even tried to extend the law to all children. [38][39][40]
“As the world’s pioneer, the Netherlands has also discovered that although legalising euthanasia might resolve one ethical conundrum, it opens a can of others – most importantly, where the limits of the practice should be drawn,” says journalist Christopher de Bellaigue. Specifically, “the idea that a measure introduced to provide relief to late-stage cancer patients has expanded to include people who might otherwise live for many years, from sufferers of diseases such as muscular dystrophy to sexagenarians with dementia and even mentally ill young people.” [41]
As MAID becomes more common globally, the ethical and moral concern we should have over issues as serious as doctoring, death, and euthanasia is dangerously weakened.
Euthanasia & Medical Aid in Dying (MAID) around the World
Euthanasia (in which a doctor administers a lethal dose of medication to a patient) and medical aid in dying (MAID) are illegal in most countries. However, several countries have legalized one or both of the practices. Below, find a sampling of countries and the legal precedents concerning euthanasia and PAS.
These countries were chosen based on the availability of legal documents and information on medical practices, and an effort to include countries that represent a variety of cultures, religions, and ethnicities. Do not rely on this information without first checking with a current and official edition of the applicable law.
Australia
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
| (Legal in Victoria & Western Australia) | (Legal in Victoria & Western Australia) |
The Northern Territory of Australia passed the Rights of the Terminally Ill Act, which legalized voluntary euthanasia in 1995. The law went into effect on July 1, 1996 and was used by four Australians who were dying from cancer.
Two 1996 court challenges, one in the Supreme Court of the Northern Territory and one in the High Court, resulted in the law being declared valid.
A bill to overturn the Act was introduced at the federal level on Sep. 9, 1996 and passed both Houses by Mar. 25, 1997, when the Northern Territory’s Act was officially overturned, making both euthanasia and PAS illegal in Australia again.
The Green Party introduced the Voluntary Assisted Dying Bill of 2013 in Tasmania in an effort to legalize medical aid in dying in that state. The bill was defeated in 2013.
On Nov. 29, 2017, Victoria (Australia’s second-most populous state) legalized medical aid in dying and limited euthanasia. The law went into effect on June 19, 2019 and allows terminally ill patients (with a life-expectancy of 6 months in most cases) to obtain a lethal drug for self-administration. The law allows the drug to be administered by a doctor if the patient is unable to do so themselves.
As of July 1, 2021, medical aid in dying and limited euthanasia is legal in Western Australia per the Voluntary Assisted Dying Act 2019. Terminally ill adult patients may request lethal drugs for self-administration or for administration by a medical practitioner. [44][45][46][47][48]
Austria
| Euthanasia | MAID |
|---|---|
| Illegal | Legal |
The Belgian Act on Euthanasia of May 28, 2002 went into effect on Sep. 3, 2002, legalizing both euthanasia and PAS for “competent” adults and emancipated minors suffering from “constant and unbearable physical or mental suffering that cannot be alleviated.” The patients do not have be suffering from terminal illnesses. On Feb. 13, 2014, the law was extended to minors. Belgium was the second country to legalize euthanasia, after the Netherlands in 2001.
On Oct. 23, 2021, Austria’s government announced plans to legalize medical aid in dying in 2022. Two doctors, one specializing in palliative care, have to review each case and a 12-week waiting period will apply unless the patient is in the terminal phase of their illness. Medical aid in dying became legal on Jan. 1, 2022. [49][50]
Belgium
| Euthanasia | MAID |
|---|---|
| Legal | Legal |
The Belgian Act on Euthanasia of May 28, 2002 went into effect on Sep. 3, 2002, legalizing both euthanasia and PAS for “competent” adults and emancipated minors suffering from “constant and unbearable physical or mental suffering that cannot be alleviated.” The patients do not have be suffering from terminal illnesses. On Feb. 13, 2014, the law was extended to minors. Belgium was the second country to legalize euthanasia, after the Netherlands in 2001. [51][52][53]
Canada
| Euthanasia | MAID |
|---|---|
| Legal | Legal |
Suicide has been decriminalized in Canada since 1972, but a provision criminalizing suicide assistance remained in the Criminal Code and was upheld by the Supreme Court of Canada in Rodriguez v. British Columbia (Attorney General) in 1993.
In June 2014, Quebec passed Bill 52, legalizing euthanasia but not medical aid in dying.
In a unanimous decision on Feb. 6, 2015, the Supreme Court of Canada struck down the prohibition on assisting suicide, giving the Canadian Parliament a year to pass a law legalizing and regulating medical aid in dying and, possibly, euthanasia. The Court extended the deadline four months to allow then-incoming Prime Minister Justin Trudeau’s administration to draft a law. Bill C-14 passed the House of Commons but was in the Senate when the June 6, 2016 deadline passed, legalizing PAS (and possibly euthanasia) without legislative regulation.
The Court ruling stated that “‘physician-assisted death’ and ‘physician-assisted dying’ [are used] to describe the situation where a physician provides or administers medication that intentionally brings about the patient’s death at the request of the patient.” While physician-administered medication that results in death is generally referred to as “euthanasia,” the Court did not make that distinction, which made their ruling unclear about which practice is legal.
On June 18, 2016 C-14 was passed by the Senate, making assisted suicide and euthanasia legal effective immediately and regulating medical aid in dying and euthanasia. The law states, “medical assistance in dying means (a) the administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes death; or (b) the prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person, at their request, so that they may self-administer the substance and in doing so cause their own death.”
Eligible persons must be citizens or permanent residents of Canada, at least 18-years-old, and have a “grievous and irremediable medical condition.”[54][55][56][57][58]
China
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
Euthanasia and medical aid in dying are illegal in China under Articles 232 and 233 of the Criminal Law of the People’s Republic of China: “Article 232 Whoever intentionally commits homicide shall be sentenced to death, life imprisonment or fixed-term imprisonment of not less than 10 years; if the circumstances are relatively minor, he shall be sentenced to fixed-term imprisonment of not less than three years but not more than 10 years.” And, “Article 233 Whoever negligently causes death to another person shall be sentenced to fixed-term imprisonment of not less than three years but not more than seven years; if the circumstances are relatively minor, he shall be sentenced to fixed-term imprisonment of not more than three years, except as otherwise specifically provided in this Law.”
In Mar. 1994 a group of China’s National People’s Congress (NPC) legislators proposed euthanasia laws but they were not passed. In Mar. 2007, a woman with muscular dystrophy had a television journalist broadcast her proposal for euthanasia legislation during the NPC annual session. [59][60][61]
Colombia
| Euthanasia | MAID |
|---|---|
| Legal | Illegal |
Euthanasia became legal in Colombia on May 20, 1997 when the Constitutional Court (the country’s highest court), ruled (6-3) that a person may choose suicide and that physicians could not be prosecuted for helping by passing Article 326 of the 1980 Penal Code. The Court ruled against the plaintiff, Jose Euripides Parra Parra, who brought the case to the Court hoping to have euthanasia declared unconstitutional and stated, “Tendencies of totalitarian fascist and Communist States are reflected in mercy killing, they respond to Hitler’s and Stalin’s ideas; where the weakest, the most seriously ill are lead and condemned to the gas chambers, to probably ‘help them die better.’” The Court instead asserted, “in the case of a terminally ill [person]… no responsibility should be attributed to the acting physician, as his conduct is justified.” The Court asked that Congress legislate the act, but Congress did not, thus putting the legalization on hold for eight years until the Health Ministry was instructed to release guidelines, which it did on Apr. 20, 2015, officially legalizing euthanasia in Colombia.
Ovidio Gonzalez, a 79-year-old man with terminal throat cancer, was the first patient to use the law on July 3, 2015 in Pereira, Colombia. DescLAB, a legal rights advocacy group, stated 178 people with terminal illnesses had been legally euthanized between 1997 and Oct. 15, 2020 in Colombia.
In 2021, the Colombian court recognized that the procedure should not be only available to those with terminal illnesses and, on Jan. 7, 2022, Victor Escobar, who had a degenerative disorder (end-stage chronic obstructive pulmonary disease), was the first person with a non-terminal illness to die via legally regulated euthanasia in Colombia. The next day, Martha Sepulveda, who suffered with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease, was the second person with a non-terminal illness to die via legally regulated euthanasia in Colombia. [62][63][64][65][67][68]
Denmark
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
Both euthanasia and medical aid in dying are illegal in Denmark. The Parliament’s advisory panel on ethics, Etisk Råd, debated the topic in 1997, 2003, and 2012, moving from collectively against the practice in 1997 to divided on the issue in 2012.
A June 17, 2003 study published in The Lancet found that 1% of deaths in Denmark were caused by the “[a]dministration of drugs with the explicit intention of hastening death” and that these deaths were more often performed outside of the hospital.
In 2022, Svend Lings, a Danish doctor who helped at least 10 patients die, was found guilty of helping two people die and a third attempted suicide. His medical license was revoked and he was sentenced to 60 days in jail. Lings appealed his conviction to the European Court of Human Rights, stating he had only legally given information to patients. The ECHU upheld Lings’s conviction on the grounds that he procured the lethal medication for patients, going beyond legal information distribution. [69][70][71][72][73]
Finland
| Euthanasia | MAID |
|---|---|
| Illegal | Legal |
A debate about legalizing euthanasia emerged in 2012 after the National Advisory Board on Social Welfare and Health Care Ethics (ETENE) brought the topic to debate and established a working group on the issue in 2011.
The Jan. 1, 2012 ETENE statement released by the Ministry of Social Affairs and Health that resulted from the working group stated, “Assisted suicide is not a crime in Finland. Assisted suicide is connected to end-of-life care when the patient takes the deadly dose of medicine himself/herself. Placing the dose of medicine within the patient’s reach at the patient’s request when he/she has decided to end his/her life, is considered assisted suicide.” The group stated that the discussion on euthanasia should continue but declined to make a recommendation about the legalization of the practice.[74][75][76]
France
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
France’s Parliament passed a law on Jan. 27, 2016 that allows doctors to sedate terminally-ill patients until their deaths from their illness or starvation. President Francois Hollande called for the law as a compromise to euthanasia and medical aid in dying. [77][78][79]
Germany
| Euthanasia | MAID |
|---|---|
| Illegal | Legal |
On Nov. 6, 2015, Germany legalized medical aid in dying that is performed on an “individual basis out of altruistic motives.” “Commercial euthanasia” or “suicide business” is illegal. Prior to the 2015 law, doctors were allowed to provide high doses of pain medication to accelerate death.
On Feb. 26, 2020, a high court overturned the ban on professionally provided assisted suicide, which will allow patients to seek the procedure from doctors.
In 2021, the German Doctors’ Federation removed the edict, “A doctor may not provide any assistance for suicide,” from its code of conduct. [80][81][82][83][84]
India
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
The Supreme Court of India legalized passive euthanasia (the withdrawal of treatment or life-sustaining machinery) on Mar. 7, 2011. The same ruling reaffirmed the illegality of active euthanasia. The Court held that their decision was the “law of the land” until Parliament passes a law on the issue.
The Supreme Court ruling was in response to a case concerning Aruna Shanbaug, a nurse who was strangled and sexually assaulted in 1973. The attack left Shanbaug in a vegetative state. Pinki Virani, a friend of Shanbaug’s, filed suit to have Shanbaug taken off life-support, stating that the “continued existence of Aruna is in violation of her right to live with dignity.” The hospital treating Shanbaug did not agree with the removal of life-support. The Supreme Court sided with the hospital staff and, thus, laid out regulations for passive euthanasia. The Court stated that only parents, a spouse, close relatives, or a “next friend” (if no relatives were available) could make the decision to remove life-sustaining treatment. The Court contended that the hospital staff, not Virani, was the “next friend” to make the decision. Aruna Shanbaug died on May 18, 2015 from pneumonia after being in a coma for 42 years. [85][86][87][88][89][90]
Ireland
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
Both euthanasia and medical aid in dying are illegal in Ireland under the Criminal Law (Suicide) Act, 1993, which states, “A person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be guilty of an offense and shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years.” [91][92][93]
Israel
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
Israeli law and Jewish law ban medical aid in dying and active euthanasia. Passive euthanasia (the withdrawal of treatment or life-sustaining machinery) is banned by Jewish law but was allowed by the Tel Aviv District Court on Dec. 9, 2014. Other bills called “physician-assisted suicide” or “Sabbath clock” bills have been discussed in Parliament but have not become law and would only legalize passive euthanasia. [94][95][96][97]
Italy
| Euthanasia | MAID |
|---|---|
| Illegal | Legal |
Piergiorgio Welby, who suffered from a rare, terminal type of muscular dystrophy, petitioned the court to be allowed medical aid in dying in 2006. After Weby’s death, which happened when his anesthetist, Mario Riccio, turned off Welby’s life-support, Riccio was investigated for “consensual homicide.” Riccio was cleared of the charges and the court called on lawmakers to legalize passive euthanasia (the withdrawal of treatment or life-sustaining machinery).
In July 2008, a court allowed Beppino Englaro to disconnect his daughter Eluana’s feeding tubes. Eluana was in a car accident in 1992 and was left in a vegetative state. Prime Minister Silvio Berlusconi issued an emergency decree that would have forced the clinic to feed Eluana but President Giorgio Napalotono refused to sign the decree. Eluana died before the Senate could enact a law that prevents doctors from withholding nutrition.
In 2019, Italy’s Constitutional Court ruled that medical aid in dying was not illegal if a patient met the following circumstances summarized in the New York Times: “they had to have full mental capacity and suffer from an incurable disease that caused severe and intolerable physical or psychological distress. They also had to be kept alive by life-sustaining treatments.”
On June 16, 2022, Federico Carboni, who was paralyzed in a traffic accident in 2010, became the first patient to legally use medical aid in dying in Italy via a special machine that allowed him to self-administer a fatal drug. Italian Parliament is now tasked with creating legislation and regulation for the practice. [98][99][100][101]
Japan
| Euthanasia | MAID |
|---|---|
| Unclear | Legal |
Japan has no specific laws banning euthanasia but medical aid in dying is a criminal offense. “Death with dignity,” or “songenshi,” means passive euthanasia in Japan.
In the Tokai University Hospital University case, on March 28, 1995 the Yokohama District Court found a doctor guilty of homicide for injecting a patient suffering from myeloma with several drugs, at the request of the patient’s son, that ultimately killed the patient. The court ruled that in order for active euthanasia to be legal: 1. The patient must be in “unbearable physical pain;” 2. The death of the patient is “unavoidable and… imminent;” 3. The doctor has tried everything else to remove the patient’s pain and nothing has worked; and 4. The patient explicitly consents to shorten his or her life. The court ruling also set forth standards for passive euthanasia (the withdrawal of treatment or life-sustaining machinery).
Ten years later, the same court decided the Kawasaki Kyodo Hospital case on Mar. 25, 2005, in which another doctor was found guilty of homicide for removing a breathing tube and then injecting a patient with muscle relaxant, which resulted in the patient’s death. The doctor was found guilty because she did not seek or get the patient’s permission. The Tokyo High Court took up the case and reversed the lower court’s decision but upheld the homicide conviction on Feb. 28, 2007, stating that the lower court’s rules for euthanasia were problematic. The Tokyo High Court did not establish any new rules for euthanasia. The ruling was appealed to the Supreme Court but the Court declined to hear the case.
The debate over euthanasia and medical aid in dying was reignited in 2020 when two doctors, Yoshikazu Okubo and Naoki Yamamoto were arrested for aiding in the suicide via the euthanization of Yuri Hayashi, who had ALS (amyotrophic lateral sclerosis). The doctors were reportedly paid 1.3 million yen (about $9,500) to administer barbiturates via gastrostomy (a small hole in the stomach). [102][103][104][105][106]
Luxembourg
| Euthanasia | MAID |
|---|---|
| Legal | Legal |
Luxembourg became the third country in Europe, after the Netherlands and Belgium, to legalize euthanasia and medical aid in dying. The law was adopted by Parliament on Feb. 19, 2008 and went into effect in Apr. 2009. Under the law, doctors have legal immunity from sanctions and lawsuits for performing euthanasia or medical aid in dying if a patient with a “grave and incurable condition” has asked repeatedly for the procedure.
Grand Duke of Luxembourg Henri refused to sign the bill into law so, on Dec. 10, 2008, Parliament passed a constitutional amendment (56-0) eliminating the requirement of the monarch’s signature and reducing the position’s power overall. The law was passed simultaneously to a law providing palliative care and paid leave for relatives with family members who are terminally ill and in the final stages of life. [107][108][109][110]
Mexico
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
Passive euthanasia (the withdrawal of treatment or life-sustaining machinery) was legalized in Mexico City (Jan. 7, 2008) and the states of Aguascalientes (Apr. 6, 2009) and Michoacán (Sep. 1, 2009) but remains illegal in the remainder of the country. A majority of Mexican states adopted constitutional amendments in line with Catholic Church doctrine to protect the right to life “from conception until natural death,” making the legalization of passive euthanasia, active euthanasia, or medical aid in dying difficult.
Bills to decriminalize active euthanasia were introduced by the Party of the Democratic Revolution (PRD) and the Institutional Revolutionary Party (PRI) in 2007 and 2009 but failed to pass. [111][112][113][114][115][116][117][118]
The Netherlands
| Euthanasia | MAID |
|---|---|
| Legal | Legal |
Euthanasia, though reported to be regularly practiced, was a criminal act in the Netherlands until 1973 when, in the Postma Case, Geertruida Postma, a doctor, was convicted for giving her terminally ill mother a lethal injection. The court decided to sentence Dr. Postma to a one-week suspended sentence and one-week probation instead of the 12 years maximum sentence. Because of the Postma Case and others, the courts established a set of conditions under which euthanasia and medical aid in dying would not be punished.
Euthanasia and medical aid in dying were legalized on Apr. 1, 2002 by the Termination of Life on Request and Assisted Suicide (Review Procedures) Act for Dutch citizens over 12 years old. The Act states that physicians who perform the procedures will be exempt from criminal liability and set forth criteria for physicians to follow to legally euthanize or assist in the suicide of a patient.
Under the law, newborns may be euthanized if they are born with unbearable suffering, there is no alternate solution, and the parents, physician, and an independent physician agree to the procedure. Called the Groningen Protocol, the criteria under which infants may be euthanized was written by Eduard Verhagen in Sep. 2004.
On Oct. 16, 2020, then Dutch Health Minister Hugo de Jonge announced plans to extend legal medical aid in dying to terminally ill children between the ages of one and 12 years old, but the law was not immediately changed. In June 2022, Dutch Health Minister Ernst Kuipers outlined protocol for expanding the law to children aged one to 12. The final proposal was expected in Oct. 2022. [119][120][121][122][123][124][125]
New Zealand
| Euthanasia | MAID |
|---|---|
| Illegal | Legal |
Section 179 of the New Zealand Crimes Act 1961 made “aiding and abetting suicide” illegal, including medical aid in dying, and is subject to a maximum sentence of 3 years in prison.
On Aug. 2, 1995, MPs (Members of Parliament) Michael Laws and Cam Campion, the latter of whom was dying of bowel cancer, introduced a “Death with Dignity” bill following the legalization of euthanasia in Australia’s Northern Territory. The bill was defeated with a 61-29 vote. Campion died of cancer on Oct. 16, 1995.
In May 2003, MP Peter Brown introduced a “Death with Dignity” similar to the Laws/Campion bill. A Ministry of Justice report argued that the bill could be in conflict with the Bill of Rights, which states that a person has the right to not be deprived of life. The bill was defeated 60-58.
MP Maryan Street planned to introduce an “End of Life Choices” bill in Oct. 2012 that would legalize euthanasia, but the proposed legislation was dropped due to rumored Labour party pressure in July 2013. MP David Seymour introduced a bill on Oct. 14, 2015 that would legalize medical aid in dying. The debate on the bill was vetoed on May 4, 2016, killing the bill.
An Oct. 2020 nationwide vote in favor of the practice legalized medical aid in dying in New Zealand on Nov. 7, 2021. [126][127][128][129][130][131][132][133][134][135]
Norway
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
Euthanasia and medical aid in dying are illegal in Norway, though, according to Penal Code § 278 (June 19, 2009), “[i]f any of compassion kills a person who is terminally ill, or who for other reasons are close to death, the penalty may be set below the minimum punishment or a milder punishment than is required by § 275.” § 275 requires that the punishment for murder be imprisonment of 8-12 years. [136]
Philippines
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
In June 1997, the Philippine Senate considered a bill to legalize passive euthanasia (the withdrawal of treatment or life-sustaining machinery). The bill did not advance. On Oct. 14, 2013, Senator Miriam Defensor-Santiago filed Senate Bill 1887, which would have made passive euthanasia legal. The bill died in the Senate. [137][138]
Portugal
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
In 2021 and 2022, Portugal’s Parliament voted three times to legalize medical aid in dying and euthanasia. The most recent set of bills passed with a 128-88 vote on June 9, 2022. The other bills had similar vote tallies. However, President Marcelo Rebelo de Sousa blocked the earlier bills for unclear wording. The June 2022 bills are expected to to be combined into one bill before being voted on by Parliament again and then sent to the president. [139]
Russia
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
Euthanasia is specifically prohibited by the “On Health Care of Russian Citizens” law passed in 1993. [140]
South Africa
| Euthanasia | MAID |
|---|---|
| Illegal | Unclear |
In 1997 the South African Law Commission published a report that included a draft law to legalize both euthanasia and medical aid in dying. The report was largely ignored and a law never passed.
In 2015, Robert James Stransham-Ford, a lawyer in his 60s with terminal stage 4 cancer, asked the Pretoria High Court to allow his physician to assist his suicide. The court ruled on Apr. 30, 2015 that the physician would face no criminal charges for assisting the suicide. Stransham-Ford died that morning, before the ruling was read. The scope of the ruling as it might apply to other cases remains unclear.[141][142][143][144]
Spain
| Euthanasia | MAID |
|---|---|
| Legal | Legal |
The Ministry of Health, at the request of the Government of Spain, wrote a “death with dignity” bill in Feb. 2011. The law would not have authorized euthanasia or medical aid in dying, but legalized passive euthanasia (the withdrawal of treatment or life-sustaining machinery) when approved later in 2011.
On Mar. 18, 2021, Spain’s parliament legalized both euthanasia and medical aid in dying for adult Spanish nationals and legal residents who are suffering a “serious or incurable illness” or a “chronic or incapacitating” condition that causes “intolerable suffering.” The person must be “fully aware and conscious” when they make two requests, 15 days apart, in writing. The law took effect on June 24, 2021. [145][146][147][148][149]
Sweden
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
On Apr. 26, 2010, Sweden legalized passive euthanasia (the withdrawal of treatment or life-sustaining machinery). The National Board of Health and Welfare issued the legalization ruling after the Swedish Society of Medicine asked for clarification between one law that allowed passive euthanasia and another law that prohibited “assisted-suicide” by means such as turning off a respirator (commonly known as passive euthanasia). The National Board ruled that a “patient who wished to discontinue treatment has a right to do so. The condition is that he or she understands the information provide by the doctor and the consequences of his or her decision.” Medical aid in dying and euthanasia remain illegal in Sweden. [150]
Switzerland
| Euthanasia | MAID |
|---|---|
| Illegal | Legal |
Euthanasia is illegal in Switzerland by article 114 of the Penal Code of Switzerland: “Any person who for commendable motives, and in particular out of compassion for the victim, causes the death of a person at that person’s own genuine and insistent request is liable to a custodial sentence not exceeding three years or to a monetary penalty.” Further, Swiss law prohibits assisted suicide for “selfish motives” (article 115) and anyone breaking this law is subject to up to five years in prison or a fine.
Assisted suicide is allowable if the person aiding the suicide has good intentions and does not actually commit the act that leads to death (such as injecting medication). “Accompanied suicides” are frequently performed at the Dignitas Clinic in Forch, Switzerland with barbituates. The suicide of Peter Smedley, who suffered from motor neuron disease, at the Dignitas Clinic was broadcast on the BBC in June 2011 as part of the “Choosing to Die” documentary series. [151][152][153][154]
Turkey
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
Both euthanasia and medical aid in dying are illegal under article 84 of the Turkish Penal Code: “(1) Any person who solicits, encourages a person to commit suicide, or supports the decision of a person for suicide or helps the suicide action in any manner whatsoever, is punished with imprisonment from two years to five years.” The article includes heavier penalties for commission of a suicide (four to ten years); encouraging others to commit suicide (three to eight years), and encouraging someone who does not understand the situation to commit suicide (felonious homicide, which carries a life sentence). [155]
United Kingdom(England, Northern Ireland, Scotland, & Wales)
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
Euthanasia is classified as either manslaughter or murder, depending upon the circumstances of the death, and carries a penalty of up to life in prison. Assisted suicide is illegal in England and Wales according to the Suicide Act 1961, which makes it illegal to “[a]id, abet, counsel or procure the suicide of another or an attempt of another to commit suicide,” and carries a penalty of up to 14 years in prison. The Suicide Act 1961 decriminalized suicide. The Coroners and Justice Act 2009 further clarified the illegality of assisted suicide and amended the Suicide Act 1961. In Northern Ireland, assisted suicide is illegal under the Criminal Justice Act (1966) and in Scotland the practice is not specifically illegal but those assisting suicide may be charged with homicide.
Diane Pretty, who was dying of motor neuron disease petitioned the Director of Public Prosecutions to allow her husband to aid her suicide. Pretty was paralyzed from the neck down and could not perform the act without assistance. She argued that the Human Rights Act 1998 should compel the Director to not prosecute anyone who assisted terminally ill people to die. The Director of Public Prosecutions refused her request. Pretty appealed the decision to the House of Lords, the United Kingdom’s Highest Court, which denied her case. Pretty died two weeks after the court ruling, on May 11, 2002 at age 43. [156][157][158][159][160][161][162]
Uruguay
| Euthanasia | MAID |
|---|---|
| Illegal | Illegal |
While assisted suicide is illegal in Uruguay, article 37 of the Penal Code (1933) states, “(Of mercy killing) Judges have the power to exempt from punishment the subject of honorable history, author of a homicide, carried out with godly motives, induced by repeated requests by the victim.” Further, article 127 states that judges can make use of “judicial pardon” in cases involving article 37. [163][164]