Mercy death, compassionate killing, putting one down – these are all phrases about the same thing – euthanasia. This is the practice of ending a life because it would be more inhumane to allow it to continue, such as with painful terminal illness or brain death. It is an argument that is as old as civilized society under the rule of law. And it is approached differently in various countries, ranging from absolute “yes/no” to “in special circumstances”. This list looks at 10 countries and their view on legal euthanasia.
Definition: Euthanasia is the intentional premature termination of another person’s life either by direct intervention (active euthanasia) or by withholding life-prolonging measures and resources (passive euthanasia), either at the express or implied request of that person (voluntary euthanasia), or in the absence of such approval (non-voluntary euthanasia).
Euthanasia was legalized in Albania in 1999, it was stated that any form of voluntary euthanasia was legal under the rights of the terminally ill act of 1995. Passive euthanasia is considered legal should three or more family members consent to the decision. Albania’s euthanasia policy has been controversial among life groups and the Catholic Church, but due to other more prominent countries also legalizing forms of euthanasia, it has meant a more relaxed world attitude to the matter.
Euthanasia was legalized in Australia’s Northern Territory, by the Rights of the Terminally Ill Act 1995. Soon after, the law was voided by an amendment by the Commonwealth to the Northern Territory (Self-Government) Act 1978. The powers of the Northern Territory legislature, unlike those of the State legislatures, are not guaranteed by the Australian constitution. However, before the Commonwealth government made this amendment, three people had already practiced legal voluntary euthanasia (PAS), aided by Dr Philip Nitschke. The first person was a taxi driver, Bob Dent, who died on 22 September 1996.
Although it is a crime in most Australian states to assist in euthanasia, prosecutions have been rare. In 2002, relatives and friends who provided moral support to an elderly woman who committed suicide were extensively investigated by police, but no charges were laid. The Commonwealth government subsequently tried to hinder euthanasia with the passage of the Criminal Code Amendment (Suicide Related Materials Offences) Bill of 2004. In Tasmania in 2005 a nurse was convicted of assisting in the death of her elderly mother and father who were both suffering from illnesses. She was sentenced to two and a half years in jail but the judge later suspended the conviction because he believed the community did not want the woman put behind bars. This sparked debate about decriminalizing euthanasia. Decriminalisation of Euthanasia in Australia is supported by the Liberty & Democracy Party as well as the Australian Greens.
The Belgian parliament legalized euthanasia in late September 2002. Proponents of euthanasia state that prior to the law, several thousand illegal acts of euthanasia were carried out in Belgium each year. According to proponents, the legislation incorporated a complicated process, which has been criticized as an attempt to establish a “bureaucracy of death”.
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” (i.e., allowing a patient to die by turning off life support) and the latter case involved “active euthanasia” (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.
In Japan, the case of passive euthanasia must meet three conditions:
- 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;
- 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;
- 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:
- The patient must be suffering from unbearable physical pain;
- Death must be inevitable and drawing near;
- The patient must give consent. (Unlike passive euthanasia, living wills and family consent will not suffice.)
- The physician must have (ineffectively) exhausted all other measures of pain relief.
The country’s parliament passed a bill legalising euthanasia on 20 February 2008 in the first reading with 30 of 59 votes in favour; it still has to pass a second reading before coming into effect.
5. The Netherlands
In 2002, The Netherlands legalized euthanasia including physician assisted suicide. The law codified a twenty year old convention of not persecuting 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.”
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. 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. The code does not give physicians a special status in assisting suicide; however, they are most likely to have access to suitable drugs. Ethical guidelines have cautioned physicians against prescribing deadly drugs. However, they also recognize that in exceptional, and defined, cases physicians may justifiably assist suicide. When an assisted suicide is declared, a police inquiry may be started. Since no crime has been committed in the absence of a selfish motive, these are mostly open and shut cases. Prosecution happens if doubts are raised on the patient’s competence to make an autonomous choice. This is rare.
Article 115 was only interpreted as legal permission to set up organizations administering life-ending medicine in the 1980s, 40 years after its introduction. These organisations have been widely used by foreigners – most notably Germans – as well as the Swiss. Around half of the people helped to die by the organisation Dignitas have been Germans.
Recent debate in Switzerland has focused on assisted suicide rights for the mentally ill. A decision by the Swiss Federal Supreme Court on November 3, 2006, laid out standards under which psychiatric patients might terminate their lives: “It cannot be denied that an incurable, long-lasting, severe mental impairment similar to a somatic one can create a suffering out of which a patient would find his/her life in the long run not worth living anymore. Based on more recent ethical, juridical and medical statements, a possible prescription of Sodium-Pentobarbital is not necessarily contra-indicated and thus no longer generally a violation of medical duty of care. However, utmost restraint needs to be exercised: It has to be distinguished between the wish to die that is expression of a curable psychic distortion and which calls for treatment, and the wish to die that bases on a self-determined, carefully considered and lasting decision of a lucid person (“balance suicide”) which possibly needs to be respected.
If the wish to die bases on an autonomous, the general situation comprising decision, under certain circumstances even mentally ill may be prescribed Sodium-Pentobarbital and thus be granted help to commit suicide.” “Whether the prerequisites for this are given cannot be judged on separated from medical – especially psychiatric – special knowledge and proves to be difficult in practice; therefore, the appropriate assessment requires the presentation of a special in-depth psychiatric opinion.” A controversial article in the Hastings Center Report by Brown University Professor Jacob M. Appel advocated adopting similar rules in the United States.
3. The United Kingdom
Euthanasia is illegal in the United Kingdom however on November 5, 2006, Britain’s Royal College of Obstetricians and Gynaecologists submitted a proposal to the Nuffield Council on Bioethics calling for consideration of permitting the euthanasia of disabled newborns. The report does not address the current illegality of euthanasia in the United Kingdom, but rather calls for reconsideration of its viability as a legitimate medical practice.
In contrast there is increasing evidence that doctors in the UK are hardening their attitude against euthanasia or physician assisted suicide:
- UK doctors are particularly cautious about decisions to shorten life.
- Compared to other countries (eg. Italy, Sweden, Denmark), UK doctors are more open about discussing end-of-life decisions (ELD) with patients and relatives.
- Compared with countries where euthanasia or physician assisted suicide is legal (eg. Belgium, Netherlands, Switzerland), UK doctors are the same or more likely to report discussions on ELD with medical and nursing colleagues.
- 94% of UK specialist doctors in palliative care are against a change in the law.
- In 2006 both the Royal College of Physicians and the Royal College of General Practitioners voted against a change in the law.
Currently in the UK, any person found to be assisting suicide is breaking the law and can be convicted of assisting suicide or attempting to do so (i.e. if a doctor gives a patient in great pain a bottle of morphine to take (to commit suicide) when the pain gets too great). Although two-thirds of Britons think it should be legal, a recent ‘Assisted Dying for the Terminally-Ill’ Bill was turned down in the lower political chamber, the House of Commons, by a 4-1 margin.
2. United States
Active euthanasia is illegal in most of 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.
A Gallup Poll survey showed that 60% of Americans supported euthanasia. Attempts to legalize euthanasia and assisted suicide resulted in ballot initiatives and legislation bills within the United States in the last 20 years. For example, Washington voters saw Ballot Initiative 119 in 1991, California placed Proposition 161 on the ballot in 1992, Oregon passed the Death with Dignity Act in 1994, and Michigan included Proposal B in their ballot in 1998.
1. The World
The question: Is euthanasia justifiable?
The answer in the scale form was given, running from 1-10, 1 being “never justifiable” and 10 being “always justifiable”. The mean score given from all the participants in the respective country is shown in the graphs below, one for the world and one for Asia: