Legality of euthanasia

On 9 May 2012, the Argentine Senate turned into law a project that enables to reject treatments that artificially prolong the life of patients with terminal or irreversible symptoms. The consent may be given by the patient or, if not in a position to do so, their relatives or legal representatives. It was promulgated on 24 May 2012 as "Law 26,742".[7]

The Australian state of Victoria has a law allowing physician-assisted suicide which came into effect in June 2019,[8] with Western Australia passing a similar law in December 2019.[9] Physician-assisted suicide and voluntary euthanasia is illegal in all other Australian states and territories. Although rare, charges have been laid for 'aiding and abetting' the suicide of others.[10] It was once 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.[11] Unlike the states, legislation in the Northern Territory is not guaranteed by the Australian constitution. During the brief period in which euthanasia was legal in the Northern Territory, Dr. Philip Nitschke helped three people end their lives through assisted suicide using his Deliverance machine. Organizations such as Exit International 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.[12]

The Belgian parliament legalised euthanasia on 28 May 2002.[13][14]

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.[15][16] There have been about 1,400 cases a year since the law was introduced, and a record 1,807 cases were recorded in 2013.[17][18]

In December 2003, 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".[19] A psychologist must also determine the patient's maturity to make the decision. The amendment emphasizes that the patient's request be voluntary.[20] The first minor to be euthanized under these new regulations occurred in September 2016.[21]

In September 2014, the Federal Euthanasia Commission gave convicted rapist and murderer Frank Van Den Bleeken the right to assisted suicide. Van Den Bleeken had served decades in prison for a 1989 crime and no longer wished to live. Over a dozen other inmates filed similar petitions.[22] In January 2015, the Justice Ministry acknowledged that Van Den Bleeken's doctors recommended against euthanasia and that alternative psychological care would be sought for him.[23]

In late 2014, a doctor administered a lethal dose of drugs to a patient after struggling with mental illness for years, upon the patient own request. Quote: "Belgium is one of five countries that allow doctors to kill patients at their request, and one of two, along with the Netherlands, that grant the procedure for people with mental illness. The idea is that those with a psychiatric illness should be afforded the same rights as those suffering from a physical one." [24]

In January 2020, the assizes court in Ghent acquitted three doctors of murder charges for an euthanasia in 2010.[25]

Voluntary active euthanasia, called "physician assisted dying", is legal in Canada for all people over the age of 18 who have a terminal illness that has progressed to the point where natural death is "reasonably foreseeable." To prevent suicide tourism, only people eligible to claim Canadian health insurance may use it. Legalization of the practice came in 2015/2016 as a result of a series of Supreme Court rulings striking down Canada's ban on medically assisted suicide. Below is a timeline of events:

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.[26][27] 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.[28]

A parliamentary committee report tasked with studying the issue in light of the Supreme Court of Canada's ruling recommended that anyone experiencing "intolerable suffering" should be able to seek a doctor's help to die. On 14 April 2016, Canada's federal Liberal government introduced legislation to legalize assisted dying under more restrictive conditions than recommended by the committee, allowing access to only those with terminal illnesses for whom death is "reasonably foreseeable".[29] The British Columbia Civil Liberties Association argues that the government's assisted dying law is unconstitutional, because it limits access to only those whose death is "reasonably foreseeable", rather than provide access to anybody suffering from a "grievous and irremediable" condition, the definition used by the Supreme Court of Canada in their court ruling that the BCCLA argues would include non-terminal conditions.[30]

The bill received considerable multi-partisan opposition within the Senate, where it was criticized as being drafted too quickly, and being too restrictive compared with the Supreme Court decision.[31] As a result, the Senate made a series of amendments to the bill. The House of Commons accepted all of the amendments made by the Senate except one, which removed the requirement that death be "reasonably foreseeable."

On 17 June 2016, a bill to legally allow assisted suicide within Canada became law after it passed both houses of the Parliament of Canada and received Royal Assent.[32]

Active euthanasia or assisted suicide are not legal in Chile. Passive euthanasia, however, is legal. Since 2012, the regulation of patients' rights creates the right to informed consent, which allows accepting or refusing any medical treatment. Patients can refuse treatment when they are terminal.[33] Currently, a bill to allow active euthanasia and assisted suicide is being discussed by the congress.[34][35] The bill was approved in general by the Chamber of Deputies on 12 December 2020.[36]

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.[37] 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. On 15 December 2014, the Constitutional Court had given the Ministry of Health and Social Protection 30 days to publish guidelines for the healthcare sector to use in order to guarantee terminated ill patients, with the wish to undergo euthanasia, their right to a dignified death.[38]

Parliament has assigned ethics panels over the years that have advised against legalisation each time[39] however it is still not specifically outlawed[40] 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).[41][42]

Active euthanasia is not legal in Finland. Passive euthanasia, however, is legal.[43]

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). More socially conservative members of the Catholic Church and other major religious groups in France had announced that after expressing an opposition to the introduction of same-sex marriage in France, their next target may be the possible decriminalisation of voluntary euthanasia.[44]

In January 2016 both houses of France's parliament approved a measure that, while stopping short of euthanasia, would allow doctors to keep terminal patients sedated until death.[45]

Passive euthanasia is legal in Germany if the patient has requested it.[46] On 17 May 2014 the Federal Constitutional Court legalized passive euthanasia by means of the withdrawal of life support to patients who request euthanasia. Forms of active euthanasia, including the lethal compound administration, are illegal.

On 6 November 2015, the German Parliament passed a bill incriminating assisted suicide if it is done in a business-like manner. "Business-like" was meant by the legislator to include any recurrent assistance. Consequently, it typically included physicians. There did not need to be an intention to gain benefits.[47]

On 2 March 2017, the Federal Administrative Court ruled that, in extreme circumstances, it was illegal that an agency denied access to life-ending substances. The relevant legal basis must be interpreted in accordance with the fundamental right to personal self-determination.[48][49]

On 7 May 2019, the Federal Court of Justice, changing its previous judicature from 1984,[50] confirmed that doctors have no obligation to stop the death of a person who, pursuant to a valid autonomous decision, attempts suicide.[51]

On 26 February 2020, the Federal Constitutional Court ruled the provision which penalized assisted suicide services unconstitutional and thus void. The provision violated the fundamental right to personal self-determination.[52][53][54]

Passive euthanasia is legal in India.[55] On 7 March 2018 the Supreme Court of India legalised passive euthanasia by means of the withdrawal of life support to patients in a permanent vegetative state.[56][57] Forms of active euthanasia, including the administration of lethal compounds, are illegal.[58]

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.[59] Doctors can stop giving a patient life sustaining treatments such as ventilators, feeding tube etc. after being sedated, allowing the patient to die peacefully in their sleep.This only occurs in certain circumstances.[60]

On 7 October 2020 the Dying with Dignity Bill[61] passed its second reading and a delaying amendment was defeated, moving Ireland closer towards the legalisation of assisted dying.[62]

The Israeli Penal Law forbids causing the death of another and specifically forbids shortening the life of another. Active euthanasia has been accepted in some cases under Israeli law.[63] In 2005, proposals were put forward to allow passive euthanasia to be administered using a switch mechanism similar to Sabbath clocks.[64] 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.[65]

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.[66]

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".[67] 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."[68]

Euthanasia is not legal in Latvia.[69] However a doctor may refuse further treatment of a patient if they believe it is the best course of action.[70]

Euthanasia is not legal in Lithuania.However, as of 2016 a draft of a law about the right to die has been produced.[71]

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.[72]

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,[73] in the central state of Aguascalientes (since 6 April 2009)[74] and, since 1 September 2009, in the Western state of Michoacán.[75] A similar law extending the same provisions at the national level has been approved by the senate[76] and an initiative decriminalizing active euthanasia has entered the same legislative chamber on 13 April 2007.[77]

In the 1973 "Postma case" a physician was convicted for having facilitated the death of her mother following repeated explicit requests for euthanasia.[78] 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 2001,[79] the Netherlands passed a law legalizing euthanasia including physician-assisted suicide.[80] 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."[81] The United Nations has reviewed and commented on the Netherlands euthanasia law.[82]

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.[83]

Assisted suicide and voluntary euthanasia are 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."

Two decriminalisation attempts – the Death With Dignity Bill 1995 and the Death With Dignity Bill 2003 – failed, the latter by only 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 December 2014 at the request of Labour Party leader Andrew Little as the issue was deemed to be distracting from bigger issues that concerned the party.[84]

In November 2019, ACT MP David Seymour's End of Life Choice Bill, which will legalise assisted suicide for a select group of people if successful, passed its third reading 69 votes in favor to 51 opposed. In return for the New Zealand First party's support of the bill through its third reading, the bill be subject to a binding referendum held alongside the 2020 general election,[85] which will take place on 17 October 2020.[86] If a majority of voters support the referendum, the End of Life Choice Act will come into force 12 months after the official referendum results are declared.[87]

The End of Life Choice binding referendum passed with 65.1% of the vote on 30 October 2020.[88]

Active voluntary euthanasia remains illegal, though a caregiver may receive a reduced punishment for taking the life of someone who consents to it.[89] Passive euthanasia is legal.

Euthanasia is a delict under the laws of Peru, although there have been some attempts to reform them.

In October 2009, the Reviser Special Commission of the Penal Code of the Parliament expressed its support of a proposal that tried to amend article 112 of the Penal Code, but it did not succeed.

However, at the beginning of 2015, the case of the Chilean woman young Valentina Maureira, who suffered from cystic fibrosis, an incurable disease, and who asked that euthanasia be allowed in her country, attracted the interest of the press of Chile and also of foreign media.[90]

On 4 March of the same year, the Peruvian legislator Roberto Angulo Álvarez, membership of Dignity and Democracy parliamentary group, motivated by this case, presented a bill that proposed to allow assisted death in case of terminal or degenerative disease, with the objective of "avoid the physical and psychological pains of the patient, as well the unnecessary expenses for the family members and the State". Angulo Álvarez also argued that his legislative project "would contribute to respect for individual freedom and human dignity".[91][92]

Active euthanasia in the Polish Criminal Code is defined as always appearing under the influence of sympathy for the suffering person and at their request. It is forbidden; it is treated as a kind of murder punishable in a milder way. The perpetrator is punishable by imprisonment of between 3 months and 5 years. Exceptionally, a court may apply leniency or even waive the sentence. The provision of Article 150 of the Penal Code, which defines the crime of euthanasia murder, does not, however, explicitly require the person requesting it to be terminally ill, but this requirement is introduced by case law. A specific type of crime related to euthanasia in the broad sense of the term is assistance to suicide (Article 151 of the Penal Code), which also includes so-called euthanasic assistance to suicide, i.e. facilitating the suicide of a terminally ill person.

The issue hit the headlines following a petition calling for euthanasia to be legalized, it rode headlong into controversy with the full knowledge of the nursing staff.[93]

One of the current ‘hot topics’ in Portugal, the deeply divisive issue was latest point of friction between faith and politics in a Catholic and a Republican country.[94] A proposal to make Portugal one of only a handful of countries allowing euthanasia and doctor-assisted suicide was narrowly rejected (115-110 vote) by lawmakers on late May 2018.[95]

Following the 2019 elections the issue began to be discussed again in the Assembly of the Republic, where, as of February 2020, it is expected to be approved by left-wing and liberal parties.[96][97][98]

On 20 February 2020, the Portuguese Parliament voted to approve plans to introduce voluntary euthanasia laws.[99] On January 29, 2021, the Assembly of the Republic approved the final version of the law, with 136 votes supporting the bill.[100] It is yet to be enacted by the President of the Republic and subsequently published.

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.[101]

The National Assembly and The Ministry of Health and Welfare voted in favor of active and passive euthanasia and went into effect since February 2018, and has announced to issue a "Well-Dying" Bill.[102] However, the topic and debate of euthanasia in South Korea sparked for a long time, starting back on 4 December 1997 when a doctor was sent to prison for a major duration for voluntarily cutting life support of a braindead patient who injured himself from a head trauma, upon the request of his wife. This incident is well known in Korea as 'Boramae Hospital Incident' (보라매병원 사건). Another incident that sparked further debate was from the imprisonment of a father who plugged off a respirator for his braindead son.[103]

Patients who qualify for active or passive euthanasia in South Korea are reserved for the terminally ill with a nonexistent chance of recovery. Patients who have a beneficial reaction to any medications, or are not in a rapidly deteriorating state of health leading to imminent death may not be qualified. Patients must have a confirmation of a registered physician and a doctor to die under dignity, and comatose patients must have the approval of both guardians.[104]

Active euthanasia or assisted suicide are not legal in Spain. Passive euthanasia, however, is legal.

In February 2020 the Spanish parliament voted to approve plans to legalise voluntary euthanasia. The bill will now go to committee and the Senate before a final vote in the lower house.[105] The lower house approved the bill in December 2020.[106]

On 17 December 2020, the Congress of Deputies passed a bill to regulate the right to euthanasia.[107] The final draft, whose intellectual authorship was attributed to María Luisa Carcedo, commanded the support from 192 legislators (PSOE, Podemos, ERC, Ciudadanos, Junts per Catalunya, PNV, Bildu, CUP, Más País, BNG), the opposition from 138 (PP, Vox, UPN) and 2 abstentions.[107][108] Given widespread parliamentary support and the incorporation of amendments, the law is expected to be directly passed by the Senate, sanctioned by the King and then published in the BOE, without needing to return to the Congress of Deputies.[108]

Passive euthanasia was deemed legal after a landmark court ruling in 2010. That means a health care professional can legally cease life support upon request from a patient if they understand the consequences stated by their health care provider, and administering a lethal substance is also illegal.[109]

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.[110] 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 only if the motive is selfish.

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 imprisonment just like a simple murder.

Active 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.[111][112][113] 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.[114] 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.[115]

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.[116]

Passive euthanasia is legal, by way of advance decisions giving patients the right to refuse life saving treatment.[117] Food and liquid can also be withdrawn from someone in a permanent vegetative state without the need for court approval.[118]

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 U.S., assisted suicide is legal in Colorado, Oregon, Hawaii, Washington, Vermont, Maine,[119] New Jersey,[4] California,[120] the District of Columbia,[6] one county in New Mexico, and is de facto legal in Montana.[121][122] Additionally, Louisiana specifically prohibits euthanasia in its Bill of Rights as cruel and unusual punishment.

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.[123] 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.[124] 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.[125]

• McDougall, Jennifer Fecio; Gorman, Martha (2008). Euthanasia: A Reference Handbook. Santa Barbara: ABC-CLIO. p. 89. ISBN 978-1-59884-121-3.