Euthanasia refers to the act of intentionally ending the life of a patient by a health care practitioner through medical means at that patient’s explicit request while PAS involves the provision or prescribing of drugs by a health care practitioner for a patient to end their own life.
Euthanasia is currently legal in seven jurisdictions: the Netherlands (since 2002), Belgium (since 2002), Luxemburg (since 2009), Colombia (since 2015), Canada (since 2016) and Victoria (since 2017) and Western Australia (since 2019) in Australia (Table 1).
As of February 2020, the Spanish legislature is debating a bill that would legalize euthanasia and assisted suicide and similar legislation is being crafted in Portugal following the approval of related proposals by parliament (15,16). New Zealand’s parliament voted in favor of legalizing euthanasia in late 2019 and a national referendum on the issue will take place in September 2020.
The Northern Territory in Australia was the first jurisdiction to legalize euthanasia in 1995, however, the law was overturned after just nine months by the federal Parliament of Australia.
PAS without the option for euthanasia, is legally practiced in Switzerland and ten US jurisdictions.
In Canada, Luxembourg and the United States, a person must be at least 18 years old to request physician-assisted suicide. In the Netherlands, a patient can request assisted dying from the age of 12 years old. Belgium has allowed a patient of any age to request euthanasia or physician-assisted suicide since 2014, provided they are of mature judgement. Switzerland does not specify an age at which a person can request assisted suicide though most right-to-die organizations require the person to be an adult with sound judgement.
Euthanasia is currently legal in seven jurisdictions: the Netherlands (since 2002), Belgium (since 2002), Luxemburg (since 2009), Colombia (since 2015), Canada (since 2016) and Victoria (since 2017) and Western Australia (since 2019) in Australia (Table 1).
As of February 2020, the Spanish legislature is debating a bill that would legalize euthanasia and assisted suicide and similar legislation is being crafted in Portugal following the approval of related proposals by parliament (15,16). New Zealand’s parliament voted in favor of legalizing euthanasia in late 2019 and a national referendum on the issue will take place in September 2020.
The Northern Territory in Australia was the first jurisdiction to legalize euthanasia in 1995, however, the law was overturned after just nine months by the federal Parliament of Australia.
PAS without the option for euthanasia, is legally practiced in Switzerland and ten US jurisdictions.
In Canada, Luxembourg and the United States, a person must be at least 18 years old to request physician-assisted suicide. In the Netherlands, a patient can request assisted dying from the age of 12 years old. Belgium has allowed a patient of any age to request euthanasia or physician-assisted suicide since 2014, provided they are of mature judgement. Switzerland does not specify an age at which a person can request assisted suicide though most right-to-die organizations require the person to be an adult with sound judgement.
Commonalities among substantive requirements for:
a) The person must have a serious and incurable
condition caused by an illness or an accident (in the US, Colombia, and Victoria the person must also be expected to die imminently)
b) The person must have unbearable physical or psychological suffering which cannot be alleviated (not required for PAS in the US)
...
Commonalities among procedural requirements for assisted suicide and euthanasia include:
a) A second independent physician must by consulted by the treating physician before euthanasia is performed (a third consultation is required for non- terminal cases in Belgium);
b) The US and Canada require mandatory waiting periods between request and provision of assisted death;
c) Euthanasia must be reported by the physician following the procedure for review by a multidisciplinary control and evaluation committee (in Colombia this must be done prior to euthanasia being carried out)
Motivation for requests and patient demographics
Studies indicate that pain is not typically the primary motivation for requesting euthanasia or physician-assisted suicide; inadequate pain control is seen in less than 33% of patients (7). Loss of autonomy, diminished quality of life and loss of dignity are the factors most frequently associated with requests for assisted dying (22). Loss of dignity is identified as the basis for requests in 61% of cases in the Netherlands and 52% in Belgium (7). Patients who request euthanasia or assisted suicide are most often dying of cancer (60–100% cases), though a lower percentage was seen in Switzerland (38–47%) (1).
Other conditions associated with requests include amyotrophic lateral sclerosis (ALS), multiple sclerosis, cardiovascular disease and immunodeficiency syndrome (1).
In countries where both euthanasia and physician- assisted suicide are legal options, euthanasia is far more frequently requested (21,23). One study in the Netherlands indicated that in 75% of cases, euthanasia was preferred (24).
a) The person must have a serious and incurable
condition caused by an illness or an accident (in the US, Colombia, and Victoria the person must also be expected to die imminently)
b) The person must have unbearable physical or psychological suffering which cannot be alleviated (not required for PAS in the US)
...
Commonalities among procedural requirements for assisted suicide and euthanasia include:
a) A second independent physician must by consulted by the treating physician before euthanasia is performed (a third consultation is required for non- terminal cases in Belgium);
b) The US and Canada require mandatory waiting periods between request and provision of assisted death;
c) Euthanasia must be reported by the physician following the procedure for review by a multidisciplinary control and evaluation committee (in Colombia this must be done prior to euthanasia being carried out)
Motivation for requests and patient demographics
Studies indicate that pain is not typically the primary motivation for requesting euthanasia or physician-assisted suicide; inadequate pain control is seen in less than 33% of patients (7). Loss of autonomy, diminished quality of life and loss of dignity are the factors most frequently associated with requests for assisted dying (22). Loss of dignity is identified as the basis for requests in 61% of cases in the Netherlands and 52% in Belgium (7). Patients who request euthanasia or assisted suicide are most often dying of cancer (60–100% cases), though a lower percentage was seen in Switzerland (38–47%) (1).
Other conditions associated with requests include amyotrophic lateral sclerosis (ALS), multiple sclerosis, cardiovascular disease and immunodeficiency syndrome (1).
In countries where both euthanasia and physician- assisted suicide are legal options, euthanasia is far more frequently requested (21,23). One study in the Netherlands indicated that in 75% of cases, euthanasia was preferred (24).
Drugs used for euthanasia and assisted suicide
Although physicians can use multiple types of drugs to perform euthanasia and some existing legislation specifies the use of particular drugs, those most often recommended within legal jurisdictions typically include a combination of (optional) benzodiazepine to relax the patient, followed by a high dose of a barbiturate such as thiobarbital, pentobarbital or secobarbital, which typically causes death, followed by a muscle relaxant, if required (5,11,33).
Supporting someone to carry out their wishes of assisted dying or assisted suicide remains a criminalised activity in the UK, as in many other countries in the World.
86.6% of those declaring no religion support that patients should be offered the opportunity to end their life, and the doctor/physician “should support” them in their decision.
Only participants who identified as Christian (23%) or Muslim (30.8%) indicated that the patient “should definitely not be allowed” this choice.
Infographic: Support for assisted suicide at an all-time high in Canada https://perma.cc/RN76-MS8L
Attitudes towards assisted suicide in cases of terminal illness and extreme pain in Great Britain in 2019, among the general population and healthcare professionals https://perma.cc/2MPW-H8HM
Do you consider doctor-assisted suicide morally acceptable or morally wrong? https://perma.cc/BK9C-FVCG
No. Euthanasia implies putting down someone on his or her request. This is prohibited in Switzerland. However, Swiss law allows for assisted / accompanied suicide https://perma.cc/4DGN-VQ34
Direct, active euthanasia is therefore also forbidden https://perma.cc/M5KW-MYHV
Legality of euthanasia https://perma.cc/N5WE-BPPK
Portuguese parliament legalises euthanasia after long battle https://perma.cc/S9YW-72VY
It would apply to people suffering from "lasting" and "unbearable" pain https://perma.cc/J5P2-YR5N
WE SHOULD ALL HAVE THE RIGHT TO DIE WITH DIGNITY https://perma.cc/V8TG-FLT7
IN YOUR STATE https://perma.cc/E4LN-GDVS
Although physicians can use multiple types of drugs to perform euthanasia and some existing legislation specifies the use of particular drugs, those most often recommended within legal jurisdictions typically include a combination of (optional) benzodiazepine to relax the patient, followed by a high dose of a barbiturate such as thiobarbital, pentobarbital or secobarbital, which typically causes death, followed by a muscle relaxant, if required (5,11,33).
Supporting someone to carry out their wishes of assisted dying or assisted suicide remains a criminalised activity in the UK, as in many other countries in the World.
86.6% of those declaring no religion support that patients should be offered the opportunity to end their life, and the doctor/physician “should support” them in their decision.
Only participants who identified as Christian (23%) or Muslim (30.8%) indicated that the patient “should definitely not be allowed” this choice.
Infographic: Support for assisted suicide at an all-time high in Canada https://perma.cc/RN76-MS8L
Attitudes towards assisted suicide in cases of terminal illness and extreme pain in Great Britain in 2019, among the general population and healthcare professionals https://perma.cc/2MPW-H8HM
Do you consider doctor-assisted suicide morally acceptable or morally wrong? https://perma.cc/BK9C-FVCG
No. Euthanasia implies putting down someone on his or her request. This is prohibited in Switzerland. However, Swiss law allows for assisted / accompanied suicide https://perma.cc/4DGN-VQ34
Direct, active euthanasia is therefore also forbidden https://perma.cc/M5KW-MYHV
Legality of euthanasia https://perma.cc/N5WE-BPPK
Portuguese parliament legalises euthanasia after long battle https://perma.cc/S9YW-72VY
It would apply to people suffering from "lasting" and "unbearable" pain https://perma.cc/J5P2-YR5N
WE SHOULD ALL HAVE THE RIGHT TO DIE WITH DIGNITY https://perma.cc/V8TG-FLT7
IN YOUR STATE https://perma.cc/E4LN-GDVS