Notes

2011 April - Note 1

Euthanasia and physician-assisted suicide – Law in other countries

Netherlands:

• Euthanasia is regulated by the ‘Termination of Life on Request and Assisted Suicide (Review Procedures) Act’, 2002.
• Euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with the criteria of due care. These criteria concern the patient’s request, the patient’s suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician, and the applied method of ending life.
• To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee.
• The law allows a medical review board to suspend the prosecution of doctors who have performed euthanasia when each of the following conditions is fulfilled:
  • the patient’s suffering is unbearable with no prospect of improvement
  • the patient’s request for euthanasia must be voluntary and persist over time (the request cannot be granted when under the influence of others, psychological illness, or drugs)
  • the patient must be fully aware of his / her condition, prospects, and options
  • there must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned earlier
  • the death must be carried out in a medically appropriate fashion by the doctor or patient, in which case the doctor must be present
  • the patient must be at least 12 years old (patients between 12 and 16 years of age require the consent of their parents)
• The doctor must also report the cause of death to the municipal coroner in accordance with the relevant provisions of the Burial and Cremation Act. A regional review committee assesses whether a case of termination of life on request or assisted suicide complies with the due care criteria. Depending on its findings, the case will either be closed or, if the conditions are not met, brought to the attention of the Public Prosecutor to initiate criminal proceedings.
• The Act offers an explicit recognition of the validity of a written declaration of the will of the patient regarding euthanasia (a ‘euthanasia directive’). Such declarations can be used when a patient is in a coma or otherwise unable to state if they wish to be euthanized.
• The following situations are considered normal medical practice and are not subject to the restrictions of the law at all:
  • stopping or not starting a medically useless (futile) treatment
  • stopping or not starting a treatment at the patient’s request
  • speeding up death as a side-effect of treatment necessary for alleviating serious suffering.

Switzerland:

• Assisted suicide is legally permitted and can be performed by non-physicians also, but active euthanasia is illegal. The difference between assisted suicide and euthanasia is that while in the former case the patient administers the lethal injection himself, in the latter a doctor or some other person administers it.
• Assisting suicide is a crime if, and only if, the motive is selfish.
• The Swiss law is unique because (1) the recipient need not be a Swiss national, and (2) a physician need not be involved.
• Many persons from other countries, especially Germany, go to Switzerland to undergo euthanasia

Belgium:

• Suicide can be practiced under certain conditions
• Patients wishing to end their own lives must be conscious when the demand is made and repeat their request for euthanasia
• The patient has to be under ‘constant and unbearable physical or psychological pain’ resulting from an accident or incurable illness
• Minors cannot seek assistance to die
• In the case of someone who is not in the terminal stages of illness, a third medical opinion must be sought
• Every mercy killing case will have to be filed at a special commission to decide if the doctors in charge are following the regulations

UK, Spain, Austria, Italy, Germany, France

• In none of these countries is euthanasia or physician-assisted death legal

United States of America:

• Active Euthanasia is illegal in all states in the USA, but physician-assisted dying is legal in the states of Oregon, Washington, and Montana

Oregon (USA):

• Oregon was the first state in USA to legalize physician-assisted death
• Under the Oregon Death with Dignity Act, 1997, a person who seeks physician-assisted suicide will have to meet certain criteria:
  • He must be an Oregon resident, at least 18 years old, and must have decision-making capacity
  • The person must be terminally ill, having six months or less to live
  • The person must make one written and two oral requests for the medication to end his / her life, the written one, substantially in the form provided in the Act, signed, dated, and witnessed by two persons in the presence of the patient, who attest that the person is capable, acting voluntarily, and not being coerced to sign the request
  • There are stringent qualifications as to who may act as a witness
  • The patient’s decision must be an ‘informed’ one, and the attending physician is obligated to provide the patient with information about the diagnosis, prognosis, potential risks, and probable consequences of taking the prescribed medication, and alternatives, including, but not limited to comfort care, hospice care, and pain control
  • Another physician must confirm the diagnosis, the patient’s decision-making capacity, and the voluntariness of the patient’s decision
  • Counseling has to be provided if the patient is suffering from depression or a mental disorder, which may impact his judgment
  • There has to be a waiting period of 15 days, next of kin have to be notified, and State authorities have to be informed
  • The patient can rescind his decision at any time
  • The attending physician must determine that the patient does not have ‘depression causing impaired judgment’ before prescribing the medication
• A person who meets all these requirements can receive a prescription of a barbiturate that would be sufficient to cause death. However, the lethal injection must be administered by the patient himself, and physicians are prohibited from administering it.

Canada:

• Physician-assisted suicide is illegal