Legal insights: the prospect of the right to die

Recent news reveals that 90% of people believe that terminally ill people should be granted the right to die. However, laws in the UK do not allow for this. Here, we examine two countries—Belgium and Canada—where the right to die has been granted, and two others—the US and the UK—where the right-to-die debate has been particularly prominent.

  • Last updated Apr 12, 2019 1:05:48 PM
  • Jan Hill

Case study: euthanasia of adults and children legal in Belgium

Belgium has what is widely considered the world’s most liberal euthanasia law. In 2014, after serving decades in prison, convicted rapist and murderer Frank Van Der Bleeken was given the right to assisted suicide because he filed a petition stating that he no longer wished to live.

The country’s law on physician-assisted suicide, which was passed in 2002, does not just cover the terminally ill—psychiatric patients and even terminally ill children can request euthanasia, with their parents’ agreement. Although surveys in Belgium reflect overwhelming public support for the policy and many doctors say it provides patients enduring constant and intolerable suffering a compassionate way to die peacefully, the law is not without controversy. 

In November 2018, Belgium launched its first-ever criminal investigation of euthanasia, examining whether doctors properly euthanised a woman with autism. The doctors are being investigated on suspicion of poisoning the 38-year-old woman, who had been diagnosed with Asperger syndrome two months before her 2010 death. In Belgium, euthanasia for psychiatric reasons is permitted if it can be proven that the person has “unbearable and untreatable” suffering. But many in Belgium question whether autism should be considered a valid reason to be euthanised. 

In the nearly 17 years since euthanasia has been legal in Belgium, more than 10,000 people have died this way, and only one other case was referred for prosecution, although that matter was later dropped.

Case Study: Canada euthanasia law requires consent be expressed, including immediately before death 

In Canada, euthanasia is known as medical assistance in dying, and along with assisted suicide, was legalized in 2016. The law is meant to end the suffering of terminally ill patients and is not an option for minors or on the grounds of mental illness, long-term disability, or any condition considered curable. It is available only to residents who are eligible for Canadian healthcare coverage, and advance directives for voluntary euthanasia are not allowed. 

Canadian euthanasia law includes legal safeguards to prevent abuse and ensure that informed consent has been obtained, and neither legal witnesses nor the physicians involved can have any legal or financial interest in the outcome. Consent must be repeatedly expressed, not implied, including in the moment directly before death. Consent can be revoked at any time, in any way, with no consequences, and there are no limits regarding how often consent can be requested. 

To be granted a medically assisted death, patients meeting the criteria must sign a written request in front of two independent witnesses who can confirm that it was done willingly, without coercion, “10 clear days before the date of death.” After that, two physicians and/or nurse practitioners must independently confirm, in writing, their agreement that the patient is in an “advanced state of irreversible decline, that the patient’s natural death is reasonably foreseeable, and that the patient is capable of consenting to a medically assisted death.” If eligible, patients must be informed of their palliative care options to relieve their suffering before they will be allowed to die.

Case Study: five US states have assisted suicide laws, but euthanasia remains illegal elsewhere 

Since 1994, California, Colorado, Hawaii, Oregon, Vermont, Washington, and Washington, D.C. have passed “death with dignity” laws that provide a protocol for physician-assisted suicide, but the rest of the country has not followed suit, and there is a wide range of public opinion regarding euthanasia and the right-to-die movement. 

Public research on the topic seems to indicate that views regarding euthanasia correlate with religious affiliation. Christian denominations such as Southern Baptists, Catholics, Pentecostals, and Evangelicals tend to oppose it; moderate protestants such as Lutherans and Methodists had mixed views and were less opposed than conservative protestants; and liberal protestants (Presbyterians and Episcopalians) as well as those not affiliated with a church seem to be the most supportive of the practice.

Many attempts to legalize euthanasia and assisted suicide were made in the US during the 1930s, but awareness dropped significantly after World War II. Interest was renewed during the 1960s and 1970s as well as in ballot initiatives and legislation proposed during the last twenty years, but as of yet, none has passed.

Case Study: euthanasia, assisted suicide illegal in the UK

Until the passage of the Suicide Act 1961, attempting suicide was a criminal act under English law, punishable by up to 14 years in prison. It is illegal to be complicit in another person’s suicide in the UK, and euthanasia is regarded as either manslaughter or murder, depending on the circumstances, with a maximum penalty of life in prison.

There are two types of euthanasia recognised in the UK: active and passive. Active euthanasia is illegal in the UK, but although it is against the law to actively end a patient’s life, many doctors assist their patients by withholding treatment to hasten death, although this is done only after consulting patients, relatives, or other doctors, and when death is imminent. In December 2018, the British Medical Association and the Royal College of Physicians jointly published guidance regarding when doctors are permitted to allow patients to die. 

Ongoing campaigns to legalize euthanasia in the UK have attracted the support of various celebrities but also raised concerns among those with disabilities who feel vulnerable given the current economic climate in which cuts have been made to the public services they depend upon, including palliative care and independent living assistance for the terminally ill or disabled.

Different view of life and death

The wide disparity in euthanasia laws demonstrates that countries around the world don’t see end-of-life decisions in the same way, and right-to-die laws are an expression of an individual country’s values. While modern medicine has made great strides in prolonging people’s lives, a solution must be found when continuing life may not be the best option.

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