Assisted dying legislation and policies

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Notes on assisted dying terminology and definitions

Notes on terminology from the Victorian Legal and Social Issues (Parliamentary) Inquiry into end of life choices

The final report of the Victorian Legal and Social Issues (Parliamentary) Committee Inquiry into end of life choices (1.4.6 page 14) included the following clarification of terminology:

“Throughout this Report, the Committee uses the term ‘assisted dying’ to describe assistance to die provided in a medical context.

“When referring to frameworks in overseas jurisdictions, the terms ‘assisted suicide’ and ‘voluntary euthanasia’ are used. In these instances, ‘assisted suicide’ refers to the practice of a doctor providing a patient with the means to end their life. ‘Voluntary euthanasia’ refers to medical assistance to die which is administered by a doctor (such as through a lethal injection).”

http://www.parliament.vic.gov.au/lsic/inquiries/article/2611

Terminology used in other countries, including death with dignity and medically assisted dying

Using the three key definitions outlined in the final report of the Victorian Legal and Social Issues (Parliamentary) Committee Inquiry into end of life choices (1.4.6 page 14), namely:

  • ‘assisted dying’: a general term referring to assistance to die provided in a medical context
  • ‘assisted suicide’: the practice of a doctor providing a patient with the means to end their life
  • ‘voluntary euthanasia’: medical assistance to die which is administered by a doctor (such as through a lethal injection)

the nature of legislation in other countries can be summarised as follows:

  • Assisted suicide is legal (but not voluntary euthanasia) in Switzerland, Germany, Japan, and in the US states/districts of Oregon, Washington State, Vermont, California, Colorado, Washington D.C. and (through a court ruling rather than legislation) Montana. Terms used include: physician-assisted dying, physician-assisted death, death with dignity, medical aid in dying, medically assisted dying.
  • Voluntary euthanasia and assisted suicide is legal in the Netherlands, Belgium, Luxembourg and Canada (whole country from 2016, with province of Quebec from 2015).
  • Voluntary euthanasia (but not assisted suicide) is legal in Colombia.

The final report of the Victorian Legal and Social Issues (Parliamentary) Committee Inquiry into end of life choices includes a summary of legislation in jurisdictions that allow assisted dying (Appendix 4, pages 283-287) with details for Netherlands, Belgium, Luxembourg, Oregon, Washington State, Quebec, Canada and Switzerland.

http://www.parliament.vic.gov.au/lsic/inquiries/article/2611

An Oregon Death with Dignity note objecting to use of ‘suicide’ in definitions and descriptions

The assisted dying law in the US state of Oregon is the Death with Dignity Act 1994. In a discussion of terminology, Oregon based non-profit organisation Death with Dignity National Center suggests that:

  • “Physician-assisted suicide, or PAS, is an inaccurate, inappropriate, and biased phrase which opponents often use to scare people about Death with Dignity laws. Because the person is in the process of dying and seeking the option to hasten an already inevitable and imminent death, the request to hasten a death isn’t equated with suicide. The patient’s primary objective is not to end an otherwise open-ended span of life, but to find dignity in an already impending exit from this world. They’re participating in an act to shorten the agony of their final hours, not killing themselves; cancer (or another common underlying condition) is killing them”.

They suggest that the ‘correct’ terms to use are:

  • “Death with dignity
  • “Physician-assisted death or physician-assisted dying
  • “Aid in dying, physician aid in dying or medical aid in dying”

and that ‘incorrect’ terms are:

  • “(Physician) assisted suicide (PAS)
  • “Suicide
  • “Euthanasia.”

https://www.deathwithdignity.org/terminology/

German speaking countries

Some commentators, including a 2014 article from The Guardian, have noted that in German-speaking countries, the term “euthanasia” is generally avoided. Rather the preferred language/definitions include “assisted suicide” (beihilfe zum suizid) and “active assisted suicide” (aktive sterbehilfe).

https://www.theguardian.com/society/2014/jul/17/euthanasia-assisted-suicide-laws-world

Victorian Government discussions about assisted dying

Next Steps in Victorian Voluntary Assisted Dying Bill (August – December 2017)

Following the July 2017 publication of the final report of the Ministerial Panel on Voluntary Assisted Dying, the Department of Health and Human Services website section on the Voluntary Assisted Dying Bill notes regarding ‘next steps’ that:

  • “The Government will consider the Panel’s Final Report in shaping its Voluntary Assisted Dying Bill. The bill is due to be introduced to Members of Parliament for a conscience vote later this year”.
  • “If the bill passes, the Panel has recommended an 18-month period prior to commencement to allow sufficient time for establishment of the voluntary assisted dying framework”.

https://www2.health.vic.gov.au/about/health-strategies/voluntary-assisted-dying-bill

Ministerial Advisory Panel on Voluntary Assisted Dying

In January 2017, the Victorian Government appointed a Ministerial Advisory Panel on Voluntary Assisted Dying (the Panel). The terms of reference for the Panel included:

  • “Taking the assisted dying framework as outlined by the Legal and Social Issues Committee (the Parliamentary Committee) as the starting point, the Panel’s task is to provide advice to government about how a compassionate and safe legislative framework for voluntary assisted dying could be implemented. This will include how it could be implemented in Victoria to provide access to eligible people while minimising risks to potentially vulnerable people”.

The Department of Health and Human Services website section on the Voluntary Assisted Dying Bill further notes that:

  • “The Panel’s role was not to debate whether voluntary assisted dying should be legalised, but to consider important practical questions about issues such as safeguards, eligibility and oversight to deliver a safe and compassionate legislative framework”.

The Panel’s final report was published in July 2017. There was also a discussion paper published in January 2017 and an interim report in April 2017.

Members of the Panel were:

  • Professor Brian K Owler
  • Professor Margaret O’Connor AM
  • Ms Mary Draper
  • Mr Julian Gardner AM
  • Dr Roger Hunt
  • Emeritus Professor Ian Maddocks AM
  • Ms Tricia Malowney

Detailed profiles for each of the members can be found on pages 3-4 of the Panel’s final report, along with the interim report and discussion paper.

https://www2.health.vic.gov.au/about/health-strategies/voluntary-assisted-dying-bill

Ministerial Advisory Panel on Voluntary Assisted Dying Final Report (July 2017)

The 250+ page final report of the Victorian Government’s Ministerial Advisory Panel on Voluntary Assisted Dying (the Panel) was published in July 2017.

The main body of the Panel’s final report is outlined in four sections:

  • Part A: Eligibility criteria
  • Part B: Request and assessment process
  • Part C: Oversight
  • Part D: Implementation

The report also included a bibliography and three appendices:

  • Appendix 1: Voluntary assisted dying framework summary
  • Appendix 2: Voluntary assisted dying and human rights
  • Appendix 3: Safeguards and jurisdictional comparison

https://www2.health.vic.gov.au/about/health-strategies/voluntary-assisted-dying-bill

or

https://www2.health.vic.gov.au/about/publications/researchandreports/ministerial-advisory-panel-on-voluntary-assisted-dying-final-report

Ministerial Advisory Panel on Voluntary Assisted Dying Interim Report (April 2017)

The 70+ page interim report of the Victorian Government’s Ministerial Advisory Panel on Voluntary Assisted Dying (the Panel) was published in April 2017.

The interim report sets out the key issues, concerns and potential solutions provided to the Panel by people who participated in a consultation process undertaken by the panel earlier in 2017. The report notes that:

  • “While there was consensus on a number of issues, the Panel also heard a range of divergent views about the most appropriate way to develop and implement voluntary assisted dying legislation.
  • “The purpose of this interim report is to reflect the range of views that the Panel has noted and will be considering in the development of its recommendations for the introduction of voluntary assisted dying in Victoria”.

The interim report has four chapters:

  • Chapter 1: Who could be eligible for voluntary assisted dying?
  • Chapter 2: the voluntary assisted dying process
  • Chapter 3: Oversight
  • Chapter 4: Implementation issues

https://www2.health.vic.gov.au/about/health-strategies/voluntary-assisted-dying-bill

Voluntary Assisted Dying Bill Discussion paper (January 2017)

In line with the proposed voluntary assisted dying framework recommended by the Victorian Legal and Social Issues (Parliamentary) Committee Inquiry into end of life choices, the Victorian Government committed to introduce legislation into parliament in 2017 to legalise voluntary assisted dying for terminally ill people in Victoria.

To support this work, the government established a Ministerial Advisory Panel (the Panel) made up of clinical, legal and consumer experts, to “build on the findings and recommendations of the Parliamentary Committee Inquiry by seeking considered and expert advice on the details associated with developing and implementing a legislative framework for voluntary assisted dying”.

As part of the consultation process, in January 2017 the panel released a ‘Voluntary Assisted Dying Bill Discussion paper’. The 25 page paper summarises a series of key issues and lists a number of ‘Questions to consider’.

https://www2.health.vic.gov.au/about/health-strategies/voluntary-assisted-dying-bill

or

https://www2.health.vic.gov.au/about/publications/researchandreports/voluntary-assisted-dying-bill-discussion-paper

Victorian Government response to the Legal and Social Issues (Parliamentary) Committee Inquiry into end of life choices (December 2016)

Following the June 2016 publication of the final report of the Victorian Legal and Social Issues (Parliamentary) Committee Inquiry into end of life choices, the Victorian Government submitted a formal response to the Committee Inquiry in December 2016. The Inquiry made 49 recommendations, one of which, Recommendation 49, related to assisted dying.

A summary of the key messages of the government’s response to all 49 recommendations can be found on the website of the Victorian Government Department of Health and Human Services. This page also provides a link to the full 17 page Victorian Government response to the Committee Inquiry published on the Committee Inquiry pages of the Parliament of Victoria website.

https://www2.health.vic.gov.au/about/health-strategies/government-response-to-inquiry-into-end-of-life-choices-final-report

Legal and Social Issues (Parliamentary) Inquiry into end of life choices (2015/16)

In May 2015, the Legal and Social Issues Committee of the Victorian Parliament’s Legislative Council instituted an inquiry on:

“the need for laws in Victoria to allow citizens to make informed decisions regarding their own end of life choices and, in particular

  1. assess the practices currently being utilised within the medical community to assist a person to exercise their preferences for the way they want to manage their end of life, including the role of palliative care;
  2. review the current framework of legislation, proposed legislation and other relevant reports and materials in other Australian states and territories and overseas jurisdictions; and
  3. consider what type of legislative change may be required, including an examination of any federal laws that may impact such legislation”.

Known as the Inquiry into end of life choices, the Committee published its final report in June 2016. Both the full final report (444 pages) and a summary of the final report (40 pages) are available from the Parliamentary Committee pages of the Parliament of Victoria website, along with an earlier published interim report (November 2015) and submissions, hearings and transcripts and links to media coverage associated with the Inquiry. The Victorian Government’s response to the Inquiry is also published on the Committee Inquiry site.

http://www.parliament.vic.gov.au/lsic/inquiries/article/2611

Other Australian-based discussions about assisted dying

Summary of recent Australian legislative attempts for assisted dying frameworks

The final report of the Victorian Legal and Social Issues (Parliamentary) Committee Inquiry into end of life choices includes a summary of Australian legislative attempts for assisted dying frameworks (Appendix 5, pages 289-293) with details of:

  • The ACT Medical Treatment (Amendment) Bill 1997
  • The NSW Rights of the Terminally Ill Bill 2013
  • The NT Rights of the Terminally Ill Act 1995
  • The South Australia Voluntary Euthanasia Bill 2016
  • The Tasmanian Voluntary Assisted Dying Bill 2013
  • The Victorian Medical Treatment (Physician Assisted Dying) Bill 2008
  • The WA Voluntary Euthanasia Bill 2010

The Committee Inquiry information was based on a University of New South Law Journal article, ‘(Failed) Voluntary Euthanasia Law Reform in Australia: Two Decades of Trends, Models and Politics’, published in 2016. Both the article and the Committee Inquiry report predated some more recent developments, including the Tasmanian Voluntary Assisted Dying Bill 2016 and the South Australian Death with Dignity Bill 2016.

http://www.parliament.vic.gov.au/lsic/inquiries/article/2611

Tasmania and the Voluntary Assisted Dying Bill 2016

The Voluntary Assisted Dying Bill 2016 was introduced to the Parliament of Tasmania in November 2016. It is is due to be debated in 2017. The co-sponsors of the Bill are Lara Giddings, former Premier and now Labor MP for Franklin, and Cassy O’Connor, Leader of the Greens and MP for Denison.

An ABC News website report from 2013, ‘Voluntary euthanasia law defeated by two votes’ and another from February 2016, Euthanasia debate to return to Tasmania’s Parliament as Labor, Greens prepare to table bill’, provide some context to the development of the 2016 Bill and the Tasmanian Parliament’s consideration of a previous bill in 2013.

The progress of the 2016 Bill can be followed through the ‘Progress of Bills’ section of the Parliament of Tasmania website.

http://www.parliament.tas.gov.au/bills/billsweb.htm

South Australia and the Death with Dignity Bill 2016

A report from the ABC News website from 17 November 2016 provides a summary of the outcome of the South Australian Parliament’s debate of the ‘Death with Dignity Bill 2016’. The Bill was defeated after a tied vote (23-23) required a casting vote from the Speaker of the House.

http://www.abc.net.au/news/2016-11-16/voluntary-euthanasia-debate-in-south-australia-goes-to-committee/8031776

Northern Territory and the (now voided) Rights of the Terminally Act 1995

Euthanasia was legalised in the Northern Territory, by the Rights of the Terminally Ill Act 1995. It passed by a vote of 15 to 10 and a year later. Subsequently, in August 1996, a repeal bill was brought before the Northern Territory Parliament. It was defeated by 14 votes to 11. Soon after, the law was voided by the Australian Parliament’s Euthanasia Laws Act 1997. This Act amended various acts of the parliaments of the Northern Territory and the Australian Capital Territory (and an act related to Norfolk Island) to remove the power of each of those territories to legalise euthanasia, and specifically to repeal the Northern Territory act. The powers of the Northern Territory, the Australian Capital Territory and the Norfolk Island legislatures, unlike those of State Governments, are not guaranteed by the Australian constitution and may be amended or overruled by the Australian Parliament. For this reason, various commentators have noted that if a state government was to pass assisted dying/voluntary dying legislation, it could not be voided by the Australian Government in the same way the Northern Territory act was.

https://eprints.qut.edu.au/95429/1/Failed%20Voluntary%20Euthanasia%20Law%20Reform%20UNSWLJ.pdf

International approaches to assisted dying - Overview

Summary of overseas approaches to assisted dying legislation from Victorian Parliamentary Inquiry

The final report of the Victorian Legal and Social Issues (Parliamentary) Committee Inquiry into end of life choices includes a summary of legislation in selected overseas jurisdictions that allow assisted dying (Appendix 4, pages 283-287) with details for Netherlands, Belgium, Luxembourg, Oregon, Washington State, Quebec, Canada and Switzerland.

Using three definitions outlined in the Committee’s final report (1.4.6 page 14), namely:

  • ‘assisted dying’: a general term referring to assistance to die provided in a medical context
  • ‘assisted suicide’: the practice of a doctor providing a patient with the means to end their life
  • ‘voluntary euthanasia’: medical assistance to die which is administered by a doctor (such as through a lethal injection)

the nature of legislation in other countries can be summarised as follows:

  • Assisted suicide is legal (but not euthanasia) in Switzerland (1942), Germany, Japan, and in the US states/districts of Oregon (from 1997), Washington State (2009), Vermont (2013), California (2016), Colorado (2016), Washington D.C (2017) and (through a 2009 Supreme Court ruling rather than legislation) Montana.
  • Voluntary euthanasia and assisted suicide is legal in the Netherlands (2002), Belgium (2002), Luxembourg (2009) and Canada (whole country from 2016, with province of Quebec from 2015).
  • Voluntary euthanasia (but not assisted suicide) is legal in Colombia.

http://www.parliament.vic.gov.au/lsic/inquiries/article/2611

International approaches to assisted dying - USA

Death with Dignity National Center summary of USA assisted dying legislation by state

The website of the US based Death with Dignity National Center includes a colour coded map with updates on ‘death with dignity’ legislation for each of the states of the USA (and the District of Columbia/Washington D.C.), including: states/districts with death with dignity legislation (Oregon, Washington State, Vermont, California, Colorado, Washington D.C.); states where death with dignity is legal via a court decision rather than legislation (Montana); along with states currently considering death with dignity legislation (including New York, Ohio and Hawaii).

https://www.deathwithdignity.org/take-action/

Oregon

Oregon’s Death with Dignity Act 1994 (the Oregon Act) was enacted in October 1997. It allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose. The Oregon Act requires the Oregon Health Authority to collect information about the patients and physicians who participate in the Act, and publish an annual statistical report. Further information about the current status and history of the Oregon Act can be gained from the US based Death with Dignity National Center’s website pages on Oregon.

https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx

Washington State

The Washington Death with Dignity Act (Initiative 1000, RCW 70.245 or the Washington State Act) was passed in 2008 and came into effect in March 2009. The Washington State Act allows terminally ill adults seeking to end their life to request lethal doses of medication from medical and osteopathic physicians. These terminally ill patients must be Washington residents who have less than six months to live. The website of the Washington State Department of Health includes a Frequently Asked Questions document, various resources and data. Further information about the current status and history of the Washington State Act can be gained from the US based Death with Dignity National Center’s website pages on Washington State.

http://www.doh.wa.gov/DataandStatisticalReports/VitalStatisticsData/DeathwithDignity

Vermont

Under the Patient Choice and Control at the End of Life Act (Act 39 of the 2013 Vermont General Assembly) Vermont residents with terminal disease have the option to be prescribed a dose of medication to hasten the end of their life. This option requires the participation of a Vermont physician. Physicians and patients must adhere to a process that provides immunity for both patients and health care providers who wish to take steps under the law. No patient, physician or pharmacist may be required to participate in activities under the statute. Every step must be voluntary. The Vermont Department of Health website includes a four page ‘Frequently Asked Questions’ document about Act 39. Further information about the current status and history of Act 39 can be gained from the US based Death with Dignity National Center’s website pages on Vermont.

http://www.healthvermont.gov/systems/patient-choice-and-control-end-life

California

California’s physician-assisted dying law, the End of Life Option Act (AB 15 or the California Act) was passed in 2015 and took effect in June, 2016. The California Act allows an adult diagnosed with a terminal disease, who meets certain qualifications, to request aid-in-dying drug from their attending physician. The Act requires physicians to submit specified forms and information to the California Department of Public Health (CDPH). CDPH collects data from forms submitted by physicians and publishes annual reports and other data on its website. Further information about the current status and history of the California Act can be gained from the US based Death with Dignity National Center’s website pages on California.

https://www.cdph.ca.gov/Pages/EndofLifeOptionAct.aspx

Colorado

The Colorado End-of-Life Options Act (Proposition 106, previously Initiative 145 or the Colorado Act) came into effect in December 2016.

The Colorado Act allows an eligible terminally ill individual with a prognosis of six months or less to live to request and self-administer medical aid-in-dying medication in order to voluntarily end his or her life and authorises a physician to prescribe medical aid-in-dying medication to a terminally ill individual under certain conditions. The Colorado Act also creates criminal penalties for tampering with a person’s request for medical aid-in-dying medication or knowingly coercing a person with a terminal illness to request the medication. Further information about the current status and history of the Colorado Act can be gained from the US based Death with Dignity National Center’s website pages on Colorado.

https://www.colorado.gov/pacific/cdphe/medical-aid-dying

Washington D.C. (District of Columbia)

Washington, D.C. (officially known as the District of Columbia) is the capital of the United States. It is a federal district under the exclusive jurisdiction of the American national parliament (Congress) and is therefore not a part of any state. The 2015 Washington D.C. Death with Dignity Act came into effect in February 2017. Further information about the current status and history of the Colorado Act can be gained from the US based Death with Dignity National Center’s website pages on Washington D.C (District of Columbia).

http://lims.dccouncil.us/Legislation/B21-0038?FromSearchResults=true

Montana

Medical aid in dying is legal in Montana by virtue of a 2009 Montana Supreme Court decision rather than legislation. The US based Death with Dignity National Center’s explanation of the history, includes: “In December 2009, the Montana Supreme Court ruled 5-2, in Baxter v. Montana, that nothing in the state law prohibited a physician from honoring a terminally ill, mentally competent patient’s request by prescribing medication to hasten the patient’s death. The ruling cited the state’s Rights of the Terminally Ill Act: because there is so little difference as a matter of public policy between taking a patient off life support and prescribing lethal medication that the patient can take, the Court determined that existing Montana law permits physician assisted dying under the circumstances of the Baxter case. Montana’s judicial approach to physician aid in dying remains unique”.

https://www.deathwithdignity.org/states/montana/

International approaches to assisted dying - Canada

Canadian national legislation

Canada’s national 2016 assisted dying legislation, Bill C-14: An Act to amend the Criminal Code and make related amendments to other Acts (medical assistance in dying) was passed in 2016 following a February 2015 decision by the Supreme Court of Canada Carter v Canada (Attorney General), which ruled that adults with grievous and irremediable medical conditions are entitled to physician-assisted suicide.

The new Canadian legislation provides for two types of medical assistance in dying – where a physician or nurse practitioner:

  1. directly administers a substance that causes death, such as an injection of a drug
  2. gives or prescribes a drug that is self-administered to cause death

In order to be eligible for medical assistance in dying, people must meet a range of conditions, including:

  • have a grievous and irremediable medical condition
  • give informed consent to receive medical assistance in dying (consented to medical assistance in dying after being given all of the information needed to make a decision, including information about: medical diagnosis; available forms of treatment; available options to relieve suffering, including palliative care

To be considered as having a grievous and irremediable medical condition, people must meet all of the following conditions.

  • have a serious illness, disease or disability
  • be in an advanced state of decline that cannot be reversed
  • be suffering unbearably from illness, disease, disability or state of decline
  • be at a point where natural death has become reasonably foreseeable, which takes into account all of medical circumstances

https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html

Quebec

http://www.assnat.qc.ca/en/travaux-parlementaires/projets-loi/projet-loi-52-41-1.html

Quebec is a province of Canada. Quebec’s The Act Respecting End-of-Life Care (the Quebec Act) was passed/sanctioned in June 2014 and came into effect in December 2015. The national Canadian law amending provisions of the Criminal Code that deal with medical assistance in dying Bill C-14: An Act to amend the Criminal Code and make related amendments to other Acts (medical assistance in dying) came into force in June 2016 and the operation of the Quebec Act was modified to comply with the national legislation.

The Quebec Act sets out an overall, integrated vision of palliative and end-of-life care, aiming to ensure that people at the end of life have access to quality care and support to suit their situation in the final stage of life, particularly by preventing and relieving suffering.

The Quebec Act has two components:

  1. The rights of persons at the end of life, and the organisation and framework of end-of-life care, which includes: palliative care, including continuous palliative sedation; medical aid in dying.
  2. Recognition of the primacy of freely and clearly expressed wishes with respect to care, in particular by establishing an advance medical directives regime.

http://sante.gouv.qc.ca/en/programmes-et-mesures-daide/loi-concernant-les-soins-de-fin-de-vie/

Other Canadian Provinces

Under the heading “Is assisted suicide legal in Canada?” the End of Life Law in Canada section of the website of the Health Law Institute of Dalhousie University includes handy links to information about medical aid in dying in the various provinces of Canada, including:

eol.law.dal.ca/page_id=236

International approaches to assisted dying - Netherlands

Netherlands

The Netherlands “Termination of Life on Request and Assisted Suicide (Review Procedures) Act” (the Netherlands Act) came into effect in 2002. Under the Netherlands Act, it is not an offence for physicians to perform euthanasia (or physician-assisted suicide), provided they comply with the ‘due care’ criteria specified in the Act and report each case after it has been carried out.

Due care criteria for physicians under the Netherlands Act include:

  • be satisfied that the patient’s request is voluntary and well-considered;
  • be satisfied that the patient’s suffering is unbearable and that there is no prospect of improvement;
  • inform the patient of his or her situation and further prognosis;
  • discuss the situation with the patient and come to the joint conclusion that there is no other reasonable solution;
  • consult at least one other physician with no connection to the case, who must then see the patient and state in writing that the attending physician has satisfied the due care criteria listed in the four points above;
  • exercise due medical care and attention in terminating the patient’s life or assisting in his/her suicide

Euthanasia (or physician-assisted suicide) can be performed/facilitated only at the patient’s own request, not at the request of relatives or friends. The Netherlands Act is only applicable to people who have a medical relationship with a physician who is subject to Dutch law. This means that people who do not reside in the Netherlands cannot apply for euthanasia or physician-assisted suicide under the Act.

https://www.government.nl/topics/euthanasia or http://www.bioeticanet.info/eutanasia/LleiEuHol.pdf

International approaches to assisted dying - Belgium

Belgium

The Belgian Act on Euthanasia came into effect in 2002. The law says doctors can help patients to end their lives when they freely express a wish to die because they are suffering intractable and unbearable pain. People can also receive euthanasia if they have clearly stated it before entering a coma or similar vegetative state. Assisted suicide is not mentioned in the law, which does not specify a method of euthanasia. However, the physician has to be present at the bedside of the person to their last breath. In a 2014 amendment, Belgium became the first country to legalise euthanasia for children. There is no age limit for minors seeking a lethal injection, but they must be conscious of their decision, terminally ill, close to death and suffering beyond any medical help. They also need the assent of their parents.

An unofficial English translation of the Belgian Act includes the following details:

“The physician who performs euthanasia commits no criminal offence when he/she ensures that:
  • – the patient has attained the age of majority or is an emancipated minor, and is legally competent and conscious at the moment of making the request;
  • – the request is voluntary, well-considered and repeated, and is not the result of any external pressure;
  • – the patient is in a medically futile condition of constant and unbearable physical or mental suffering that can not be alleviated, resulting from a serious and incurable disorder caused by illness or accident;”
Further, before carrying out euthanasia the physician “must in each case:
  1. inform the patient about his/her health condition and life expectancy, discuss with the patient his/her request for euthanasia and the possible therapeutic and palliative courses of action and their consequences. Together with the patient, the physician must come to the belief that there is no reasonable alternative to the patient’s situation and that the patient’s request is completely voluntary;
  2. be certain of the patient’s constant physical or mental suffering and of the durable nature of his/her request. To this end, the physician has several conversations with the patient spread out over a reasonable period of time, taking into account the progress of the patient’s condition;
  3. consult another physician about the serious and incurable character of the disorder and inform him/her about the reasons for this consultation. The physician consulted reviews the medical record, examines the patient and must be certain of the patient’s constant and unbearable physical or mental suffering that cannot be alleviated.”

http://www.ethical-perspectives.be/viewpic.php?TABLE=EP&ID=59

International approaches to assisted dying - Luxembourg

Luxembourg

The parliament of Luxembourg (the Grand Duchy) adopted legislation on euthanasia and assisted suicide in 2009. At the same time, legislation was introduced on palliative care and end-of-life accompaniment. The law describes the conditions for a legal request for euthanasia or assisted suicide in Luxembourg, the steps to be taken by the doctor who receives a request as well as the doctor’s obligations.

http://www.luxembourg.public.lu/en/vivre/famille/fin-vie/euthanasie-soinspalliatifs/index.html

International approaches to assisted dying - Switzerland

Switzerland

Assisted dying in Switzerland is governed by the interpretation of legislation from 1937 (which came into force in 1942), the Swiss Criminal Code, specifically articles 114 and 115.

In the unofficial English translation of the Swiss Criminal Code Article 115 is headed “Inciting and assisting suicide” and reads:

“Any person who for selfish motives incites or assists another to commit or attempt to commit suicide shall, if that other person thereafter commits or attempts to commit suicide, liable to a custodial sentence not exceeding five years or to a monetary penalty”.

Article 115 has been interpreted to mean that assisting suicide is a crime only if the motive for doing so is selfish such as personal gain. It is on this basis that organisations such as Dignitas have established processes to provide people with opportunities to end their life in Switzerland. The Swiss law does not require people to be Swiss nationals.

Also of note is Article 114, headed “Homicide at the request of the victim” and says:

“Any person who for commendable motives, and in particular out of compassion for the victim, causes the death of a person at that person’s own genuine and insistent request is liable to a custodial sentence not exceeding three years or to a monetary penalty.”

The final report of the Victorian Legal and Social Issues (Parliamentary) Committee Inquiry into end of life choices (Appendix 4) notes that while Article 114 makes it clear that voluntary euthanasia is illegal in Switzerland, a less severe penalty is imposed compared to other homicides.

https://en.wikipedia.org/wiki/Euthanasia_in_Switzerland

International approaches to assisted dying - Germany

Germany

In November 2015, the German parliament (the Bundestag) adopted a law that seeks to criminalise ‘commercial assisted suicide’ (applying to associations, organisations, and individuals that offer suicide assistance with a commercial intent) while exempting from criminal liabilit close relatives or other people who are close to the person wishing to commit suicide.

Suicide has long been exempt from criminal punishment in Germany. Due to suicide not being a criminal offence, aiding and abetting a voluntary suicide is also exempt from punishment, so long (since the introduction of the 2015 law) as it is not being conducted on a business/commercial basis.

Killing on request remains criminally punishable in Germany according to section 216 of the German Criminal Code.

http://www.loc.gov/law/foreign-news/article/germany-parliament-adopts-draft-act-to-criminalize-commercial-assisted-suicide/

International approaches to assisted dying - Colombia

Colombia

The USA based non-profit organisation procon.com explains that euthanasia became legal in Colombia in May 1997 when the the country’s highest court (the Constitutional Court), ruled that a person may choose suicide and that physicians could not be prosecuted for helping. The Court asked that the Colombian Parliament (Congress) legislate to confirm details. This did not occur for many years. Following further Consitiutional Court processes the Colombian Health Ministry was instructed to release guidelines, which it did in April 2015, officially legalising euthanasia in Colombia with a variety of safeguards and associated processes.

http://euthanasia.procon.org/view.resource.php?resourceID=000136