Assisted Dying: Ethical Considerations and Global Perspectives

The subject of assisted suicide for terminally ill patients has gained popularity in recent years among the medical community, the general public, and lawmakers. Assisted dying is the process of prescribing terminally sick, mentally competent persons to take their own life-ending medications, provided that they comply with stringent legal requirements.¹ A major moral justification opposing assisted dying laws is that they would violate the fundamental idea of the sanctity of life if they permitted purposeful killing or assistance in killing someone, regardless of how noble or compassionate the motivation may be.²

Strict procedures and safety measures are frequently in place in nations like Belgium, the Netherlands, and Switzerland where physician-assisted suicide is permitted in certain situations. These could include conditions guaranteeing the patient's complete mental capacity and consent, mandated waiting periods, and several medical consultations. Furthermore, certain states in the United States, including Oregon, Washington, and California, have established safeguards for these terminal decisions. By means of specialized legislation and case law that highlights stringent qualifying criteria and reporting obligations, these states have approved physician-assisted suicide. On the other hand, a number of states in the United States as well as several other nations uphold strict bans on physician-assisted suicide, citing the importance of protecting life and preventing abuses or dangerous situations. This glaring contradiction captures the current discussion around the morality and real-world applications of physician-assisted suicide.³

Ethical debates surrounding assisted dying

Arguments for assisted dying

• Respect for autonomy: Individuals get to decide when and how they will pass away. The ability to decide how and when to pass away should belong to competent individuals
• Justice: In order to achieve justice, we must "treat like cases alike." Patients who are competent and near death have the legal right to decline medical intervention that could hasten their demise. Refusing treatment won't be enough to speed up death for people who are in pain but aren't on life support, such as respirators or dialysis. Since assisted death is the only way for these individuals to expedite their death, we should permit it in order to treat them fairly
• Compassion: Suffering encompasses more than just physical pain; some patients feel that their functional abilities and loss of independence compromise their dignity. Other physical, existential, social, and psychological difficulties include this. Suffering cannot always be alleviated. Therefore, Physician-Assisted Dying (PAD) might be a kind reaction to unceasing misery
• Personal freedom versus public interest: Even while society is very interested in saving lives, this interest wanes when someone is really sick and wants to end their life. A total ban on PAD would be an unreasonable restriction on an individual's freedom. Thus, in certain situations, PAD should be permitted
• Honesty and openness: Some admit that assisted suicide does already happen, albeit covertly. The majority of governments' illegality of PAD hinders candid conversations between medical professionals and patients as well as in public discourse. Legalizing PAD would encourage candid communication and potentially lead to improved end-of-life care since patients and doctors could discuss alternatives and concerns more directly⁴

Arguments against assisted dying

• Sanctity of life: Historically, cultures that respect the sanctity of human life have forbade suicide and assisted suicide. Because PAD is seen as undermining the sanctity of life, it is morally immoral
• Passive vs. Active distinction: There's a big difference between "letting die" passively and "killing" actively. While PAD equates to killing (active) and is not justified, treatment rejection or withholding equates to letting someone die (passive)
• Possibility of abuse: Vulnerable groups could be coerced into assisted suicide if they don't have access to good care and support. Moreover, assisted suicide can end up being a cost-cutting tactic. Healthcare practitioners and burdened family members may persuade loved ones to choose assisted suicide, and legal protections may not always prevent all cases of this kind of coercion or exploitation. In order to prevent these misuses, PAD ought to stay prohibited
• Professional fallibility: This raises the worry that mistakes will be made by doctors. The prognosis and diagnosis, for example, could be unclear. It's possible that sadness and pain are not being properly diagnosed and treated. In order to prevent these unavoidable errors and to enhance the standard of pain and symptom management in the final stages of life, the State bears a responsibility⁴

Criteria for assisted dying

Countries where assisted dying is legal

Only a small number of nations worldwide have approved assisted suicide, but lately, that number has been rising. Euthanasia, in which a doctor administers lethal medications upon request, and self-administered medication-assisted suicide, which has only been permitted in Switzerland since the 1980s, are legal practices that have been carried out in the Netherlands, Belgium, and Luxembourg since the 2000s. In 2015, Colombia authorized assisted suicide and euthanasia; the same year, Canada allowed both practices. Spain, Austria, and New Zealand have legalized assisted suicide and euthanasia in the last two years. A number of Australian states also enacted similar legislation, beginning in 2019 with Victoria and continuing until 2021 with Western Australia. These laws will be implemented by the remaining states in the union, with the exception of the Northern Territory, during the remainder of 2022 and early 2023.⁵

Criteria for eligibility

According to Queensland Government (Australia), the criteria include:

• Have a disease, sickness, or medical condition that qualifies
• Have the ability to make decisions
• Behaving voluntarily and free from compulsion
• Must be 18 years of age
• Meet the prerequisites for citizenship and residency⁶

Global perspectives in assisted dying

European Union

In 2002, Belgium and the Netherlands became the first two member states of the European Union to legalize euthanasia. After that, Portugal in 2023, Spain in 2021, and Luxembourg in 2009 joined them. The end-of-life bill in France will not be considered until 2024.⁸

Netherlands

Only when all of the requirements outlined in the Dutch Termination of Life on Request and Assisted Suicide (Review Procedures) Act are met are euthanasia and assisted suicide considered lawful. Patients who are in excruciating pain with no chance of recovery frequently make requests for euthanasia. They must be completely sincere and honest in their request. Euthanasia seemed to be their sole means of escaping the circumstances. Nonetheless, neither physicians nor patients have an unqualified obligation to carry out euthanasia.⁷

Belgium

Three crucial requirements must be met in order for euthanasia to be authorized under Belgian law: the patient must be suffering extremely, the request must be voluntary, and the suffering must be brought on by a serious and incurable illness.⁸

North America

Canada

The government of Canada has halted a contentious bill that would have permitted those suffering from mental illnesses but not physical ones to get medical assistance in dying, just weeks before it was supposed to go into effect.

In 2021, Canada revised its medical assistance in dying (MAID) legislation to permit those suffering from "grievous and irremediable" mental illnesses to request a doctor's assistance in passing away. The law was supposed to go into effect in 2023, but the administration moved it up to March 17, 2024, a year ahead of schedule.⁹

United States

In 1994, Oregon became the first state to allow medical assistance in dying. Since then, such legislation has been approved by nine states .¹⁰ Ten U.S. states (Maine, New Jersey, Vermont, New Mexico, Montana, Colorado, Oregon, Washington, California, and Hawai'i) as well as Washington, D.C. currently permit physician-assisted death. ¹¹

Australia

All states in Australia have legalized voluntary assisted dying. It is accessible to those who fulfil the qualifying requirements under specific conditions. Both the Northern Territory and the Australian Capital Territory forbid Voluntary Assisted Dying (VAD). Nonetheless, the Australian Capital Territory parliament received draft legislation to legalize VAD in October 2023.¹²

New Zealand

The requirements for becoming eligible for an assisted death are strict. Not every patient suffering from a terminal illness will qualify. Assisted dying may be available to New Zealanders who are 18 years of age or older and whose terminal illness is expected to take their life within six months.¹³

Religious and cultural perspectives

Islam

Since taking someone's life is prohibited in Islam, the code of law addresses a number of matters pertaining to life and death. Euthanasia and PADS are banned in all Islamic beliefs. However, it is acceptable to withhold or stop a medical treatment if the patient has a condition that is likely to be deadly. Legally speaking, euthanasia and PADS are not permitted in Islamic nations. Therefore, these procedures are regarded as homicides when doctors perform the surgery on patients, and suicides when patients give consent.¹⁴

Christianity

Christians oppose assisted suicide and euthanasia because they see life as a precious gift from God. Christians do not, however, think that life should be extended at any cost. Instead, they support the use of sedation and analgesia to relieve terminal pain as long as it does not intentionally take a person's life or their chance to repent.¹⁵

^Summary

Although physician-assisted dying suicide (PADS), in particular, has become more popular worldwide, there are still significant ethical concerns surrounding it. Opponents raise issues with the sanctity of life, possible abuse, and professional fallibility, while supporters make the case for respect for autonomy, compassion, and justice. Different nations have different legal systems; some, like Belgium, the Netherlands, and several US states, allow assisted suicide under very strict guidelines, while others continue to forbid it in order to protect human life. Attitudes are also influenced by cultural and theological viewpoints; Islam and Christianity, for example, are largely against assisted suicide. It is essential to comprehend these many points of view in order to make educated policy decisions and have moral conversations about end-of-life care.