Ingrid Burke for the Russian Legal Information Agency (RAPSI)

Albert Camus once wrote, “There is but one truly serious philosophical problem and that is suicide.” While the context may have changed since the 1940s, these words remain as true as ever today as legislatures worldwide grapple with questions of the legality and ethicality of assisted suicide and euthanasia. On April 1, 2002, the Netherlands’ euthanasia legislation entered into force. We would like to commemorate the anniversary with a discussion of the legal status of euthanasia and assisted suicide in various countries that have legalized such end-of-life choices, as well as those whose courts and legislatures have continued to struggle with the decision to do so.

USA

Assisted suicide is legal under strictly limited conditions in the states of Oregon, Washington, and Montana. In Oregon and Washington, the rules are established by way of legislation. In Montana, a state Supreme Court ruling provides the legal basis for assisted suicide. A representative of the Oregon-based advocacy group Death With Dignity National Center told RAPSI agency that the organization is currently working to support other states in enacting legislation based on Oregon’s assisted suicide law. The representative added that laws currently being considered by the Massachussetts and Vermont legislatures are making steady progress toward passage. In most other states in the US, assisted suicide is considered a felony offense, and in many states it is the legal equivalent of manslaughter.

US health care attorney Ivana Grujic shared with RAPSI her views in support of an expansion of assisted suicide legislation throughout the states: “a growing market in new life-sustaining technologies coupled with an aging population with increasing rates of dementia, end-of-life care decisions have become increasingly important in our society today. Life is the most precious gift of all, and no one wants to part with it, but this does not mean that people must be kept alive for as long as possible at any cost… Based on similar rights afforded to patients who wish to refuse/terminate life-sustaining treatment, a competent person who is experiencing unrelieved suffering which outweighs the value of continued life should have a right to choose assisted death… In conjunction, that individual should be able to enlist the help of a physician who in turn should not be forced by legislative prohibition into covert actions nor placed in jeopardy of criminal prosecution for acting on their humanitarian responsibilities.”

Switzerland

The sole limitation on assisted suicide posed by Swiss law is a prohibition against selfish motivation in the act. As such, the law is open to a very liberal interpretation. This is one reason that Switzerland has become a premier destination for assisted suicide tourism. DIGNITAS, Switzerland’s world-famous assisted suicide clinic, prides itself on carefully screening patients to ensure that prerequisites are met and that patients’ intentions are clear. Furthermore, the clinic scrutinizes each patient’s mental capacity, and screens each patient’s surroundings in order to ensure against external coercion.

The UK

In England and Wales, assisted suicide is punishable by up to 14 years in prison. However, courts have been generally lenient toward individuals who have assisted in the suicides of loved ones. Stroke victim Tony Nicklinson was given the green light in a high profile hearing to stand trial in defense of his right to a physician assisted suicide. It is unlikely that this trial will unify the legislation with the prosecutorial realities, however. In high profile assisted suicide case that has since been overruled by the House of Lords, that of Debbie Purdy, the Court of Appeals held that, “In short, the law which governs this case was made by Parliament. It is clear and unequivocal. We cannot subject it to judicial interpretation and produce a meaning which the statute does not bear.”

RAPSI spoke with Penney Lewis, a law professor at King’s College London and expert on end-of-life issues. Lewis explained that “There aren't any current legislative proposals (being considered by the legislature) although debates were held in the House of Commons on the Director of Public Prosecutions' (DPP) policy on assisted suicide.” Lewis is critical of the DPP’s current policy due to its failure to include any reference to a patient’s condition or experience on the basis of discrimination concerns, its preferential treatment of amateur rather than medically assisted suicide, and its focus on the motives of the suspect rather than those of the patient.

The Scottish Parliament is currently considering a proposed bill on assisted suicide. According to its website, a decision will be made on the draft bill by the end of April 2012.

RAPSI spoke with Sheila McLean, Professor of Law and Medical Ethics at the University of Glasgow and expert on end-of-life issues. Mclean told that the parliament has long displayed a reluctance to pass legislation favorable to assisted suicide. In her view, this results from a failure of the legislature to truly engage the issue—to the extent of accepting the legality of certain forms of passive euthanasia and examining the implications of such on discussions of active assisted suicide—as well as from the unwillingness of members of parliament to take on faith groups who are opposed to the legislation. In closing, McLean explained, “Given the apparent public support for law reform, and given also that I believe the arguments against liberalisation are defeasible the ultimate problem lies with the democratic deficit that sees politicians afraid to act and behaving as plenipotentiaries rather than representatives of the electorate.  I firmly believe that the public debate has been won, but that political reluctance stands in the way of progress.”

Canada

As in the UK, assisted suicide is punishable in Canada by up to 14 years in prison. Two separate high profile court cases are currently challenging this legislation with the help of advocacy organizations. ALS patient Gloria Taylor recently stood trial in front of the British Columbia Supreme Court in order to appeal for her right to assisted suicide. Her lawyer Joseph Arvay explained his decision to take the case on as follows, “A number of countries around the world as well as a number of states in the U.S. now allow for medically-assisted aid in dying. The time has come for Canada to follow their lead.” Across the country Ginette Leblanc, another ALS patient, is preparing to challenge the legislation in front of the Quebec Superior Court. Canadian advocacy organization Farewell Foundation argues that the legislation contradicts the fundamental rights guaranteed to Canadian citizens.

RAPSI spoke with Carole Saindon, a representative of Canada’s Department of Justice. Saindon described the Canadian government’s official stance on these matters as follows: “Euthanasia and assisted suicide raise complex ethical, legal, and medical issues which involve competing interests. The Government of Canada’s position is that the laws prohibiting medical professionals, or anyone else, purposely taking a life or assisting in a suicide, prevent harm to Canadian society and individuals. It is also important to recognize that these laws are in place to protect all persons, including those who are very vulnerable such as the sick, elderly and disabled.”

The Benelux countries

Euthanasia (including assisted suicide) is legal throughout the Benelux countries. The Netherlands’ legislation boasts the most liberal interpretation in providing for the eligibility of certain classes of minors to qualify for euthanasia. Belgium requires patients either to have reached the age of majority or to have attained legal emancipation. Adulthood is prerequisite in Luxembourg. Throughout the Benelux countries, preconditions include: well-considered and repeated consent free of external coercion arising from a hopeless and unendurably painful medical condition.

RAPSI spoke with Stefanie Michelis, communications officer for Right to Die-NL (NVVE in Dutch), the world’s largest euthanasia advocacy group with over 132,000 members. Michelis explained that the group’s primary goal in the Netherlands is to align medical practice with the country’s legislative realities. Michelis told that Dutch doctors—especially psychiatrists—often refuse to comply with the wishes of qualified patients to end their own lives. Quite frequently, the discomfort of doctors with the gravity of euthanasia and assisted suicide has trumped the desires of their patients. NVVE continues to address this disconnect between legislative realities and medical practice by way of various informational campaigns spreading awareness of the issues at all levels of society as well as with educational initiatives targeted at psychiatrists and other doctors.

Assisted suicide and euthanasia are illegal in the vast majority of countries around the world. The limited number of jurisdictions that have legalized or that have sincerely entertained the idea of legalizing end-of-life choices, combined with the absolute lack of uniformity in the existing international legislation emphasizes the immense ethical complexity of these issues. A vast array of ethical concerns forms the core of the philosophical debate of end-of-life choices. There are religious concerns. There are civil and human rights concerns. There are concerns that the legalization of assisted suicide and euthanasia will open the floodgates to a sort of unnatural selection, whereby physicians will have free reign to prescribe death to helpless disabled, elderly, and psychologically vulnerable victims. There are no easy answers to these questions. And while considering the international legislation on these matters as a whole is interesting, it is far from determinative. It becomes clear when considering the legal statuses of euthanasia and assisted suicide throughout the world that Camus’ statement of suicide as the only truly serious philosophical problem holds true, today more than ever. This is ultimately a philosophical problem. As such, legislatures throughout the world will likely continue to grapple with these issues for the foreseeable future.