tag:theconversation.com,2011:/us/topics/assisted-dying-bill-14437/articlesAssisted Dying Bill – The Conversation2022-07-06T12:18:34Ztag:theconversation.com,2011:article/1830182022-07-06T12:18:34Z2022-07-06T12:18:34ZMedical aid in dying is still called ‘assisted suicide’; an anthropologist explains the problem with that<figure><img src="https://images.theconversation.com/files/471935/original/file-20220630-22-871otr.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4256%2C2809&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More than 20% Americans live in a state with access to a medically assisted death.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/bedside-pastoral-services-royalty-free-image/182445781?adppopup=truem">nathamag11/iStock / Getty Images Plus</a></span></figcaption></figure><p><a href="https://deathwithdignity.org/states/">Several states</a> around the U.S. are currently considering whether to legalize medical aid in dying for terminally ill patients. <a href="https://www.uptodate.com/contents/physician-assisted-dying">More than 20%</a> of Americans already live in a state with access to a medically assisted death. Despite this rapidly changing legal climate, the language for describing this new way to die remains surprisingly antiquated. </p>
<p>The term that continues to dominate <a href="https://apnews.com/article/business-health-oregon-lawsuits-portland-3cf31cb519d84a47e2d3cb70e8f0bce7">media coverage</a> on the <a href="https://www.nytimes.com/2022/06/26/opinion/america-the-merciless.html">issue</a> is “assisted suicide.” The American Medical Association uses the term “<a href="https://www.ama-assn.org/delivering-care/ethics/physician-assisted-suicide">physician-assisted suicide</a>.” </p>
<p>A quick look at <a href="https://trends.google.com/trends/?geo=US">Google Trends</a> reveals that <a href="https://trends.google.com/trends/explore?geo=US&q=assisted%20dying,assisted%20suicide">nine times</a> as many people search for “assisted suicide” as opposed to “assisted dying.” </p>
<p>As a <a href="https://www.brandeis.edu/facultyguide/person.html?emplid=7cda5153378472ba304a33ef0cbeb2f2fac3a8ed">cultural anthropologist</a>, I know that how we name something determines how we think about it. Until just recently, the primary term in the English language for the purposeful, voluntary death of oneself was “suicide.” Besides martyrdom or sacrifice, there was no other way to refer to an intentional self-death. </p>
<p>But times have changed. For the past 25 years, since Oregon enacted the country’s <a href="https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/statute.pdf">first assisted dying law</a>, a medically assisted death has occupied a new legal and moral category. An assisted death is a medical response to the devastating reality of terminal illness. </p>
<p>Equating assisted dying with suicide isn’t only antiquated or misleading – it’s actually harmful. I have spent five years shadowing patients, families and physicians involved with assisted dying in America, and I saw how damaging this conflation can be. In my new book, “<a href="https://anitahannig.com/">The Day I Die: The Untold Story of Assisted Dying in America</a>,” I explore the complexities and constraints of the choices that people who pursue an assisted death face.</p>
<h2>A loaded term</h2>
<p>Until well into the 19th century, suicide was viewed as a crime in the United States, punishable with confiscation of the deceased’s property and denial of a Christian burial. Although suicide – but not its assistance – has been decriminalized today, it remains heavily stigmatized. As philosopher <a href="https://philosophy.utoronto.ca/directory/ian-hacking/">Ian Hacking</a> <a href="https://doi.org/10.1086/595626">writes</a>, “News of a suicide among us has an immediate response: horror.” Calling assisted dying “suicide” taps into the social taboos and moral outrage that surround the act of taking one’s life. </p>
<p>That stigma can lead to very sick patients’ hiding their desire to pursue an assisted death from loved ones for fear of being judged for “suiciding” – leaving patients without critical support. It also poses a problem for terminally ill patients who have a strong wish to be released from their suffering but whose religion considers committing “suicide” a sin. One devout homeless patient from Portland with end-stage renal failure spent his last waking moments before he drank the lethal medication agonizing about whether God would forgive him for ending his life.</p>
<p>As I found during my research, the conflation of assisted dying with suicide sometimes causes families to feel isolated in the bereavement process. Afraid of being shamed for “abetting” their loved one’s “suicide,” some have had to mask their grief. </p>
<p>Valerie, whose elderly mother used Oregon’s assisted dying law in 2018, told her supervisor at work about her mother’s chosen death. He emitted a “hushed groan,” offering no condolences for her loss. “After that encounter, I only revealed the details to trusted friends and family,” Valerie told me. “It added a layer of sadness to expend energy trying to figure out what someone’s reaction might be.”</p>
<p>Bereavement experts call this type of mourning “<a href="https://www.socialworker.com/feature-articles/practice/disenfranchised-grief-when-grief-and-grievers-are-unrecogniz/">disenfranchised grief</a>” – hidden grief that is not fully acknowledged or even allowed by society because of the way someone died, such as from a drug overdose or in utero. </p>
<h2>A medical procedure</h2>
<p>From their inception, assisted-dying laws in America were designed to mobilize the tools of medicine to ease suffering at the end of someone’s life. These laws draw a clear line between assisted dying and a suicidal act. The nation’s first assisted-dying statute, Oregon’s 1997 <a href="https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/statute.pdf">Death with Dignity Act</a>, specifies that “Actions taken in accordance with [the Act] shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law.” </p>
<p>As Roger Kligler, a physician and cancer patient who is <a href="https://www.bostonglobe.com/2022/03/05/metro/cape-cod-doctors-quest-legalize-medically-assisted-death-goes-before-sjc/">suing</a> the commonwealth of Massachusetts for his right to die, put it, “Calling it suicide means that we’re not talking about end-of-life issues.”</p>
<p>The participation of medicine and a patient’s social network, write <a href="https://www.mayoclinic.org/biographies/bostwick-j-michael-m-d-mfa/bio-20053180">psychiatrists John Michael Bostwick</a> and <a href="https://doctor.webmd.com/doctor/lewis-cohen-3cfa993f-3610-4c7b-aa14-d6a36a788e34-overview">Lewis Cohen</a>, are what differentiate assisted dying from suicide. An assisted death is collaborative and sanctioned by a patient’s support system – not unilateral and covert. “When they acquiesce to requests to facilitate dying, [physicians] are not abetting suicide or committing homicide,” Bostwick and Cohen write. “The distinction between clinical suicide and other types of end-of-life decisions demands a new formulation.” </p>
<h2>Key differences</h2>
<p>Terminally ill patients who seek an assisted death aren’t suicidal. Absent a terminal prognosis, they have no independent desire to end their life. In fact, prescribing physicians must uphold the distinction between assisted dying and suicide in their clinical work by screening for mental illness, such as depression (which is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165520/">clinically associated</a> with suicidal thoughts). A patient who shows any signs of mental impairment must undergo further scrutiny by a mental health expert. </p>
<p>Patients who pursue medical aid in dying are no longer looking at an open-ended life span either. To qualify for an assisted death in states with these laws they must already be on the verge of dying – that is, within <a href="https://www.compassionandchoices.org/our-issues/medical-aid-in-dying">six months</a> of the end of their life. These patients don’t face a meaningful decision between living and dying, but between one kind of death and another. </p>
<p>As <a href="https://deathwithdignity.org/states/">more states</a> are inching closer to legalizing assisted dying, it’s time that we revise and refine our cultural lexicon around this emergent end-of-life practice. A medically assisted death definitively warrants a linguistic and conceptual category of its own.</p><img src="https://counter.theconversation.com/content/183018/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anita Hannig does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Terminally ill patients who seek an assisted death have no desire to end their life. Calling their decision ‘assisted suicide’ can have harmful consequences.Anita Hannig, Associate Professor of Anthropology, Brandeis UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/908382018-01-31T01:14:04Z2018-01-31T01:14:04ZConscience vote on euthanasia bill exposes democratic weakness of New Zealand’s voting system<figure><img src="https://images.theconversation.com/files/203936/original/file-20180130-170413-1br9dg5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A parliamentary select committee will hold hearings and receive public submissions on the euthanasia bill.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>The New Zealand parliament has voted 76 to 44 to refer a euthanasia bill to a select committee for public submissions. The Labour and National parties are allowing their MPs a conscience vote on <a href="https://www.parliament.nz/en/pb/bills-and-laws/bills-proposed-laws/document/BILL_74307/end-of-life-choice-bill">the bill</a>. </p>
<p>However, New Zealand’s mixed-member proportional (MMP) electoral systems gives 49 of 120 seats to people elected from party lists. Voters have no means of voting for or against any of these people as individuals. They have no means of registering support or opposition at the ballot box for the position a list MP takes.</p>
<h2>Euthanasia is not a left/right issue</h2>
<p>The euthanasia bill made it through <a href="https://www.newsroom.co.nz/2017/12/13/68408/big-vote-in-favour-of-euthanasia-bill">parliament’s first reading</a> in December. A similar bill failed in 1995 by 61 votes to 29, and again in 2003 by 60 votes to 58.</p>
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<a href="https://theconversation.com/in-places-where-its-legal-how-many-people-are-ending-their-lives-using-euthanasia-73755">In places where it's legal, how many people are ending their lives using euthanasia?</a>
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<p>This time, New Zealand First, Labour’s coalition partner in government, voted as a bloc in favour of the bill after it was amended to allow for a public referendum to confirm any change to the law. New Zealand First’s policy is for matters of conscience to be settled by referendum.</p>
<p>The bill allows adults with a terminal illness or an irremediable medical condition the option of <a href="https://www.parliament.nz/en/pb/bills-and-laws/bills-proposed-laws/document/BILL_74307/end-of-life-choice-bill">requesting medical assistance to end their lives</a>. Euthanasia is not a left/right political issue. The major parties do not have the philosophical traditions, nor shared view of the good life, from which to bind their MPs to either side of the argument.</p>
<p>Pragmatically, parties accept that imposing a collective position on legislation where personal convictions are so deeply held carries political risk. A party line may be difficult to establish, and a party may simply polarise a public debate on an issue where personal passions run high. </p>
<h2>Conscience votes and democratic accountability</h2>
<p>Many MPs voted for the <a href="http://www.legislation.govt.nz/bill/member/2017/0269/latest/DLM7285905.html">bill</a> at the first reading just so that public submissions would be heard. Some may be guided by those submissions. Many will be guided by deeply held religious convictions on the nature and value of human life. Others will reflect on family experiences.</p>
<p>The 71 electorate MPs may consult their electorates. Some may survey their constituents, even surrendering conscience to the survey, just as on other issues conscience may be surrendered to the party whip. The convictions of others may be so strong that they are willing to get on the wrong side of popular opinion and accept whatever electoral consequences. </p>
<p>The supremacy of human conscience justifies the free vote, as does Burke’s <a href="https://books.google.com.au/books?id=J1xUAAAAcAAJ&pg=PA15&lpg=PA15&dq=%22Government+and+legislation+are+matters+of+reason+and+judgement,+and+not+of+inclination%22&source=bl&ots=oC9IYQBCJk&sig=jfji4Oy9PxVI86Ro0TUGj3Vn7wI&hl=en&sa=X&ved=0ahUKEwiO1p_ry_fYAhWDwLwKHWJUCDoQ6AEIMjAD#v=onepage&q=%22Government%20and%20legislation%20are%20matters%20of%20reason%20and%20judgement%2C%20and%20not%20of%20inclination%22&f=false">foundational argument in democratic theory</a>:</p>
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<p>Your representative owes you, not his industry only, but his judgement; and he betrays, instead of serving you, if he sacrifices it to your opinion. Government and legislation are matters of reason and judgement, and not of inclination; and, what sort of reason is that, in which the determination precedes the discussion; in which one set of men deliberate, and another decide; and where those who form the conclusion are perhaps three hundred miles distant from those who hear the arguments?</p>
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<p>The representative’s duty to reason is balanced by the voters’ capacity to elect somebody of a different persuasion at the next election. However, list MPs are representatives of their parties. There is no democratic check – one votes for or against them as a group through one’s party vote. </p>
<h2>A democratic problem with no obvious solution</h2>
<p><a href="https://nzhistory.govt.nz/politics/fpp-to-mmp">MMP was introduced</a> to ensure political parties would hold seats in parliament in proportion to their share of the vote. The system is conducive to making the parliament broadly reflective of the national <a href="https://www.aspg.org.au/wp-content/uploads/2017/08/Session-2-Dr-Therese-Arseneau-The-Impact-of-MMP-on-Representation-in-New-Zealands-Parliament.pdf">demographic character</a>.</p>
<p>The former first-past-the-post electoral system did not elect women to parliament in great numbers, nor younger people. Māori did not enjoy a political voice consistent with their share of the population, nor one that allowed them to secure claims of <a href="https://policypress.co.uk/indigeneity-a-politics-of-potential">prior occupancy</a>. It was <a href="https://www.aspg.org.au/wp-content/uploads/2017/08/Session-2-Dr-Therese-Arseneau-The-Impact-of-MMP-on-Representation-in-New-Zealands-Parliament.pdf">most unusual</a> for a person from an ethnic minority to sit in parliament.</p>
<p>However, the democratic advantages of the proportional electoral system – a broad and diverse parliament – come at a democratic cost. <a href="http://www.tandfonline.com/doi/abs/10.1177/003231879804900201">List MPs</a> cannot be held personally to account by the voters.</p>
<p>In respect of conscience votes, this is a democratic problem without an obvious solution. The idea that list MPs not be allowed to participate in conscience votes would create distinct classes in parliament. It would undermine the legitimacy of the list MP on which the system depends for proportionality and diversity.</p>
<p>Proportionality and diversity may mean the collective conscience of the parliament is more likely to reflect the collective conscience of the people. A deeply unpopular list MP may be removed from the party list to minimise electoral damage to the party. However, these are mere possibilities. They are not democratic guarantees.</p>
<p>MMP entrenches the political party as the system’s essential and most important feature. Individuals rarely vote in parliament – a party’s votes are collectively cast by a whip. Conscience votes are the exception. </p>
<p>Conscience is for the individual, but the voter ought reasonably be able to provide a democratic response to the list MPs’ exercise of conscience. It is a weakness that undermines the system’s democratic worth.</p><img src="https://counter.theconversation.com/content/90838/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dominic O'Sullivan has been a member of the New Zealand Labour Party.</span></em></p>New Zealand MPs will cast a conscience vote on a euthanasia bill. But with 49 out of 120 seats held by ‘list’ MPs, this raises issues about the democratic process under the country’s electoral system.Dominic O'Sullivan, Associate Professor of Political Science, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/883242017-12-05T19:19:44Z2017-12-05T19:19:44ZFrom Oregon to Belgium to Victoria – the different ways suffering patients are allowed to die<figure><img src="https://images.theconversation.com/files/197532/original/file-20171204-4062-1p2hrsh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Victoria's model is pretty conservative compared to other jurisdictions that have legalised euthanasia or assisted dying.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Australia will, from mid-2019, once again join the list of countries that have legalised a person’s right to die if he or she is suffering unbearably. This comes after Victoria became the first state in the country to <a href="http://www.abc.net.au/news/2017-11-29/euthanasia-passes-parliament-in-victoria/9205472">legalise voluntary assisted dying</a> in November 2017 – more than two decades after the federal parliament struck down the Northern Territory’s short-lived <a href="https://en.wikipedia.org/wiki/Rights_of_the_Terminally_Ill_Act_1995">euthanasia act</a>.</p>
<p>The <a href="http://www.legislation.vic.gov.au/domino/Web_Notes/LDMS/PubPDocs.nsf/ee665e366dcb6cb0ca256da400837f6b/d162e1f2fcc3f7c3ca2581a1007a8903!OpenDocument">Victorian bill</a> provides a model for physician-assisted suicide, where a patient can request and receive help to <a href="https://theconversation.com/dying-a-good-death-what-we-need-from-drugs-that-are-meant-to-end-life-85445">source the drugs</a> necessary to bring about their own death. This is different to voluntary euthanasia, which typically requires another person such as a doctor to actively cause the death of the patient at the patient’s request. </p>
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Read more:
<a href="https://theconversation.com/want-to-better-understand-victorias-assisted-dying-laws-these-five-articles-will-help-88310">Want to better understand Victoria's assisted dying laws? These five articles will help</a>
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<p>Under the Victorian model, there is scope for a doctor to administer the drugs if the patient is physically incapable of doing so themselves. To access the scheme, the patient must meet strict criteria. They must have an illness likely to end their life within six months (12 months for neurodegenerative conditions such as motor neuron disease) and be experiencing suffering that can’t be managed in a way tolerable to the patient. They must be over the age of 18 and a resident of Victoria. </p>
<p>Victoria’s model is pretty conservative compared to other jurisdictions. Some broaden eligibility to minors, non-residents and people suffering non-terminal conditions and disabilities. Others include access to both voluntary euthanasia and physician-assisted dying. </p>
<p>Here is a roundup of the laws around the world that permit assisted dying or euthanasia and ways in which they differ.</p>
<h2>Oregon</h2>
<p>Outcomes of the Oregon model have influenced debate in many jurisdictions, including Australia. Oregon passed its <a href="http://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/pages/index.aspx">Death with Dignity Act</a> in 1994. Finally taking effect in 1997, it is one of the longest-standing legislative schemes for physician-assisted suicide. </p>
<p>Oregon’s eligibility requirements are similar to those in Victoria. Assisted dying is available to adults over 18 who are capable of making decisions, have a terminal diagnosis with a life expectancy of six months and are Oregon residents.</p>
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Read more:
<a href="https://theconversation.com/the-six-month-amendment-could-defeat-the-purpose-of-victorias-assisted-dying-bill-87941">The six-month amendment could defeat the purpose of Victoria's assisted dying bill</a>
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<p>The initial process for seeking assistance to die is also similar: a series of requests and evaluations over a period of time. Unlike the Victorian bill, though, the Oregon law doesn’t require patients or doctors to seek a licence or permit from the state prior to taking or allowing the medication. But doctors are required to report deaths to the state for evaluation purposes. </p>
<p>As of January 2017, 1,749 people had <a href="http://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year19.pdf">received prescriptions under the Oregon law</a> since it came into force in 1997. Around 1,127 patients had died from ingesting the medications provided, 133 of these in 2016. Most participants (70%) were 65 years or older, and most (77.4%) had cancer.</p>
<p>The Oregon law has been remarkably stable. There was an unsuccessful attempt in 2015 to extend the eligibility period from six to 12 months. But the regulatory and eligibility criteria remain unchanged since 2006, when the law’s validity was last challenged in the courts.</p>
<p>Other US states to legalise assisted dying include Washington, Montana, Vermont and California. These are <a href="https://lop.parl.ca/Content/LOP/ResearchPublications/2015-116-e.html?cat=law#a6">based on the Oregon model</a>, but there is <a href="https://www.deathwithdignity.org/learn/access/">minor variation in process between jurisdictions</a>. </p>
<h2>Netherlands, Belgium and Luxembourg</h2>
<p>In the Netherlands, Belgium and Luxembourg, both voluntary assisted dying and euthanasia are legal. There are no specific diagnostic requirements for access to the scheme for adults. The patient only needs to be experiencing unbearable suffering without prospect of a cure. </p>
<p>Patients accessing assisted dying and euthanasia in these jurisdictions have done so not only for terminal conditions but also non-terminal ones too. These include <a href="http://www.worldrtd.net/news/belgium-analysis-euthanasia-cases-dementia-and-psychiatry">dementia</a>, alcohol and drug addiction, mental illness and <a href="http://www.telegraph.co.uk/news/worldnews/europe/belgium/9801251/Euthanasia-twins-had-nothing-to-live-for.html">disability</a>. </p>
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Read more:
<a href="https://theconversation.com/separating-fact-from-fiction-about-euthanasia-in-belgium-58203">Separating fact from fiction about euthanasia in Belgium</a>
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<p>Both Belgium and the Netherlands have reduced or removed age eligibility criteria to include minors. Since 2014, minors of any age who are terminally ill have been able to access assisted dying or euthanasia in Belgium, after a psychiatric assessment. In the Netherlands, children from 12 years can access the laws.</p>
<p>In the <a href="http://statline.cbs.nl/Statweb/publication/?DM=SLEN&PA=81655eng&D1=10&D2=a&D3=a&D4=l&LA=EN&VW=T">Netherlands</a>, 6,672 people died as a result of euthanasia and 150 of assisted suicide in 2015 – or 4.6% of all deaths. This is <a href="https://www.ncbi.nlm.nih.gov/pubmed/27380345">consistent with estimates</a> that assisted suicide or euthanasia accounts for between 0.3% and 4.6% of all deaths in jurisdictions where it is legal. Thus it remains relatively rare.</p>
<h2>Switzerland</h2>
<p>Despite being recognised as the first “euthanasia” jurisdiction, the Swiss system is somewhat of a legal irregularity, as the laws don’t expressly authorise physician-assisted suicide. Rather, while the <a href="https://www.admin.ch/opc/en/classified-compilation/19370083/201709010000/311.0.pdf">Swiss Penal Code 1942</a> makes voluntary euthanasia and assisted suicide an offence in the case of “selfish” motives, it is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125125/">silent on the status</a> of assisted suicide for “non-selfish” motives. </p>
<p>As the system rests on an omission rather than an express scheme, there are no mandated eligibility requirements relating to age, residency, condition or prognosis. </p>
<p>Since the 1980s, not-for-profit organisations have interpreted this law as permitting them to provide assisted suicide services.</p>
<h2>Canada</h2>
<p>In the 2015 case of <a href="https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/14637/index.do">Carter v Canada</a>, the Canadian Supreme Court ruled that a terminally ill patient has a right to a physician’s assistance in dying under the <a href="http://laws-lois.justice.gc.ca/eng/Const/page-15.html">Canadian Charter of Rights and Freedoms</a>. The case resulted in <a href="http://www.parl.ca/DocumentViewer/en/42-1/bill/C-14/royal-assent">Bill C-14,</a> which excludes from Canadian criminal laws those who provide assistance in dying to Canadian residents over the age of 18, with capacity to make decisions, who are suffering from a “grievous and irremediable” medical condition rendering the end of their life reasonably foreseeable.</p>
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Read more:
<a href="https://theconversation.com/viewpoints-should-euthanasia-be-available-for-people-with-existential-suffering-79564">Viewpoints: should euthanasia be available for people with existential suffering?</a>
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<p>Bill C-14 has been challenged because of the “reasonably foreseeable” requirement. The <a href="https://bccla.org/wp-content/uploads/2016/08/2016-06-27-Notice-of-Civil-Claim.pdf">British Columbia Civil Liberties Association</a> has argued it is more restrictive than the finding of the Canadian Supreme Court in Carter, which required only that the plaintiff be experiencing intolerable suffering. <a href="http://www.cbc.ca/news/canada/british-columbia/assisted-dying-constitutional-challenge-1.4349773">That court challenge is continuing</a>, while the law remains valid.</p>
<p>Quebec, a province of Canada, has also legislated a form of euthanasia. Under <a href="http://legisquebec.gouv.qc.ca/en/showdoc/cs/S-32.0001">Quebecois law</a>, doctors must administer assistance personally and remain with the patient until they die. This imposes a greater burden on doctors than assisted dying models. </p>
<h2>Colombia</h2>
<p>Colombia permits both voluntary euthanasia and physician-assisted suicide to terminally ill adults. The practice is regulated by a set of guidelines published in 2015 by the Colombian Ministry of Health and Social Protection. The guidelines came some 20 years after the <a href="http://www.patientsrightscouncil.org/site/wp-content/uploads/2015/05/Colombia_Court_Decision_05_20_1997.pdf">Constitutional Court ruled</a> no person could be criminally liable for taking the life of a terminally ill patient who had consented.</p>
<p>In common with the Victorian model, the Colombian guidelines require prior external authorisation. However this is obtained from an external review committee in Colombia, rather the Secretary of the Department of Health, as in the case of the Victorian model. </p>
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<p><em>If this article has raised concerns for you or anyone you know, contact <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14, or <a href="https://www.beyondblue.org.au/">beyondblue</a> 1300 224 636.</em></p><img src="https://counter.theconversation.com/content/88324/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wendy Bonython does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Victorian assisted dying laws are based on those in Oregon, which are quite conservative. Laws in the Netherlands, Belgium and Canada are more relaxed.Wendy Bonython, Associate professor, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/879412017-11-23T01:04:47Z2017-11-23T01:04:47ZThe six-month amendment could defeat the purpose of Victoria’s assisted dying bill<p>Victoria’s historic bill to legalise assisted dying passed the upper house
after a marathon 28-hour sitting on November 22, 2017. The 40 MPs voted with their conscience, and the final count was 22 to 18. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"933201394395316224"}"></div></p>
<p>The bill returns to the lower house for <a href="http://www.abc.net.au/news/2017-11-22/euthanasia-victorian-parliament-passes-assisted-dying-laws/9156016">final ratification of amendments</a>. The original bill specified that the person requesting assistance to die should have no more than 12 months to live. This has been reduced to a much more restrictive six months.</p>
<p>However, people with neurodegenerative conditions, such as motor neuron disease and multiple sclerosis, can apply for assistance to die up to 12 months before their expected death. This follows medical advice that people with these conditions may not be able to give clear requests for assisted dying once they have reached the final stages of their illness.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/four-reasons-victorian-mps-say-no-to-assisted-dying-and-why-theyre-misleading-87168">Four reasons Victorian MPs say 'no' to assisted dying, and why they're misleading</a>
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<p>Both the amendment and the exception give rise to a number of concerns. The first is that it is widely accepted that estimating the time a patient has to live is one of the most difficult core clinical skills. A doctor who gets this prognosis wrong could conceivably deny the patient a peaceful death. This would defeat the entire purpose of the legislation.</p>
<h2>Overestimating time left to live</h2>
<p>The six-month amendment brings the Victorian legislation into line with that in the US state of Oregon, on which the Victorian bill was largely based. But it’s much more restrictive than in Canada, where there is no <a href="https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html">requirement for a specific prognosis</a> as to how long a person has left to live. Canada’s legislation does have other stringent eligibility criteria, such as having a terminal illness in which a natural death has become “reasonably foreseeable”. </p>
<p>A physician would usually be able to predict how long, on average, a patient with a specific disease is likely to live. But given all other aspects of the patient’s condition at the individual level, such prognosis is often inaccurate. A review of studies <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161407">exploring predictions</a> of survival in palliative care for patients with a range of illnesses found that doctors’ predictions were “frequently inaccurate”. Estimates ranged from an underestimate of 86 days to an overestimate of 93 days. </p>
<hr>
<p><strong><em><a href="https://theconversation.com/how-much-time-have-i-got-doc-the-problems-with-predicting-survival-at-end-of-life-52700">How much time have I got, doc? The problems with predicting survival at end of life</a></em></strong></p>
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<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/12881260">Another review</a> of similar studies concluded that doctors tended to be “overly optimistic”, and that</p>
<blockquote>
<p>…clinicians consistently overestimate survival [which] may affect patients’ prospects for achieving a good death. </p>
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<p>Under the Victorian bill, a patient given an “overly optimistic” prognosis of 12 months to live would not be eligible for assistance to die, but may then die before reaching the six-month threshold. That patient would, meanwhile, have had to meet all the other eligibility criteria, including suffering that cannot be relieved in any way acceptable to the patient.</p>
<p>This may result in patients who would have been eligible, had they received an accurate prognosis, continuing to suffer until they die, thereby depriving them of a good death.</p>
<h2>Neurodegenerative diseases</h2>
<p>The narrow exception to the amendment, from six to 12 months for people with neurodegenerative conditions, is also cause for concern. This amendment was made both because of possible mental deterioration, and because of the extreme difficulty of controlling pain relief for people with neurodegenerative conditions, requiring high doses of medication that could potentially render the person unconscious.</p>
<p>However, neurodegenerative diseases are not the only ones where great distress towards the end of life may make it difficult to give clear requests for assisted dying. Patients suffering from conditions such as congestive cardiac failure, chronic obstructive pulmonary disease and chronic renal (kidney) failure can be given such strong medication at the end of life, which may render them incapable of clear decision-making.</p>
<p>My <a href="https://espace.library.uq.edu.au/view/UQ:261477">2004 research</a> explored factors that affect requests for euthanasia in older people with terminal illness. Of 43 people who had died in the previous 12 months, six had asked for help in ending their lives. None of them had cancer, but five had chronic obstructive pulmonary disease and found their suffering intolerable.</p>
<p>The current narrow amendment would not offer these patients the same extended time frame and could thus be considered to be discriminatory.</p>
<h2>Defeating the purpose</h2>
<p>Victoria’s lower house passed the Assisted Dying Bill on 20 October 2017, by 47-37. It is expected to take effect in 2019, to allow time for discussion and resolution of all implementation issues, including what drugs can be used to assist a person to die.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/dying-a-good-death-what-we-need-from-drugs-that-are-meant-to-end-life-85445">Dying a good death: what we need from drugs that are meant to end life</a>
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<p>The bill was the result of extensive and meticulous work by two Victorian government committees, consisting of many prominent Victorians, including those with experience in palliative care, medicine, nursing and the law. </p>
<p>Compared with other jurisdictions that allow assisted dying, the Victorian Bill is extremely conservative in relation to the eligibility criteria and the processes that must be followed. It also contains 68 safeguards and harsh penalties for breaches of the proposed legislation. Further restrictions are unnecessary and stand to jeopardise the very purposes of the legislation.</p><img src="https://counter.theconversation.com/content/87941/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colleen Cartwright received funding from the National Health and Medical Council grants program of the Australian government </span></em></p>Doctors often overestimate the time a patient has left to live. In the case of Victoria’s assisted dying bill, an optimistic prediction could deny the patient the peaceful death they deserve.Colleen Cartwright, Emeritus professor, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/814012017-07-21T06:53:52Z2017-07-21T06:53:52ZVictoria may soon have assisted dying laws for terminally ill patients<p>An independent group of experts set up by the Victorian government has today delivered its <a href="https://www2.health.vic.gov.au/about/health-strategies/voluntary-assisted-dying-bill">final report</a> outlining 66 recommendations for how voluntary assisted dying would work in the state.</p>
<p>Chaired by former head of the Australian Medical Association, Brian Owler, the Ministerial Advisory Panel’s role was to work out how legislation should be drafted to allow terminally ill people to receive assistance to die. The panel based its report on the recommendations of the <a href="http://www.parliament.vic.gov.au/lsic/inquiry/402">Parliamentary committee’s Inquiry into end of life choices</a> in December 2016.</p>
<p>Legislation giving effect to the report is likely to be tabled in the Victorian Parliament <a href="http://www.theage.com.au/victoria/assisted-dying-new-laws-could-see-victorians-get-lethal-medicine-within-10-days-20170720-gxfbcn.html">within a month</a>.</p>
<h2>Who does the law cover?</h2>
<p>At the heart of debates about assisted dying are eligibility criteria – who can get assistance to die and who cannot. The panel’s recommendations are broadly consistent with the report of the parliamentary committee. Access is allowed for an adult who can make their own decisions, is terminally ill and their suffering cannot be relieved. They must also be a resident of Victoria.</p>
<p>But the panel widens the committee’s earlier recommendation that a person must be “at the end of life (final weeks or months of life)” to be granted their request. Instead, the current report states the “incurable disease, illness or medical condition” must be expected to cause death in no later than 12 months. </p>
<p>While we agree eligibility should be based on a terminal illness, we don’t favour time limits as they are arbitrary and difficult to accurately predict. They can also lead to people taking harmful steps to fall inside them, such as starving themselves. </p>
<p>But the panel’s recommendation to extend the time to 12 months is still a better approach than the committee’s, as it is likely forming a clinical view about prognosis will be more manageable in that time. Providing a set time frame also avoids the uncertainty of the vague use of the phrase “at the end of life”.</p>
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<figcaption><span class="caption">Former AMA president, Professor Brian Owler, chaired the Ministerial Advisory Panel.</span></figcaption>
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<p>Also of note is that the panel specifically stated mental illness alone and disability alone will not satisfy eligibility requirements; but nor will they exclude access to voluntary assisted dying.</p>
<h2>What assistance can be provided?</h2>
<p>This is primarily a physician-assisted dying model, which means the patient is expected to take the lethal dose of medication themselves. This is a narrow approach to assisted dying as it is the person themselves who takes the final step to end life, not the doctor.</p>
<p>The panel’s approach is consistent with the committee’s report – both are broadly along the lines of the US assisted dying model such as the one in Oregon. </p>
<p>There are downsides to this and we favour a more inclusive model (like in Canada or under the European model) that permits assistance to die being directly provided by a doctor as well. This choice better reflects the autonomy that underpins these laws. </p>
<p>But the panel (and the committee) did recommend an exception where the person is physically unable to take the medication or digest it themselves. This may not be used often but helps address potential discrimination, for example on the grounds of physical disability which prevents someone taking the medication themselves.</p>
<h2>What safeguards are there?</h2>
<p>The panel has proposed a very rigorous process - comprised of 68 safeguards – that involves three separate requests for voluntary assisted dying (one which is witnessed by two independent witnesses) and two independent medical assessments.</p>
<p>A patient seeking assistance to die must be provided with a range of information including about diagnosis and prognosis, treatment options available, palliative care, and the expected outcome and risks of taking the lethal dose of medication. Doctors involved will have to receive special training about the law and how it operates.</p>
<p>Other safeguards are at the systems level, with a Voluntary Assisted Dying Review Board recommended to examine each case and also to report on how the scheme as a whole is operating. The panel has also proposed a range of new offences specifically about voluntary assisted dying to deter conduct outside the scope of the regime, such as an offence against inducing someone to request assisted dying.</p>
<h2>Will these recommendations become law?</h2>
<p>Strong public opinion, shifting views in the health and medical professions and international trends towards allowing assisted dying mean it will become lawful in Australia at some point. But will it be in Victoria, and soon? </p>
<p>The politics of assisted dying are notoriously fickle and this is the latest of <a href="https://eprints.qut.edu.au/95429/1/Failed%20Voluntary%20Euthanasia%20Law%20Reform%20UNSWLJ.pdf">over 50 bills</a> in Australian parliaments addressing this issue over the past two decades.</p>
<p>But as we <a href="https://theconversation.com/victorias-model-for-assisted-dying-laws-may-be-narrow-enough-to-pass-70120">have argued in the past</a>, features of this law reform effort suggest it could happen. The process of examining the issue has been very careful, inclusive and thoughtful with multiple reports and engagement with expert opinion and national and international evidence. </p>
<p>This is a narrow assisted dying model with a lot of safeguards. There is also high level and public support of senior politicians on both sides of politics. But as always, the ultimate test is what happens on the floor of parliament.</p><img src="https://counter.theconversation.com/content/81401/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ben White receives funding from the Australian Research Council and the National Health and Medical Research Council for research into law, policy and practice relating to end-of-life care</span></em></p><p class="fine-print"><em><span>Lindy Willmott does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Public opinion, shifting views in the health profession and international trends allowing assisted dying mean it will be lawful in Australia at some point. But will it be lawful in Victoria soon?Ben White, Professor of Law and Director, Australian Centre for Health Law Research, Queensland University of TechnologyLindy Willmott, Professor of Law and Director, Australian Centre for Health Law Research, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/737552017-03-03T04:53:30Z2017-03-03T04:53:30ZIn places where it’s legal, how many people are ending their lives using euthanasia?<figure><img src="https://images.theconversation.com/files/159231/original/image-20170303-24331-15wkfi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">One paper reported that between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/126396110@N06/26137241265/in/photolist-FPEcdM-p44dbM-oDVwym-yjqsr-9yLRbh-xd3QZC-wxB2qJ-xvfSQt-xcZGPN-xd7PWP-xv9Fz4-ozjqCb-5xYYyD-s3inR-9BG9eQ-cQay4s-puzqPc-6HNRj7-qRKw1f-kowQG9-2V2uSq-pdnpsG-74taDB-74sJAK-8GggAp-EnGPHB-EnGPFn-aBq5BW-55PvFX-bgc1KX-8bdRFs-q7Gre-74x5z3-bsvp45-4yk6nn-pdVvm4-2A3qv6-53Z5nP-oUoibY-oDW3YX-6h6rZp-6hC8ZU-puydo2-pdnC1X-9gUcFY-DwyaEF-crVdu9-Aj6No-5J6uam-9gR6hF">Flickr/Alberto Biscalchin</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>The Victorian Parliament will consider a bill to <a href="http://www.theage.com.au/victoria/victorian-parliament-to-vote-on-assisted-dying-laws-next-year-20161208-gt6t0w.html">legalise euthanasia</a> in the second half of 2017. That follows the South Australian Parliament’s decision to <a href="http://www.abc.net.au/news/2016-11-16/voluntary-euthanasia-debate-in-south-australia-goes-to-committee/8031776">knock back</a> a voluntary euthanasia bill late last year, and the issue has also cropped up in <a href="http://www.abc.net.au/news/2017-02-24/wa-election-barnett-mcgowan-christian-safe-schools-euthanasia/8298754">the run-up</a> to the March 11 Western Australian election.</p>
<p>With the issue back in the headlines, federal Labor’s justice spokesperson, Clare O'Neil, told <a href="http://www.abc.net.au/tv/qanda/txt/s4615749.htm">Q&A</a> that in countries where the practice is legal, “very, very small” numbers of people use the laws.</p>
<p>Whether or not you agree with O'Neil’s statement depends largely on your interpretation of the subjective term “very, very small”, but there is a growing body of data available on how many people are using euthanasia or assisted dying laws in <a href="https://www.ncbi.nlm.nih.gov/pubmed/27380345">places</a> such as the Netherlands, Belgium, Luxembourg, Colombia, Canada and some US states.</p>
<h2>Assisted dying, assisted suicide and euthanasia</h2>
<p>Many people use the terms “assisted dying”, “assisted suicide” and “euthanasia” interchangeably. But, technically, these phrases can have different meanings.</p>
<p>Assisted dying (sometimes also assisted death) is where the patient himself or herself ultimately takes the medication. Euthanasia, by contrast, is usually where the doctor administers the medication to the patient. </p>
<p>Assisted suicide includes people who are not terminally ill, but who are being helped to commit suicide, whereas assisted dying refers to people who are already dying. Some reports do not, however, distinguish between assisted dying and assisted suicide, and I will not distinguish them here.</p>
<p>In some jurisdictions, the word “euthanasia” is used to refer to both assisted dying/suicide (where the patient himself or herself takes the medication) and to euthanasia (where the doctor administers the medication to the patient). So “euthanasia” can sometimes be used as a broad term to cover a range of actions.</p>
<h2>Euthanasia and assisted suicide rates around the world</h2>
<p>According to a peer-reviewed <a href="https://www.ncbi.nlm.nih.gov/pubmed/27380345">paper</a> published last year in the respected journal JAMA:</p>
<blockquote>
<p>Between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal. The frequency of these deaths increased after legalization … Euthanasia and physician-assisted suicide are increasingly being legalized, remain relatively rare, and primarily involve patients with cancer. Existing data do not indicate widespread abuse of these practices.</p>
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<p>The authors of that paper said that 35,598 people died in Oregon in 2015. Of these deaths, 132, or 0.39%, were reported as physician-assisted suicides. The same paper said that in Washington in 2015 there were 166 reported cases of physician-assisted suicide (equating to 0.32% of all deaths in Washington in that year).</p>
<p>Interestingly, the same paper noted that US data show that:</p>
<blockquote>
<p>pain is not the main motivation for PAS (physician-assisted suicide)… The dominant motives are loss of autonomy and dignity and being less able to enjoy life’s activities.</p>
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<p>The authors said that in officially reported Belgian cases, pain was the reason for euthanasia in about half of cases. Loss of dignity is mentioned as a reason for 61% of cases in the Netherlands and 52% in Belgium.</p>
<p>A 2016 Victorian parliamentary <a href="http://www.parliament.vic.gov.au/file_uploads/LSIC_pF3XBb2L.pdf">report</a> has quoted from the UK Commission on Assisted Dying, which in turn referenced the work of John Griffiths, Heleen Weyers and Maurice Adams in their book <a href="https://books.google.com.au/books/about/Euthanasia_and_Law_in_Europe.html?id=x6YEQgAACAAJ">Euthanasia and Law in Europe</a>. The commission said:</p>
<blockquote>
<p>There are no official data in Switzerland on the numbers of assisted suicides that take place each year, as the rate of assisted suicide is not collected centrally. Griffiths et al observe that there are approximately 62,000 deaths in Switzerland each year and academic studies suggest that between 0.3% and 0.4% of these are assisted suicides. This figure increases to 0.5% of all deaths if suicide tourism is included (assisted suicides that involve non‑Swiss nationals).</p>
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<p>Around 3.7% of deaths in the Netherlands in 2015 were due to euthanasia. The Netherlands’ regional euthanasia review committees <a href="https://www.euthanasiecommissie.nl/uitspraken/jaarverslagen/2015/april/26/jaarverslag-2015">reported</a> that there were 5,516 deaths due to euthanasia in 2015. That is out of a <a href="https://www.statista.com/statistics/520011/total-number-of-deaths-in-the-netherlands/">total</a> of around 147,000 - 148,000 <a href="https://www.cbs.nl/en-gb/news/2016/04/population-growth-fuelled-by-immigration">deaths in the Netherlands</a> that year.</p>
<p>This figure represents an increase of 4% of deaths due to euthanasia <a href="https://www.euthanasiecommissie.nl/uitspraken/jaarverslagen/2015/april/26/jaarverslag-2015">compared to 2014</a>.</p>
<p>A 2012 <a href="https://www.ncbi.nlm.nih.gov/pubmed/22789501">paper</a> published in The Lancet reported on the results of nationwide surveys on euthanasia in the Netherlands in 1995, 2001, 2005 and 2010. The researchers said:</p>
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<p>In 2002, the euthanasia act came into effect in the Netherlands, which was followed by a slight decrease in the euthanasia frequency … In 2010, of all deaths in the Netherlands, 2.8% were the result of euthanasia. This rate is higher than the 1.7% in 2005, but comparable with those in 2001 and 1995.</p>
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<p>Another Netherlands-based <a href="http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2426428">study</a> published in the journal JAMA Internal Medicine reported in 2015 that: </p>
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<p>Certainly, not all requests are granted; studies conducted between 1990 and 2011 report rates of granting requests between 32% and 45%.</p>
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<p>A 2015 <a href="http://www.nejm.org/doi/citedby/10.1056/NEJMc1414527#t=citedby">paper</a> in the New England Journal of Medicine about euthanasia rates in the Flanders region of Belgium (the northern half of the country) noted:</p>
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<p>The rate of euthanasia increased significantly between 2007 and 2013, from 1.9% to 4.6% of deaths.</p>
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<h2>Filling in the bigger picture</h2>
<p>It can be hard to put these rates in context, but what is clear is that euthanasia is by no means a leading cause of death in countries where it is legal. For example, <a href="http://statbel.fgov.be/en/binaries/PRESS%20RELEASE%20Causes%20of%20death%202012_tcm327-267267.pdf">Statistics Belgium</a> said that for the year 2012, cardiovascular disease was the most common cause of death (28.8%), and cancer was the second most common cause of death (26%).</p>
<p>And in the Netherlands – where <a href="https://www.euthanasiecommissie.nl/uitspraken/jaarverslagen/2015/april/26/jaarverslag-2015">5,516</a> of deaths were due to euthanasia in 2015 – more than <a href="https://www.cbs.nl/en-gb/news/2015/38/number-of-dementia-related-deaths-increased-to-12-5-thousand">12,000</a> Dutch people died from the effects of dementia in 2014, approximately 10,000 Dutch people died from lung cancer and nearly 9,000 died from a heart attack. In <a href="https://www.cbs.nl/en-gb/news/2014/50/most-people-die-of-cancer-and-cardiovascular-disease">2013</a>, 30% (about 42,000) of Dutch deaths were from cancer and 27% (about 38,000) of Dutch deaths were from cardiovascular disease.</p>
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<p><em>If this article has raised issues for you or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/73755/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew McGee does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is a growing body of evidence available on how many people are using euthanasia and assisted dying laws in places where it is legal.Andrew McGee, Senior Lecturer, Faculty of Law, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/701202016-12-09T05:04:06Z2016-12-09T05:04:06ZVictoria’s model for assisted dying laws may be narrow enough to pass<p>After much speculation, the Victorian Government has announced it will put <a href="http://www.theage.com.au/victoria/victorian-parliament-to-vote-on-assisted-dying-laws-next-year-20161208-gt6t0w.html">assisted dying legislation before parliament</a> in the second half of next year. This follows the recent and narrow defeat of a <a href="http://www.abc.net.au/news/2016-11-16/voluntary-euthanasia-debate-in-south-australia-goes-to-committee/8031776">bill in South Australia</a>.</p>
<p>In making the announcement, Premier Daniel Andrews <a href="http://www.theaustralian.com.au/national-affairs/state-politics/daniel-andrews-to-push-ahead-with-euthanasia-laws/news-story/07bef054147f48803c41882d9bb5f7e4">said</a>:</p>
<blockquote>
<p>Each and every member of my team will have a conscience vote and I am confident that each and every member of the parliament more broadly will search their conscience, search their values and search their personal experiences to make a decision that they believe is the right decision for the future.</p>
</blockquote>
<p>What is interesting from a law reform perspective is the decision to include an implementation review step in the process. The premier revealed that an expert Ministerial Advisory Panel of clinical, legal, consumer, health administrator and palliative care experts will help draft the laws. </p>
<p>Media reports suggest the starting point for the review will be the recommendations of a parliamentary committee report “<a href="http://www.parliament.vic.gov.au/lsic/inquiry/402">Inquiry into end of life choices</a>”, released in June 2016. The model proposed by the committee includes a range of safeguards common to assisted dying bills in Australia. </p>
<p>The patient must be an adult and mentally capable of making their own decisions when they make an informed and voluntary request for assistance to die. This request must be repeated (three times in this model), and enduring in that it persists over time. </p>
<p>The patient must have a serious and incurable condition that is causing enduring and unbearable suffering that can’t be relieved. Two doctors must be involved in the process, with a psychiatrist additionally involved in cases where mental capacity is in question.</p>
<p>The model recommended by the parliamentary committee is also narrow in scope. First, it is a physician-assisted dying model. This means the law would focus on permitting the prescription of lethal medication, which is then taken by the patient themselves, rather than being directly administered to the patient by the doctor, as would be the case under a voluntary euthanasia model. </p>
<p>This is different from almost all the other Australian bills, including the recent South Australian one, which would have permitted voluntary euthanasia where death occurs under the direct supervision of the doctor. There is a limited exception where voluntary euthanasia would be allowed under the Victorian model, and that is when a patient is physically unable to take the medication themselves.</p>
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<p><em><strong>Further reading: <a href="https://theconversation.com/south-australias-reasons-for-voting-down-euthanasia-go-against-the-evidence-69050">South Australia’s reasons for voting down euthanasia go against the evidence</a></strong></em></p>
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<p>A second way in which the recommended model is narrow is that it is limited to patients “at the end of life”. The parliamentary committee report clarifies this as being in the “final weeks or months of life”. Although the precise meaning of these words can be debated, the intent is that assistance to die is limited to when death is expected in the foreseeable future.</p>
<p>It is narrower than many other Australian bills as it confines the law to a group already close to death. Other bills have, for example, required a patient have a terminal illness but not stipulated a precise period within which death must be predicted to occur.</p>
<p><a href="http://www.heraldsun.com.au/news/victoria/voluntary-euthanasia-laws-placed-under-review-by-andrews-government/news-story/1eeb9800ccf0af39e2d74d32148e08d4">Reports suggest</a> almost half of the members of Victoria’s Legislative Assembly have stated their support for reform. But would a bill pass? </p>
<p>There have been <a href="https://eprints.qut.edu.au/95429/1/Failed%20Voluntary%20Euthanasia%20Law%20Reform%20UNSWLJ.pdf">more than 50 bills</a> dealing with assisted dying in Australian parliaments over the last two decades. Apart from a brief period in the Northern Territory, assisted dying remains unlawful. Legislation was widely tipped to pass in the South Australian parliament last month but fell short by one vote. </p>
<p>Reform in this area is tricky, and apparent consensus can dissolve very quickly. But building and maintaining consensus is more likely for a bill with a narrower focus and with these safeguards. </p>
<p>The inclusion of this further stage of review and deliberation by an expert ministerial advisory panel also makes it more likely reform will occur. One of the barriers to changing the law is parliament debating a bill that fails to consider important issues or turns out to give rise to unintended consequences. </p>
<p>This can be avoided through careful deliberation by experts from a range of disciplines who can iron out the “bugs” that may not be apparent at first glance. </p>
<p>One example of potentially unforeseen problems in the recommended model is the proposal the patient be “at the end of life”. How is this policy position best implemented? Options include specifying a concrete timeframe or taking a more qualitative approach such as that death is “reasonably foreseeable”. </p>
<p>Both can give rise to different problems in principle and in practice as demonstrated by international experience. We have <a href="http://www.cbc.ca/news/canada/montreal/sherbrooke-man-hunger-strike-death-1.3529392">seen this in Canada</a> with reports a small group of people are starving themselves so they can be close to death which is then “reasonably foreseeable”. It is important these and other issues are carefully considered in the drafting of the Victorian bill.</p>
<p>Victoria stands a chance of becoming the first Australian jurisdiction in 20 years, and the first ever Australian state, to have an assisted dying law. But history has shown law reform in this area is especially contentious so we should not expect this bill to be any different.</p><img src="https://counter.theconversation.com/content/70120/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Victoria stands a chance of becoming the first Australian jurisdiction in 20 years, and the first ever Australian state, to have an assisted dying law.Ben White, Professor of Law and Director, Australian Centre for Health Law Research, Queensland University of TechnologyAndrew McGee, Senior Lecturer, Faculty of Law, Queensland University of TechnologyLindy Willmott, Professor of Law, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/474322015-09-12T09:42:10Z2015-09-12T09:42:10ZMPs vote no on assisted dying – so what are the arguments for and against?<p><em>After a heartfelt and passionate debate in the House of Commons, <a href="http://www.bbc.co.uk/news/health-34208624">MPs have voted</a> 330 to 118 to reject the <a href="http://www.publications.parliament.uk/pa/bills/cbill/2015-2016/0007/cbill_2015-20160007_en_2.htm#l1g1">Assisted Dying Bill</a>. As many as 85 MPs spoke, sharing personal stories and compelling arguments both for and against the bill, which proposed that a terminally ill person should be able to request assistance to end their own life.</em></p>
<p><em>The bill specified that for a person’s request to be granted, they must be terminally ill and “reasonably expected” to die within six months. Their decision would have had to be “voluntary, clear, settled and informed”, put forward in a written declaration signed by two doctors, and approved by a High Court judge. Only after a cooling off period of 14 days would a lethal drug have been prescribed.</em> </p>
<p><em>Here, two experts in medical ethics sum up some of the arguments for and against the bill.</em></p>
<h2>Arguments in favour</h2>
<p><strong>Hazel Biggs, professor of Healthcare Law at the University of Southampton</strong></p>
<p>There are a number of arguments to be made in favour of the Assisted Dying Bill. </p>
<p>For one thing, the law should accommodate people who want to exercise their autonomy by being assisted to die, as long as they are capable of making that decision. We must be certain that any such decision has been well-considered and endured over a period of time. It’s crucial that the person making the decision has the capacity to do so, and that their choice is voluntary, and free from coercion. Such decisions must be made on the basis of clear, accurate and unbiased information about the prognosis, the alternatives available, the ways an assisted death might be brought about and what the patient might experience. </p>
<p>The Assisted Dying Bill included safeguards to ensure that all these criteria were met, and to protect those who might be vulnerable to exploitation or manipulation.</p>
<p>Currently, it is not unlawful to commit suicide, but assisting someone to commit suicide carries a maximum prison sentence of 14 years. In practice, if a loved one or carer assists someone to die, they are <a href="http://www.cps.gov.uk/publications/prosecution/assisted_suicide.html">less likely to be prosecuted</a> than someone operating in a professional capacity. That means that doctors and nurses, who could assist someone to die in a safe and reliable way, are more likely to be prosecuted. The concern here is that people may ask carers to help them because professional assistance is not available, which can end up in botched suicide attempts and result in greater suffering.</p>
<p>We also see people travelling to places where assisted suicide is lawful and available to foreign nationals, such as the DIGNITAS clinic in Switzerland. Anybody who helps someone travel to these places could be prosecuted. Around <a href="http://www.telegraph.co.uk/news/newsvideo/9631861/Right-to-die-debate-rages-on-as-figures-reveal-sharp-rise-in-Britons-travelling-to-Dignitas.html">200 people</a> have travelled from the UK to use DIGNITAS. No one has faced prosecution so far, but a good and dignified death should ideally happen in familiar surroundings with loved ones close by. Forcing people to spend their final hours in a foreign land with limited contact with family and friends is inhumane. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/94564/original/image-20150912-1559-1e6m5co.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/94564/original/image-20150912-1559-1e6m5co.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/94564/original/image-20150912-1559-1e6m5co.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/94564/original/image-20150912-1559-1e6m5co.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/94564/original/image-20150912-1559-1e6m5co.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/94564/original/image-20150912-1559-1e6m5co.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/94564/original/image-20150912-1559-1e6m5co.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The vote takes place.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/stuckincustoms/4978571696/sizes/l">Stuck in Customs/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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</figure>
<p>Another problem with the status quo is that the law doesn’t come in to play until after the assisted suicide has taken place. As a result, those who might be vulnerable to being exploited or pressurised into an assisted suicide are only protected by the threat of criminal prosecution after the fact. If we regulated assisted suicide, we could make sure that no one was being pressured into suicide, that it really was their considered wish, and that they were competent to make that decision before any action was taken. This would provide greater protection than currently exists.</p>
<p>The sanctity of life is obviously a huge issue in this area. For medical professionals, the first imperative is to cure and sustain life. But the reality is that in some situations this is not possible anymore. Medicine is about caring, but it is not always about curing. It is about keeping people comfortable and making sure that they end their lives in a way that they would wish. </p>
<p>Palliative care can go some way towards providing this, and offers huge support to some patients. But it is not available to all and does not suit everybody. Sometimes the more caring option might be to give a person who wants it the choice of a properly regulated assisted suicide.</p>
<p>Reform of the law to permit assisted suicide would be safer for those who are vulnerable to exploitation and provide more choice for those who are terminally ill. It would remove barriers for those who wish to commit suicide but are physically incapable of so doing, and make it available to everybody who is eligible – not just those who can afford to join DIGNITAS and travel to Switzerland.</p>
<h2>Arguments against</h2>
<p><strong>Charles Foster, research associate at the University of Oxford</strong></p>
<p>The Assisted Dying Bill is dangerously misconceived. It is unnecessary: in all the circumstances envisaged by the bill, effective palliative care is readily available. It is simply wrong to claim – as some <a href="http://www.dignityindying.org.uk/assisted-dying/suffering-at-the-end-of-life/">proponents of the bill do</a> – that if the remedy of assisted suicide is not available, patients will die in pain or other distress. </p>
<p>Even if this were the case, the remedy is not to kill the patient, but to ensure that proper palliative care is available. If the bill becomes law, there will be less motivation to improve palliative care than there is currently. That is bad news for a far bigger cohort of patients than simply those who might consider assisted suicide.</p>
<p>The bill claims to ensure that no patient will consent to assisted suicide without fully understanding what they are asking for and without having the capacity to consent. But the safeguards on this front are inadequate. In fact, no imaginable safeguards would be adequate. The incidence of undiagnosed (but treatable) depression in terminally ill patients <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181973/">is very high</a>.</p>
<p>So there is no reason to suppose that depression will always be diagnosed by the clinicians assessing those who request assistance to die. Depression often generates suicidal thoughts, which can evaporate <a href="http://www.currentpsychiatry.com/home/article/assessing-and-treating-depression-in-palliative-care-patients/c3ec9466fd10c1cbb97e9dfd1c511c42.html">with proper treatment</a>. It can also <a href="http://archpsyc.jamanetwork.com/article.aspx?articleid=497740">compromise a patient’s capacity</a> to make decisions – meaning that many of the assisted deaths would be of patients who have not fully, autonomously consented.</p>
<p>The bill also assumes that clinicians can be reasonably certain that a patient will die within six months. Medically speaking, the idea that such a prognosis can be in any way certain is ludicrous. Diseases don’t read medical textbooks. </p>
<p>Even when one can be certain that the patient is wholly capable and understands what they are asking for, there will very often be concerns about the patient’s motivation for asking to die. These worries are not addressed by the bill, and indeed cannot be addressed by any conceivable legislation. Vulnerable patients often feel that they are a burden – to relatives, to carers, to the healthcare system as a whole – and may ask to die in order to relieve others. </p>
<p>The way to deal with that concern is not to kill the patient: that implies that there is nothing wrong about the patient being made to feel that way. Hard though it may be, the ethos that generates the concern needs to be addressed.</p>
<p>Where doctors are permitted to assist suicide, all doctor-patient relationships are immediately and irretrievably changed. Imagine how you would feel if the doctor treating you for cancer came to your bedside having just helped to kill the patient in the next bed. It would mean that doctors were no longer simply healers, but accessories to killing. Doctors themselves have <a href="http://bma.org.uk/practical-support-at-work/ethics/bma-policy-assisted-dying">repeatedly</a> and <a href="https://www.rcplondon.ac.uk/press-releases/rcp-reaffirms-position-against-assisted-dying">emphatically</a> made it clear that they do not want that change. Assisted suicide denotes the failure of medicine: it is not a part of medicine. We can and should do better.</p><img src="https://counter.theconversation.com/content/47432/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charles Foster acted as counsel for the Society for the Protection of Unborn Children in the House of Lords case of Debbie Purdy, and for Care Not Killing in the Supreme Court case of Tony Nicklinson. Both cases concerned the law of assisted suicide.</span></em></p><p class="fine-print"><em><span>Hazel Biggs does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Two experts in medical ethics sum up some of the arguments for and against the bill.Charles Foster, Research Associate, University of OxfordHazel Biggs, Professor of Healthcare Law, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/363112015-01-16T13:21:48Z2015-01-16T13:21:48ZUK moves to join countries with some form of assisted dying – but a way to go yet<figure><img src="https://images.theconversation.com/files/69126/original/image-20150115-5198-1sr6bep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">UK legislation still has various hurdles to overcome</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&search_tracking_id=c2si0KHLjO2kCYzrLDXLJQ&searchterm=euthanasia&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=123384046">Robert Kneschke</a></span></figcaption></figure><p>The debate on the role of law and ethics at the end of life is an enduring one. In 1971, such debate was focused almost solely upon the Netherlands when a rural physician called Truus Postma <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1796690/">facilitated</a> the death of her severely handicapped mother, Margina van Boven-Grevelink, following her repeated, explicit requests for euthanasia. </p>
<p>Although Postma was convicted two years later, the court’s judgment determined when a doctor would not be required to keep a patient alive contrary to their will in what was the world’s first test case. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Truus Postma in 1973.</span>
<span class="attribution"><a class="source" href="http://commons.wikimedia.org/wiki/File:Truus_Postma_(1973).jpg#mediaviewer/File:Truus_Postma_(1973).jpg">Nationaal Archief</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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</figure>
<p>A set of criteria developed through <a href="http://bne.catholic.net.au/qbc/downloads/downloader.php?euthanasia/euthanasia-in-the-netherlands.pdf">a number of cases</a> in the country during the 1980s and <a href="http://www.euthanasiecommissie.nl/Images/Wet%20toetsing%20levensbeeindiging%20op%20verzoek%20en%20hulp%20bij%20zelfdoding%20Engels_tcm52-36287.pdf">resulted in</a> the Termination of Life on Request and Assistance with Suicide (Review Procedures) Act 2001. This did not legalise end-of-life assistance but instead provided statutory defences to prosecution, subject to certain procedures being followed. </p>
<h2>Assisted dying now</h2>
<p>Today the Netherlands has been joined by Belgium, Luxembourg and Switzerland; the US states of Oregon, Washington, Montana and Vermont; and most recently the Canadian state of Quebec as jurisdictions which have enacted legal provision to permit assistance at the end of life. In the UK, <a href="http://www.scottish.parliament.uk/parliamentarybusiness/Bills/69604.aspx">Scotland</a>, <a href="http://www.dignityindying.org.uk/assisted-dying/lord-falconers-assisted-dying-bill/">England and Wales</a> are developing bills that propose to bring similar provisions to this country for the first time. </p>
<p>The provisions in the different jurisdictions vary but have similarities too. They have mostly had to address recurring concerns such as what form a request for assistance to end life should take; whether there should be a minimum age; how the consultation and referral process will be monitored; how capacity is to be determined; who will oversee reporting and scrutiny; who will provide such assistance; and above all, how transparency, accountability and equity are to be ensured. </p>
<p>Many jurisdictions have experienced difficulty with terminology and definitions. For example, how can it be shown that a person’s suffering is at a point that it can no longer be endured? Legislative proposals have included descriptions such as “unbearable”, “intolerable”, “unrelievable”, “hopeless”, “intractable” and “irremediable”, and it has been questioned whether any of these words capture the essence of what an individual may feel at that moment and, if so, how it be adequately reflected in legal provision. </p>
<h2>Euthanasia vs assisted suicide</h2>
<p>Among regimes that permit assisted dying, they don’t always permit both euthanasia and assisted suicide, the <a href="http://www.worldrtd.net/qanda/what-difference-between-assisted-dying-and-euthanasia">distinction between the two</a> being about who is doing the killing (though more on the fineness of the distinction below). Euthanasia involves administering the lethal drugs, while assisted suicide is about making the means available to the patient to administer themselves. Where both types of assisted death are available, <a href="http://ukpollingreport.co.uk/blog/archives/212">surveys have shown</a> that individuals usually choose euthanasia, placing the responsibility for the dying process onto another. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The assisted dying that different jurisdictions permit varies widely.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&search_tracking_id=c2si0KHLjO2kCYzrLDXLJQ&searchterm=euthanasia&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=123384046">Robert Kneschke</a></span>
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<p>The Netherlands and Luxembourg permit both euthanasia and assisted suicide. Belgium allows only doctors to perform euthanasia. Assisted suicide is not explicitly covered but there appears to be acceptance that it would be permitted within the provisions. All four American states permit only physician-assisted suicide, which is broadly the route now being proposed in Scotland, whereas England and Wales have seen proposals for assisted dying. </p>
<p>Switzerland permits assisted suicide but excludes euthanasia. The law does not require a physician to be involved, nor does it require the recipient to be a Swiss national. This latter aspect of Swiss law is unique and the <a href="http://www.dignitas.ch/index.php?option=com_content&view=article&id=22&lang=en">Dignitas clinic in Zurich</a> has been the focus of much discussion around what is referred to as “suicide tourism”. </p>
<h2>The European human rights conundrum</h2>
<p>During the committee hearings on the Scottish bill this week, the Law Society of Scotland <a href="http://news.stv.tv/scotland-decides/news/306301-proposed-assisted-suicide-law-could-breach-human-rights-laws/">indicated that</a> it could be in breach of the <a href="http://news.stv.tv/scotland-decides/news/306301-proposed-assisted-suicide-law-could-breach-human-rights-laws/">European Convention on Human Rights (ECHR)</a>. This stems from <a href="http://www.legislation.gov.uk/ukpga/1998/46/section/57">rules that</a> that prohibit the Scottish government from passing laws that are incompatible with the convention. </p>
<p>One potential area of incompatibility is <a href="http://www.echr.coe.int/Documents/Convention_ENG.pdf">Article 2</a>, which protects the right to life. The English case of <a href="http://www.theguardian.com/society/2002/apr/29/health.medicineandhealth">Diane Pretty in 2002</a> noted that the right to life could not, without a distortion of language, be interpreted as conferring a “right” to die. Understandably, states place great emphasis on the value of human life and their obligation to protect this may outweigh an individual’s right for assistance to end life. </p>
<p>It is worth pointing out in the this context that most legislation in place does not confer a personal right to seek assistance to die, however. It is arguably broader than that, since it creates an environment where, under certain conditions, it is lawful for that help to be provided. That might be a key distinction for reconciling ECHR Article 2 and the forthcoming UK laws, assuming they are enacted. </p>
<p>Through a series of English cases, there has been much legal discussion on whether the present law on assisting a suicide is incompatible with <a href="http://www.echr.coe.int/Documents/Convention_ENG.pdf">Article 8</a> of the convention (right to respect for private and family life). In June 2014, in the case of <a href="https://www.supremecourt.uk/decided-cases/docs/UKSC_2013_0235_Judgment.pdf">Nicklinson and others</a>, the UK Supreme Court concluded that it was the role of parliament to decide whether current law was incompatible with the provisions of Article 8. This is what is currently happening as both the Westminster and Scottish parliaments consider their proposed assisted dying legislation. </p>
<h2>The problem of ‘practical assistance’</h2>
<p>When legislation was passed in Oregon in 1997, some of the first challenges came from those who argued that if they wished to end their lives the law prevented them because they lacked the ability to hold the medication in their hands or put in it their mouths and ingest it. This was particularly an issue with people with progressive neurological diseases. </p>
<p>So one important question for the UK legislators will be, if assistance is provided, at what point does it cease to be assistance and instead become euthanasia – the primary responsibility having passed to another to bring about death? There is whole spectrum of what may be construed as assistance – helping someone travel to another country to die might be included for example, though to date the law has not recognised this as assistance. But is holding a person’s head up, or putting pills into their hands or mouths, or giving them a glass of water, euthanasia or assisted suicide? </p>
<p>Other issues are vital too. There is the question of the protection of those who are vulnerable. And society will need to ensure that any law, if introduced, applies equally and transparently to all. In short, as the UK moves towards joining the group of countries who permit some form of assisted dying, there is still much that needs carefully considered first.</p><img src="https://counter.theconversation.com/content/36311/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alison Britton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The debate on the role of law and ethics at the end of life is an enduring one. In 1971, such debate was focused almost solely upon the Netherlands when a rural physician called Truus Postma facilitated…Alison Britton, Professor of Healthcare and Medical Law, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.