Legislation on euthanasia and assisted suicide by country

The question of the place of the euthanasia or assisted suicide in the laws of different countries is a source of debate ¹ . Most countries prohibit, with notable exceptions such as Belgium , the Switzerland , the Netherlands , the Luxembourg and some US states .

By 2015, active euthanasia is legal only in four countries: Colombia, the Netherlands, Belgium and Luxembourg ² . Assisted suicide is legal in Switzerland as well as in five American states ( Oregon , Washington , Montana , Vermont and California ). However, many countries prohibiting active euthanasia have legalized cessation of treatment at the request of the patient, prohibited therapeutic efforts and instituted end-of-life support initiatives.

Germany

In Germany ³ , euthanasia was widely practiced under the Nazi regime with the euthanasia of over 150,000 German patients, including 6,000 children ( Aktion T4 program ). Euthanasia is currently prohibited in the texts but its passive form is tolerated. Germans tend to use the term Sterbehilfe (de) assisted death rather than euthanasia which echoes Operation T4 .

Australia

In Australia, active euthanasia and assisted suicide are illegal, but they have been heavily debated, especially since the Northern Territory has authorized, through a 1995 law, Death of a terminally ill patient. This law came into force on 1 ^st July 1996 was repealed in March 1997 by the Federal law on euthanasia laws, while four people had used ³ .

Belgium

The law of 28 May 2002 ⁴ adopted after two years of debate decriminalizes active euthanasia. This is defined in the law as “the act, carried out by a third party, which intentionally ends the life of a person at the request of the latter” .

The act of euthanasia is authorized under three conditions:

• The patient must be of age (or emancipated minor), capable and conscious at the time of application;
• It must be formulated in a voluntary, reflective and repeated manner and does not result from external pressure;
• The patient finds himself in a dead-end medical situation and reports a constant and unbearable physical or psychological suffering which can not be appeased and which results from a serious and incurable accidental or pathological affection.

The practicing physician must be voluntary, no person can be compelled to participate.

The procedure to be followed by the doctor is strictly defined by law, supplemented by implementing decrees. It includes precise information to the patient on the condition and palliative care options , compliance with the conditions imposed (see above), and consultation with a second independent physician. If death is not expected in the short term (≤ 1 year), a 3 ^rd medical opinion by a pathologist or a psychiatrist is required, as well as a minimum of one month between the application Written of the patient and euthanasia.

The possibility of preparing witness statements in advance by any person of full age, in order to take account of his wishes, should he no longer be able to express it, is provided for in a royal decree published on 13 May 2003 ⁵ .

The doctor who has practiced euthanasia must then submit a report to the “Federal Monitoring and Evaluation Commission” composed of doctors and lawyers who examine compliance with the legislation.

But as to the application of the law, M ^gr André-Joseph Leonard , archbishop of Mechelen-Brussels said inMay 2012 : “The Federal Supervisory Commission is almost obliged to close its eyes to practices that are not in conformity with the law, and explicitly confesses its inability to effectively control its application” ⁶ .

Ten years after the adoption of the law, the Socialist Party is calling for an extension of the law to “tackle, in a calm and uninhibited manner, cases of minors or persons in a state of progressive unconsciousness” ⁷ . One of the experts interviewed in the Senate argues that active euthanasia is already practiced among minors, outside the legal framework, in full awareness. The people with Alzheimer’s are also the subject of proposals to extend the law ⁸ .

Since February 2014, Belgium has become the first country in the world to legalize the euthanasia of minors, without any age limit, by extending the 2002 law. But under more stringent conditions than for adult euthanasia. The child or the adolescent must indeed be confronted with unbearable physical suffering, since moral suffering has been disregarded here. And must also be in a deadly medical situation resulting in death in the short term. Moreover, the child must be recognized “in a capacity to appreciate all the consequences” by an independent psychiatrist or psychologist, in addition to the agreement of the medical team and the parents ⁹ .

Canada

The voluntary active euthanasia, non-voluntary and involuntary was criminal and punishable under count charge of murder of ¹⁰ , but there was a tolerance in some provinces on passive euthanasia at the terminal ¹¹ . Article 241 of the Criminal Code of Canada condemned “assist and encourage suicide” ¹² . However, the15 June 2012, Justice Lynn Smith of the Supreme Court of British Columbia ruled in Carter v. Canada (Attorney General) (in) that this article of the Criminal Code imposed an unduly discriminatory burden on people with severe disabilities who are not valid under sections 7 and 15 of the Canadian Charter of Rights and Freedoms in opposition to the judgment of the 1993 Supreme Court of Canada in the case of Rodriguez v. British Columbia (Attorney General) (in) which decided that Article 241 of the Criminal Code was constitutionally valid. Since that 1993 decision, there have been nine bills in the House of Commons of Canada to decriminalize euthanasia and assisted suicide, all of which have been rejected, the latest being Bill C-384, Was rejected on April 21 , 2010With a majority of 228 votes against and 59 for ¹³ . This bill was proposed by Francine Lalonde of the Bloc Québécois , who had already proposed two similar bills in the past. The6 February 2015, The Supreme Court delivered a judgment in Carter that the prohibition of medical aid to death is unconstitutional in that sections 14 and 241 of the Criminal Code of Canada violate section 7 of the Charter Canadian Charter of Rights and Freedoms guaranteeing the right to life, liberty and security; The Supreme Court invalidated its own judgment in Rodriguez in 1993. However, the judgment states that this constitutional invalidity applies only to able-bodied adults who clearly consent to end their lives and are affected by health problems Serious and irremediable causes of persistent and intolerable suffering. The federal and provincial governments have 12 months to adjust their legislation ^{14 , 15} . June 17, 2016, the law ended the criminalization of euthanasia and / or assisted suicide ¹⁶ .

The 5 June 2014, The Quebec National Assembly adopted the Act respecting end - of - life care, which introduced “medical aid to die” in the Quebec health system. The Quebec thus became the first Canadian province to legislate on the “right to die”. The text of the law does not include any mention of “euthanasia” but provides that a patient with an incurable disease and suffering exceptionally may seek medical assistance to die which consists in administering medications resulting in death of the patient ¹⁷ . It is expected that the federal government will challenge this law before the courts. However, the Supreme Court’s ruling on the cases of two British Columbia women invalidating the crime of medical aid to die in specific cases that closely resemble the scope of the Quebec the federal government’s argument was based on the fact that the Criminal Code of Canada takes precedence over provincial laws even health ¹⁵ .

Colombia

In Colombia, euthanasia is regulated according to the resolution n ^o 1216 of 20 April 2015 ¹⁸ . On July 3 of the same year, Colombia recorded the first case of legal euthanasia with the death of Ovidio González, the father of cartoonist Julio César González alias Matador ¹⁸ . On that occasion, she also became the first country in Latin America to legally practice ¹⁹ .

Denmark

Apart from the penal code, which condemns homicide, even if committed at the request of the victim, as well as assisted suicide, several texts evoke euthanasia without naming it. They seek above all to limit the therapeutic relentlessness ³ .

Spain

Passive euthanasia and assisted suicide were decriminalized in 1995 ²⁰ . Medical professionals have an obligation to respect patients’ wishes ^{[citation needed]} , even if this may lead to their death. The law recognizes the binding value of advance directives . Their existence must be indicated on the patient’s medical record and on a national file. Consent to care may be given by a third party: a family member, relative or legal representative.

United States

Passive euthanasia is accepted by the Supreme Court . The legislation is in fact dependent on States . Five of them accept assisted suicide:

• Oregon ²¹ (since 1997). InMay 2009, 401 people had used this law in Oregon, and the first woman with stage 4 pancreatic cancer had used it in Washington State ^{22 , 3} ,
• Washington (since 2008): by the referendum of the4 November 2008, Approved by 58% of the vote, Washington State authorizes the use of euthanasia for terminally ill patients ²³ ,
• Montana ²¹ (since 2009),
• Vermont ²¹ (since 2013),
• California (since 2015): the text is adopted by the House of Representatives from California September 9, 2015, and then by the Senate 11 September 2015 ²⁴ . The law was finally ratified by Governor Jerry Brown 5 October 2015 ²⁵ . This vote follows the agony Brittany Maynard, a Californian of 29 years diagnosed with brain cancer who visited Oregon to end his suffering ²¹ .

Finland

Passive euthanasia is legal ²⁶ . Finland has until 2012 refused to legislate on active euthanasia, considering that this was an ethical and not a political issue. However, the question divides the political and NGO tried in May 2012 to gather 50,000 signatures for a petition to force the Parliament to examine the question ²⁷ without success ²⁸ .

France

In France , ” death ” is governed mainly by two laws: the law of 2002 on the rights of patients and the Léonetti law of 22 April 2005 on the rights of patients at the end of life .

The general idea is to promote palliative care , to prohibit “active euthanasia” and to prevent the doctor from practicing “unreasonable obstinacy” in the care of patients at the end of life. A balance is also sought between avoiding suffering that is deemed unnecessary for a patient who is believed to be destined to die, and that of keeping him alive.

The 2002 law resulted in the reformulation of the Code of Medical Conduct , which now provides that the physician:

“Must refrain from any unreasonable obstinacy in investigations or treatment and may waive undertake or pursue treatments that appear useless, disproportionate or that have no purpose or effect that artificial life support ²⁹ . ”

The Public Health Code (L1110-5) also provides for the possibility of shortening suffering:

“Health professionals are using every means at their disposal to ensure that everyone lives a life worthy of death. If the physician finds that he can not relieve the suffering of a person in the advanced or terminal stage of a serious and incurable disease, whatever the cause, by applying treatment to him that may have the effect He must inform the patient, without prejudice to the provisions of the fourth paragraph of Article L. 1111-2, the person of confidence referred to in Article L. 1111-6, the family or, Failing that, one of the relatives. The procedure followed is recorded in the medical file. ”

This legislative framework is the culmination of a parliamentary mission chaired by Jean Leonetti , requested by President Chirac following the Vincent Humbert case , and aims to ensure end-of-life quality by providing palliative care and recognizing the duty to respect the ” dignity of the dying” whose will is recognized throughout the writing of his early declaration and the appointment of a trusted person ²⁹ . A mission to evaluate the Leonetti law was then carried out, following the case of Chantal Sébire ³⁰ .

According to a review of the code of medical ethics, “the aggressive therapy is defined as an unreasonable obstinacy, refusal by a stubborn reasoning to recognize that man is destined to die and it is not curable ³¹ “. Therefore, the definition of “therapeutic relentlessness” depends on the actual legal criteria for death (which are based on the concept of brain death rather than just the cardiovascular arrest ). But other criteria, including the will of the patient, are at stake. The Leonetti law thus has, when it comes to conscious patients :

“Art. L. 1111-10 Public Health Code. - When a person, in an advanced or terminal phase of a serious and incurable condition , whatever the cause, decides to limit or stop any treatment, the physician respects his will after having informed him of the consequences of his choice. The decision of the patient is recorded in his medical file. ”

On 27 January 2016, Parliament should pass a new law on end of life including establishing a right to a “deep sedation and continues” and clarification measures on advance directives ³² .

Greece

Euthanasia is totally illegal ^{[ref. Required]} .

Hungary

Passive euthanasia is permitted at the request of the patient ²⁰ .

Italy

Active euthanasia is considered a crime punishable by imprisonment between 5 and 16 years of age.

Luxembourg

Euthanasia and assisted suicide have been legal since March 17, 2009.

On 19 February 2008, Luxembourg’s Deputies voted, on first reading and by a small majority ³³ , the Err / Huss ³⁴ law on the decriminalization of euthanasia, but the law did not immediately enter into force because the Grand Duke Henri threatened to refuse to sanction the law. A second reading of the law took place in December 2008, but the Sovereign informed the Prime Minister on 2 December 2008 that he would not sanction this law. As a result of this, the prerogatives of the sovereign were limited: now the Grand Duke no longer sanctions the laws, but promulgates them. On March 16, 2009 , the law decriminalizing euthanasia was promulgated by the Grand Duke Henri and the text came into force on March 17, 2009 ³⁵ .

Mexico

Passive euthanasia is authorized since 7 January 2008. Active euthanasia remains illegal.

Norway

Passive euthanasia is allowed on the request of the dying patient or a close if it is unconscious ³⁶ .

Netherlands

Euthanasia has been legal since April 2001 ³ .

Euthanasia in the Netherlands is legal in case of:

• Repeated request from the patient, if he is able to make a speech;
• The disease must be incurable;
• Take advice from another doctor;
• Report the death to the authorities.

Moreover, in the same country, since 2004, euthanasia is permitted for children over 12 years of age, and the opinion of the parents can supplement that of the child.

In 2003 , almost 1,800 euthanasia cases were carried out. In 2012, this number is over 4,188 according to the Dutch Ministry of Health. The ministry explains this growth by training in 2012, brigades of mobile doctors empowered to make a fatal injection at the patient’s home. The number of mobile brigades from six to ten initially due to their high stress ³⁷ .

Poland

The legislation refuses euthanasia.

Portugal

The active and passive euthanasia is doomed but the Ethics Council has accepted the judgment of some of the heaviest treatments in some desperate cases, to the exclusion of hydration and nutrition ²⁰ .

UK

Euthanasia is assimilated to murder and is punishable by 14 years in prison. Conflicting court decisions have yet been taken ³ .

Scotland

The bill to authorize assisted suicide, filed by Margo MacDonald in 2013, is rejected by the Scottish parliament on May 27, 2015 ^{38 , 39} .

Sweden

Active euthanasia is prohibited but passive euthanasia was legalized in 2010 ⁴⁰ . The assisted suicide is tolerated ³⁶ .

Switzerland

Active euthanasia is not allowed. Passive euthanasia and assisted suicide are tolerated ³ .

Notes and references