Assisted suicide – legal regulations and practices

Here’s the second post in our special series to mark the publication of the EAPC’s latest white paper on euthanasia and physician-assisted suicide

Lukas Radbruch (Germany), Carlo Leget (The Netherlands), Patrick Bahr (Germany) and Paul Vanden Berghe (Belgium), who are all contributing authors to the paper, discuss the background to the longer paper that is published in Palliative Medicine Online First.

Lukas Radbruch (top) Carlo Leget

Lukas Radbruch (top)
Carlo Leget

Around the world, some important changes relating to euthanasia and physician-assisted suicide have been taking place. In 1996, for the first time in history, a democratic government enacted a law that made both euthanasia and physician-assisted suicide legal acts, under certain conditions as described in the Rights of the Terminally Ill Amendment Act 1996, Northern Territory, Australia (Northern Territory of Australia 1995). The law was, however, made ineffective by the Euthanasia Laws Bill of the Parliament of Australia in 1997. (Parliament of Australia 1996).

In the same year, physician-assisted suicide (but not euthanasia) was legalised through the Oregon Death with Dignity Act. (Oregon Health Authority) This has been followed by similar legislation in Washington (2008) Vermont (2013) and California (2015), and is currently being debated in New Jersey. In Montana, a court ruling finding no constitutional objection to assisted suicide has opened the way for similar practices in 2009, and a similar court ruling in New Mexico in 2014 is currently under appeal. In contrast to the legal requirements in European countries, in Oregon, Washington, and Vermont patients must have a terminal physical illness in order to qualify for physician- assisted suicide.

Patrick Bahr (top) Paul Vanden Berghe

Patrick Bahr (top)
Paul Vanden Berghe

In Oregon, the number of people receiving prescriptions to self-administer lethal doses of drugs has increased from 24 in 1998 to 155 in 2014 (total number 1328), and the number of people dying from ingesting these drugs has increased from 16 to 105 per annum (total number 857). This corresponds to 0.31% of all deaths in Oregon. (Oregon Health Authority 2015).

In Washington, the number of people receiving prescriptions to self-administer lethal doses of drugs has increased from 63 in 2009 to 173 in 2013, and the number of deaths from these drugs has increased from 36 in 2009 to 119 in 2013 (total number 359), corresponding to 0,23% of all deaths in Washington in 2013. (Washington State Department of Health 2014).

No data on the frequency of physician-assisted suicide are available from Vermont, Montana, New Mexico or New Jersey.

Switzerland has a long tradition of assisted suicide, not only for Swiss citizens but also for foreigners. Swiss law, which dates back to 1942, is not specifically related to medical illness. Right-to-die organisations are involved in the majority of cases. The lethal drugs are prescribed by physicians, but they do so at the request of the organisations. In contrast to the regulations in the Netherlands, Belgium or Luxembourg the process is not one of physician-assisted suicide, as a doctor-patient relationship is not required. (Steck et al. 2013). The physician is generally not present when the patient commits suicide. (Schmidlin et al. 2014). The total number of registered cases of assisted suicide for Swiss residents was approximately 300 in 2009, corresponding to 0.48% of all deaths, (Bundesamt für Statistik 2013) and 353 cases corresponding to 0.56% in 2010. (Steck et al. 2013). The number has increased throughout the last 10 years since registration had started. (Bundesamt für Statistik 2013).

To find out more…
This post relates to the paper: Radbruch L, Leget C, Bahr P, Müller-Busch C, Ellershaw J, De Conno F, Vanden Berghe P. Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care on behalf of the board members of the EAPC, Palliative Medicine. Prepublished 20 November 2015, DOI: 10.1177/0269216315616524. Available to download on subscription to Palliative Medicine

EAPC members get FREE access to this paper …
If you are currently an Individual or Associate EAPC Member you have full access to the EAPC website, and the chance to download a free PDF of ‘Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care’ and many other papers too. Just click here – enter your email address and membership password and choose from the list of journal articles. The German version of this paper is available here.

To join the EAPC, or renew your membership, click here.
Note: You can apply to be an Associate Member FREE of charge provided that you are a member of your country’s national palliative care association, and that the association is an EAPC National Association member.

Read more posts about euthanasia and pysician-assisted suicide on the EAPC blog.

Bundesamt für Statistik. Todesursachenstatistik 2009 –  Sterbehilfe (assistierter Suizid) und Suizid in der Schweiz. 2013.  (abgerufen am 2.3.2014).

Chambaere K, Bilsen J, Cohen J, Onwuteaka-Philipsen BD, Mortier F, Deliens L (2011). Trends in Medical End-of-Life Decision Making in Flanders, Belgium 1998-2001-2007. Med Decis Making 31(3): 500-10.

Chambaere K, Vander Stichele R, Mortier F, Cohen J, Deliens L (2015). Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium. N Engl J Med.

Commission Nationale de Contrôle et d’Evaluation de la loi du 16 mars 2009 sur l’euthanasie et l’assistance au suicide. Deuxieme rapport à l’attention de la Chambre des Députés (Années 2011 et 2012). 2012. (abgerufen am 19.2.2014).

Dan B, Fonteyne C, de Clety SC (2014). Self-requested euthanasia for children in Belgium. Lancet 383(9918): 671-2.

Director of Public Prosecutions. Policy for Prosecutors in respect of Cases of Encouraging or Assisting Suicide. 2014. (abgerufen am 16.3.2015).

Federale Controle- en Evaluatiecommissie Euthanasie. Vijvde Verslag aan de Wetgevende Kamers (2010 – 2011). 2012. (abgerufen am 28.2.2014).

Federale Controle- en Evaluatiecommissie Euthanasie. Zesde Verslag aan de Wetgevende Kamers (2012 – 2013). 2014. (abgerufen am 28.2.2014).

Levenseinde Kliniek. Levenseindekliniek helpt opnieuw meer mensen. 2015. (abgerufen am 15.3.2015).

Ministerie van Justitie. Wet betreffende de euthanasie (1) 2002.  (abgerufen am 18.2.2014).

Ministre de al Santé et de la Sécurité Sociale. Legislation reglementant les soins palliatifs ainsi que l’euthanasie et l’assistance au suicide. 2009. (abgerufen am 18.2.2014.

Northern Territory of Australia. RIGHTS OF THE TERMINALLY ILL ACT 1995. 1995.  (abgerufen am 18.2.2014).

Onwuteaka-Philipsen BD, Brinkman-Stoppelenburg A, Penning C, de Jong-Krul GJ, van Delden JJ, van der Heide A (2012). Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. Lancet 380(9845): 908-15.

Oregon Health Authority. The Oregon Death with Dignity Act, Oregon Revised Statutes.  (abgerufen am 18.2.2014).

Oregon Health Authority. Oregon’s Death with Dignity Act 2014. 2015. (abgerufen am 18.2.2015).

Parliament of Australia. Bills Digest 45 1996-97 Euthanasia Laws Bill 1996. 1996. (abgerufen am 18.2.2014).

Regionale Toetsingscommissies Euthanasie. Jaarverslag 2014. 2015. (abgerufen am 11.11.2015).

Regionale Toetsingsocmmissies Euthanasie. Jaarverslag 2013. 2014. (abgerufen am 15.3.2015).

Schmidlin E, Elger BS, McLennan S (2014). Assisted suicide in Switzerland:- where do we come from and where are we going? European Journal of Palliative Care 21: 61-65.

Staten-Generaal EKd. Toetsing van levensbeëindiging op verzoek en hulp bij zelfdoding en wijziging van het Wetboek van Strafrecht en van de Wet op de lijkbezorging (Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding). 2001.  (abgerufen am 18.2.2014).

Steck N, Egger M, Maessen M, Reisch T, Zwahlen M (2013). Euthanasia and assisted suicide in selected European countries and US states: systematic literature review. Med Care 51(10): 938-44.

Supreme Court of Canada. Carter v. Canada (Attorney General), 2015 SCC 5. 2015.  (abgerufen am 16.2.2015).

Washington State Department of Health. 2013 Death with Dignity Act Report. 2014. (abgerufen am 27.9.2014).

Ysebaert D, Van Beeumen G, De Greef K, Squifflet JP, Detry O, De Roover A, Delbouille MH, Van Donink W, Roeyen G, Chapelle T, Bosmans JL, Van Raemdonck D, Faymonville ME, Laureys S, Lamy M, Cras P (2009). Organ procurement after euthanasia: Belgian experience. Transplant Proc 41(2): 585-6.

Vanden Berghe P, Mullie A, Desmet M, et al. Assisted dying – the current situation in Flanders: euthanasia embedded in palliative care. Eur J Palliat Care 2013; 20: 266–272.

This entry was posted in EAPC ACTIVITIES, EAPC White Papers, Guidelines & Recommendations, Euthanasia and physician-assisted suicide and tagged . Bookmark the permalink.

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