Euthanasia and assisted suicide – the struggle continues

Today, we publish the final 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

Although the public debate in many European countries continues, across Europe as a whole there is little evidence in the last 10 years of concerted attempts to bring about the legalisation of euthanasia through parliamentary processes. Indeed, in many European countries the legalisation of euthanasia is opposed by a wide range of professional associations representing doctors, nurses and others, groups representing disabled or older people and also by palliative care organisations.

Assisted suicide is not prosecuted under the criminal law of many European states. In Switzerland, assisted suicide is a crime if, and only if, the motive is selfish according to Article 115 of the Swiss penal code. The German legislation is even more permissive, and assistance or encouragement is not punishable according to Article 216 of the penal code. The German parliament has only very recently passed a new law prohibiting any organised assistance for suicide and individual cases are still not penalised. However, prosecution is possible for other reasons such as neglected duty to rescue or homicide by omission.

Patrick Bahr (top) Paul Vanden Berghe

Patrick Bahr (top)
Paul Vanden Berghe

In the United Kingdom, assisted suicide is a criminal offence in England and Wales according to the Suicide Act 1961 and in Northern Ireland through sections 12 and 13 of the Criminal Justice Act (Northern Ireland) 1966. It does not apply to Scotland. Several attempts have been made in recent years to introduce bills that would legalise assisted suicide in England and Wales, but all have been rejected by parliament. In 2010, the Director of Public Prosecutions published a policy for prosecutors describing public interest factors tending in favour or tending against prosecution. (Director of Public Prosecutions 2014). The policy indicates that prosecution is less likely if the victim had reached a voluntary, clear, settled and informed decision to commit suicide and the suspect had been wholly motivated by compassion. An assisted dying bill was introduced to the House of Lords by Lord Falconer of Thoroton in June 2015, but was turned down as in previous years.

Outside of Europe, most recently the Supreme Court of Canada has extended the constitutional right to autonomy by ruling that the criminal code has no force to prohibit physician-assisted suicide for a competent adult person who clearly consents to it and has a grievous and irremediable medical condition (including illness, disease or disability) that causes enduring suffering that is intolerable to the individual. (Supreme Court of Canada 2015). The government is currently drafting legislation according to this court rule.

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 on subscription from Palliative Medicine OnlineFirst).

Or download a free copy from the EAPC website
English version. German version. (You can also download the German version in the ‘EAPC documents in other languages’ section of the website).

Read all four posts in this special series on the EAPC Blog.

References
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. .

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 White Papers, Guidelines & Recommendations, EAPC-LINKED JOURNALS, Euthanasia and physician-assisted suicide and tagged . Bookmark the permalink.

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