Countries with End-of-life help laws and/or regulations

 

Switzerland

The Swiss Criminal Code, which became effective on 1 January 1942, penalizes assist- ance in suicide out of selfish motives. The Swissgerman original text speaks of „selbstsüchtig“ which also translates into “self-seeking, self-serving”, clarifying that it takes a clearly despicable, egoistic motive. An example would be to deliberately incite a person to commit suicide in order to rid oneself of having to pay financial support for that person; or to do so in order to inherit earlier. If no such reprobate motives are given (e contrario), no offence is done. in Switzerland, euthanasia - both voluntary or involuntary - is prohibited. Additional articles in further Codes and court decisions make for the framework of the practice of physician-supported assisted/accompanied suicide by non-profit member societies like Dignitas and Exit.

English (non-official) version of the Swiss Criminal Code (Link / PDF)

Germany

For around 150 years, in Germany assistance in suicide was not a crime, neither suicide itself. On 10 December 2015, due to conservative-clerical inducement, 360 Parliamentarians of the “Bundestag” voted for an article § 217 Criminal Code “geschäftsmässige Förderung der Selbsttötung” (“geschätsmässig” translating into and meaning “repated”); de facto a prohibition of all professional and knowledgable advisory work and help for personal end-of-life-choices, with an additional negative side effect on palliative carae. The Bundestag did so despite the fact that the Scientific Advisory Body (“Wissenschaftliche Dienst”) of the Bundestag and many law experts of Germany had pointed out it was highly likely that article 217 was in conflict with the rule of clarity (“Bestimmtheitsgebot”) and the Basic Law, the German “Grundgesetz”, therefore unconstitutional. § 217 had nothing to do with prohibiting alleged making business out of assistance in suicide, as it was falsely claimed sometimes. In fact, § 217 related to everyone, also physicians. On 26 February 2020, the Federal Constitutional Court in Karlsruhe had to judge on several constitutional complaints against § 217, amongst others by the two DIGNITAS membership associations of Switzerland and Germany: the Court found that the prohibition of assisted suicide services set out in § 217 violates the Basic Law and is void. With this, the status antes quo is re-installed.

Press release by the Federal Constitutional Court (Link)

The Netherlands

Since becoming effective on 1 April 2002, The Netherlands have the “Termination of Life on Request and Assisted Suicide Act” (Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdodin, WTL) which in one edict regulates the ending of life on explicit request by the individual (voluntary euthanasia) as well as accompanied suicide.

English version of the law in The Netherlands (PDF)

Information by the Government of the Netherlands (Link)

Belgium

An “Euthanasia-Law”, which permits and regulates the ending of life by physicians on request by the individual who wishes to end life, become effective as of 22 September 2002. Each case is reviewed by the Belgian Federal Control and Evaluation Commission for Euthanasia FCECE) reporting to the Public Prosecutor if need be. The law is complimented by a law on patient’s rights of 22 August 2002 and a regulation on palliative care.

The law in Belgium (Link to the website of ADMD, in French)

Luxembourg

On 16 March 2009, a law on palliative care, patient’s advance directive (patient’s living will) and assistance in dying, as well as a law on assisted suicide became effective.

The law in Luxembourg (Link, in French)

Spain

On 18 March 2021, the parliament of Spain has legalised voluntary euthanasia and assisted suicide for people with serious and incurable or debilitating diseases who wish to end their suffering and life.
The individual must be a resident of Spain, competent, the request must be made on several occasions and be backed by medical reports, and healthcare workers will retain their right to conscientious objection. After the procedure is approved by an evaluating committee, the patient must give final consent again.

Ley Orgánica 3/2021, de 24 de marzo, de regulación de la eutanasia (link, in Spanish)

Portugal

After being approved four times by parliament, but sent back each time by the conservative president Marcelo Rebelo de Sousa for constitutional review, the law was finally passed with support from the governing socialists who hold a majority. The law gives access to assistance in dying for people over the age of 18 and who are terminally ill and suffering intolerably.

Canada

On 6 February 2015, in a unanimous 9:0 decision Canada’s Supreme Court has struck down the country’s Criminal Code laws prohibiting physician-assisted suicide. The rule did not come into force for 12 months; extended by another 4 months on application by the government to gain time for drafting legislation. This delay elapsed 6 June 2016. It means it is no longer against the law, under certain circumstances, for a doctor to help someone who is severely ill to end their life.

Supreme Court judgment of Carter v. Canada (Link)

A brief summary of the case by the BCCLA (Link)

On 17 June 2016, Bill C-14 – an Act to amend the Criminal Code and to make related amendments to other Acts (Medical Assistance In Dying) – passed in the House of Commons and the Senate and is now law in Canada. The law no allows for physician-assisted accompanied suicide and voluntary euthanasia.

Legislative Summary of Bill C-14 (Link)

Bill C-14 in English and French (Link / PDF)

However, Bill C-14 will be challenged in court because it conflicts with the Supreme Court’s decision: by limiting access to only those patients whose natural deaths are “reasonably foreseeable”, the new law denies rightful access to entire classes of patients who have severe chronic conditions but who are not approaching end of life. (Link)

On 18 March 2021, Bill C-7 became law which further develops medical assistance in dying (MAID): 1) the discriminating prerequisite that a person must have “a reasonably foreseeable death” in order to be eligible for MAID is abolished; 2) people who have been assessed and approved for MAID, but risk losing capacity to consent prior to the MAID procedure, will be able to sign a waiver of final consent; 3) over a period of two years, the Government of Canada will hear from experts and develop safeguards and protocols for people who seek access to MAID due to a psychiatric illness.

Overview / Facts on Canada's medical aid in dying law (Link)

Province of Québec, Canada

On 5 June 2014 the Assemblée Nationale du Québec voted 94 : 22 for the introduction of the Bill n° 52 : An Act respecting end-of-life care. The purpose of the Bill is to ensure that end-of-life patients are provided care that is respectful of their dignity and their autonomy and to recognise the primacy of wishes expressed freely and clearly with respect to end-of-life care. It sets out special rules applicable to the providers of end-of-life care. It also establishes requirements for certain types of end-of-life care, namely continuous palliative sedation and medical aid in dying. The Bill will come into force on 10 December 2015 or earlier.

Website of the National Assembly of Canada with the law-text, forms, etc. (Link)

USA

All States of the USA must allow patients to refuse life-saving medical treatment, and a few States and the District of Columbia also have laws in place referred to as “death with dignity,” “medical aid-in-dying,” or “physician-assisted death”. These laws allow mentally competent individuals to end their lives by self-administration of a lethal dose of medication prescribed by a doctor for that purpose. All of these laws require the diagnosis of terminal illness and a prognosis of six months or less to live from physicians, waiting periods, and psychiatric evaluations when recommended by a physician.

US-State of Oregon

In 1998, the ‘Death with Dignity Act’ came into force, a law regulating physician-assisted suicide for terminally ill patients who have a life-expectancy of not more than 6 months.

Website of the government with links to the law and annual reports (Link)

The history of the Oregon Death with Dignity Act (Link)

On 14 July 2023, Governor Tina Kotek signed HB2279 into law, making Oregon the second state after Vermont to remove residency requirements to access the state’s Death With Dignity law. Information provided by Death with Dignity (Link)

US-State of Washington

Since 2008, a similar law exists like the one in the US-State of Oregon, also called ‘Death with Dignity Act’.

Website of the government with links to the law, reports, forms, etc. (Link)

US-State of Vermont

The Parliament of Vermont supported "An act relating to patient choice and control at the end of life" and approved a law similar to the "Death with Dignity Act" in the US-States Oregon and Washington. The law offers terminally ill competent individuals a procedure which allows them a self-determined end of life by ingestion of medication provided by a physician. Gouvernor Peter Shumlin signed the Act on 20 May 2013 which enacted the new law partially; the part on "death with dignity" and immunity for physicians came into force by 1 July 2016.

Website of the Department of Health, with text of the law, forms, etc. (Link)

On 2 May 2023, Governor Phil Scott signed bill H. 190 which removes the residency requirement from Vermont’s patient choice at end of life laws. Information provided by Patient Choices Vermont (Link)

US-State of California

On 5 October 2015, Governor Edmund G. Brown Jr. signed legislation to allow physicians assisted suicide for terminally ill – the End of Life Option Act. Thus, California becomes a further US-State in which terminally ill have freedom of choice to self-determinedly end their suffering with physician’s assessment and prescription of medication. The End of Life Option Act definetely took effect on 9 June 2016.

Website of the government with the text of the law and further information (Link)

California End of Life Option Act Data Report 2019 (Link / PDF)

US-State of Colorado

On 9 September 2016, 65 % of the voters in Colorado supported a proposition for a «Colorado End-of-Life Options Act». This law bases on the «Death with Dignity Act» in Oregon. It came into force on 16 December 2016.

Text of the Act (Link/PDF)

Information provided by the Department of Public Health & Environment (Link)

District of Columbia / Washington DC

The Washington, D.C. Death with Dignity Act has come into effect on 18 February 2017. In December 2016, Washington Mayor Muriel Bowser had signed the Death with Dignity Act, which legalized assisted suicide in the district and gave doctors the ability to offer lethal medication to individuals who are terminally ill and will die within six months. The Act is supported by 67 % of D.C. people. Unfortunately, the time-consuming process of district agencies setting up the required process and the city identifying funds for the project put the Act at risk. The District of Columbia is not a State and thus needs federal approval. Federal Law Makers and the House of Representatives Oversight Committee aim at crushing the Act, thus turning back the clocks.

Full text of the Act B21-0038 (Link / PDF)

Further resources, provided by Death with Dignity National Center (Link)

US-State of Hawaii

As of 1 January 2019, the ‘Our Care, Our Choice’ Bill gives residents of the US-State of Hawaii who are 18 years old or older the right to request and receive a prescription medication so as to end their suffering self-determinedly, under the condition that the person is suffering from a medically confirmed terminal illness with less than six months to live and possessing decisional capacity.

The Hawaii State Legislature / HB 2739 (Link)

Information by the Department of Health (Link)

US-State of New Jersey

On 12 April 2019, in the US-State of New Jersey Governor Philip D. Murphy signed the “Aid in Dying for the Terminally Ill Act”, after the bill passed both the Assembly and the Senate. The Act permits terminally ill patients with a prognosis of six months or less to get a prescription for life-ending medication for self-administering so they can end their life in a humane and dignified manner.

Full text of the bill A1504 (Link / PDF)

Governor Philip D. Murphy’s signing statement (Link / PDF)

US-State Maine

On 12 June 2019, in the US-State of Maine, Governor Janet Mills signed the “Death with Dignity Act”, after the bill passed both the House of Representatives and the Senate. The Act permits competent terminally ill residents of Maine with a prognosis of six months or less to get a physicians’ prescription for life-ending medication for self-administering so they can end their life in a humane and dignified manner.

Full text of the act LD1313 (Link / PDF)

Further resources (Link)

US-State of Montana

Montana became the third US-State which has, in theory, legalised physician-assisted-suicide through a single-case Court decision: On 31 December 2009, the Supreme Court of Montana ruled that, under the Constitution of Montana, Article II, paragraph 4 and 10, terminally ill Robert Baxter had the right to a dignified death and at the same time that his physician had the right to being protected from prosecution. Even though the right to physician assisted dying was not guaranteed by the Constitution of Montana, such assistance, taking into consideration court cases and the law, was not in conflict with public interests and therefore not illegal. The decision was done by 5 : 2.

Decision of the Supreme Court of Montana (Link)

US-State of New Mexico

After Montana, New Mexico is another State which, in theory, legalised physician-assisted suicide through a single case Court decision: New Mexico State law provides a fundamental right to a terminally ill, competent patient to choose a physician’s aid in getting prescription medications that will allow a peaceful death, Second Judicial District Judge Nan Nash ruled on April 3, 2014. The Court ruled that two oncologists at the University of New Mexico Hospital could not be prosecuted under the state’s Assisted Suicide Statute, which is defined as the act of “deliberately aiding another in the taking of his own life", and makes such assistance punishable.

Decision of the Second Judicial District Court (Link)

Colombia

In 1997, by judgment C-239, the Constitutional Court legalised voluntary euthanasia for terminally ill individuals who have decision making capacity. In 2014, this was followed by judgment T-970 of the Constitutional Court of Appeal setting out the rules how to apply voluntary euthanasia. A year later, the Ministry of Health and Social Protection issued Resolution no. 1216 regulating details on how to conduct voluntary euthanasia. An attempt to nullify judgment T-970 was defeated by judgment 414 a CC in 2015. Further judgments and laws followed to improve freedom of choice and public health, such as Health Law 1751, judgment T-132 in 2016 on proper diagnosing patients and judgment C-274 in 2016 clarifying conscious objection to voluntary euthanasia. In August 2017, the Constitutional Court of Colombia issued judgment T-544, in which it decided that boys, girls and adolescents should also be allowed to die with dignity. In 2018, resolution 825 by the Ministry of Health and Social Protection clarified the procedures as to a death with dignity for minors. Access to this end-of-life-choice is for residents of Colombia who are registered with the state health care system. This was followed by court judgment C-233/21 of 22 July 2021 abolishing the “terminally ill” requirement, and judgment C-146/22 of 11 May 2022 decreminalising assisted suicide.

Website of the 'Fundacion Pro Derecho a Morir Dignamente' (DMD Colombia) providing further information (Link)

Reports by the Colombian human rights organization DescLAB | Laboratorio de Derechos Económicos, Sociales y Culturales (Link):

Muerte Digna en Colombia. Activismo judicial, cambio social y discusiones constitucionales sobre un derecho emergente / The Right to Die in Colombia. Judicial activism, social change and constitutional discussions on an emerging right, analysing how the right has emerged and strengthened (Link / PDF)

De Muerte Lenta #1. Informe sobre las cifras y las barreras para ejercer el derecho a morir dignamente en Colombia / A slowly death. A report on the data and the barriers to access a dignified death in Colombia (Link / PDF)

Taiwan

Taiwan passed the “Patient Autonomy Act” on 18 December 2015, making it the first Asian country to allow patients under five specific clinical conditions to refuse life-sustaining treatments including artificial nutrition and hydration even if they are not terminally ill. The law was drafted by Professor Sun Hsiao-chih and Yang Yu-Xing, Honorary Adviser to the Legislator of Taiwan.

Patient Autonomy Act (Link, in Chinese/Mandarin)

Patient Autonomy Act (PDF, in English)

Victoria, Australia

On 29 November 2017, the Parliament of Victoria, Australia, passed the Voluntary Assisted Dying Act 2017. Victorians who are suffering and who meet strict eligibility criteria will be able to request access to voluntary assisted dying. The Act came into force on 19 June 2019.

Information by the Victoria State Government (Link)

Resources by 'Dying with Dignity Victoria' (Link)

Western Australia

On 10 December 2019, the Parliament of Western Australia passed the Voluntary Assisted Dying Act 2019. Under the law, which will come into effect in mid-2021, terminally ill adults having less than six months to live – or one year if they have a neuro-degenerative condition – will have access to the choice of professional help to end their suffering and life if approved by two medical doctors.

Information by the Government of Western Australia, Dept. of Health (Link)

Ressources by 'Dying with Dignity Western Australia' (Link)

Tasmania, Australia

On 23 March 2021, Tasmania passed the End-of-Life Choices (Voluntary Assisted Dying) Bill. Tasmania is such the third Australian State with such legislation. It officially commenced as of 23 October 2022.

Tasmanian Government / End-of-Life Choices (VAD) Act 2021 (Link)

Information provided by the Tasmanian Department of Health (Link)

First six month Voluntary Assisted Dying Report of Operations (Link)

South Australia

On 24 June 2021, the Voluntary Assisted Dying Bill 2020 was passed by the South Australian Parliament. Eligible participants must be over 18, have lived in South Australia for at least a year, deemed compliant by two doctors, and their condition must be terminal, causing intolerable suffering and expected to cause death within weeks or month. Residents in aged care and retirement villages can access the scheme in their own homes or units. Implementation of the law is likely to span 18 to 24 months.

Government of South Australia / Voluntary Assisted Dying Bill 2021 (Link)

Queensland, Australia

With 61 votes to 30, Queensland Parliament legalised voluntary assisted dying (VAD) on 16 September 2021. The new laws will allow people aged 18 and older who are expected to die within 12 months to seek medical assistance to end their lives; it will come into place 1 January 2023.

Queensland Government / Voluntary Assisted Dying Bill 2021 (Link)

New South Wales, Australia

The Parliament of NSW passed the Voluntary Assisted Dying Act 2022 on 19 May 2022. As of 28 October 2023, voluntary assisted dying (VAD) is possible for mentally competent adult residents suffering from an advanced and progressive illness which will cause their death within six months (or within 12 months for neurodegenerative disease)

Information by NSW Health (Link)

New Zealand

As of 7 November 2021, the End of Life Choice Act 2019 takes full effect, such permitting assisted dying as a new health service. New Zealanders aged 18 or over who experience unbearable suffering from a terminal illness that is likely to end their life within six months may be able to access medication to end their life.

Information provided by the Ministry of Health (Link)

toetsing levensbeëindiging op verzoek en hulp bij zelfdoding
 
 

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