Euthanasia and the law

Efforts to change government policies on euthanasia in the 20th century have met limited success in Western countries. Country policies are described below in alphabetical order, followed by the exceptional case of the Netherlands. Euthanasia policies have also been developed by a variety of NGOs, most notably medical associations and advocacy organizations.

Albania

Euthanasia was legalized in Albania in 1999, it was stated that any form of voluntary euthanasia was legal under the rights of the terminally ill act of 1995. Passive euthanasia is considered legal should three or more family members consent to the decision. Albania's euthanasia policy has been controversial among life groups and the Catholic Church, but due to other more prominent countries also legalizing forms of euthanasia, it has meant a more relaxed world attitude to the matter.

Resources: Bardhyl Çipi, Department of Forensic Medicine, Faculty of Medicine, Tirana University. Some philosophical, juridical and bioethical problems of end of life: death criterion and euthanasia. A paper analyzing the situation in Albania. From [http://biospace.nw.ru/bioethics/bioethics3.htm The third international symposium on bioethics] , Ukraine, Kyiv, April 2004.

Australia

Euthanasia was legalized in Australia's Northern Territory, by the Rights of the Terminally Ill Act 1995. Soon after, the law was voided by an amendment by the Commonwealth to the Northern Territory (Self-Government) Act 1978. [ [http://www.nt.gov.au/lant/parliament/committees/rotti/parldebate.shtml Legislative Assembly ] ] The powers of the Northern Territory legislature, unlike those of the State legislatures, are not guaranteed by the Australian constitution. However, before the Commonwealth government made this amendment, three people had already practiced legal voluntary euthanasia (PAS), aided by Dr Philip Nitschke. The first person was a taxi driver, Bob Dent, who died on 22 September, 1996.

Although it is a crime in most Australian states to assist in euthanasia, prosecutions have been rare. In 2002, relatives and friends who provided moral support to an elderly woman who committed suicide were extensively investigated by police, but no charges were laid. The Commonwealth government subsequently tried to hinder euthanasia with the passage of the Criminal Code Amendment (Suicide Related Materials Offences) Bill of 2004. In Tasmania in 2005 a nurse was convicted of assisting in the death of her elderly mother and father who were both suffering from illnesses. She was sentenced to two and a half years in jail but the judge later suspended the conviction because he believed the community did not want the woman put behind bars. This sparked debate about decriminalizing euthanasia.Fact|date=May 2007 Decriminalisation of Euthanasia in Australia is supported by the Liberty & Democracy Party [http://www.ldp.org.au/federal/policies/Assisted_Suicide.html] as well as the Australian Greens.

Also, very recently in Australia, an assisted euthanasia case has arisen about the suspected issuing of the Euthanasia drug Nembutal imported from Mexico illegally. The sedative is used to put down cats and dogs in Mexican pet shops. The two women convicted of providing Nembutal to former pilot Graeme Wylie, Shirley Justins and Karen Jennings, were guility of manslaughter and accessory to manslaughter respectively. Ms. Justins claims that Wylie wanted to die 'with dignity.' The prosecution argued that Graeme Wylie did not have the mental capacity to make the crucial decision to end his life, classing it as involuntary euthanasia.

Belgium

The Belgian parliament legalized euthanasia in late September 2002. Proponents of euthanasia state that prior to the law, several thousand illegal acts of euthanasia were carried out in Belgium each year. According to proponents, the legislation incorporated a complicated process, which has been criticized as an attempt to establish a "bureaucracy of death".

India

In a first step towards legalising euthanasia, The Law Commission of India, Ministry of Law and Justice has decided to recommend to the Indian Government to allow terminally ill to end their lives. [ [http://timesofindia.indiatimes.com/Law_panel_backs_mercy_killing_for_terminally_ill/rssarticleshow/3176245.cms Indian Law Commission to recommend euthanasia to Government] ]

Japan

The Japanese government has no official laws on the status of euthanasia and the Supreme Court of Japan has never ruled on the matter. Rather, to date, Japan's euthanasia policy has been decided by two local court cases, one in Nagoya in 1962, and another after an incident at Tokai University in 1995. The first case involved Nihongo|"passive euthanasia"|消極的安楽死|shōkyokuteki anrakushi (i.e., allowing a patient to die by turning off life support) and the latter case involved Nihongo|"active euthanasia"|積極的安楽死|sekkyokuteki anrakushi (e.g., through injection). The judgments in these cases set forth a legal framework and a set of conditions within which both passive and active euthanasia could be legal. Nevertheless, in both of these particular cases the doctors were found guilty of violating these conditions when taking the lives of their patients. Further, because the findings of these courts have yet to be upheld at the national level, these precedents are not necessarily binding. Nevertheless, at present, there is a tentative legal framework for implementing euthanasia in Japan. [cite encyclopedia
title = 安楽死
encyclopedia = 現代用語の基礎知識
pages = 951,953
publisher = 自由国民社
date = 2007]

In the case of passive euthanasia, three conditions must be met:
# the patient must be suffering from an incurable disease, and in the final stages of the disease from which he/she/ is unlikely to make a recovery;
# the patient must give express consent to stopping treatment, and this consent must be obtained and preserved prior to death. If the patient is not able to give clear consent, their consent may be determined from a pre-written document such as a living will or the testimony of the family;
# the patient may be passively euthanized by stopping medical treatment, chemotherapy, dialysis, artificial respiration, blood transfusion, IV drip, etc.

For active euthanasia, four conditions must be met:
# the patient must be suffering from unbearable physical pain;
# death must be inevitable and drawing near;
# the patient must give consent. (Unlike passive euthanasia, living wills and family consent will not suffice.)
# the physician must have (ineffectively) exhausted all other measures of pain relief.

Luxembourg

The country's parliament passed a bill legalising euthanasia on 20 February 2008 in the first reading with 30 of 59 votes in favour; it still has to pass a second reading before coming into effect. [ [http://afp.google.com/article/ALeqM5j_LY2E4ut3ccEXydLd0C3zlVOXFA AFP: Luxembourg to become third EU country to allow euthanasia ] ]

The Netherlands

In 2002, The Netherlands legalized euthanasia including physician assisted suicide. The law codified a twenty year old convention of not persecuting doctors who have committed euthanasia in very specific cases, under very specific circumstances. The Ministry of Public Health, Wellbeing and Sports claims that this practice "allows a person to end their life in dignity after having received every available type of palliative care." [ [http://www.minvws.nl/en/themes/euthanasia/default.asp discussion of euthanasia] on the [http://www.minvws.nl site] of the Dutch ministry of Health, Welfare and Sport]

witzerland

In Switzerland, deadly drugs may be prescribed to a Swiss person or to a foreigner, where the recipient takes an active role in the drug administration. More generally, article 115 of the Swiss penal code, which came into effect in 1942 (having been written in 1918), considers assisting suicide a crime if and only if the motive is selfish. The code does not give physicians a special status in assisting suicide; however, they are most likely to have access to suitable drugs. Ethical guidelines have cautioned physicians against prescribing deadly drugs. However, they also recognize that in exceptional, and defined, cases physicians may justifiably assist suicide. When an assisted suicide is declared, a police inquiry may be started. Since no crime has been committed in the absence of a selfish motive, these are mostly open and shut cases. Prosecution happens if doubts are raised on the patient's competence to make an autonomous choice. This is rare.

Article 115 was only interpreted as legal permission to set up organizations administering life-ending medicine in the 1980s, 40 years after its introduction.

These organisations have been widely used by foreigners - most notably Germans - as well as the Swiss. Around half of the people helped to die by the organisation Dignitas [ A Swiss assisted suicide organization that facilitates assisted suicides for the hopelessly physically and mentally ill. [http://news.bbc.co.uk/2/hi/europe/2676837.stm] [http://www.dignitas.ch/] ] have been Germans.

Recent debate in Switzerland has focused on assisted suicide rights for the mentally ill. A decision by the Swiss Federal Supreme Court on November 3, 2006, laid out standards under which psychiatric patients might terminate their lives: “It cannot be denied that an incurable, long-lasting, severe mental impairment similar to a somatic one can create a suffering out of which a patient would find his/her life in the long run not worth living anymore. Based on more recent ethical, juridical and medical statements, a possible prescription of Sodium-Pentobarbital is not necessarily contra-indicated and thus no longer generally a violation of medical duty of care. However, utmost restraint needs to be exercised: It has to be distinguished between the wish to die that is expression of a curable psychic distortion and which calls for treatment, and the wish to die that bases on a self-determined, carefully considered and lasting decision of a lucid person ("balance suicide") which possibly needs to be respected. If the wish to die bases on an autonomous, the general situation comprising decision, under certain circumstances even mentally ill may be prescribed Sodium-Pentobarbital and thus be granted help to commit suicide." "Whether the prerequisites for this are given cannot be judged on separated from medical – especially psychiatric – special knowledge and proves to be difficult in practice; therefore, the appropriate assessment requires the presentation of a special in-depth psychiatric opinion." A controversial article in the Hastings Center Report by Brown University Professor Jacob M. Appel advocated adopting similar rules in the United States. [ [http://www.thehastingscenter.org/publications/hcr/hcr.asp The Hastings Center Report ] ]

On August 22, 2007, Paul Rubin of the Phoenix-based New Times broke the story of Jana Van Voorhis, a woman with a history of mental illness whose suicide was assisted by the Final Exit Network. The case drew strong criticism from conservative bioethicist Wesley J. Smith in his Second Hand Smoke column.

Thailand

Thailand's National Health Act BE 2550 (2007) has come into force as of 20 March 2007. Such Act contains the provisions in relation to euthanasia as follows, with the pertained provisions: [ [http://www.krisdika.go.th/lawHeadPDF.jsp?formatFile=pdf&hID=0 พระราชบัญญัติสุขภาพแห่งชาติ พ.ศ. 2550. (2550, 19 มีนาคม). ราชกิจจานุเบกษา, (เล่ม 124, ตอนที่ 16 ก).] ]

quote|Section 12. A person shall have right to express in a written form the intention not to receive the public health service as provided for prolonging the death in the final stage of his or her life or for extinguishing the sufferings occurred from illness.

The performances according to the written document under Paragraph One shall be in accordance with the rule and procedure as prescribed in the Ministerial Regulations.

After the medical practitioner has followed the intention of the person under Paragraph, such performance shall not be deemed wrongful and he shall be exempted from all liabilities.

Section 3. In this Act:

"public health service" means all services concerning the enhancement of health, the protection and monitor of illness and homininoxious factors, the exploration and therapy of illness and the rehabilitation of the capability of person, family and community;

"medical practitioner" means a medical practitioner under the law on xenodochium.

Section 4. The Prime Minister and the Minister of Public Health shall have charge and control of the execution of this Act, and shall have power to issue Ministerial Regulations in order to comply with this Act.

Such Ministerial Regulations shall come into force upon their publication in the Government Gazette.

The United Kingdom

Euthanasia is illegal in the United Kingdom however on November 5, 2006, Britain's Royal College of Obstetricians and Gynaecologists submitted a proposal to the Nuffield Council on Bioethics calling for consideration of permitting the euthanasia of disabled newborns. [cite news
last=Templeton
first=Sarah-Kate
title=Doctors: let us kill disabled babies
url=http://www.timesonline.co.uk/article/0,,2087-2437921.html
accessdate=2007-02-05] The report does not address the current illegality of euthanasia in the United Kingdom, but rather calls for reconsideration of its viability as a legitimate medical practice.

In contrast there is increasing evidence that doctors in the UK are hardening their attitude against euthanasia or physician assisted suicide:

* UK doctors are particularly cautious about decisions to shorten life.Seale C. Characteristics of end-of-life decisions: survey of UK medical practitioners. Palliative Medicine 2006; 20(7): 653-9.]
* Compared to other countries (eg. Italy, Sweden, Denmark), UK doctors are more open about discussing end-of-life decisions (ELD) with patients and relatives.
* Compared with countries where euthanasia or physician assisted suicide is legal (eg. Belgium, Netherlands, Switzerland), UK doctors are the same or more likely to report discussions on ELD with medical and nursing colleagues.
* 94% of UK specialist doctors in palliative care are against a change in the law. [Survey. Association of Palliative Medicine, 2006.]
* In 2006 both the Royal College of Physicians and the Royal College of General Practitioners voted against a change in the law.

Currently in the UK, any person found to be assisting suicide is breaking the law and can be convicted of assisting suicide or attempting to do so (i.e. if a doctor gives a patient in great pain a bottle of morphine to take (to commit suicide) when the pain gets too great). Although two-thirds of Britons think it should be legal, a recent 'Assisted Dying for the Terminally-Ill' Bill was turned down in the lower political chamber, the House of Commons, by a 4-1 margin. Currently, Dr Nigel Cox is the only British doctor to have been convicted of attempted euthanasia. He was given a 12 month suspended sentence in 1992. [ [http://news.bbc.co.uk/2/hi/programmes/panorama/1971527.stm Nigel Cox conviction] ] The principle of double effect is however firmly established. In 1957 Judge Devlin in the trial of Dr John Bodkin Adams ruled that causing death through the administration of lethal drugs to a patient, if the intention is solely to alleviate pain, is not considered murder even if death is a potential or even likely outcome. [ [http://books.google.pl/books?id=mDvBJ5J4tusC&pg=PA177&lpg=PA177&dq=%22Thomas+Lodwig%22+dr&source=web&ots=R80ZiJiXJG&sig=278YayRrg1BNUyEQ7X3fIQ36Srw&hl=pl&sa=X&oi=book_result&resnum=5&ct=result#PPA177,M1 Margaret Otlowski, "Voluntary Euthanasia and the Common Law", Oxford University Press, 1997, pp. 175-177] ]

United Nations

The United Nations has reviewed and commented on the Netherlands euthanasia law. [ [http://www.unhchr.ch/tbs/doc.nsf/385c2add1632f4a8c12565a9004dc311/dbab71d01e02db11c1256a950041d732?OpenDocument&Highlight=0,euthanasia Observations of the UN human rights committee] ]

United States

Active euthanasia is illegal in most of the United States. Patients retain the rights to refuse medical treatment and to receive appropriate management of pain at their request (passive euthanasia), even if the patients' choices hasten their deaths. Additionally, futile or disproportionately burdensome treatments, such as life-support machines, may be withdrawn under specified circumstances.

A recent Gallup Poll survey showed that 80% of Americans supported euthanasia. [Carroll, Joseph (2006, June 19). Public Continues to Support Right-to-Die for Terminally Ill Patients. Retrieved on January 16, 2007, from The Gallup Poll Web site: Please note this was a push poll in where the questions were much broader than just the support of euthansia and to conclude overall support is a mischaracterization. The poll is not a good indicator of the support for euthanasia but instead an indicator for an agenda driven result to show support for euthanasia http://www.galluppoll.com/content/?ci=23356&pg=1] Attempts to legalize euthanasia and assisted suicide resulted in ballot initiatives and legislation bills within the United States in the last 20 years. For example, Washington voters saw Ballot Initiative 119 in 1991, California placed Proposition 161 on the ballot in 1992, Oregon passed the Death with Dignity Act in 1994, and Michigan included Proposal B in their ballot in 1998.

Non-governmental organizations

There are a number of historical studies about the thorough euthanasia-related policies of professional associations. In a chapter entitled "End-of-life Decisions," for instance, Brody et al. present Codes of Ethics and other policies developed by: the American Medical Association, the American Academy of Physical Medicine and Rehabilitation, the American College of Emergency Physicians (ACEP), the American College of Physicians - American Society of Internal Medicine (ACP-ASIM), the American Geriatrics Society (AGS), the American Academy of Hospice and Palliative Medicine (AAHPM), and the American Academy of Neurology (AAN). [Brody, Baruch, McCullough, Rothstein and Bobinski. Medical Ethics: Analysis of the issues raised by the Codes, Opinions and Statements] In their analysis, Brody et al. found it necessary to distinguish such topics as euthanasia, physician-assisted suicide, informed consent and refusal, advance directives, pregnant patients, surrogate decision-making (including neonates), DNR orders, irreversible loss of consciousness, quality of life (as a criterion for limiting end-of-life care), withholding and withdrawing intervention, and futility. Similar distinctions presumably are found outside the U.S., as with the highly contested statements of the British Medical Association. [ [http://www.doctorsfed.org.uk/content/view/165/39/ On the BMA controversy.] ] [For professional policies in the English-speaking world, see [http://www.euthanasia.com/page17.html this selection by an advocacy NGO.] ]

On euthanasia (narrowly-defined here as directly causing death), Brody sums up the U.S. medical NGO arena:

The debate in the ethics literature on euthanasia is just as divided as the debate on physician-assisted suicide, perhaps more so. Slippery-slope arguments are often made, supported by claims about abuse of voluntary euthanasia in the Netherlands.... Arguments against it are based on the integrity of medicine as a profession. In response, autonomy and quality-of-life-base arguments are made in support of euthanasia, underscored by claims that when the only way to relieve a dying patient's pain or suffering is terminal sedation with loss of consciousness, death is a preferable alternative -- an argument also made in support of physician-assisted suicide. [Brody et al., p.283]

Other NGOs that advocate for and against various euthanasia-related policies are found throughout the world. Among proponents, perhaps the leading NGO is the UK's Dignity in Dying, the successor to the (Voluntary) Euthanasia Society. [ [http://www.dignityindying.org.uk Dignity in Dying.] In an unsympathetic account, the International Task Force on Euthanasia and Assisted Suicide has detailed the ebb and flow of euthanasia proponents. http://www.internationaltaskforce.org/rpt2005_I.htm#204] In addition to professional and religious groups, there are NGOs opposed to euthanasia [ [http://www.euthanasia.com/page10.html Euthanasia suicide mercy-killing right-to-die physician assisted suicide living wills research ] ] found in various countries.

References