MEDICALLY REVIEWED

Regulating End-of-Life Care: What is Euthanasia and Assisted Dying?

Navigating end-of-life choices, such as euthanasia and assisted dying, is a complex issue globally. 

In Europe, there have been significant strides in legislation, while Asia is gradually addressing these sensitive topics. The demand for dignified end-of-life care is rising, especially in Asia’s ageing population.

Understanding Euthanasia and Assisted Dying

Euthanasia and physician-assisted suicide both involve deliberate actions taken with the intention of ending a life to relieve persistent pain or suffering. However, the two differ in terms of who ultimately administers the life-ending procedure.

What is Euthanasia? 

In the case of euthanasia, a doctor is legally permitted to end a person’s life by painless means, provided the person and their family consent. This practice may be classified further as either voluntary or involuntary, and active or passive. Voluntary euthanasia, conducted with the individual’s consent, is legal in several countries and U.S. states, including Australia, Belgium, Canada, Colombia, Luxembourg, The Netherlands, Spain, Switzerland, and New Zealand. 

Non-voluntary euthanasia occurs when the decision is made by another appropriate person, due to the individual’s inability to consent because of their current health condition. Involuntary euthanasia is performed without the person’s consent and is generally considered illegal and unethical​​.

Active euthanasia involves the use of lethal substances or forces to end a person’s life, whereas passive euthanasia refers to the withholding of life-sustaining treatments. The line between these classifications can sometimes be blurred, such as when increasing doses of strong pain-management medications may eventually prove toxic​.

What is Assisted Dying?

Physician-assisted suicide, often referred to as assisted dying, involves a doctor assisting an individual in taking their own life at the person’s voluntary and competent request. This includes providing drugs for self-administration to relieve intractable (persistent, unstoppable) suffering​​.

In many countries, including the U.S., individuals have the right to refuse treatment recommended by a health professional, as long as they have been properly informed and are “of sound mind”​​.

The largest proportion of these cases involved individuals with cancer. Additionally, Switzerland is known to attract individuals from various countries for assisted suicide. 

Progressive Approach in Europe

In Europe, several countries have adopted a progressive approach towards end-of-life choices by legalising euthanasia and assisted dying. Notably, the Netherlands, Belgium, and Luxembourg have implemented comprehensive regulatory frameworks and safeguards to govern these practices. Switzerland, renowned for its dignified clinics, has also embraced assisted dying with a long-standing history.

  • The Netherlands became the first country to legalise euthanasia in 2002. The Termination of Life on Request and Assisted Suicide Act outlines strict criteria and procedural safeguards for physicians and patients.
  • Belgium: Belgium passed a law allowing euthanasia in 2002, following the footsteps of the Netherlands. The Belgian Act on Euthanasia emphasises the importance of informed consent, consultation with multiple physicians, and review committees to ensure proper implementation. 
  • Luxembourg legalised euthanasia and assisted dying in 2009 through the Law on Palliative Care, Advance Directives, and End-of-Life Care. This legislation establishes rigorous procedures, including the involvement of multiple medical professionals, to ensure the voluntary and well-considered nature of the decision. 
  • Switzerland has a unique approach to assisted dying, where organisations like Dignitas and Exit International offer end-of-life options. The Swiss Academy of Medical Sciences provides guidelines for physicians to follow in assisted dying cases, emphasising careful assessment and evaluation. 

These countries have demonstrated a commitment to ensuring that they conduct euthanasia and assisted dying practices within a regulated framework. They prioritize patient autonomy, establish strict eligibility criteria, and emphasize consultation with medical professionals.

Breakthroughs in Asian Countries

While much of Asia maintains conservative attitudes towards euthanasia and assisted dying, individual territories such as Hong Kong and Taiwan have begun discussions on the potential legalisation and regulation of these practices. In Hong Kong, however, the law currently considers euthanasia an unlawful act, including intentional killing with the involvement of a third party, manslaughter, or aiding, abetting, counseling, or procuring someone’s suicide. Similarly, as of 2023, euthanasia remains illegal in Taiwan.

Contrastingly, India has made strides in this area, having legalised passive euthanasia under stringent guidelines. As of January 2023, the Supreme Court of India has modified its 2018 order in Common Cause v. Union of India And Anr, which recognised passive euthanasia. 

The aim of this modification was to simplify the process of withholding life support from terminally ill patients, making it less complicated for patients, their families, and doctors, and limiting the government’s role in the procedure.

Challenges and Concerns

Regulating euthanasia and assisted dying in Asia involves addressing ethical concerns, the potential for abuse, and the need for stringent safeguards. Balancing individual autonomy with cultural values and ensuring the availability of palliative care are also crucial considerations.

References:

  1. Euthanasia and assisted suicide: What are they and what do they mean? (n.d.). Euthanasia and Assisted Suicide: What Are They and What Do They Mean? Available at: https://www.medicalnewstoday.com/articles/182951 (Accessed June 2023)
  2. Davis, N. (2019, July 15). Euthanasia and assisted dying rates are soaring. But where are they legal? The Guardian. Available at: http://www.theguardian.com/news/2019/jul/15/euthanasia-and-assisted-dying-rates-are-soaring-but-where-are-they-legal  (Accessed June 2023)
  3. Euthanasia, assisted suicide and non-resuscitation on request. (n.d.). Euthanasia, Assisted Suicide and Non-resuscitation on Request | Euthanasia | Government.nl. Available at: https://www.government.nl/topics/euthanasia/euthanasia-assisted-suicide-and-non-resuscitation-on-request (Accessed June 2023)
  4. Euthanasia. (2016, January 12). FPS Public Health. Available at: https://www.health.belgium.be/en/health/taking-care-yourself/patient-related-themes/cross-border-health-care/euthanasia (Accessed June 2023)
  5. LCQ4: Euthanasia. (n.d.). LCQ4: Euthanasia. Available at: https://www.info.gov.hk/gia/general/201612/14/P2016121400657.htm (Accessed June 2023)
  6. Tribune, T. T. (2020, June 12). OpEd: Euthanasia should be illegal | Madeline Shen – Grade 7 – Taipei Teen Tribune. Taipei Teen Tribune. Available at: https://taipeiteentribune.com/euthanasia-illegal/ (Accessed June 2023)
  7.  Legal, P. (2023, January 29). Passive euthanasia in India – Prime Legal. Prime Legal. Available at: https://primelegal.in/2023/01/29/passive-euthanasia-in-india/ (Accessed June 2023)

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