The issue of assisted suicide has been playing on the minds of many American citizens this week, after a bright, articulate young woman made public her decision to take her own life. Brittany Maynard passed away on November 1st, after first saying her goodbyes to her loved ones. Before going through with her decision to die via assisted suicide, Brittany recorded her thoughts on the right to die in a series of videos to which the world has bore witness. She began the Brittany Maynard Fund, which serves as a fundraising and awareness-raising forum for the non-profit end-of-life support and planning group, Compassion and Choices.
29 year old Brittany was diagnosed with terminal brain cancer earlier this year. Rather than suffer through the decline and death with which she was faced, Brittany decided to opt for assisted suicide. The option was unavailable in the San Francisco Bay area, where she lived, so she and her family made the move to Portland, Oregon, where assisted suicide is legal.
Brittany's final words to the public were posted on her Facebook page, reading;
"Goodbye to all my dear friends and family that I love. Today is the day I have chosen to pass away with dignity in the face of my terminal illness, this terrible brain cancer that has taken so much from me… but would have taken so much more"
Brittany's story is certainly an evocative one, and as Time magazine this week pointed out, it has revived the debate on assisted suicide. Many believe a family should not have to uproot themselves in order to allow their daughter her choice to 'die with dignity' - the name given to the assisted suicide advocacy movement. Should this be an option available to all, whether or not they have the means to relocate to one of the few areas where this is legal? The Catholic Church have spoken out against the practice in the wake of Maynard's death, and only a few countries the world over offer terminally ill patients the option of assisted suicide. Those who disagree with the practice cite not only religious concerns but the potential for abuse of the practice - unintended knock-on effects which could see a decline in society's respect for life on a larger scale. Many will point out that effective pain medication is available, so that a terminally ill patient need not end their life in pain, and some critics of assisted suicide will assert that carrying the practice is against the fundamental ethical code of medical professionals.
Perhaps you feel strongly about one side or the other, or maybe you're still on the fence about this enormously contentious issue. To help clarify the issue, we've taken a look here at the parts of the world where euthanasia or assisted suicide have been legalised, and the impact this had on each society.
The Netherlands is one of only three parts of the world where euthanasia is legal. Euthanasia is typically distinguished from assisted suicide, one crucial difference being that assisted suicide authorises a physician to make the means for dying available to a patient while euthanasia may see a medical professional take a more active role in the administration of lethal drugs. Euthanasia is, by definition, the act of painlessly and compassionately ending someone's life to prevent further suffering. Since the 70s, when a physician was convicted for facilitating a terminally ill patient's request to die, euthanasia was a pressing issue in the Netherlands. After ongoing discussions and assertions as to circumstances wherein a patient's request to have his life ended may legally be carried out by a doctor, an official law was passed in 2002. A set of strict criteria are to be followed, which take into consideration the patient's age (he or she must be above 12 years old), their full, informed and voluntary consent, their unbearable suffering and the consultation of more than one authorised medical professional.
A year after the law was passed, in 2003, 1.2% of all deaths in the Netherlands were physician-assisted deaths, constituting over 1,600 deaths. In 2013, that number had risen to 4,188. As reported by The Guardian last year, 78% of those deaths were cancer patients.
In the same year as the Netherlands, 2002, Belgium legalised euthanasia. Its policies and practices have attracted significant attention in the worldwide debate on euthanasia and assisted suicide; in 2013, it emerged that deaths by euthanasia were up a full 25% on the previous year. One of the country's most controversial policies allows the euthanasia laws to be extended to terminally ill children. Some sources - pro-life leaning publications including LifeSite News and LibertyVoice - report that in some regions of Belgium over 30% of euthanasia cases are carried out without consent. This statistic, however, is in contrast to a 2007 figure of 1.8% found in a study by university researcher Johan Bilsen, as reported by TheStraitsTimes.
As of 2009, Luxembourg became the third country in Europe - and indeed, only the third country in the world - to legalise euthanasia. Similar criteria apply here as in the Netherlands; the patient's request must be approved by at least two authorised medical professionals, as well as an independent panel of experts. The Telegraph reported that between 2011 and 2012, just 14 people were killed by euthanasia, which constituted a rate of death by euthanasia per capita which is 10 times less than that of the Netherlands.
The legality of assisted suicide remains unclear in Japan, as there's no national law either permitting or forbidding it. However, in terms of legal precedent, two local cases are pointed to which indicate a permissive attitude towards both passive (i.e. letting nature take its course by ending artifical life support) and active (i.e. lethal medication) assisted suicide in the country. Within the current legal framework, a patient must be facing certain death within the near future, the patient must give consent - although in the case of passive euthanasia, the testimony of family will suffice. In the case of active euthanasia, the patient must be in unbearable pain, while for the conditions of passive euthanasia to be met, the patient must be unlikely to ever make a recovery.
Japan's Right to Die society is the largest of its kind in the world, with over 100,000 members.
Dating back to the 1940s, Switzerland's laws allow assisted suicide both for Swiss citizens and for foreigners in the country. Assisted suicide in the country is legal in all cases where the motive is unselfish. It's not uncommon for foreigners to travel to Switzerland in order to die with dignity. In 2012, there were a reported 172 cases of non-Swiss nationals travelling to the country for assisted suicide. Many of those hailed from Germany, the UK and France.
Germany holds to slightly stricter standards than its neighbouring Switzerland with regard to assisted suicide laws. While in Germany, assisted suicide is only legal if the patient in question self-administers the lethal drug - which might be impossible for those with severely debilitating illnesses - Switzerland allows assisted suicide to be carried out by a third party. This is likely why so many of the foreigners travelling to Switzerland for assisted suicide come across the border from Germany.
As of 1999, Albania allows passive assisted suicide; that is, it is legal to stop life support for a patient being kept alive artificially. This is a controversial law in the country, as Albania is a predominantly Catholic country, and the Catholic Church is outspoken about its position against assisted suicide.
As far back as 1997, Colombia's High Court ruled that doctors could not be prosecuted for helping patients make the legal decision to end their lives. This is contentious for the same reason as Albania's laws - Colombia is a heavily Catholic country. Conditions which must be met include a medical determination that the patient has a terminal illness, and the patient's consent.
Returning to the most current debate, American laws on assisted suicide vary by state. Throughout the nation, patients have the right to choose to refuse medication, or to increase pain medication where necessary, even if this poses a risk to their life. However, physician-assisted suicide has been made legal in five states since the issue first came to light in modern America with the case of 'Dr. Death', Dr. Kevorkian (who assisted the death of around 40 patients in Michigan in the 1990s).
In Vermont, Montana, Washington, New Mexico and Oregon it is legal for a physician to provide life-ending medication, as long as it meets a set of strict standards which typically include that the patient must suffer from a terminal illness, as determined by more than one medical professional. Between 1997, when the Death by Dignity Act was passed in Oregon, and 2007, there were 341 official reports of assisted-suicide deaths, with 20 reported complications. It was in Portland, Oregon that 29 year old brain cancer sufferer Brittany Maynard chose to end her life in the high profile case which brought the assisted suicide question to the forefront of America's consciousness. In Washington, physician-assisted suicide became legal in 2009 and in the following three years, 255 people had been prescribed lethal drugs.