By Charalampos Karouzos,
Assisted suicide, often referred to as medical aid in dying (MAiD) or euthanasia, although still remains a topic of intense debate worldwide, it has emerged as a significant medical development in the past few decades. In particular, several countries, mainly in Europe and North America, have developed the necessary legal frameworks allowing patients to end their lives under strict medical supervision. While some view MAiD as a humane solution to unbearable suffering, others see it as a moral and ethical challenge that undermines the sanctity of life. The expansion of such services worldwide has been accompanied by increasing public acceptance, yet controversies remain regarding access, eligibility, and potential societal implications.
Medical Assistance in Dying (MAiD), culturally referred to as the lethal shot, or assisted suicide, is defined as the legally regulated procedure that allows individuals with grievous and irremediable medical conditions to seek a medically assisted death. It is intended for patients experiencing unbearable suffering due to terminal illnesses, advanced chronic conditions, or, in some jurisdictions, severe mental health disorders. Depending on the legal framework of each country, MAiD can be administered either by the patient themselves or by a healthcare professional, using medications that ensure a peaceful and painless passing. The process involves strict eligibility criteria, including comprehensive medical assessments, informed consent, and mandatory waiting periods to confirm that the request is voluntary and well-considered. While MAiD has been embraced as a means of preserving autonomy and dignity for those facing immense suffering, it remains a subject of ethical and legal debate, as concerns persist over its potential misuse and broader societal implications.
One of the most well-documented cases of legalized assisted dying is in Canada, where Aide médicale à mourir (AMM) has been in place for almost 10 years, since 2016. The system allows terminally ill patients who meet specific medical and psychological criteria to request and receive assistance in ending their lives. Indeed, data from Health Canada suggests that the number of people opting for MAiD has steadily increased, accounting for approximately 4% of all deaths in the country by 2022. The majority of these patients were suffering from terminal cancer, neurodegenerative diseases, or severe cardiovascular conditions. In fact, proponents argue that these laws provide dignity to those experiencing extreme suffering, offering them a choice over their end-of-life care. Quebec, the french-speaking provence of Canada in particular, has seen high acceptance rates, with many patients and medical professionals supporting its implementation as an extension of palliative care rather than a replacement for it.
In Europe, the Netherlands, Belgium, and Luxembourg were among the first to legalize euthanasia, setting the stage for wider discussions on patient autonomy. The Dutch and Belgian models are particularly notable for allowing both euthanasia, where a physician directly administers the lethal dose, and physician-assisted suicide, where the patient self-administers the prescribed medication. The availability of both options, holds great importance as although the choice always belongs to the patient, the last step can be taken by the patient themselves. These laws, in place for over two decades, have provided extensive data on patient satisfaction, ethical concerns, and the impact on healthcare systems. Further, studies have shown that most patients who opt for assisted dying suffer from unbearable physical pain, loss of autonomy, or psychological distress related to their illness. Indeed, Belgium has gone a step further by allowing assisted death for minors in exceptional circumstances, a decision that has fueled intense debates on whether children can fully consent to such an irreversible choice.
Switzerland presents a unique case, as it has allowed assisted suicide since the 1940s but without requiring terminal illness as a prerequisite. Organizations such as Dignitas and Exit provide assistance to both Swiss citizens and foreigners seeking to end their lives under strict legal conditions. As a consequence this has led to the phenomenon of “suicide tourism,” where individuals from countries with restrictive laws travel to Switzerland for assisted suicide services. Wihtout a doubt, ethical concerns have been raised about whether such accessibility promotes death over life-saving interventions, though proponents argue that it offers a crucial escape for those in unbearable situations. In addition, the proponents of these services focus our attention on the presence of the option for those who are suffering, not forcing them to do so.
Recent years have seen more countries, following the example of the frontrunners, to consider or even start implementing assisted dying policies. In Europe, Spain and Portugal have both passed laws allowing euthanasia, while Italy has made significant progress in recognizing the right to die with dignity, without yet taking the next step. In the eastern sore of the atlantic, in the United States, the practice is legal in several states, including Oregon, Washington, California, and Colorado, through Death with Dignity laws, however the current sociopolitical situation prevents us to predict the next chapter in the story. In these states, policies typically require patients to have a terminal illness with a prognosis of six months or less to live, ensuring that only those facing imminent death have access, however, restrictions vary by state, leading to disparities in access of these services based on their location.
References
- Health Canada. “Fourth Annual Report on Medical Assistance in Dying in Canada, 2022.” Government of Canada, 2023.
- Dyer, Owen. “Canada’s Expanding Euthanasia Laws: A Dangerous Precedent?” BMJ, vol. 380, 2023.
- Emanuel, Ezekiel J., et al. “Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe.” JAMA, vol. 316, no. 1, 2016, pp. 79-90.
- Jones, David A., and David Paton. “How Does Legalization of Assisted Suicide Affect Rates of Suicide?” Medical Ethics Quarterly, vol. 30, no. 4, 2022, pp. 567-589.
- Van Wesemael, Yanna, et al. “Implementation of Euthanasia Legislation in Belgium: Analysis of Official Data.” New England Journal of Medicine, vol. 376, 2017, pp. 121-128.
