By Charalampos Karouzos,
Despite growing acceptance, assisted dying remains controversial, particularly in countries with strong religious or conservative influences. For example, the Catholic Church has been one of the most vocal opponents, arguing that life should be preserved at all costs and that palliative care should be improved instead of offering euthanasia. Similarly, disability rights groups have expressed concerns that legalizing assisted dying could lead to the devaluation of disabled lives, with some fearing that societal pressures might push vulnerable individuals toward seeking death rather than receiving adequate support. Although this argument is built on solid foundation, reports from countries with assisted dying laws indicate that safeguards are generally effective in preventing abuse—though critics argue that these systems could become a slippery slope, where eligibility criteria gradually expand to include individuals with non-terminal conditions.
Another crucial debate surrounding assisted dying, as with many novel medical advancements, involves disparities in access. While wealthier, well-informed patients in countries like Canada and the Netherlands often have seamless access to these services, individuals in less developed nations or regions with restrictive laws face limited choices. Norway, for example, has not legalized assisted suicide, meaning that Norwegian citizens seeking MAiD must travel abroad— usually to Switzerland—which can be emotionally burdensome and financially prohibitive. Meanwhile, in many African and Asian countries, discussions around euthanasia remain taboo, and palliative care infrastructure is often inadequate, leaving terminally ill patients with few options beyond enduring prolonged suffering or resorting to what some term “forced suicide”.
Enabling the conversation around MAiD to begin in any country requires the prior establishment of legal frameworks and jurisdictional clarity. Most countries with legalized euthanasia operate under an opt-in system, where individuals must explicitly request and repeatedly consent to the procedure. However, some discussions have emerged about whether an opt-out system—where euthanasia could be considered the default option unless the patient specifies otherwise—might improve access for those unable to navigate complex bureaucratic processes. While no country currently employs a full opt-out model, some have adopted policies allowing for advance directive. These legal instruments enable patients to request euthanasia before they lose cognitive function, as seen in cases of dementia.
Regardless of the buracreautic groundwork that must be done, data on the efficacy of assisted dying laws suggest that they provide substantial relief for patients and families while also reducing the financial burden on healthcare systems. A 2021 study from the Journal of Medical Ethics found that MAiD programs significantly reduce the need for prolonged hospitalizations and intensive end-of-life treatments, which often impose high costs on both patients and healthcare providers. Countries like Canada and the Netherlands have reported that expanding MAiD services has freed up resources for palliative care programs, ensuring that those who wish to continue treatment receive the best possible support.
While economic considerations should never be the primary justification for assisted dying, it is undeniable that the cost of end-of-life care is substantial. In a country like Germany—where debates on assisted dying continue—broadly legalizing MAiD could have a significant financial impact. With an aging population and rising healthcare expenditures, allowing terminally ill patients to choose assisted dying could alleviate some of the economic strain associated with prolonged palliative care. Again, although finances and human life should never be considered equal in importance, avoiding this point prevents societies from developing a holistic view of the issue and ultimately making an informed choice.
Ultimately, the expansion of assisted dying services worldwide reflects a broader shift toward respecting patient autonomy and dignity, acknowledging that suffering should not be prolonged against an individual’s will. However, the ethical, medical, and social debates surrounding this issue remain complex. Striking a balance between accessibility, safeguards, and ethical considerations will be crucial as more countries consider legalizing MAiD. While some argue that expanding such services risks prioritizing early death over life, evidence from countries with established programs suggests that, when properly regulated, assisted dying can coexist with comprehensive palliative care to offer patients true dignity in their final moments.
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.
