This POSTbrief provides a brief overview of assisted dying, including ethical debate and stakeholder opinion. It examines how assisted dying functions within health services in countries where it is a legal option, focusing on jurisdictions where most data are available on outcomes: Belgium, Canada, the Netherlands, Oregon (United States), Switzerland and Victoria (Australia). It also covers evidence and expert opinion on key practical considerations that are raised in the context of assisted dying.
The POSTnote on assisted dying highlights some particular concerns:
The incremental extension of legislation
This has been seen in other jurisdictions where assisted dying is legal. Over time, the criteria have widened, for example, by legalising euthanasia of terminally ill children, including those with mental illness, or shortening the period of reflection.
Making a prognosis of life expectancy is notoriously difficult. It is even more difficult to evaluate the degree of suffering an individual is experiencing. For those with concomitant mental illness, it is difficult to predict whether suffering may be remediable over time.
Assessing mental capacity is complex. Research shows that a terminally ill person’s request for an assisted death may stem from mental or emotional distress and not necessarily imply a genuine wish to hasten death. Determining capacity is more challenging in cases of psychiatric disorder. Palliative interventions can be associated with changes of mind about assisted suicide among dying patients. Also, coercion is very hard to detect, particularly when financial pressures occur.
Belgium is the only jurisdiction where assisted suicide is legal in which palliative care has developed. In all other jurisdictions the relationship between the two is more complicated. There are concerns that legalising assisted dying can stunt the development of palliative services.
In 2021, UN human rights experts expressed concern about legislation that enables access to assisted dying for those who are not terminally ill, suggesting that it can devalue the lives of people living with disabilities and put pressure on vulnerable people to end their lives.
There is concern that assisted dying is incompatible with the principle of respect for human life. It can lead to emotional distress, conflict with perceptions of professional responsibilities, impact on relationships with other doctors and increase workloads. It also poses the risk of a cost-saving approach towards both health service provision and patient care needs.
Find it here:POSTnote on Assisted Dying