Belgium, Switzerland, Canada, United States… who authorizes what?

Emmanuel Macron must define Tuesday, September 13 the contours of the citizens’ convention on the end of life that he promised. This assembly must, in the words of the President of the Republic, “to allow society to take into account the essential developments on this immense subject”. The same day, the National Consultative Ethics Committee (CCNE) must submit a report on the subject.

In France, end-of-life legislation is enshrined in the Claeys-Leonetti law. This text, adopted in 2016, reaffirms access to palliative care, prohibits therapeutic relentlessness and allows dying people whose pain is too severe to receive “deep and continuous sedation (…) maintained until death.

► Belgium, the first country to legalize euthanasia

Since 2002, Belgium has decriminalized the act of a doctor actively accompanying a patient at the end of life. According to the legislation in force in the country, the doctor administers to the patient a lethal dose intentionally ending his life. The procedure can be performed at home or in the hospital. The health professional assumes his responsibility.

The practitioner must also ensure that the patient has not been subjected to external pressures. The latter must be suffering from an incurable disease which causes physical and psychological suffering “unbearable, constant, which cannot be appeased”. Since 2014, this regulation has evolved in order to extend the right to euthanasia to minors.

► In Switzerland, the role of associations

Switzerland allows assisted suicide. Patients thus administer themselves a lethal dose by means of an infusion, a drinkable or injectable solution. These are associations that supervise active euthanasia and not doctors. Assisted suicide is conditional on the patient’s capacity for discernment and the caregiver must not have “selfish motives”.

► In Canada, an extensive right

Referred to as “medical assistance in dying”, assisted suicide has been legal in Canada since 2016. Since 2021, however, significant changes have been introduced into the law, firstly the removal of the “reasonably foreseeable death”.

It is now enough for the patient to justify a serious and incurable illness to request assistance in dying if he considers his suffering unbearable. A physically handicapped person can now request assisted suicide. People with mental illness are nevertheless excluded from this system, but the study of a new text concerning them could open as early as 2023.

► In the United States, low access to assisted suicide

Only ten US states have legislated to legalize assisted suicide for their residents: Oregon, Washington, Vermont, California, Colorado, Hawaii, New Jersey, Maine, Washington DC and New Mexico. To use assisted dying, applicants must provide proof of a medical diagnosis attesting that they have less than six months left to live.

► Spain and Portugal, recent opening of rights to euthanasia

On the other side of the Pyrenees, euthanasia has been decriminalized since 2021. A patient with “serious incurable disease”of “serious, chronic and disabling illness certified by the attending physician” causing pain ” insupportable ” and “cannot be mitigated” can request euthanasia from a physician.

In Portugal, a bill authorizing euthanasia and assisted suicide is under consideration. Approved twice by the deputies, the text was rejected, the president having vetoed. The latter asks the representatives for clarification on the eligibility criteria.

► Sweden tolerates passive euthanasia

If active euthanasia remains prohibited in Sweden, passive euthanasia has been possible since 2010. The patient, if he is in full possession of his faculties, can ask the doctor to stop the treatments keeping him alive, such as respiratory assistance, for example.

► In Italy and Germany, the intervention of the Constitutional Courts

In 2019, the Italian Constitutional Court introduced an exception to the ban on euthanasia for “Patients kept alive by treatments (…) and suffering from an irreversible pathology, a source of physical and psychological suffering that they consider intolerable, while being fully capable of making free and conscious decisions».

A bill aimed at regulating assisted suicide is being examined in the country, where the Catholic Church retains a strong influence.

In Germany, Parliament is currently working on a bill regulating the use of assisted suicide. A 2020 decision of the Karlsruhe Constitutional Court had affirmed “the right to choose one’s death”. “This right includes the freedom to take one’s own life and seek assistance in doing so”, had then decided the highest court of the country. Legislation laying down the conditions for this right is currently under consideration.

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