Tread Carefully When You Help to Die
Assisted Suicide Laws Around the World
Updated 01 March 2005
Compiled by Derek Humphry, former editor of World Right-to-Die Newsletter
Assisted suicide laws around the world are clear in some nations but unclear if they exist at all in others. Just because a country has not defined its criminal code on this specific action does not mean all assisters will go free. It is a complicated state of affairs. A great many people instinctively feel that suicide and assisted suicide are such individual acts of freedom and free will that they assume there are no legal prohibitions. This fallacy has brought many people into trouble with the law. While suicide is no longer a crime and where it is because of a failure to update the law it is not enforced assistance remains a crime almost everywhere by some statute or other. Ill try to explain the hodge-podge.
For example, it is correct that Sweden has no law specifically proscribing assisted suicide. Instead the prosecutors might charge an assister with manslaughter and do. In 1979 the Swedish right-to-die leader Berit Hedeby went to prison for a year for helping a man with MS to die. Neighbouring Norway has criminal sanctions against assisted suicide by using the charge "accessory to murder". In cases where consent was given and the reasons compassionate, the courts pass lighter sentences. A recent law commission voted down de-criminalizing assisted suicide by a 5-2 vote.
A retired Norwegian physician, Christian Sandsdalen, was found guilty of wilful murder in 2000. He admitted giving an overdose of morphine to a woman chronically ill after 20 years with MS who begged for his help. It cost him his medical license but he was not sent to prison. He appealed the case right up to the Supreme Court and lost every time. Dr. Sandsdalen died at 82 and his funeral was packed with Norways dignitaries, which is consistent with the support always given by intellectuals to euthanasia.
Finland has nothing in its criminal code about assisted suicide. Sometimes an assister will inform the law enforcement authorities of him or her of having aided someone in dying, and provided the action was justified, nothing more happens. Mostly it takes place among friends, who act discreetly. If Finnish doctors were known to practice assisted suicide or euthanasia, the situation might change, although there have been no known cases.
Germany has had no penalty for either suicide or assisted suicide since 1751, although it rarely happens there due to the hangover taboo caused by Nazi mass murders, plus powerful, contemporary, church influences. Direct killing by euthanasia is a crime. In 2000 a German appeal court cleared a Swiss clergyman of assisted suicide because there was no such offence, but convicted him of bringing the drugs into the country. There was no imprisonment.
France does not have a specific law banning assisted suicide, but such a case could be prosecuted under 223-6 of the Penal Code for failure to assist a person in danger. Convictions are rare and punishments minor. France bans all publications that advise on suicide - Final Exit has been banned since l991 but few nowadays take any notice of the order. Since l995 there has been a fierce debate on the subject, which may end in law reform eventually. Denmark has no specific law banning assisted suicide. In Italy the action is legally forbidden, although pro-euthanasia activists in Turin and Rome are pressing hard for law reform. Luxembourg does not forbid assistance in suicide because suicide itself is not a crime. Nevertheless, under 410-1 of its Penal Code a person could be penalized for failing to assist a person in danger. In March 2003 legislation to permit euthanasia was lost in the Luxembourg Parliament by a single vote.
Tolerance for euthanasia appears in the strangest of places. For instance, in Uruguay it seems a person must appear in court, yet Article 27 of the Penal Code (effective 1934) says: "The judges are authorized to forego punishment of a person whose previous life has been honorable where he commits a homicide motivated by compassion, induced by repeated requests of the victim." So far as I can tell, there have been no judicial sentences for mercy killing in Uruguay.
In England and Wales there is a possibility of up to 14 years imprisonment for anybody assisting a suicide. Oddly, suicide itself is not a crime, having been decriminalized in 1961. Thus it is a crime to assist in a non-crime. In Britain, no case may be brought without the permission of the Director of Public Prosecutions in London, which rules out hasty, local police prosecutions. It has been a long, uphill fight for the British there have been eight Bills or Amendments introduced into Parliament between 1936-2003, all trying to modify the law to allow careful, hastened death. None has succeeded, but the Joffe Bill currently before Parliament is getting more serious consideration than any similar measure. As in France, there are laws banning a publication if it leads to a suicide or assisted suicide. But Final Exit can be seen in bookstores in both countries.
The law in Canada is almost the same as in England; indeed, a prosecution has recently (2002) been brought in B.C. against a grandmother, Evelyn Martens, for counselling and assisting the suicide of two dying people. Mrs. Marten was acquitted on all counts in 2004. One significant difference between English and Canadian law is that no case may be pursued by the police without the approval of the Director of Public Prosecutions in London. This clause keeps a brake on hasty police actions.
Assisted suicide is a crime in the Republic of Ireland. In 2003 police in Dublin began proceedings against an American Unitarian minister, George D Exoo, for allegedly assisting in the suicide of a woman who had mental health problems. He responded that he had only been present to comfort the woman, and read a few prayers. This threatened and much publicized case had disappeared by 2005.
Suicide has never been illegal under Scotland's laws. There is no Scots authority of whether it is criminal to help another to commit suicide, and this has never been tested in court. The killing of another at his own request is murder, as the consent of the victim is irrelevant in such a case. A person who assists another to take their own life, whether by giving advice or by the provision of the means of committing suicide, might be criminally liable on a number of other grounds such as: recklessly endangering human life, culpable homicide (recklessly giving advice or providing the means, followed by the death of the victim), or wicked recklessness.
Hungary has one of the highest suicide rates in the world, caused mainly by the difficulties the peasant population has had with adapting to city life. Assistance in suicide or attempted suicide is punishable by up to five years imprisonment. Euthanasia practiced by physicians was ruled as illegal by Hungary's Constitutional Court (April 2003), eliciting this stinging comment from the journal Magyar Hirlap: "Has this theoretically hugely respectable body failed even to recognize that we should make legal what has become practice in everyday life." The journal predicted that the ruling would put doctors under commercial pressure to keep patients alive artificially.
Russia, too, has no tolerance of any form of assisted suicide, nor did it during the 60-year Soviet rule. The Russian legal system does not recognize the notion of 'mercy-killing'. Moreover, the 1993 law 'On Health Care of Russian Citizens' strictly prohibits the practice of euthanasia. A ray of commonsense can be seen in Estonia (after getting its freedom from the Soviet bloc) where lawmakers say that as suicide is not punishable the assistance in suicide is also not punishable.
The only four places that today openly and legally, authorize active assistance in dying of patients, are:
- Oregon (since l997, physician-assisted suicide only);
- Switzerland (1941, physician and non-physician assisted suicide only);
- Belgium (2002, permits 'euthanasia' but does not define the method;
- Netherlands (voluntary euthanasia and physician-assisted suicide lawful since April 2002 but permitted by the courts since l984).
Two doctors must be involved in Oregon, Belgium, and the Netherlands, plus a psychologist if there are doubts about the patient's competency. But that is not stipulated in Switzerland, although at least one doctor usually is because the right-to-die societies insist on medical certification of a hopeless or terminal condition before handing out the lethal drugs.
The Netherlands permits voluntary euthanasia as well as physician-assisted suicide, while both Oregon and Switzerland bar death by injection.
Dutch law enforcement will crack down on any non-physician assisted suicide they find, recently sentencing an old man to six months imprisonment for helping a sick, old woman to die.
Switzerland alone does not bar foreigners, but careful watch is kept that the reasons for assisting are altruistic, as the law requires. In fact, only one of the four groups in that country, DIGNITAS, chooses to assist foreigners. When this willingness was published in newspapers worldwide, sick people from all over Europe, and occasionally America, started trekking to Switzerland to get a hastened death. In 2001 the Swiss National Council confirmed the assisted suicide law but kept the prohibition of voluntary euthanasia.
Belgian law speaks only of 'euthanasia' being available under certain conditions. 'Assisted suicide' appears to be a term that Belgians are not familiar with. It is left to negotiation between the doctor and patient as to whether death is by lethal injection or by prescribed overdose. The patient must be a resident of Belgium (pop.: 10 million), though not necessarily a citizen. In its first full year of implementation, 203 people received euthanasia from a doctor.
All three right-to-die organizations in Switzerland help terminally ill people to die by providing counselling and lethal drugs. Police are always informed. As we have said, only one group, DIGNITAS in Zurich, will accept foreigners who must be either terminal, or severely mentally ill, or clinically depressed beyond treatment. (Note: Dutch euthanasia law has caveats permitting assisted suicide for the mentally ill in rare and incurable cases, provided the person is competent.)
The Oregon Death With Dignity Act came under heavy pressure from the US Federal government in 2001 when Attorney General John Ashcroft issued a directive essentially and immediately gutting the law. This brought on a public outcry that the Federal government was nullifying a law twice voted on by Oregon citizens. A disqualification of democracy! An interference with states' rights! Immediately the state of Oregon went to court (2002) to nullify the directive, won at the first stage, but the appeals are likely to continue until 2004. Since l980, right-to-die groups have tried to change the laws in Washington State, California, Michigan, Maine, Hawaii, and Vermont, so far without success. Thus in the USA, Oregon stands alone and under great pressure.
In 2005 the US Supreme Court agreed to the federal government's request for it to decide whether Oregon's law was constitutional. The case concerned not so much the ethical correctness of physician-assisted suicide but turned legally on whether it was the federal government or the states which controlled dangerous drugs, as used by doctors in Oregon. The court's decision, expected in early 2006, will affect pain control throughout America.
New Zealand forbids assistance under 179 of the New Zealand Crimes Act, l961, but cases were rare and the penalties lenient. Then, out-of-the-blue in New Zealand in 2003 a writer, Lesley Martin, was charged with the assisted suicide of her mother that she had described in a book. Ms. Martin was convicted of manslaughter by using excessive morphine and served half of a fifteen-month prison sentence. She remained unrepentent. That same year the country's parliament voted 60-57 not to legalize a form of euthanasia similar to the Dutch model.
Similarly, Colombia's Constitutional Court in 1997 approved medical voluntary euthanasia but its parliament has never ratified it. So the ruling stays in limbo until a doctor challenges it. Assisted suicide remains a crime.
RARE IN JAPAN
Japan has medical voluntary euthanasia approved by a high court in l962 in the Yamagouchi case, but instances are extremely rare, seemingly because of complicated taboos on suicide, dying and death in that country, and a reluctance to accept the same individualism that Americans and Europeans enjoy. The Japan Society for Dying with Dignity is the largest right-to-die group in the world with more than 100,000 paid up members. Currently, the Society feels it wise to campaign only for passive euthanasia good advance directives about terminal care, and no futile treatment. Voluntary euthanasia and assisted suicide are rarely talked about, which seems strange to Westerners who have heard so much about the culture of ritual suicide, hari kari, in Japanese history. This is because, one Society official explained: "In Japan, everything is hierarchical, including academics, and government organization, and this makes it difficult for the medical staff and those who offer psychiatric care to join forces to treat the dying."
Another factor in Japan's backwardness on euthanasia is that some 80 percent of their people die in hospitals, compared to about 35 percent in the Netherlands, 35 percent in America, with as low as 25 percent in Oregon which has a physician-assisted suicide law. Euthanasia is essential an in-home action.
The right-to-die movement has been strong in Australia since the early l970s, spurred by the vast distances in the outback country between patients and doctors. Families were obliged to care for their dying, experienced the many harrowing difficulties, and many became interested in euthanasia. The Northern Territory of Australia actually had legal voluntary euthanasia and assisted suicide for seven months until the Federal Parliament stepped in and repealed the law in l997. Only four people were able to use it, all helped to die by the undaunted Dr. Philip Nitschke, who now runs the progressive organization, Exit International (formerly 'Final Exit Australia'). Other states have since attempted to change the law, most persistently South Australia, but so far unsuccessfully.
In a rare show of mercy and understanding, a judge in the Supreme Court of Victoria, Australia, in July 2003 sentenced a man to 18 months jail but totally suspended the custody. Alex Maxwell had pleaded guilty to 'aiding and abetting' the suicide of his terminally ill wife, actions that the judge said were motivated by compassion, love, and humanity and thus did not deserve imprisonment. This was a trend in the right direction.
EUROPE ON THE MOVE
The strongest indication that the Western world is moving gradually to allow assisted suicide for the dying and the incurable rather than to permitting voluntary euthanasia comes from a huge survey that the Council of Europe did in 2002. It received answers from 34 Central Asian and European states, plus the USA and Russia. Not a few replied that such terms were nowhere to be seen in their laws so had difficulty answering.
Asked if legislation or rules made euthanasia possible, only one country (Netherlands) answered in the affirmative (Belgium had not yet passed its similar law) and 25 nations said definitely not. Asked if they had any professional codes of practice on assisted suicide, eight countries said that they did, while 21 said no.
Some of the other questions had revealing answers:
- Is the term 'assisted suicide' used in your country: Yes 18; No 5.
- Do criminal sanctions against assisted suicide exist: Yes 23; No 4.
- If so, have they ever been applied: Yes 6; No 6.
The Council of Europe, representing 45 nations, did not let the matter rest there. Its Social, Health and Family Affairs Committee approved a report which called on European states to consider decriminalizing euthanasia. This was a massive step forward for the previously ignored right-to-die movement.
The commonsense of the Committee's approach is shown in the draft report by Swiss Rapporteur Dick Marty:
- Nobody has the right to impose on the terminally-ill and the dying the obligation to live out their life in unbearable suffering and anguish where they themselves have persistently expressed the wish to end it.
- There is no implied obligation on any health worker to take part in an act of euthanasia, nor can such an act be interpreted as the expression of lesser consideration for human life.
- Governments of Council of Europe member states are asked to collect and analyse empirical evidence about end-of-life decisions; to promote public discussion of such evidence; to promote comparative analysis of such evidence in the framework of the Council of Europe; and, in the light of such evidence and public discussion, to consider whether enabling legislation authorising euthanasia should be envisaged.