Assisted dying around the world

Webinars | September 11, 2021

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Over the past twenty years, assisted dying legislative practices have expanded around the world. Jenna Carter, the granddaughter of Kay Carter, gave a presentation exploring global trends and shifting public perceptions surrounding the practice.

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Webinar Summary

On September 11, 2021, Dying With Dignity Canada’s Ottawa Chapter hosted a webinar focused on assisted dying around the world, presented by Jenna Carter, Kay Carter’s granddaughter, and moderated by Chapter Chair Susan Harrison.

Over the past twenty years, assisted dying legislative practices have expanded around the world. Jenna’s presentation explores global trends and shifting public perceptions surrounding assisted dying.

If you prefer to view this content in video format, you can access the recording here.

Kay Carter

Kay Carter was an independent and adventurous woman; she had seven children and she was a loving grandmother to her many grandchildren. She was diagnosed with a degenerative disease at the age of 85. Her condition, spinal stenosis, left her dependent on others to eat, get dressed and go to the bathroom. One day, she told her daughter Lee that she had had a full life and was ready to move on. She did not want to spend the rest of her life in chronic and unbearable pain. At the time, it was illegal to seek a medically assisted death in Canada and she was forced to travel away from her home and overseas to Switzerland, where she could die on her own terms.

It was a six-month process for Kay to decide, seek and receive an assisted death in Switzerland.

Upon returning to Canada, Lee Cater was interviewed by a prominent Canadian reporter; an opportunity to advocate for Kay’s wish to die with dignity in her own country. A year later The British Columbia Civil Liberties Association (BCCLA) filed a lawsuit, Carter v. Canada, in the British Columbia Supreme Court, challenging the laws that criminalize physicians helping competent, seriously suffering individuals, end their life at a time of their choosing.

In 2014, the BCCLA received a leave to appeal in Carter v. Canada, taking the case to Canada’s highest court, the Supreme Court of Canada. It argued that the right to control the circumstances of one’s death is integral to the life, liberty, and security of gravely ill Canadians. The BCCLA argued that section 241 of the Criminal Code violates the Charter of Rights and Freedoms.

In February 2015, the SCC rendered a unanimous (9-0) judgement in favour of the plaintiff in the Carter case.

As of June 2016, the practice of assisted death is no longer illegal in Canada.

Note: Quebec was the first Canadian province to pass right-to-die legislation in 2014. This was challenged by the Government of Canada in December 2015 and the Quebec Court of Appeal confirmed that the “medical aid in dying” law would stand in the light of the Supreme Court decision in Carter v. Canada.

Assisted dying around the globe

A 2020 [1] study reported that assisted dying is available to 200 million people around the globe. Including seven E.U. countries, Canada, Switzerland, some provinces in Australia and several states in the U.S.

Terminology varies between countries but there are two methods of assisted death:

Clinician assisted dying
Self-administered medically assisted death

Trends

More acceptance as global population ages

In industrialized countries, population ageing is associated with higher likelihood that there will be discussions and debates on the issue of dying with dignity. Loss of autonomy, diminished quality of life and loss of dignity are the factors most frequently associated with requests for an assisted death.

Higher level of chronic disease and protracted illnesses

Chronic conditions are the leading cause of death. They often have long and debilitating trajectories which can extend life but lead to protracted suffering.

Access to assisted dying

An overarching trend of all assisted dying legislation around the world is that they include substantive and procedural requirements that can include age, waiting period, specific health conditions and thorough medical consultations. Transparency is another similarity of assisted dying laws whereby there are oversite systems in place, and they require mandatory reporting.

Canada

In June 2016, Canada was the first Commonwealth country to allow assisted dying.

The number of medically assisted deaths has increased over the years, according to Health Canada reporting [2].

2016 – 1018 deaths

2017 – 2,838 deaths

2018 – 4,478 deaths

2019 – 5,660 deaths

2020 – 7, 595 deaths

The increase in medically assisted deaths is attributed to better awareness of the law and acceptance by Canadians of medical assistance in dying (MAID) as an end-of-life option.

In March 2021, Bill C-7 was passed in parliament, expanding access to MAID to those whose death is not reasonably foreseeable. Bill C-7 was informed through feedback from over 300,000 Canadians, as well as over 120 experts and witness testimonies.

Profile of assisted dying applicants in Canada:

Older, white, well-educated Canadians who cite pain as the primary motivation for wanting an assisted death (from a 2016 study).[3]
Average age in 2019 was 75.2 years old [4]
Central motivation – physical decline and loss of control
Conditions include cancer (67%), respiratory (10%), neurocognitive (10%) cardiovascular (10%)

Netherlands

Netherlands was the first country to allow assisted dying, beginning in 2002. Patients do not have to be close to death however they must be informed, and the request must be voluntary. They must have unbearable suffering without the prospect of improvement, and no reasonable alternative to address their condition.

Advance requests are permitted when a person is unable to express their wishes but is nonetheless conscious, such as persons with dementia and Alzheimer’s.

Belgium

Belgium also introduced assisted dying legislation in 2002 to both adults and minors with fairly strict conditions. According to the Belgium media 2,357 clinician-assisted deaths were performed in 2018, a majority of patients were over the age of 60.[5]

Luxembourg

Luxembourg introduced assisted dying legislation in 2019 for adults only.

Colombia

Colombia is the only country in Latin America to have assisted dying legislation. Requests are reviewed by an interdisciplinary committee.

Spain

Recently, in March 2021, clinician assisted dying was made law in Spain.

Switzerland

Since 1942, Switzerland has supported people who wish to have an assisted death. The patient must administer the medication to die themselves. In 2018, 221 people travelled from outside the country to access an assisted death.[6]

New Zealand

As of November 2021, clinician assisted dying will be law in New Zealand for those experiencing unbearable suffering from a terminal illness.

U.S.A.

Assisted dying laws are governed by individual states.

In 1997, Oregon was the first U.S. state to allow assisted dying; followed by Washington, Montana, Vermont, California, Colorado, District of Columbia, Maine and New Jersey. In 2020, 16 other states were considering assisted dying laws.

Australia

Assisted dying laws are governed by state governments, however the territories are governed by the federal government.

States with assisted dying laws include Victoria, Western Australia, Tasmania, South Australia.

Note: Since this webinar was presented Queensland has also adopted an assisted dying law.

Countries with pending assisted dying laws

Countries with pending assisted dying laws include Italy, Germany and Austria.

Roadblocks

Religious debates

Beliefs about death, resurrection, reincarnation and the afterlife all impact a person’s position on assisted dying. Positions on assisted dying are not neatly matched with national cultures or religious denominations. Attitudes are personally decided on by political, social and existential beliefs of the individual.

Concerns of disability groups

Some groups representing people living with disabilities have expressed concern that the practice of assisted dying could put pressure on those living with non-terminal conditions to end their lives.

A 2007 study [7] on the Netherlands and Oregon, U.S. found that there was no evidence to justify the grave and important concern often expressed about the potential abuse – namely the fear that legalized assisted dying will target the vulnerable or pose great risk to people in vulnerable groups, and that there was no factual evidence for the ‘slippery slope’ concerns.

Debates among clinicians

Some physicians are conflicted because of their oath to ‘do no harm;’ however, attitudes are changing as assisted dying becomes more common and understood.