Feysal Mohamed Bakaal Assignment
Submitted
to:
Dr. Shahanaz Chowdhury
MBBS (SSMC,DU), MPH (NIPSOM,DU), MBGPH, PhD
Associate Professor
& Head,
Dept. of Community
Medicine,
Faculty of Public
Health,
Bangladesh University
of Health Sciences (BUHS)
Submitted
by:
Feysal Mohammed Bakaal
BPH in Environmental
Health & Safety, Spring 2019
ID: 02106191005
Course Title:
Bioethics
Course code: 02011202
Submitted on 20th March 2021
Where Is
Euthanasia Legal?
Historically, the word euthanasia means
“good death”, in other words, death without pain, without suffering. In the
twentieth century, during the Third Reich, the word gained a negative
connotation when it was improperly used in Nazi policies aimed at eliminating
lives that were considered not worthy to exist. Subsequently, after the word
was demystified, discussions on the topic resurfaced, and, currently, the
practice of euthanasia, in its classic sense, is allowed in some countries. In
a more contemporary definition, euthanasia can be understood as employment or
abstention of procedures that allow accelerating or inducing the death of
incurably ill patients, in order to free them from the extreme suffering that
torments them.
As for
the patient’s consent, euthanasia can be classified into non-voluntary and
voluntary – the first takes place without knowing the will of the patient, and
the second in response to the expressed wishes of the patient 1.
The latter differs from assisted suicide as it is performed by a physician,
while in assisted suicide the patient is the one who performs the final action.
Both
from the medical and from the legal point of views, there is a big difference
between “killing” and “letting die”. Therefore, regarding the act, euthanasia
is divided into active and passive, the first of which denotes the deliberate
act of inducing death without the patient suffering (using, for example, lethal
injection), and the second refers to death by deliberate omission to start
medical action that would guarantee the prolongation of survival. It is worth
noting the vagueness of the distinction between passive euthanasia and
orthothanasia, which refers to “death at the right time”, since there is no
real boundaries between” not intervening and simply letting die” and “letting
die in the seemingly correct time”.
The
term “assisted death” or “assisted dying” encompasses both the concept of
euthanasia and assisted suicide, both subjects of ongoing debates in today’s
society. Four European, one South American and two North Americans countries
have legalized euthanasia and/or assisted suicide, but the law of these
countries differ considerably regarding the practices 3.
In
July 2015, the topic was widely reported by the media after the first legal
case of euthanasia was performed in Colombia 4.
In the same year, assisted suicide was legalized in Canada and in the state of
California, in the United States (US) 4.
Given the divergent views and the general interest of the community on the
subject, having knowledge of the experience and the views of various countries
regarding the issue is essential to form opinions 3.
This is still a very controversial debate and - regardless of political,
religious or moral aspects– it is fundamentally a human issue 2.
Thus, the objective of this work is to establish the prevalence and the
criteria adopted for the practice of euthanasia and assisted suicide in Western
countries and to discuss the position of other countries where the practice is
not recognized.
This
work consists of a systematic review of the literature. The words “euthanasia,”
“assisted suicide”, “Netherlands”, “Belgium”, “Luxembourg”, “Switzerland”,
“United Kingdom”, “Brazil”, “Colombia” “Canada” and “United States” were used,
in English and Portuguese, as keywords for the research. To identify the
publications that composed this study, an online search was done in the
following databases: Scientific Electronic Library Online (SciELO), National
Center for Biotechnology Information (PubMed) and Google Scholar. The MeSH tool
was used to help the search and categorization of articles.
The
research was based on 19 publications relevant to the topic investigated. A
list with these publications is presented at the end in Appendix
1. The following previously established inclusion criteria were considered:
original works or reviews, available in full, published between 2005 and 2015.
The articles that did not fit the inclusion criteria were removed from the
sample. Regarding the exclusion criteria, we considered duplicated articles,
publications prior to 2005 and those that, despite having the selected
descriptors, did not directly address the proposed topic. In addition, recent
news articles, websites and official reports from the countries mentioned were
consulted to update data. Moreover, some articles were suggested by experts
METHOD
AND RESULTS
The selection of items
for systematic review was done according to the flow chart (Figure
1). Based on these publications, Table 1 briefly describes information
regarding the journal, author, year of publication, article title, type of
study, objective and limitations presented by the publications studied.
DISCUSSION
Assisted
death is allowed in four Western European countries: the Netherlands, Belgium,
Luxembourg and Switzerland; two North American countries: Canada and the United
States, in the states of Oregon, Washington, Montana and Vermont; and in South
America: in Colombia 4.
The laws and criteria adopted for the purposes of this practice differ in each
country. Explaining how assisted death occurs in these locations and compare
their legislation to that of other similar countries in socio-economic and
cultural aspects allows a better understanding of the subject, and works as a
basis for future discussions 2.
The situation in Brazil and the UK has been addressed at the end of this paper
in order to compare the position of other countries and enrich the discussion.
The timeline with key milestones regarding assisted death in the world is
presented in Appendix
2 to facilitate understanding.
Colombia is the only
country in Latin America where euthanasia is permitted. Although it was
decriminalized in 1997 by the Constitutional Court, only in April 2015 the
Ministério da Saúde (Ministry of Health) defined how it might occur. Until that
date, it was classified as “murder by compassion” according to Article 326 of
the Criminal Code, and the lack of well-established criteria for its
realization, coupled with the controversial legislation, generated ambiguity,
conflicting interpretations and uncertainties regarding the matter 4,5.
Currently, the practice
is regulated by Resolution 12116/2015 from the Ministério da Saúde e Proteção
Social (Ministry of Health and Social Protection), which establishes criteria
and procedures to ensure the right to death with dignity 6,7.
Intravenous drugs can be administered by physicians, in hospitals, to adult
patients with terminal diseases that cause intense pain and suffering that
cannot be relieved. The patient must consciously request assisted death, which
must be authorized and supervised by a specialist doctor, a lawyer, and a
psychiatrist or psychologist. Moreover, the current legislation does not
prohibit this procedure for foreign patients 4.
Only one case of euthanasia
has been reported so far in the country, on the 3rd July 2015.
It was Ovídio Gonzáles (79) who was stricken by a rare facial cancer that,
although not metastasized, caused intense chronic pain 4.
Therefore, in view of the recent legalization, it is necessary to invest in the
training of physicians and health professionals to deal with end of life
ethical dilemmas 5,8.
Assisted suicide is legal
in five of the fifty US states: Oregon, Washington, Montana, Vermont and
California 4,9.
In 2014, New Mexico passed legislation consistent with the practice, but the
decision was reversed on appeal in August 2015 4.
On the other hand, euthanasia is banned in all states 2.
The first state to
legalize assisted suicide was Oregon, on the 27th October 1997,
with the approval of the “Death with Dignity Act” 10,
which allows competent (able to consciously express their will) adults (from
the age of 18), residents in Oregon, with terminal illnesses and life expectancy
of less than six months, to receive medications in lethal doses, through
voluntary self-administration, expressly prescribed by a doctor for this
purpose. According to the Act, the self-administration of these lethal drugs is
not considered suicide, but death with dignity 3,11.
It is worth noting that many Catholic hospitals have opted out from this
practice 4.
Since the law was passed
in 1997 until the end of 2014, 1,327 people received the prescription of lethal
medication, and of those, 859 died after self-administration. Six people woke
up after the procedure, and most died within days. Some patients for whom the
medication was prescribed died before administration, others waited to receive
it, and some cases were not properly notified 12.
Of the 859 people who
received lethal medication, 52.7% were men, predominantly in the age group
between 65 and 74, with higher education or post-graduation degree (45.9%). In
78% of the cases, the disease was cancer, followed by amyotrophic lateral
sclerosis (ALS) at 8.3%. Most patients died at home (94.6%) and received
palliative care. The most common concerns of these patients were loss of
autonomy, mentioned by 91.5% of them, loss of ability to participate in
activities that make life enjoyable (88.7%) and loss of dignity (79.3%).
In March 2009, the State
of Washington approved its “Death with Dignity Act”, almost identical to the
one from Oregon, by which competent adults living in the area, with a life
expectancy of six months or less, may require self-administration of a lethal
medication prescribed by a doctor. From 2009 to 2014, 724 people received
prescriptions for lethal medication, of these, 712 died after
self-administration. The situation of patients who received the prescriptions
but did not use them is unknown. As in Oregon, the statistics show, among the
deaths, a higher incidence of men between 65 and 74 of age, with high
education. The predominant underlying disease was also cancer, followed by
neurodegenerative diseases
In the state of Montana,
the Supreme Court ruled on the 31st December 2009, that
assisted suicide was not illegal, after the case of the patient Robert Baxter,
a 76-year-old retired truck driver, carrying a terminal form of lymphocytic
leukemi. Unlike other states, Montana law is not as well-regulated on the
subject. According to the Supreme Court, patients should be adults, mentally
competent and suffer from terminal illnesses to request lethal medication. The
act is secured by rights of privacy and dignity established by the
constitution, and the doctors who assist are also protected by law.
In Vermont, assisted
suicide was legalized on the 20th May 2013 by Act 39 –
regarding “patient choice and control at end of life”. The Departamento de
Saúde estadual (state Department of Health) suggested that by 2016, physicians
and patients were gradually adhering to the proposal of the Act, since many
hospitals opted out, stating they were not ready to implement it. In any case,
the right to assisted death is reserved for adult patients, residents of
Vermont, with life expectancy shorter than six months, who are able to
voluntarily request and self-administer the medication dose.
On the 5th October
2015, Jerry Brown, governor of California, signed the Assembly Bill No. 15,
also referred to as the “End of Life Option Act”, allowing assisted suicide for
competent adults, residents in the state, with terminal illnesses and life
expectancy of less than six months. The law, which came into force in 2016, was
based on the Act from Oregon, from 1997. Its approval resumed old discussions
about assisted death. At the time the law was passed, the governor stated that,
in the end, he was led to reflect on how he would act in the face of his own
death. The governor declared that he would not know what to do if he was dying
with prolonged and excruciating pain. Also, he pointed out that it was
comforting to be able to consider the options offered by the Oregon Act and
would not deny that right to others
In February 2015, after
six years of debate in the Supreme Court, with the cases of patients Kay Carter
and Gloria Taylor, Canada suspended the ban on euthanasia and assisted suicide.
A grace period of one year was established, during which the federal and
provincial government of Canada, as well as health professionals, were to
prepare themselves to implement the new law. In January 2016, the deadline was
extended for four months, extending the official legalization of assisted death
and the deadline for provincial governments to establish their guidelines to
the 6th June. If this does not happen, the activity is going to
be legal in the country, but not regulated in certain provinces, which will
give physicians freedom to modify their own behaviour. Moreover, by that date,
in un-regulated territories, aid to assisted death can be obtained through
legal concessions.
Quebec was the first
province to regulate assisted death through the “Act Respecting End-of-Life
Care”, which entered into force in December 2015. Approved in the previous
year, and based on Oregon’s legislation, the Act covers capable adults who were
diagnosed with serious and incurable diseases, advanced and irreversible
decline of their capabilities, and intense physical and psychological
suffering. However, it does not require a maximum life expectancy of six
months. According to the Act, “medical aid in dying” is the administration by a
physician, of a lethal substance, following the patient’s request. This
practice characterizes active voluntary euthanasia, although the term is not
used explicitly in the document. The Canadian media announced in January 2016
that the first case of assisted death was confirmed by health authorities in
Quebec, which did not provide information about the procedure and the patient’s
profile.
The other Canadian
territories have also mobilized themselves for the regulation of assisted
death. In November 2015, a group created by the provincial government issued an
advisory report to the provinces, aiming to draw up their own guidelines.
In January 2016, the
College of Physicians and Surgeons of Ontario published the “Interim Guidance
on Physician-Assisted Death”, regulating euthanasia and assisted suicide, with
criteria similar to those adopted by Quebec In the same month, in a press
article, a lawyer from the Canadian Justice Department expressed his concerns regarding
the new changes. According to him, the country will face a major challenge in
the management of issues related to assisted death, as the country’s health
policies are regulated by provincial laws, while criminal laws are under
national jurisdiction. To avoid problems, authorities suggested unified
national guidelines, despite the short time to regulate.
In April 2002, both
euthanasia and the assisted suicide were regulated and became no longer
punishable in the Netherlands, after more than thirty years of debate. Before
legalization, these practices were tolerated for a few decades, having been
reported by Dutch doctors since 1991.
The process of assisted
death should fit into several criteria very similar to those applied in Belgium
and Luxembourg. In all three countries, the patient must be competent, carry
out the request voluntarily, and have chronic conditions that cause intense
physical or psychological suffering. The physician should inform the patient
about his or her health status and life expectancy and, together, reach the
conclusion that there is no reasonable alternative. Also, another doctor should
be consulted about the case, and all procedures should be reported to the
authorities.
People with dementia are
also eligible, as well as children, aged between 12 and 17, with proven mental
capacity. Parents or guardians must also agree to act in the case of patients
between 12 and 15 years old, and join the discussions for patients between 16
and 17 years old. In some specific circumstances, assisted death may also apply
to newborns, according to the regulations of the “Groningen Protocol”, from
2005.
Between September 2002
and December 2007, 10,319 cases were reported. Of these, 54% were male, 53%
were between 60 and 79 years old and 87% were diagnosed with cancer in
2013, 4,829 cases were reported, and 78.5% of these occurred at home. In recent
years, five doctors (0.1% of cases) were judged for not fulfilling the criteria
set out in the legislation.
Since September 2002, voluntary
euthanasia has been allowed in Belgium for mentally competent people, suffering
from incurable conditions, including mental illness, which cause unbearable
physical or psychological suffering. The assisted suicide is not explicitly
regulated by law, but cases reported to the Comissão Federal de Controle e
Avaliação de Eutanásia (Federal Evaluation and Control Commission for
Euthanasia) are treated the same as euthanasia.
The Belgian legislation
is similar to the Dutch one, however, if the patient is not terminal, the
doctor should consult an independent third-party specialist, and at least one
month should pass between the patient’s request and the euthanasia procedure.
On the 13th February
2014, Belgium removed the age restriction for euthanasia, despite strong
opposition from religious people and from some members of the medical
profession. Before this change, the legislation of euthanasia already applied
to adolescents over 15 years old, legally emancipated by legal decree. In any
case, in the last twelve years, the Federal Commission reported only four cases
involving patients younger than 20, and none of them was a child.
With the new legislation,
children of any age may require euthanasia, provided they are able to
understand the consequences of their decisions, as certified by a child
psychologist or psychiatrist. The child must be in terminal condition, with
constant and unbearable physical suffering, which cannot be relieved. The
child’s decision should be supported by their parents or legal guardians, who
have veto rights. Although the age restriction is not imposed by law, the child
must show discernment capacity and be conscious at the time of making the
request. These prerequisites limit the range of children who might qualify, and
the forecast is that the changes, although very important, will not have such a
significant impact.
According to the Federal
Commission between 2010 and 2014, reported cases almost doubled, increasing
from 953 to 1,807. The prevalence remains men, aged between 60 and 79, with
cancer; however, a recent study showed increased requests from patients older
than 80 and with other diseases. Furthermore, it is estimated that 44% of
assisted deaths occur in hospitals, 43% at home and 11% in nursing homes.
On the 16th March
2009, euthanasia and assisted suicide were legalized in Luxembourg, and are
currently regulated by the Comissão Nacional de Controle e Avaliação (National
Commission for Control and Assessment). The law covers competent adults, people
with incurable and terminal diseases that cause physical or psychological
constant and unbearable suffering, with no possibility of relief.
The patient must request
the procedure through his or her “end-of-life provisions”, which is a written
document that is obligatorily registered and analysed by the Comissão Nacional
de Controle e Avaliação (National Commission for Control and Assessment). The
document also allows the patient to record the circumstances in which he or she
would like to be submit to assisted death, which is performed by a physician
who the applicant trusts. The request may be revoked by the patient at any
time, and in this case will be removed from the medical record. Before the
procedure, the physician should consult another independent expert, the
patient’s health team, and a “trusted person” appointed by the patient; after
its completion, the death must be reported to the Commission within eight days
According to the
Commission’s last report, between 2009 and 2014, 34 cases of assisted death had
been registered. Of these, 21 were female, predominantly aged between 60 and
79; 27 had cancer and 22 underwent the procedure in a hospital.
Assisted suicide is
permitted in Switzerland and, in accordance with Article 115 of the Código
Penal (Penal Code) of 1918, the practice is only punishable when performed for
“non-altruistic” reasons. Unlike other countries, such as the Netherlands, and
some US states, assisted suicide is not clearly regulated, and there are no
specific laws that determine under what conditions a person can request
assistance
Although Article 115 was
not originally developed for the regulation of this practice, from the 1980s
onwards many institutions who support assisted death used it as a basis to
justify their actions. Currently, six active institutions are responsible for
most cases of assisted suicide in the country, with different criteria for
selecting candidates .
Only three institutions
restrict the procedure for terminally ill patients, and in four of them
foreigners can also undertake the procedure. It is estimated that between 2008
and 2012, 611 foreigners, including a Brazilian, 268 from Germany and 126 from
the UK, received lethal medication. During this period, foreigners accounted
for almost two-thirds of all cases . The service has attracted a
considerable number of patients, called “suicide tourists”, to the country. In
the UK, for example, the term “going to Switzerland” has become a euphemism for
assisted suicide
The procedure is also
allowed for people with mental illness, but the Supreme Court requires a
psychiatric report stating that the patient’s suicide desire was
self-determined and well considered, and is not part of their mental disorder.
Doctors who prescribe the
drug are responsible for the process and should always inform patients about
their condition and possible alternatives. However, a well-established
doctor-patient relationship is not prerequisite for practice, and usually these
doctors are not present at the time of death.
All countries, except
Switzerland and the state of Montana (US) require notification of cases of
assisted suicide and regular release of public reports. However, recent studies
show that the user’s profile differs from other countries: assistance is predominant
amongst women, and the percentage of cancer patients is lower. Euthanasia is
prohibited in Switzerland in accordance with Article 114 of the Código Penal
(Penal Code).
Although not yet
regulated in Brazil, the topic has been widely discussed among physicians,
philosophers, religious people and legal professionals who seek the best way to
insert the issue in our legal system. Euthanasia is considered a crime of
murder, according to the Article 121 of the Código Penal (Criminal Code), and,
depending on the circumstances, the conduct of the agent can also be configured
as a crime of inducement, instigation or assistance to suicide, as stated in
Article 122. Furthermore, in accordance with Article 41 of the sixth Código de
Ética Médica (Code of Medical Ethics), it is forbidden for physicians to
shorten the patient’s life, even if upon their request or that of their legal
representative. The Code also points out that, in cases of incurable and
terminal illness, the physician should offer all palliative care available
without undertaking useless or obstinate diagnostic or therapeutic actions.
It is noteworthy that, as
claimed by Felix, Costa, Alves Andrade, Duarte and Brito, orthothanasia
(sometimes used as a synonym for “passive euthanasia”) is well secured by the
Constitution, as it aims to ensure a dignified death for the terminal patient,
who has the autonomy to refuse inhuman and degrading treatment .
The Conselho Federal de
Medicina (Federal Council of Medicine) also made its position clear on the
subject. Resolution 1805/2006 allows the physician to limit or suspend
procedures and treatments that prolong the life of terminally ill patients,
respecting the will of the person or their legal representative. It also
ensures that the patient continues to receive all the care necessary to relieve
suffering, assuring them comfort, comprehensive care and right to be
discharged . Resolution 1995/2012, valuing the principle of patient
autonomy, provides for an advance directive (or living will), ensuring its
prevalence over any other non-medical opinion, including the wishes of the
family. The directives are defined by the resolution as a set of
desires, previously and expressly manifested by the patient, regarding the care
and treatment they want, or do not want, to receive when they are unable to
freely and autonomously express their will 40,42.
The UK does not
officially allow assisted death, although in recent years discussions on the
subject have been very frequent 43.
Recent research shows that the majority of the population, including much of
the medical profession, is in favour of assisted suicide 43.
However, in the last decade, the British Parliament rejected several proposals
for its regulation 2.
The last of them, the “Assisted Dying Bill”, prepared by Lord Falconer, was
rejected by the lower house in September 2015 44.
The document, based on the Oregon legislation, proposed the legalisation of
assisted suicide (but not of euthanasia) for competent patients, over 18 years
old, with a life expectancy of less than six months 43,45.
Active euthanasia is
considered a crime of murder, and according to section 2 of the Suicide Act
1961, assisting it is punishable by up to 14 years in prison 2,46.
However, in February 2010, the Crown Prosecution Service introduced new
guidelines on assisted suicide, after the case of Debbie Purdy. She was
diagnosed with multiple sclerosis in 1994, and wanted to know if her husband
would be charged if he accompanied her to Switzerland to receive lethal
medication. The new guidelines state that assisting a suicide may, in some
cases, be decriminalized, for example, if the assistance is out of compassion,
and the decision of death is voluntary, conscious, well thought out and
communicated to the authorities 2,47.
Even after this resolution, legal conflicts continue to occur. In 2013, for
example, the wife and the son of a man were arrested for trying to take him to
a clinic of assisted death in Switzerland 42.
Abstract
Background: Studies show that patient requests for physician-assisted
suicide (PAS) are a relatively common clinical occurrence. The purpose of this
study was to describe how experienced physicians assess and respond to requests
for assisted suicide.
Methods: Focused ethnography in the offices of 11 acquired
immunodeficiency syndrome physicians, 8 oncologists, and 1 hospice physician
who had received requests for assisted suicide in their practice. Ten had
facilitated PAS.
Results: Informants had a similar approach to evaluating patients who
requested assisted suicide, often asking, "Why do you want to die
now?" Reasons for requests fell into 3 broad categories: physical
symptoms, psychological issues, and existential suffering. Physicians thought
they competently addressed patients' physical symptoms, and this obviated most
requests. They treated depression empirically and believed they did not assist
depressed patients with assisted suicide. Physicians had difficulty addressing
patients' existential suffering, which led to most facilitated requests.
Informants rarely talked to colleagues about requests for assisted suicide,
suggesting a "professional code of silence."
Conclusions: Regardless of divergent attitudes about PAS, physicians respond
similarly to requests for assisted suicide from their patients, creating a
common ground for professional dialogue. Our sample addressed physical
suffering aggressively, treated depression empirically, but struggled with
requests arising from existential suffering. A professional code of silence
regarding PAS creates professional isolation. Clinicians do not share knowledge
or receive social support from peers about their decisions regarding assisted
suicide. Educational strategies drawing on approaches used by experienced
clinicians may create an atmosphere that enables physicians with divergent
beliefs to discuss this difficult subject.
in 2015 the issue of assisted death was widely
publicized by the international media after the first legal euthanasia case was
held in Colombia. Also in this same year, assisted suicide was legalized in
Canada and in the state of California in the United States. Currently, assisted
death is allowed in four Western European countries: Netherlands, Belgium,
Luxembourg and Switzerland; two North American countries: Canada and the US, in
the states of Oregon, Washington, Montana, Vermont and California; and
Colombia, the sole representative in South America. From a systematic
literature review, this work aims to establish the prevalence and the criteria
adopted for the practice of euthanasia and assisted suicide in western countries
and to discuss the position of similar countries where this practice is not
recognized. A better understanding of the subject appears to be critical to the
formation of opinions and the encouragement of further discussions.
FINAL
CONSIDERATIONS
With the increase in
population life expectancy, the cases of chronic and disabling diseases also
increase. Added to this, a stronger focus on humanized medicine and palliative
care prompted debates on quality of death in many countries. In this scenario, assisted
death is a current, and still very controversial, topic.
In the Western World,
euthanasia and/or assisted suicide are legal in some countries. Although the
criteria adopted for these practices are different in each location, the
profile of patients who seek assistance is almost invariably the same.
In Brazil, assisted death
is not legalized, but the debate is timely, among other reasons, due to the
anticipated growth of the elderly population in the coming years, which will
also increase the number of chronic and disabling diseases. It is estimated
that in 2020 the country will be the sixth largest in the number of
elderly 48.
This data is worrying, since the quality of death in Brazil is considered poor
and undeveloped 48,49.
Therefore, we consider that improvements in terminal patient care are
imperative, regardless of the debate in question.
The UK also criminalizes
assisted death. However, in recent years, discussions on the subject have
become increasingly frequent. The British Parliament refused various
legalization proposals, although surveys indicate that the majority of the
population is in favour of change. Still, unlike Brazil, the UK leads the
ranking of the most developed countries in the care of patients at the end of
life and is considered a world reference in palliative care 48,49.
During the writing of
this paper, the first case of euthanasia in Colombia took place, assisted
suicide was recognized in Canada and in the state of California in the United
States, and the state of New Mexico repealed the decision of legalization. That
said, we suggest updated research be done at regular intervals.
The issue of assisted
death is broad and multifaceted; therefore, the analysis of the data from the
countries presented should consider the context in which they are, valuing
historical, religious, socioeconomic and cultural aspects. Moreover, the
discussion raises awareness regarding human finitude, making room for the
timely and favourable development of palliative care services, and stimulating
consideration of important bioethical issues such as the right to death and the
patient’s autonomy; the sacredness of life; the doctor-patient relationship;
the principles of beneficence and non-maleficence; and issues related to the
regulation of the practice itself.
Finally, we hope that
this review represents an updated source of assisted death scenario in the
Western World, allowing for more comprehensive and critical view on the
subject.
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