Emmanuel Macron will have to define the contours of the city conference on the end of life he promised on Tuesday 13 September. This assembly must, in the words of the President of the Republic, “to allow the company to take into account the essential developments on this immense topic”. On the same day, the National Ethics Advisory Committee (CCNE) must present a report on the matter.
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 restlessness, and allows dying people whose pain is too severe to receive “Deep and continuous sedation (…) kept until death.
► Belgium, the first country to legalize euthanasia
Since 2002, Belgium has decriminalized the act of a doctor actively accompanying a patient to the end of life. According to the legislation in force in the country, the doctor administers a lethal dose to the patient, intentionally ending his life. The procedure can be done at home or in the hospital. The healthcare professional assumes his or her responsibility.
The physician must also ensure that the patient has not been subjected to external pressure. The latter must be suffering from an incurable disease that causes physical and psychological suffering “unbearable, constant, which does not subside”. Since 2014, this regulation has evolved to extend the right to euthanasia to minors.
► In Switzerland, the role of associations
Switzerland admits assisted suicide. Patients thus administer a lethal dose by means of an infusion, a drinkable or injectable solution. These are associations that monitor active euthanasia and not doctors. Assisted suicide is conditioned on the patient’s ability to discern and the caregiver must not have it “selfish motives”.
► In Canada, an extensive right
Referred to as “medical assistance in death”, assisted suicide has been legal in Canada since 2016. Since 2021, however, significant changes have been introduced in the law, primarily the removal of the “Reasonably foreseeable death”.
Now it is enough for the patient to justify a serious and incurable illness to ask for assistance in dying if he considers his suffering unbearable. A physically disabled person can now apply for assisted suicide. People with mental illnesses are still excluded from this system, but the study of a new text concerning them could open as early as 2023.
► In the United States, little 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 that they are less than six months old.
► Spain and Portugal, recent opening of the right to euthanasia
On the other side of the Pyrenees, euthanasia has been decriminalized since 2021. A patient with “Serious and incurable disease”from “Serious, chronic and disabling disease certified by the attending physician” causing pain “unbearable” et “cannot be mitigated” may request euthanasia from a doctor.
In Portugal, a bill is being studied authorizing euthanasia and assisted suicide. Approved twice by the deputies, the text was rejected, as the president vetoed it. 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 in full possession of his faculties, can ask the doctor to stop the treatments that keep 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, despite 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 maintains a strong influence.
In Germany, parliament is currently working on a bill regulating the use of assisted suicide. He had affirmed a 2020 decision of the Constitutional Court in Karlsruhe “the right to choose one’s own death”. “This right includes the freedom to take one’s own life and seek assistance to do so”, then ruled the highest court in the country. Currently, legislation is being studied which establishes the conditions for this right.
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