Euthanasia-on-demand could be legalised in Canada and Germany, while Spain and Portugal debate legalising assisted suicide

Assisted suicide advocates are seeking to legalise the practice in Spain and Portugal while expanding the availability in Canada and Germany.

Euthanasia-on-demand could become available in Canada and Germany for the majority of the general population, showcasing how, once introduced in law, assisted suicide regimes often expand significantly either through the courts or parliament.

Canada

The Canadian Government has tabled a bill that, if approved, would expand the country’s assisted suicide regime to include people without a terminal illness.

The legislation comes after the Quebec Superior Court ruled last year that a safeguard requiring patients to prove their natural death was “reasonably foreseeable” was unconstitutional.

According to Reuters, the bill will now “remove the requirement for a person’s natural death to be reasonably foreseeable in order to be eligible for medical assistance in dying,” opening up assisted suicide to those who aren’t terminally ill.

Disability advocates, including the Council of Canadians with Disabilities, have said the court’s decision sent the message that “having a disability is a fate worse than death”.

A recent report by the Special Rapporteur on the rights of persons with disabilities in Canada highlighted very troubling concerns about the impact Canada’s assisted suicide laws are having on people with disabilities.

According to the report, “The Special Rapporteur is extremely concerned about the implementation of the legislation on medical assistance in dying from a disability perspective. She has learned that there is no protocol in place to demonstrate that persons with disabilities deemed eligible for assistive dying have been provided with viable alternatives.”

The report goes on to say: “moreover, she [the special rapporteur] has received worrisome information about persons with disabilities in institutions being pressurised to seek medical assistance in dying and of practitioners not formally reporting cases involving persons with disabilities.”

During her visit, the Special Rapporteur said people with disabilities told her “they are being offered the ‘choice’ between a nursing home and medical assistance in dying”.

More than 13,000 Canadians have been given a medically-assisted suicide since it was legalised in September 2016, according to the data from the justice department.

Ethical concerns were raised earlier this year when it was revealed the legalisation of assisted suicide in the country had resulted in a surge of organ donations and the open solicitation of those considering medically assisted death.

In Ontario, a hospital has faced criticism for advertising euthanasia in an urgent care waiting room.

An alarming study has found that the legalisation of assisted suicide could save the Canadian health care system up to $138 million per year.

According to the Alzheimer’s Society of Canada, over 500,000 Canadians live with dementia, with 25,000 new cases diagnosed each year.  It currently costs more than $10 billion per year to care for those in Canada’s health system.  

Germany

A five-year-old law banning professional assisted suicide in Germany has been declared unconstitutional by the country’s top court.

In 2015, Germany’s parliament voted to amend paragraph 217 of the country’s criminal code to add in safeguards preventing groups or individuals creating a form of business that profited from assisted suicide.

However, in its ruling on Wednesday, the Federal Constitutional Court declared Germany’s constitution includes a right to a self-determined death which encompasses the freedom to take one’s own life and use assistance provided voluntarily by third parties.

The Government must now draw up new laws to reflect the legality of assisted suicide in the country.

The German Medical Association opposed any relaxing of Paragraph 217, warning it could open the door to euthanasia, where doctors take an active role in helping a patient die – for example through lethal injection.

The head of Germany’s Palliative Medicine Society, Heiner Melching, said that overturning the ban on professional assisted suicide could also open the door to “self-styled euthanasia assistants”.

The court stressed however that legislators still had “a broad spectrum” of options to regulate assisted suicide, for instance through mandatory waiting periods or through introducing other safeguards in law.

Portugal

Last week, Portugal’s parliament moved closer to legalising assisted suicide and euthanasia after voting in favour of five “right-to-die” bills. 

The details of the bill will now be discussed in detail and amended by the parliament’s constitutional affairs committee, after which it will be subject to a final vote.

President Marcelo Rebelo de Sousa can veto any new law passed by the Government, but the country’s parliament can override his veto by voting a second time for approval.

Francisco Guimaraes, a 21-year-old protestor, told Reuters that he believes “life is an inviolable asset, human life has an inviolable value, consecrated by our Portuguese constitution.”

“We must care for life until it comes to its natural end,” he added.

Spain

The lower chamber of Spain’s parliament, the Congress of Deputies, has voted in favour of considering a bill that would legalise assisted suicide and euthanasia in cases of “clearly debilitating diseases without a cure, without a solution and which cause significant suffering.”

The bill will now go to the upper chamber of Spain’s parliament, the Senate, for a final vote with assisted suicide activists hoping it will be approved by June.

Rocio Monasterio, the leader of the Madrid branch of the Spanish political party Vox, told Reuters her party would mount “fierce” resistance to the bill, which she said would allow people whose life was no longer considered useful to be “eliminated”.

A spokesperson for Right To Life UK, Catherine Robinson said:

“You can learn a lot from paying close attention to countries and other places where assisted suicide and euthanasia has been legalised. What we often see is that death soon starts to appear as an all-too-acceptable solution to all sorts of conditions and, alarmingly, emotional situations.

“Every year there is a significant increase in the number of people being euthanised or helped to commit suicide by their doctors. This is compounded by the fact that once assisted suicide has been legalised for one category of people, it is often only a matter of time before it is extended to others, whether it is imposed through the courts or Government.

“In Belgium and the Netherlands doctors now routinely end the lives of patients suffering from psychiatric illness, with no underlying physical illness. 

“Recently, The Telegraph and the Daily Mail reported that a Dutch family held down their mother as she fought against being euthanized by her doctor.

“Cases like these aren’t one off rarities but are becoming commonplace and have even prompted Theo Boer, a medical ethicist at the University of Groningen, to issue a warning to countries considering legalising assisted suicide and euthanasia.

“‘Look closely at the Netherlands because this is where your country may be 20 years from now,’ he said.

“Furthermore, evidence from Canada demonstrates how a so-called ‘right to die’ can become a ‘duty to die’. Feelings of being a burden were cited in 55% of Oregon and 56% of Washington assisted-suicide requests in 2017.

“This is especially the case when families and health budgets are under financial pressure, which makes the Canadian study which found that the legalisation of assisted suicide could save the health care system more than $138 million per year so alarming.

“Legalising assisted suicide would likely lead to pressure on vulnerable people to choose the quicker, cheaper option of death over palliative care.”

Royal College of GPs will remain opposed to assisted suicide

The Royal College of General Practitioners (RCGP) will continue to oppose a change in law on assisted suicide, following a consultation of its members.   

The RCGP’s consultation, conducted independently by Savanta ComRes, was sent to almost 50,000 members, who were asked whether RCGP should change its current position of opposing a change in the law on assisted dying.

Just under half (47%) of those surveyed said the College should not change its position, while 40% said it should support a law change providing there is a regulatory framework and appropriate safeguarding processes in place.

11% of respondents said the RCGPs should be neutral, while 2% abstained.

The RCGP Council agreed that the survey results did not support a change in the RCGP’s existing position on assisted suicide.

Professor Martin Marshall, Chair of the Royal College of GPs, said: “Assisted dying is a controversial topic and this was reflected in the responses to our consultation. However, the highest proportion of respondents said that the College should continue to oppose a change in the law on assisted dying…

“The role of the College now is to ensure that patients receive the best possible palliative and end of life care, and to this end we are working with Marie Curie and others to support this.”

In a victory for pro-life campaigners, the RGCP declared it will not review the College`s position on assisted suicide for at least five years unless there are significant developments on the issue.

The medical body last consulted members on the issue in 2013, when the majority said the college should remain opposed.

Currently, no professional medical body supports changing the law on assisted suicide, which is illegal in the UK.

However, activists have been attempting to introduce assisted suicide legislation to the UK through the courts, medical bodies and parliament.

The British Medical Association (BMA) is currently surveying its member’s views on assisted suicide.  The results of the BMA survey, which closes on 27 February, will be discussed at this year’s annual conference in June and could see the professional body changing its current policy on assisted suicide.

Currently, the BMA believes that “the ongoing improvement in palliative care allows patients to die with dignity … [and] insists that physician-assisted suicide … voluntary euthanasia … [and] non-voluntary euthanasia should not be made legal in the UK.” 

However, the BMA is now asking its 160,000 members:

“whether they believe the BMA should support, oppose, or take a neutral stance on a change in the law to permit doctors to prescribe drugs for eligible patients to end their own life … [and] about a stance to a change in the law to permit doctors to administer drugs with the intention of ending an eligible patient’s life.”

The doctors’ union has had a policy opposing assisted suicide since the 1950s, but very briefly became neutral on the issue in 2005.

Since then, the BMA has been opposed to all forms of assisted suicide – a position they reaffirmed in 2016 at the organisation’s annual representative meeting.

In a letter published in The Times, a large group of prominent palliative care doctors have called on the BMA to uphold their duty of care and remain opposed to assisted suicide.

The Royal College of Physicians dropped its long-standing opposition to assisted dying in favour of neutrality following a 2019 membership survey, despite continued opposition to assisted suicide being the most favoured position among those surveyed. The change in stance from the college is currently the subject of a legal challenge.

In November, the High Court rejected to hold a judicial review of the current law on assisted suicide, with judges stating the court was “not an appropriate forum for the discussion of the sanctity of life”. The Court of Appeal rejected an attempt to challenge this decision last month.

Similarly, in 2018, the Court of Appeal ruled that Parliament was a “better forum” than the courts for determining the issue of legalising assisted suicide.

Parliament has consistently rejected attempts by the assisted suicide lobby to introduce assisted suicide, with 330 to 118 voting against introducing assisted suicide in 2015. 

Just last month, strong opposition from MPs resulted in the Government rejecting a call for review on assisted suicide, despite the best efforts from large pressure groups in favour of assisted suicide.

Additionally, the Lord Chancellor Robert Buckland QC has recently confirmed the Government has “no plans” to introduce assisted suicide legislation, saying: “Personally, I have grave doubts about the ability of legislation to be watertight when it comes to the potential for abuse.”

Assisted suicide pressure groups cite a poll that shows there is widespread support for legislation of assisted suicide, yet experts have heavily criticised the polling as deeply flawed. In fact, when asked questions that drill down into the merits of the debate, the percentage of those in support drops dramatically.

Lord Chancellor rejects Government review into assisted suicide law amid ‘grave concerns’

The Lord Chancellor Robert Buckland QC has confirmed the Government has “no plans” to introduce assisted suicide legislation. 

In a letter to Dr Gordon Macdonald, the CEO of anti-euthanasia group Care Not Killing, Mr Buckland said: “Personally, I have grave doubts about the ability of legislation to be watertight when it comes to the potential for abuse.”

He added: “My predecessor was… supportive of a call for evidence but no call was initiated before he left office, nor… does the Government currently have any plans to initiate a call for evidence. This remains my position.”

Activists have been attempting to introduce assisted suicide legislation to the UK through the courts and through parliament.

In November, the High Court rejected a judicial review of the current law on assisted suicide, with judges stating the court was “not an appropriate forum for the discussion of the sanctity of life”. The Court of Appeal rejected an attempt to challenge this decision last month.

Similarly, in 2018, the Court of Appeal ruled that Parliament was a “better forum” than the courts for determining the issue of legalising assisted suicide.

Parliament has consistently rejected attempts by the assisted suicide lobby to introduce assisted suicide, with 330 to 118 voting against introducing assisted suicide in 2015. 

Just last month, strong opposition from MPs resulted in the Government rejecting a call for review on assisted suicide, despite the best efforts from large pressure groups in favour of assisted suicide.

Assisted suicide pressure groups cite a poll that shows there is widespread support for legislation of assisted suicide, yet experts have heavily criticised the polling as deeply flawed. In fact, when asked questions that drill down into the merits of the debate, the percentage of those in support drops dramatically.

In addition to lobbying the Government and parliament, activists have been seeking to lobby medical bodies in the UK.

Not a single doctors group or major disability rights organisation in the UK supports changing the law, including the British Medical Association (BMA), the Royal College of General Practitioners, the Royal College of Physicians, the British Geriatric Society and the Association for Palliative Medicine. 

The Royal College of Physicians dropped its long-standing opposition to assisted dying in favour of neutrality following a 2019 membership survey, despite continued opposition to assisted suicide being the most favoured position among those surveyed. The process used by the College is currently subject to a legal challenge. Meanwhile, the results of a recent poll by the Royal College of General Practitioners (RCGP) are due to be released later this month.

The BMA, which is currently opposed to assisted suicide, has launched its first ever survey on the issue. The poll will ask their 160,000 members for their views “on whether the BMA should adopt a neutral position with respect to a change in the law on assisted dying”. The results of the British Medical Association survey will be announced in July at the medical bodies Annual Representatives Meeting. 

Assisted suicide pressure group Dignity in Dying (formerly the Voluntary Euthanasia Society), which spent over £1,600,000 last year, said in an email to supporters “that the poll is happening is a significant win” for their campaign. Meanwhile, a large group of palliative care doctors have written to The Times calling on the BMA to continue opposing the involvement of doctors and that assisted dying will not become a medical intervention in the UK.

A spokesperson for Right To Life UK, Catherine Robinson said: 

“Despite the best efforts of well-resourced assisted suicide activists, who continue to seek legislative change through lobbying the courts, medical bodies and parliament, there is currently no appetite for such laws from any group. 

“The concerns raised by a large number of MPs last month highlighted just a small number of the reasons why the Government should look away from assisted suicide and instead fund better hospice and palliative care. 

“Any legislative change could place many vulnerable people at risk of abuse and put pressure on those with terminal and chronic illnesses and on the disabled to end their lives prematurely.

“Evidence from Oregon demonstrates how a so-called ‘right to die’ may become the ‘duty to die’. Feelings of being a burden were cited in 55% of Oregon and 56% of Washington assisted-suicide requests in 2017.

“This is especially the case when families and health budgets are under financial pressure, which makes the Canadian study which found that the legalisation of assisted suicide could save the health care system more than $138 million per year so alarming.

“Legalising assisted suicide would inevitably lead to pressure on vulnerable people to choose the quicker, cheaper option of death over palliative care.”

Large group of palliative care doctors call on BMA to remain opposed to assisted suicide

A large group of prominent palliative care doctors have called on the British Medical Association (BMA) to uphold their duty of care and remain opposed to assisted suicide.

The call comes as the BMA has launched a new survey of its members on the issue. The results of the BMA poll, which closes on 27 February, will be discussed at this year’s annual conference in June and could see the professional body changing its current policy on assisted suicide.

Currently, the BMA believes that “the ongoing improvement in palliative care allows patients to die with dignity … [and] insists that physician-assisted suicide … voluntary euthanasia … [and] non-voluntary euthanasia should not be made legal in the UK.” 

The doctors’ union has had a policy opposing assisted suicide since the 1950s, but very briefly became neutral on the issue in 2005.

Since then, the BMA has been opposed to all forms of assisted suicide – a position they reaffirmed in 2016 at the organisation’s annual representative meeting.

However, the BMA will now ask its 160,000 members:

“whether they believe the BMA should support, oppose, or take a neutral stance on a change in the law to permit doctors to prescribe drugs for eligible patients to end their own life … [and] about a stance to a change in the law to permit doctors to administer drugs with the intention of ending an eligible patient’s life.”

In a letter published in The Times, over 50 palliative care doctors and healthcare professionals said the existing law, which prohibits any form of assisted suicide or euthanasia, “ensures that doctors continue to uphold their duty of care, avoiding the inherent risks to sick and vulnerable patients that physician assisted suicide would bring”.

The doctors also used the letter to highlight how safeguards are ignored and eligibility criteria is soon expanded in countries that allow assisted suicide. Referencing Canada, the doctors say: 

“Canada’s Federal government has consulted on expanding assisted dying laws to the mentally ill, to ‘mature minors’ and individuals whose deaths are not imminent. Meanwhile Canadian hospices are facing pressure to provide assisted death or risk losing their funding.”

Activists have been attempting to introduce assisted suicide legislation to the UK through the courts, medical bodies and parliament.

The Royal College of Physicians dropped its long-standing opposition to assisted dying in favour of neutrality following a 2019 membership survey, despite continued opposition to assisted suicide being the most favoured position among those surveyed. The process used by the College is currently subject to a legal challenge.

Meanwhile, the results of a recent poll by the Royal College of General Practitioners (RCGP) are due to be released later this month.

In November, the High Court rejected to hold a judicial review of the current law on assisted suicide, with judges stating the court was “not an appropriate forum for the discussion of the sanctity of life”. The Court of Appeal rejected an attempt to challenge this decision last month.

Similarly, in 2018, the Court of Appeal ruled that Parliament was a “better forum” than the courts for determining the issue of legalising assisted suicide.

Parliament has consistently rejected attempts by the assisted suicide lobby to introduce assisted suicide, with 330 to 118 voting against introducing assisted suicide in 2015. 

Just last month, strong opposition from MPs resulted in the Government rejecting a call for review on assisted suicide, despite the best efforts from large pressure groups in favour of assisted suicide.

Assisted suicide pressure groups cite a poll that shows there is widespread support for legislation of assisted suicide, yet experts have heavily criticised the polling as deeply flawed. In fact, when asked questions that drill down into the merits of the debate, the percentage of those in support drops dramatically.

The Lord Chancellor Robert Buckland said the government had no plans to launch an inquiry into current laws preventing euthanasia.

He added: “Personally, I have grave doubts about the ability of legislation to be watertight when it comes to the potential for abuse.”

Palliative care doctors letter in full:

Sir, Today the BMA launches a consultation surveying its members’ views on physician-assisted dying. Challenging individual cases have prompted calls to change the law. However, the existing law ensures that doctors continue to uphold their duty of care, avoiding the inherent risks to sick and vulnerable patients that physician-assisted suicide would bring. The NHS is already overloaded, struggling to serve an expanding ageing population without adequate funding for palliative care.

In other jurisdictions with legalised assisted dying, the picture is disturbing, and the World Medical Association recently reiterated its opposition to doctor-assisted dying. Canada’s federal government has consulted on expanding assisted dying laws to the mentally ill, “mature minors” and individuals whose deaths are not imminent. Meanwhile, Canadian hospices are facing pressure to provide assisted death or risk losing their funding. We understand that the medical profession cannot and should not dictate the law but are concerned that the public’s trust in doctors and medical institutions will lead our patients to equate assisted dying with good end-of-life care, as in Canada. We hope that the BMA will continue to oppose the involvement of doctors and that assisted dying will not become a medical intervention in the UK.

Prof Bill Noble, Consultant in Palliative Care; Dr Jim Gilbert, Consultant in Palliative Medicine; Dr David Randall, Registrar in Renal Medicine; Dr Alexander Cary GP Trainee; Dr Dominic Whitehouse, Consultant Physician in Palliative and Respiratory Medicine; Prof Rob George, Medical Director and Consultant in Palliative Care; Dr Alison Brooks, GP; Dr Aiofe Gleeson, Consultant in Palliative Medicine; Dr Robert Twycross, Emeritus Clinical Reader in Palliative Medicine; Prof David Oliver, Professor of Palliative Medicine; Prof Simon Noble, Professor of Palliative Medicine; Prof Irene Tuffrey-Wijne, Professor of Intellectual Disability and Palliative Care; Dr Amy Proffitt, Deputy Medical Director; Dr Mark Taubert, Consultant and Lead Clinician in Palliative Medicine; Dr Marina Malthouse, Consultant in Palliative Medicine; Dr Craig Gannon, Consultant in Palliative Medicine; Dr Rosemary Anthony-Pillai, Consultant in Palliative Medicine; Dr Kevin O’Kane, Consultant in Acute Internal Medicine; Dr Melody Redman, Junior Doctor in Paediatrics; Dr Fiona McCormick, Consultant in Palliative Medicine; Dr Simon Anderson, Consultant Gastroenterologist; Dr Angela Campbell, Consultant Geriatrician; Dr Luigi Camporata, Consultant in Intensive Care Medicine; Dr Peter Diem, Consultant Geriatrician; Dr Terrence Gibson, Consultant in Acute Internal Medicine; Dr Philip Howard, Consultant Gastroenterologist; Dr Mustafa Kadam, Registrar in Acute Internal and Stroke Medicine; Dr Iain Kennedy, GP; Dr Taryn Pile, Consultant Nephrologist; Dr Sanna Khawaja, Registrar in internal Medicine; Dr Ranjababu Kulasegaram, Consultant in HIV Medicine; Dr Roshan Navin, Consultant in Acute Internal Medicine; Dr Aysha Nazir, Registrar in Emergency Medicine; Dr Laura O’Sullivan, Registrar in Acute Internal and Intensive Care; Dr Farica Patel, Registrar in Acute Internal Medicine; Dr Richard Rawlins, Retired Consultant Orthopaedic Surgeon; Dr Shabaz Roshan, Consultant Geriatrician; Dr Nadia Short, Consultant in Acute Internal Medicine; Dr Fiona Stephen, Trainee in Emergency Medicine; Dr Duncan Brown, Medical Director and Consultant in Palliative Care; Dr Ollie Minton, Clinical Lead in Palliative Medicine; Dr Claud Regnard, Honorary Consultant in Palliative Care Medicine; Dr Chris Farnham, Consultant in Palliative Medicine; Baroness Sheila Hollins, Retired Consultant Psychiatrist; Dr Ellie Smith, Consultant in Palliative Medicine and Clinical Lead for Palliative Care; Dr Sarah Cox Consultant and Lead Clinician in Palliative Medicine; Dr Idris Baker, Consultant in Palliative Medicine; Dr Seamus Coyle, Community Consultant in Palliative Care; Dr David Brooks, Consultant in Palliative Medicine; Prof Scott Murray, Emeritus Professor of Primary Palliative Care; Dr Juliet Spiller, Consultant in Palliative Medicine; Prof Marie Fallon, Professor of Palliative Medicine