Euthanasia and Assisted Dying Around the World

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açık Ekim 27, 2025

Summary:

As of October 27, 2025, countries take five broad approaches to end-of-life law: (1) full prohibition; (2) decriminalization of assisted suicide only (e.g., Switzerland, Germany via constitutional ruling); (3) tightly regulated assisted dying (self-administration) but not active euthanasia (e.g., New Zealand, many U.S. states, Australia (states)); (4) fully regulated euthanasia and assisted dying (e.g., Netherlands, Belgium, Luxembourg, Spain, Portugal, Colombia); and (5) mixed/transition models driven by courts with partial carve-outs (e.g., Italy, India for passive euthanasia). Key differentiators are eligibility (terminal vs. intolerable suffering), capacity checks, waiting periods, second opinions, reporting to review bodies, and conscientious objection. Canada’s regime (MAiD) remains one of the most expansive, but eligibility for mental illness as a sole condition is deferred to March 17, 2027.

Why the terms matter: legal taxonomy you can’t skip

Active euthanasia (a clinician administers a lethal medication) vs. assisted dying / physician-assisted suicide (PAS/MAiD) (the patient self-administers).
Passive euthanasia is usually treated separately: withholding/withdrawing life-sustaining treatment, often lawful under patients’ rights and advance directive rules even where active measures are criminal.
“MAiD” (Canada) groups euthanasia and assisted dying under one umbrella, whereas Australia and many U.S. states legalize assisted dying but not clinician-administered euthanasia.

Understanding that vocabulary is critical, because eligibility, safeguards, and review obligations attach to different acts in different systems.

Models by region — what’s legal, what isn’t, and how it’s supervised

A. The Benelux–Iberian model: regulated euthanasia and assisted dying

Netherlands. The Termination of Life on Request and Assisted Suicide Act (2002) allows both euthanasia and assisted suicide if stringent “due care” criteria are met (voluntary and well-considered request; unbearable suffering with no prospect of improvement; informed patient; lack of reasonable alternatives; independent second opinion; due medical care). Special rules apply to minors aged 12–16 (with parental consent) and 16–17 (parents informed). Each case is post-reviewed by regional committees.

Belgium. Since 2002, euthanasia has been lawful (for adults and, since 2014, minors in exceptional circumstances) under strict conditions: a voluntary, well-considered, repeated request; intolerable suffering that cannot be alleviated; and procedural safeguards including second opinions and paperwork filed with the Federal Commission for Control and Evaluation.

Luxembourg. The Law of 16 March 2009 authorizes euthanasia and assisted suicide for competent adults under defined conditions and review by a national commission.

Spain. Organic Law 3/2021 regulates euthanasia as a new individual right within the public health system for patients with serious, chronic, and disabling conditions or serious, incurable disease causing intolerable suffering. It imposes multiple consultations, a reflection period, and review by oversight bodies.

Portugal. After years of constitutional and political back-and-forth, Law No. 22/2023 created a carefully tiered system for medically assisted death, with a default preference for assisted suicide and euthanasia permitted where self-administration is impossible; layered assessments and waiting periods apply.

Practical takeaways (Benelux–Iberia):

Scope: Both euthanasia and assisted dying are possible.
Trigger: Not always “terminal illness” — “unbearable suffering” without prospect of improvement can suffice (evaluated case-by-case).
Minors: Limited pathways exist in Netherlands and Belgium with additional safeguards.
Oversight: Mandatory reporting to review commissions with powers to refer to prosecutors in case of non-compliance.

B. Switzerland, Germany, Austria, Italy: assisted suicide focus, divergent paths

Switzerland. Active euthanasia remains illegal; however assisted suicide is not punishable unless done for selfish motives under Article 115 of the Swiss Criminal Code. That narrow penal formulation enabled right-to-die organizations, with practice frameworks shaped by professional guidance and cantonal processes; acts where a third party administers the lethal dose remain criminal.

Germany. In 2020, the Federal Constitutional Court struck down §217 StGB (which had criminalized “business-like” assisted suicide), recognizing a right to a self-determined death and to seek assistance; Parliament’s 2023 attempts to re-criminalize or tightly regulate failed, leaving a patchwork governed by general criminal law and professional codes (euthanasia is still prohibited).

Austria. Following a 2020 constitutional ruling, Austria enacted the Sterbeverfügungsgesetz (StVfG) effective 1 January 2022, legalizing assisted suicide (not euthanasia) for adults meeting strict criteria (two medical assessments, capacity checks, waiting period—12 weeks or 2 weeks if death is imminent—then a notarized “death declaration” that unlocks access via pharmacies).

Italy. The Constitutional Court’s Judgment 242/2019 created a narrow constitutional defense (non-punishability) for assisted suicide when a fully capable patient suffers intolerable suffering from an irreversible condition, is dependent on life-sustaining treatment, and passes public-health vetting—pending parliamentary legislation. Regional steps (e.g., Tuscany 2025) attempt to operationalize the pathway; active euthanasia remains illegal.

Practical takeaways (DACH-Italy):

Assisted suicide framed by constitutional or penal law exceptions; euthanasia generally prohibited.
Administrative practice and medical codes are doing heavy lifting where the legislature has not acted.
Cross-border “travel for assistance” can raise complex jurisdictional and professional-ethics issues (especially vis-à-vis Switzerland).

C. The Americas: Canada’s expansive MAiD, Colombia’s judicial path, the U.S. state model

Canada (MAiD). Canada authorizes both clinician-administered and self-administered MAiD subject to detailed Criminal Code exemptions and federal–provincial care protocols. Key point for 2025: eligibility where mental illness is the sole underlying condition is deferred until March 17, 2027 by Bill C-62 (2024); current eligibility otherwise tracks serious and incurable conditions with enduring, intolerable suffering under robust safeguards (assessments, written requests, reflection periods, reporting).

Colombia. The Constitutional Court decriminalized euthanasia in 1997 (C-239) and required the health system to implement access; the Ministry of Health issued regulations in 2015. In May 2022, the Court decriminalized medically assisted suicide under similar conditions, making Colombia the first Latin American country to authorize both pathways.

United States (state-by-state). The U.S. does not have federal legalization. Instead, assisted dying (self-administration) is legal in a growing number of states (and D.C.) under “Death with Dignity” or similar terminal-illness statutes that require adult capacity, two physicians, written requests, and waiting periods; clinician-administered euthanasia is not permitted. (For foundational practice materials see Oregon Health Authority, which pioneered the model.) Several jurisdictions have lifted residency requirements (e.g., Vermont in 2023 court settlement; Oregon by 2022–23 policy change), shaping cross-state access.

Practical takeaways (Americas):

Canada is comprehensive but not yet open to mental-illness-only cases until 2027.
U.S. access hinges on terminal prognosis; process is paper-heavy and physician-driven.
Colombia provides full judicially crafted access to both euthanasia and assisted suicide within the health system.

D. Oceania: New Zealand’s referendum model and Australia’s state-law architecture

New Zealand. The End of Life Choice Act 2019, commenced in 2021 after a binding referendum, enables assisted dying (self-administration or clinician administration) for competent adults with terminal illness likely to end life within 6 months, severe decline, and unbearable suffering, confirmed by two independent doctors (and a psychiatrist if capacity is in doubt); a Registrar and Review Committee oversee compliance.

Australia. All six states (Victoria, Western Australia, Tasmania, South Australia, Queensland, New South Wales) now operate Voluntary Assisted Dying (VAD) regimes; the ACT has legislated with commencement expected November 2025; the Northern Territory remains pending. The “Australian model” is tightly regulated (adult, decision-making capacity, advanced progressive disease expected to cause death—often within 6–12 months, multiple requests, independent assessments, mandatory training, and detailed reporting). Excellent consolidated references: QUT’s End-of-Life Law in Australia and national clinical toolkits.

Practical takeaways (Oceania):

NZ: national regime endorsed by referendum, with centralized oversight.
Australia: state legislation with broadly aligned eligibility and very prescriptive processes.

E. The UK, France and other evolving jurisdictions

United Kingdom. Assisting or encouraging suicide is a criminal offence under Section 2 of the Suicide Act 1961 (max 14 years), and courts have declined to declare the law incompatible with the ECHR (R (Nicklinson) v MoJ (2014)). The CPS publishes public-interest guidance affecting charging decisions, but no legalization is in force as of today.

France. France has moved toward a bespoke “aide à mourir” bill (assisted dying with strict criteria) since 2024; by mid-2025 the National Assembly approved a first reading, with the final contours and timing still in flux. Practitioners should track legislative calendars and decrees for any implementing rules.

India. India recognizes passive euthanasia and advance directives (living wills) through Supreme Court jurisprudence—anchored in Common Cause v. Union of India (2018)—with January 2023 modifications simplifying the procedure (fewer administrative steps, clearer hospital protocols). Active euthanasia remains unlawful.

Key design variables you must analyze in any jurisdiction

Eligibility trigger
- Terminal illness within a defined horizon (e.g., NZ six months; Australia six–twelve months; many U.S. states): narrower access, easier to standardize.
- Unbearable suffering with no prospect of improvement (Benelux, Spain, Portugal): broader access but highly individualized; hinges on clinical judgment and documentation.
Mode permitted
- Assisted dying only (self-administration): U.S. states, Australia, typically NZ.
- Euthanasia and assisted dying: Benelux, Spain, Portugal, Colombia.
- Assisted suicide decriminalized but euthanasia barred: Switzerland, Germany, Austria (with statutes or constitutional carve-outs).
Capacity & voluntariness checks
- Nearly universal two-physician assessment; psychiatric evaluation if doubt arises (explicit in NZ; often embedded in codes elsewhere).
Waiting/reflection periods
- Fixed windows (e.g., Austria’s 12-week/2-week rule) or multi-step request processes (e.g., Oregon-style).
Reporting & ex post review
- Mandatory notification to independent committees (e.g., Netherlands review committees; Belgium Federal Commission; NZ Registrar/Review Committee).
Conscientious objection
- Widely protected; systems typically require referral/transfer rather than forcing participation (express in Iberian/Benelux laws and NZ practice documents).
Special populations
- Minors: tightly limited (Netherlands 12+, Belgium exceptional pediatric access).
- Mental illness as sole condition: explicitly excluded or deferred in most systems (Canada delayed to 2027).

Country-by-country snapshots (practitioner quick read)

Netherlands: Euthanasia and assisted suicide lawful under the 2002 Act; “due care” criteria; minors 12–17 in tightly circumscribed ways; mandatory review committees.
Belgium: Euthanasia lawful for competent adults and, since 2014, minors in exceptional, vetted cases; Federal Commission oversight.
Luxembourg: 2009 law permits euthanasia/assisted suicide with commission review.
Spain: Organic Law 3/2021 establishes a public-system right to euthanasia under defined suffering criteria.
Portugal: Law 22/2023 regulates medically assisted death with a hierarchy favoring self-administration; euthanasia possible when self-administration is not.
Switzerland: Assisted suicide is unpunished unless selfishly motivated (Art. 115 SCC); euthanasia (active killing) remains prohibited.
Germany: §217 StGB invalidated (2020); no new statute as of mid-2023; assisted suicide possible under constitutional jurisprudence; euthanasia remains unlawful.
Austria: Assisted suicide legalized via StVfG (2022) with physician assessments, waiting periods, and notarized “death declaration.”
Italy: No statute; Judgment 242/2019 permits assisted suicide in narrow, supervised circumstances; regions like Tuscany have adopted implementing protocols. Euthanasia remains criminal.
Canada: MAiD covers both clinician-administered and self-administered; mental-illness-only eligibility deferred until March 17, 2027.
U.S. states & D.C.: Assisted dying permitted in a defined set of jurisdictions under terminal illness statutes; Oregon and Vermont have relaxed residency barriers through policy/litigation.
Colombia: Euthanasia decriminalized in 1997 (C-239); assisted suicide decriminalized in 2022; Ministry resolutions provide clinical pathways.
New Zealand: End of Life Choice Act 2019 (in force 2021), terminal-illness criteria, two independent doctors, national review.
Australia (states): VAD in all states; ACT commencement slated for Nov 2025; rigorous, multi-step compliance, and mandated training/reporting.
United Kingdom: Assisting suicide remains an offence (Suicide Act 1961 s.2); Nicklinson declined to judicially mandate reform; CPS policy affects prosecution discretion.
India: Passive euthanasia and advance directives recognized by Supreme Court; 2023 guidelines simplified hospital procedures; active euthanasia illegal.

Oversight architecture and compliance — what regulators actually check

Documentation trail. Statutes typically require a written, witnessed request (some jurisdictions forbid family members as witnesses), second medical opinion, and a cooling-off period.
Capacity and voluntariness. Expect repeated, recorded confirmations of voluntariness, and screening for coercion or treatable psychiatric conditions that might impair decision-making.
Alternatives offered. Guidelines often require documented discussion of palliative care, pain management, and hospice options before eligibility is confirmed.
Reporting & review. After the death, clinicians must often file a detailed report; review committees (e.g., in Netherlands/Belgium/NZ) may audit and, in rare cases, refer to prosecutors if criteria were unmet.
Conscience clauses. Many regimes protect conscientious objection, balanced by referral/transfer duties to avoid obstructing access (e.g., Iberia/Benelux models; formalized in NZ practice).

Edge cases and hard problems counsel should anticipate

Minors & mature-minor doctrines. Belgium’s pediatric access and Netherlands’ 12–17 pathways are outliers globally, each with amplified safeguards and parental involvement; case selection is exceedingly rare.
Mental illness as sole condition. Politically and clinically contentious. Watch Canada’s 2027 horizon; most other systems either exclude or require terminal/progressive somatic conditions.
Competence fluctuations & dementia. Many frameworks reject advance requests for euthanasia once competence is lost (some Benelux nuance exists, but practice is complex and scrutiny is high).
Cross-border access. Switzerland’s permissive Article 115 has long attracted foreign applicants, creating choice-of-law, professional discipline, and insurance questions.
Drug supply and professional training. Australia’s VAD and U.S. statutes often specify drug protocols, training/certifications, and pharmacy control; mishandling triggers coroner or disciplinary review.
Data transparency. Annual reports (e.g., Netherlands, Belgium, NZ States/Boards) are central to public oversight debates.

Litigation and reform trends to monitor in 2025

France’s assisted-dying bill (scope, eligibility, and clinician obligations) as it moves through bicameral scrutiny and implementation decrees.
Germany’s post-BVerfG vacuum: renewed legislative attempts could set nationwide criteria for assisted suicide while maintaining the ban on euthanasia.
Canada’s MAiD mental-illness debate ahead of March 2027, including readiness of assessment standards and safeguards.
Australia’s ACT commencement (Nov 2025) and refinement in state reporting after early coroner feedback (e.g., overdose control, contact-person roles).

Frequently asked (and Googled) questions — concise answers for clients

Is euthanasia the same thing everywhere? No. In Benelux/Iberia/Colombia, both euthanasia and assisted dying may be available; in Australia, NZ, and U.S. states, it’s typically assisted dying only; Switzerland/Germany/Austria permit assisted suicide within penal/constitutional contours; UK/India (active) prohibit it.

Do I have to be terminally ill? Often yes (NZ, Australia, U.S. states). Not in every regime: Netherlands, Belgium, Spain, Portugal emphasize unbearable suffering with no reasonable alternative; Colombia also recognizes non-terminal pathways.

What about psychiatric illness? Most regimes bar or severely limit mental-illness-only cases. Canada has postponed such eligibility to 2027 while building assessments and safeguards.

Can minors access it? In rare, highly regulated circumstances in Belgium and the Netherlands; elsewhere generally no.

How are abuses prevented? Multi-layered capacity checks, independent opinions, reflection periods, documentation, and ex post review by commissions (or ministry registrars). Breaches can be referred for prosecution or discipline.

Practical compliance checklist (counsel & clinic)

Terminology audit: Confirm whether the jurisdiction permits clinician administration, self-administration, or only non-punishable assistance under penal exceptions.
Eligibility matrix: Age; residency/citizenship (some require it); prognosis threshold (terminal vs. unbearable suffering); decision-making capacity; voluntariness; alternatives discussed.
Process map: Number and type of medical assessments; any mandatory training; waiting/reflective periods; manner of administration (self vs. practitioner).
Paper trail: Statutory forms, witness rules, documentation of counseling on palliative care and psychosocial supports.
Reporting & review: Filing deadlines to review commissions/registrars, data elements, cooperation with audits.
Conscience and referral: Objectors’ obligations to transfer or refer; employment policies and facility rules.
Risk controls: Medication custody (chain of control), “contact person” rules (Australia), and protocols for unused medication recovery.

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