In the Netherlands, assisted suicide was legalized in 2001. The law presupposes a long doctor-patient relationship and requires patients be legal residents of the Netherlands. It enshrines guidelines adopted by parliament in 1993 that require a clear statement from the patient indicating the choice to die is voluntary, rational and reasoned, that the suffering be unbearable with no prospect of improvement and that a second medical opinion concurs. Patients may request that euthanasia be performed if they become physically unable to make their wishes known when the time comes. This is intended to make sure patients have their wishes honoured, but also turns over to the physician discretion about when to perform death. Each case is reviewed by a commission comprising at least one lawyer, one doctor and one expert on medical ethics. Some 90 percent of the population backed the changes. Before the bill was adopted, doctors conducted an estimated 5,000 mercy killings a year in the Netherlands, but only a handful were ever prosecuted for misconduct. Surveys showed that doctors refuse far more requests to assist suicides than they accept.
In 1996, the Northern Territory of Australia passed the world's first voluntary euthanasia law. However, it did not survive the legal challenges from churches and conservative politicians and the aboriginal communities of the NT, who saw it as a threat to their cultural traditions. It was revoked in 1997 by the federal parliament. Polls in Australia showed at the time support for voluntary euthanasia in excess of 85%. Australia's leading euthanasia campaigner reportedly plans to set up a floating euthanasia clinic in a ship flying the Dutch flag in international waters off the Australian coast.
Several countries – Switzerland, Colombia and Belgium – tolerate euthanasia. A law legalizing euthanasia is awaiting presentation to the Belgian parliament. An opinion poll suggested that 80 percent of Belgians would approve the law, as are a large majority of MPs.
In the United States, Oregon became the first state in the USA to adopt a law making physician-assisted suicide legal in 1994. The law, which was made as an amendment to the state constitution, allowed terminally ill people to request a lethal dose of drugs if a doctor determined they had less than six months to live, the legal definition for terminally ill under the law. The patients had to administer the dose themselves. Doctors had to decide individually whether to comply with someone's request to die. The request had to be in writing and signed by two witnesses. And a second request, made orally, was required just before the prescription was written.
This measure did not take effect after a group of patients, physicians and other care givers challenged the law by arguing that it would allow sick people, especially those who were depressed, to be pressured into suicide. A federal district judge agreed the law was unconstitutional in 1995, ruling that the law discriminated against the terminally ill. That decision was reversed in 1997. The next phase of litigation would test whether the federal constitution grants a right to assisted suicide, which would bar individual states from criminalizing it. The case rests largely on guarantees of liberty versus equal protection and religious freedoms.
A network of medical ethics committees in San Francisco, a city with many AIDS patients, has drawn up a protocol for hastening death. A 48-hour waiting period, a patient consent form signed before a witness, and a checklist for the doctor to fill in are requirements. The doctor must ensure that the patient is mentally competent and expected to die within 6 months, has been offered high-quality pain relief, and that he has not been coerced by family, finances, health insurance or other pressures into choosing death.
Euthanasia is already widespread, but clandestine and unregulated.
It is normal that euthanasia should take place in secret, because it is wrong.
It is not a doctor's task to take a life, it's to save lives.
Perhaps the most troubling aspect of legalized euthanasia is the confusion of roles it may create for physicians. Doctors acting as agents of death and health at the same time can only undermine trust in the medical profession.
The question is not whether any of us must choose death but whether we may, and whether we can enlist our physician in the process.
Legalization of euthanasia may lead to an expectation that patients will use it.