Legislative Background: Medical Assistance in Dying (Bill C-14)
Annex D: Overview of Recent Foreign Medical Assistance in Dying Bills
| State or Country | Type of Medical Assistance in Dying | Eligibility Criteria | Safeguards |
|---|---|---|---|
| US States (Alaska, Arizona, Colorado, Hawaii, Iowa, Kansas, Maryland, Massachusetts, Minnesota, Missouri, Nebraska, New Hampshire (study), New Jersey, New York, North Carolina, Rhode Island, Tennessee (study), Utah, Wisconsin) (considered by or currently before State legislatures) | Physician-assisted suicide only | Patient must be terminally ill with less than 6 months to live Terminal disease: incurable / irreversible disease that will, within reasonable medical judgment, produce death within six months; Tennessee: at least 2 physicians must diagnose terminal condition (Mental disorders alone: not eligible) Adults only (except Hawaii: at least fifty years of age) No advance directives |
Approval of request: Attending physician + 1 consulting physician + mental health specialist if needed Oral + written requests; Iowa: for patients incapable of making oral request, a written submission to the attending physician will be required; Alaska: patients incapable of signing request may direct a proxy to sign on behalf; and oral requests may be made using various means (e.g. electronic devices); Tennessee: written request must be notarized Written request in prescribed form signed before 2 independent witnesses; Hawaii: if patient is in health care facility, 3rd witness designated by facility Time delays between oral requests, between written request and prescription Patient may rescind request at any time |
| South Australia (Adjourned at Second Reading in June 2016) | Voluntary euthanasia | Patients must be suffering from medical condition (whether terminal or not) that is unbearable to the person (determined subjectively) and hopeless (determined by reasonable availability of medical treatment to reduce/relieve suffering) Adult only No advance requests |
Approval of request: Attending physician + 1 consulting physician + psychiatrist if deemed necessary by attending physician Written request in prescribed form; signed in presence of independent witness and attending physician Time delay between request and administration of medication Patient may revoke request at any time |
| New Zealand (Private Member’s Bill in Parliament) | Physician-assisted suicide and euthanasia | Competent adults who suffer from a terminal illness likely to die within 6 months or have a grievous and irremediable medical condition; advanced state of irreversible decline in capability; and unbearable suffering that cannot be relieved in a manner they consider tolerable No advance requests |
Approval of request: attending physician + 1 consulting physician + 1 mental health specialist if necessary Oral and written requests; written request in prescribed form signed before 1 independent witness and in the presence of the attending physician |
| France (adopted January 27, 2016) | Does not permit medical assistance in dying Permits terminal palliative sedation |
Conscious patients with serious and incurable disease, and who decide to stop taking medication or whose treatment no longer successful Patients have the right to refuse artificial life-support treatments Advance directives: adults can express their preference not to be kept alive by medical interventions, should they become too ill to make that decision |
Patients can designate a person (e.g. relative or attending physician) who could be consulted in cases where patients are not able to express their wishes with regards to their advance directives Advance directives can be modified or cancelled at any moment Creation of a national registry of advance directives |
| Germany (November 6, 2015) | Prohibits the commercialization of assisted suicide | This legislation criminalizes organizations that assist patients in terminating their own lives for profit, and includes penalties of up to three years of imprisonment; prevents the commercialization of the procedure as a “suicide business” | |
| United Kingdom (defeated September 2015) | Physician-assisted suicide only | Patients must be competent adults diagnosed by a registered medical practitioner as having a terminal illness and reasonably expected to die within six months Terminal illness is defined as “an inevitably progressive condition which cannot be reversed by treatment” No advance directive |
Approval of request: Attending physician + 1 consulting physician; approval by Family Court Written request in prescribed form; signed in presence of one independent witness and countersigned by attending physician Time delays between written request and delivery of medication |
| Scotland (defeated on May 27, 2015) | Physician-assisted suicide only | Competent individual (at least 16 years old) suffering from an illness that is terminal or life-shortening or a condition that is, for them, progressive and either terminal or life-shortening No advance directive |
Approval of request: 2 registered medical practitioners Three written requests in prescribed forms; signed in presence of qualified witness and confirmed by medical practitioner Time delay between requests |
| New South Wales (defeated on May 23, 2013) | Physician-assisted suicide and voluntary euthanasia | Patients must be suffering from an illness that will, in the normal course, result in death; illness is causing severe pain, suffering or distress to an extent unacceptable to the patient; there is no medical measure acceptable to the patient that can reasonably be undertaken in the hope of effecting a cure No advance request |
Approval of request: 2 medical pracititioners + independent qualified psychiatrist + independent qualified social worker, if necessary Oral and written requests; signed by patient and both medical pracititioner; interpreters, if required by the patient, may be required to sign the request form to confirm patient’s understanding of the request; proxy may be used to sign certificate on patient’s behalf Time delay between requests Patient may rescind request at any time and in any manner |
| Tasmania (defeated on October 17, 2013) | Physician-assisted suicide and voluntary euthanasia | Patients must have incurable and irreversible medical condition caused by an illness, disease or injury, causing persistent and intolerable suffering, and that is in advanced stages with no reasonable prospect of improvement No advance requests |
Approval of request: Attending physician + 1 consulting physician Two oral and one written requests; written request signed before 2 independent witnesses Time delays between requests Patient may rescind request at any time |
| Parliament of Victoria (study, June 2016) | Physician-asssisted dying and voluntary euthanasia (where patients are physically unable to take lethal drug) | Capable adult (18+) at end of life (final weeks or months of life) suffering from a serious and incurable condition which is causing enduring and unbearable suffering that cannot be relieved in a manner the patient deems tolerable Mental illness only: not eligible No advance directives |
Approval of request: 2 properly qualified and independent doctors + 1 psychiatrist if required Two oral and one written request signed by 2 independent witnesses Patient may withdraw request at any time |
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