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Assisted suicide: Where do Canada and other countries stand?

10/13/2014 05:00 EDT | Updated 12/12/2014 05:59 EST
The debate on medically assisted death will be front and centre again this week as the Supreme Court of Canada hears arguments Wednesday in a case that could make the practice legal on a federal level mere months after Quebec adopted its own law allowing it.

The constitutional challenge of the Criminal Code prohibition on assisted suicide was launched on behalf of two B.C. patients who have both since died.

Kathleen (Kay) Carter, who suffered from a degenerative spinal condition, died at an assisted-suicide clinic in Switzerland in 2010. Gloria Taylor, who had Lou Gehrig's disease and wanted help ending her life, died of an infection in 2012, a little over a year after joining the court challenge launched by Carter's family.

The court will have to decide whether the law violates sections 7 and 15 of the Charter of Rights and Freedoms. The first guarantees the right to life, liberty and security of a person, and the second ensures equal treatment before the law for all — which right-to-die advocates have argued is violated when people who are physical disabled are not able to take their own life as able-bodied individuals are.

A decision is not expected for months, but right-to-die advocates say the time could be right for Canada's highest court to overturn the law given recent opinion polls suggesting there is broad public support for legalization of assisted suicide.

We take a look at where legislation stands today, in Canada and abroad.

Canada

Helping a person commit suicide is a crime in Canada — spelled out in Criminal Code Section 241 (b) — and carries a maximum sentence of 14 years in prison. 

The first doctor to be sentenced under the law was Maurice​ Généreux, who got a jail term of two years less day and three years' probation in 1998 for prescribing sleeping pills to two men with AIDS who were depressed but not terminally ill. One of the men survived and later launched a civil suit against Généreux.

The constitutionality of the law has been challenged before, by Sue Rodriguez, who suffered from Lou Gehrig's disease​ and took her fight to the Supreme Court of Canada and lost in 1993. She died with the help of a doctor less than half a year after the court ruling. 

A number of Canadians have been prosecuted for helping ill patients or loved ones die. Marielle Houlle, for example, was sentenced to three years' probation by a Quebec court in 2004 for helping her 36-year-old son, who suffered from multiple sclerosis, end his life. 

In 2007, B.C. doctor Ramesh Kumar Sharm was given a conditional sentence of two years less a day and had his physician's licence revoked after prescribing a lethal dose of drugs for a 93-year-old patient.

Canada does allow doctors to induce a coma and turn off life-sustaining equipment for suffering patients near death, a practice known as palliative sedation that right-to-die advocates argue is ethically, morally and legally no different than assisted suicide.

Quebec

This past June, Quebec broke new ground when it passed the Act Respecting End of Life Care, bypassing the Criminal Code by incorporating medically assisted death into provincial health care legislation. The new law is expected to come into force by the end of 2015 and allows people with a terminal illness that is causing unbearable suffering to request a physician to administer a lethal dose of medication.

"Quebec was a groundbreaker in terms of saying, 'We're not talking about assisted suicide or homicide… but we're talking about end of life: this is a natural extension of palliative care, so it needs to come under provincial legislation,' " said Wanda Morris, CEO of the advocacy group Dying With Dignity.

The U.S.

Assisted-suicide laws in the U.S. allow the practice only for those who are critically ill and have six months or less to live, and the rules require the patient to administer the medication themselves. 

Vermont: The latest state to legalize assisted suicide. Under regulations passed in May 2013, a patient must verbally request to die at least 15 days in advance and again — verbally and in writing — 48 hours prior to taking lethal drugs. Two physicians determine whether the patient qualifies, which means they must have an "incurable and irreversible disease" and no more than six months to live.

Oregon: The first state to pass a law allowing physician-assisted suicide. Enacted in 1997, the law was challenged in subsequent years but was upheld by the U.S. Supreme Court in January 2006. To date, about 750 people have died from lethal doses of medications prescribed under the act, according to data compiled by state health authorities. 

The law stipulates that the patient must have been declared terminally ill by two physicians and must have requested lethal drugs three times, including in writing. 

Washington: The Death With Dignity Act went into effect in March 2009 and has similar stipulations to assisted-suicide legislation in other states.

Montana: The state does not have a law legalizing assisted suicide, but in December 2009, the state supreme court ruled that a physician who helps a mentally competent, terminally ill patient end their life should not be held criminally liable if the patient has given consent.

New Mexico: An Albuquerque judge ruled in January that it is a constitutional right for a mentally competent, terminally ill patient to seek aid in dying. The challenge to the state's prohibition on assisted suicide was brought forward by two doctors who wanted to help a 49-year-old patient suffering from terminal cancer end her life. The state attorney general has appealed.

Europe

European laws on medically assisted death are broader than those in the U.S., with most allowing physicians to prescribe and administer lethal drugs and not setting conditions tied to life expectancy.

"The eligibility is not restricted to terminal illness. It includes a medical condition but also unbearable suffering," Morris said.

The Netherlands: Legislation legalizing assisted suicide and euthanasia was introduced in 2002, but the country's courts have permitted these actions since 1984.

Dutch doctors must follow a narrow set of guidelines when helping patients end their life: The patient, who must be suffering unbearably and have no hope of improvement, must ask to die. The patient must clearly understand the condition and prognosis and a second doctor must agree with the decision to help the patient die.

The law allows for assisted suicide in cases of dementia but only if a prior directive from the patient exists. Children between ages 16 and 17 don't need parental consent to undertake assisted suicide but must involve parents in their decision.

Belgium: It legalized euthanasia and physician-assisted suicide in 2002 and, in February 2014, removed the age limit of 18, allowing assisted suicide for children as long as they are terminally ill, suffering unbearably, conscious of their decision and have the consent of their parents and doctors.

Under the Belgian law, the patient must ask to die and two doctors must sign off on the request, as well as a psychologist if the patient's competency is in doubt. The doctor and patient negotiate whether death is to be by lethal injection or prescribed overdose. 

Switzerland: Assisted suicide has been allowed since 1942, but euthanasia is forbidden, with patients having to administer the lethal medication themselves. Unlike other countries, Switzerland does not specify any criteria for who can assist with a suicide — as long as they are not motivated by immoral or financial reasons — and how ill the patient must be.

Right-to-die organizations such as Dignitas help carry out assisted suicides, providing counselling and lethal drugs. Death by injection is banned.

Switzerland also allows non-citizens to seek assisted suicide in the country, and several Canadians have done so over the years, including one of the plaintiffs in Wednesday's Supreme Court case.

Luxembourg: This country of about 600,000 people passed a law legalizing euthanasia and assisted suicide in 2009 with conditions similar to those in the Netherlands.

Other cases of note

Britain: Assisted suicide carries a maximum prison sentence of 14 years, but in 2010 the director of public prosecutions published an assisted suicide policy that allows prosecutors to examine each case on its merits and decide whether there is a public interest in prosecuting. Euthanasia can be prosecuted as manslaughter or murder, with a maximum sentence of life in prison.

Colombia: The predominantly Catholic country doesn't have a law explicitly condoning assisted suicide, but its Constitutional Court ruled in 2010 that a doctor who helps someone die cannot be prosecuted for euthanasia, which is a crime under Colombian law, as long as the patient had a terminal illness and gave their consent.

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