When lawmakers in Britain last week voted in favor of a proposal to legalize assisted dying for some terminally ill patients, it signaled a profound shift in a country that decisively rejected the idea almost a decade ago.
It also underscored the growing global momentum for legalizing assisted dying as improved medical treatments help people live longer — including patients with terminal illnesses.
Assisted dying is legal or partly legal in about a dozen countries, according to a July report by the Swedish National Council on Medical Ethics.
In Britain, a survey ahead of Parliament’s vote showed that almost two-thirds of people in England and Wales supported the legalization of assisted dying. That reflected Britain becoming more socially liberal, said Bobby Duffy, director of the Policy Institute at King’s College in London, which ran the survey of more than 2,000 adults.
“It’s important to remember this isn’t a uniform global trend: There is still very high disapproval in many more religious, more traditional and lower development countries,” Mr. Duffy said.
In countries that allow assisted dying, the laws are implemented differently: Some allow doctors to administer the lethal drugs, while others do not; some allow people to seek assisted death for mental illnesses, while others restrict the practice to terminal illnesses; and some allow minors to seek assisted death.
Here are the countries where assisted dying is legal or under discussion.
A Country Where Assisted Dying Has Been Legal for Decades
Switzerland has allowed assisted dying for over 80 years, with the first documented case occurring in 1985, according to the medical and public health journal Deutsches Ärzteblatt International. The law permits the practice as long as it is not motivated by “selfish” intentions, though in the years since the law was enacted, some restrictions have been introduced.
Doctors and loved ones are not allowed to administer any lethal drugs. The person wishing to die must carry out the final act.
But doctors can prescribe the drugs and offer advice, based on medical guidelines that outline who is eligible.
Nonprofit organizations like Dignitas, which was founded in 1998, and the more recently established Pegasos, assist people who want to die voluntarily. Dignitas said it had assisted nearly 4,000 people as of last year, most of whom had traveled from countries outside of Switzerland.
Countries That Recently Legalized Assisted Dying
In 1997, Colombia’s constitutional court ruled that a doctor could not be prosecuted for helping terminally ill people who have given informed consent to end their lives. In 2015, at further prompting from the court, Colombia issued regulations to allow assisted death conducted by a medical practitioner, paving the way for what was considered the country’s first legal case. The country widened the practice to include self-administered death and patients with chronic illnesses in the 2020s.
The Netherlands, which for decades practiced informal assisted dying, and where doctors have had some form of protection against prosecution since the 1970s, in 2001 became the first European Union country to officially legalize assisted dying. Belgium and Luxembourg followed in 2002 and 2009. Spain and Austria enacted laws in 2021, and Portugal in 2023.
Canada introduced medical assistance in dying laws in 2016, a year after its Supreme Court found a ban on the practice unconstitutional. It later amended the laws to include people who do not have a terminal or fatal condition but are in “an advanced state of irreversible decline.”
In New Zealand, a public referendum in 2020 legalized assisted dying for terminal patients, allowing doctors or registered nurses to administer the medication.
Belgium, Colombia and the Netherlands allow assisted dying for some minors.
Where Assisted Dying Is Partly Legalized
Assisted dying is legal in 10 states across the United States, along with Washington, D.C. Nineteen other states are considering bills that could legalize some form of assisted dying.
Oregon was the first U.S. state to legalize the practice with the 1997 implementation of the Death with Dignity Act. Washington and Montana followed in the late 2000s, and Vermont in 2013. Since 2016, the District of Columbia and six states have legalized assisted dying in some form: California, Colorado, Hawaii, Maine, New Jersey and New Mexico. Regulations differ, with some states limiting the practice to residents only, while others require a waiting period.
Australia experienced a similar legislative wave. After the state of Victoria passed legislation to allow voluntary assisted dying in 2017, the practice is now legal in all six states, with differing regulations on eligibility criteria and the administration of the lethal drugs. Assisted dying is set to take effect in the Capital Territory, home to the country’s capital, Canberra, next November. It remains illegal in the more remote Northern Territory.
Countries Where Assisted Dying Is in a Legal Gray Area or Under Consideration
Germany has had a shifting relationship with assisted dying over the last decade. A 2015 law effectively banned it, but the measure was overturned by the Constitutional Court in 2020. Germany has not passed laws clearly regulating the practice, creating some legal confusion for doctors, patients and organizations.
In Italy, the situation is similarly complex. The law bans assisted death, but, in 2019, the country’s Constitutional Court decriminalized the practice in certain limited circumstances. In 2022, after a lengthy legal battle, a 44-year-old was granted the right to self-administered death, becoming the first such case in Italy. A handful of other cases have been approved by local health services, and the Constitutional Court has repeatedly called on Parliament to regulate the practice.
In 2024, Ecuador’s Supreme Court ruled in favor of a woman with A.L.S., a severe neurological disorder, who wanted to end her life. The ruling decriminalized assisted dying and gave lawmakers the task of drafting legislation to regulate the practice within 12 months.
Other countries, including Cuba, France, Ireland, Mexico, Chile, and others, are considering or have considered proposals on assisted dying in recent years.
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