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Global 21 fourth quarter 2015

healthy. But both sides need to listen more to the terminally ill, who will be most affected by assisted dying laws. A 2015 Dignity in Dying Populus poll of 5,000 people in the UK – the largest ever poll conducted on assisted dying in the country – showed that 86 per cent of people with a disability and 79 per cent of religious people would support a law that allowed assisted dying. Dignitas has disclosed that, in its first 16 years of operation, 920 Germans had travelled to Switzerland to end their lives with them, 273 Britons and 194 French citizens. “I am not suicidal. I do not want to die. But I am dying. And I want to die on my own terms,” said 29-year-old Brittany Maynard, who had an assisted death under Oregon’s Death with Dignity Act in November 2014. Since the law allowing lethal prescriptions was passed in Oregon in 1997, fewer than 900 people have used it and, as Rachel Aviv points out in The New Yorker, those who did were overwhelmingly white, educated and well-off – the demographic least likely to be pressured into asking for a death they don’t want. The concept of assisted dying has been equated by many to that of suicide, but the desire to take control of the manner and timing of one’s death when it is already encroaching is not the same. During the Committee stage of Lord Falconer’s Assisted Dying Bill in the UK, which was hotly debated this year but ultimately rejected by the House of Commons, peers voted two-to-one against an amendment that would insert the word ‘suicide’ into the bill. One of the main arguments for assisted dying is the autonomy of mentally competent patients. Only the individual can feel the suffering that comes with drawn-out terminal illness, and only they can judge what it means for them to continue living or to die. The question boils down to this: should we have the right to make the ultimate decision when it comes to our own lives? Fundamentally, the debate is between an individual’s right to autonomy and the forfeiting of personal autonomy to the state. “An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy,” reads Canada’s Supreme Court unanimous ruling of February 2015, which made it legal for a doctor to assist in a patient’s death. “The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person.” In a letter to The Guardian this September, a group of senior UK doctors – including the National Health Service’s chief knowledge officer – called the country’s current law on assisted dying “dangerous and cruel” for forcing terminally ill patients to end their lives abroad, and pointed out that the practice of assisted dying is already happening behind closed doors – legalising it would only help to ensure that the practice is safeguarded. Arena Health Luxembourg Passed in 2008, Luxembourg’s Law on the Right to Die with Dignity allows for euthanasia and for a physician to assist in a patient’s death providing that the patient is terminally ill, in unbearable pain and competent of the decision, with those aged 16-18 requiring a parent or guardian’s consent. USA While euthanasia remains illegal in the USA, six states – Oregon, Washington, Vermont, Montana, California and New Mexico – permit doctors to prescribe lethal doses of medication, with several of these also allowing assisted dying. The rulings in place tend to protect doctors from facing prosecution for helping a patient die. In 2013 approximately 300 terminally ill Americans were prescribed lethal medication. Of these, 230 died, while others chose not to take the medication. Switzerland Switzerland, which allows assisted dying so long as the assistant’s reasons for helping are not ‘selfish’, has not actually legalised active assisted dying. But it has seen an increase in so-called suicide tourists in recent years. In 2009 there were 86 recorded suicide tourists and by 2012 this figure had doubled, with the majority of patients coming from Germany and one-in-five originating from the UK. Dignitas is the most popular assisted-dying organisation. Founded in 1998 by Ludwig Minelli, a Swiss lawyer, the non-profit organisation has featured in several controversial films on assisted dying, including the heart-rending documentary Terry Pratchett: Choosing to Die. Operating from clinics and rented apartments in Zurich, Dignitas has met with its share of controversy. In a 2011 referendum held in the Canton of Zurich, 85 per cent of voters rejected an initiative to ban assisted dying and 78 per cent voted against outlawing the practice for foreigners. Germany In Germany, the term ‘euthanasia’ is avoided due to its unsavoury links with the eugenicist policies of the Nazi era, the law instead differentiating between ‘assisted suicide’ and ‘active assisted suicide’. The latter, which would involve a doctor prescribing and supplying a lethal drug, remains illegal. Assisted suicide is, however, allowed so long as the lethal draught is taken by the individual without any external help. Although recent surveys suggest that around two-thirds of Germans would back legislation supporting assisted-dying, Minister of Health Hermann Gröhe does not support the idea of having assisted-dying organisations such as Dignitas in the country. Belgium In 2002 Belgium became the second country in the world to legalise euthanasia and permits doctors to help patients end their lives as long as they freely express their wish to die due to unbearable and intractable pain; patients may also be euthanised when in a coma or vegetative state provided that they clearly stated this wish beforehand. They do not necessarily have to be terminally ill. Curiously, Belgian law does not mention assisted suicide, nor does it specify a method of euthanasia, although it does state that a physician must be present at the patient’s bedside when the act is carried out. In February of this year, Belgium became the first country in the world to lift the age restriction from its euthanasia policy, allowing terminally ill minors to request a lethal injection. One of the most high-profile cases of euthanasia in Belgium was that of 44-year-old Nathan Verhelst, whose botched sex-change operation left him feeling “like a monster”. In 2013 there were 1,807 cases of euthanasia in Belgium, up from 1,432 in 2012, and more than half of them concerned people aged over 70. four 48 l www.global -br ief ing.org th quar ter 2015 global


Global 21 fourth quarter 2015
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