Appendix C
THE INTERNATIONAL SCENE

THE NETHERLANDS, BELGIUM, AND SWITZERLAND: LEGALIZED ASSISTED DYING

In The Netherlands in the early 1980s, the national medical society outlined the circumstances under which it felt doctors might ethically end the lives of suffering, terminally ill patients by euthanasia, but there was no law that allowed euthanasia. It was simply the doctors saying that such action was ethical and in the best interests of their patients. The prosecutors and the legal system looked the other way, and euthanasia was practiced (reasonably) openly.

However, in 2002, the Parliament of The Netherlands finally wrote into law permission for doctors to perform euthanasia, adopting the requirements the medical society had previously laid out. The patient must be completely informed and must be competent to make such a request. The euthanasia must be voluntary and in response to more than one request, and there are other limiting conditions that protect against abuse, similar to the Oregon law. As of 2005, about 3,800 Dutch a year opt for a fatal injection from a physician or a prescribed overdose.¹

Belgium, acting similarly in 2002, also passed a euthanasia law for people of sound mind but “futile medical condition.” In early 2005, deaths by euthanasia were occurring at a rate of about thirty per month, about 60 percent of which occurred in the hospital and the rest at home.²

In Switzerland, it has been legal since 1941 for physicians to assist in suicide but not carry out euthanasia. “More than 2,000 people have received medically prescribed doses of barbiturates to kill themselves in Switzerland over the past 10 years, according to figures kept by the three main suicide organizations. So-called assisted suicide is legal here as long as the agencies that arrange death do so for ‘honorable reasons,’ without seeking profit, although they may charge basic fees. Dignitas [a private group in Zurich that will assist patients in suicide] has raised concerns among prosecutors in other European countries by facilitating the suicides of non-Swiss, a legal gray area, arranging everything from travel tickets to funeral services, as well as the fatal dose.”³ Dignitas has helped 493 individuals end their lives since 1998.

EXIT Deutsche Schweiz is another similar organization operating in Switzerland. During the 1990s EXIT Deutsche Schweiz “offered instruction and personal guidance through suicide to members who suffer from diseases with ‘poor prognosis, unbearable suffering or unreasonable disability’ and wish to die. It currently has more than 50,000 members, almost 1% of Switzerland’s population. The proportion of the total number of Swiss patients suffering multiple sclerosis, amyotrophic lateral sclerosis or HIV/AIDS who chose to end their lives with assistance from Exit (4.5%, 3.4%, and 1.7% respectively) was markedly higher than in cancer patients (0.5%).”⁴ Details of these 748 cases have been reviewed.⁵

These countries (along with Oregon) are the only jurisdictions at present in which these actions are legal.

AUSTRALIA: A SPECIAL CASE

Australia has been particularly active in the arena of hastening death under prescribed circumstances. In 1995, the Northern Territory Parliament passed an act allowing euthanasia and assisted suicide, and four people utilized that law to hasten death, all with guidance from euthanasia advocate Dr. Philip Nitschke. In 1997, the national parliament overturned the Northern Territory law, but Dr. Nitschke has continued his activism.⁶

DYING WITH DIGNITY, CANADA

Dying with Dignity is Canada’s active “voice for choice at the end of life.”⁷ This organization has goals similar to those of groups in the United States: “Our mission as a national non-profit organization is to improve quality of dying and to expand end-of-life choices in Canada . . . by educating, by informing, and by providing a confidential support program for individuals faced with making important end-of-life decisions.” It also advocates for legislative change that includes physician aid-in-dying, if a patient so chooses.

WORLD FEDERATION OF RIGHT-TO-DIE SOCIETIES

In 1980 at a conference in Oxford, England, the World Federation of Right-to-Die Societies was organized, indicating the extent to which the movement has spread to many countries. Derek Humphry and Sidney Rosoff were among the organizers. The Federation began with twenty-seven societies from eighteen countries and subsequently has grown to thirty-eight societies in twenty-three countries. It holds biennial conferences at various places around the world to discuss right-to-die issues, and representatives of the Federation have made many presentations to medical ethics groups, geriatric organizations, and human rights conferences. It publishes regular newsletters and disseminates information about the movement.⁸