The Right to Die in Practice

Kayacan, Derya Nur

doi:10.1007/978-3-031-04516-5_3

Derya Nur Kayacan¹⁸

Part of the book series: European Union and its Neighbours in a Globalized World ((EUNGW,volume 6))

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Abstract

‘The Right to Die in Practice’ examines selected jurisdictions, illustrating the different paths that led to or did not lead to the right to die practice. Switzerland, which is famous for its assisted suicide organizations, and the Netherlands, which is the first State to legalize euthanasia are examined in extensive detail. Belgium, Germany, the United Kingdom, and—as an exception to the Convention perspective—Canada are also included. While this examination gives a better understanding into what the right to die looks like in practice, it also provides an insight to the slippery slope argument, which stands on the opposite side of personal autonomy on the balancing scale, without making a definitive statement on its existence.

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Notes

1.
In 1997, the Constitutional Court of Colombia had ruled that ‘denying a terminal patient the right to die with dignity violated equality and imposed a discriminatory burden against those seriously ill or impaired.’ The Government did not take any steps to regulate the right to die until 2015, and the Court’s decision did not find any implementation. Upon another judgment from the Constitutional Court in 2014, the Ministry of Health adopted a resolution in 2015 that provided guidelines for the practice euthanasia. The choice is only available for terminal patients with unbearable suffering and who are competent to make a decision to end their life. Only a physician is authorized to carry out the procedure. [1997] Colombian Constitutional Court Decision C-239/1997; [2014] Colombian Constitutional Court Decision T-970/2014; See also Palomino (2017), pp. 51ff.
2.
[2017] Colombian Constitutional Court Decision T-544/2017; Triviño (2018) Colombia Has Regulated Euthanasia for Children and Adolescents. In: LatinAmerican Post. https://latinamericanpost.com/20090-colombia-has-regulated-euthanasia-for-children-and-adolescents.
3.
The physician will administer the medication only if the patient is not physically capable of doing so himself or herself. Therefore, the rule is physician-assisted suicide with an exception for euthanasia only when the circumstances do not allow otherwise. Victoria, Australia, Voluntary Assisted Dying Act 2017, No 61 of 2017 (19 June 2020).
4.
Western Australia, Australia, Voluntary Assisted Dying Act 2019, No 027 of 2019 (19 December 2019).
5.
New Zealand, End of Life Choice Act 2019, 2019 No 67 (7 November 2020); Official Referendum Results Released. In: Electoral Commission. https://elections.nz/media-and-news/2020/official-referendum-results-released/.
6.
Jones et al. (2017), p. 1.
7.
Due to the frequent public debates on the matter, the phrase Sterbetourismus, which translates to death tourism, was chosen as the Word of the Year in 2007 in Switzerland. (2007) Death Tourism Tops Swiss Word List. In: SWI swissinfo.ch. https://www.swissinfo.ch/eng/death-tourism-tops-swiss-word-list/6299814; See also Srinivas (2009), pp. 91ff; Yu et al. (2020), pp. 694ff.
8.
Dignitas, Accompanied Suicide of Members of Dignitas, by Year and by Country of Residency 1998–2020. http://www.dignitas.ch/index.php?option=com_content&view=article&id=32&Itemid=72&lang=en.
9.
Oltermann (2018) David Goodall, Australia’s oldest scientist, ends his own life aged 104. In: The Guardian. https://www.theguardian.com/society/2018/may/10/david-goodall-australias-oldest-scientist-ends-his-own-life-at-104.
10.
Carter v Canada (Attorney General) 2015 SCC 5, [2015] 1 SCR 331; Todd (2015) The Story at the Heart of Friday’s Supreme Court Ruling on Assisted Suicide. In: Vancouver Sun. https://vancouversun.com/news/staff-blogs/b-c-woman-chooses-a-dignified-death-in-switzerland.
11.
R (Purdy) v the Director of Public Prosecutions [2009] UKHL 45, [2010] 1 AC 345; Hirsch (2009) Debbie Purdy wins “significant legal victory” on assisted suicide. In: The Guardian. https://www.theguardian.com/society/2009/jul/30/debbie-purdy-assisted-suicide-legal-victory.
12.
Hurst and Mauron (2017), p. 203.
13.
Bondolfi (2020) Why assisted suicide is “normal” in Switzerland. In: SWI swissinfo.ch. https://www.swissinfo.ch/eng/why-assisted-suicide-is%2D%2Dnormal%2D%2Din-switzerland-/45924614.
14.
Bondolfi (2004), p. 89.
15.
Thommen (2018), p. 373.
16.
‘Eine Bestrafung des Selbstmörders, dessen Versuch misslungen ist, sehen die schweizerischen Gesetze mit Recht nicht vor; in den meisten Fällen liegt der That Geistesstörung zu Grunde, in allen ein Zustand, der Mitleid und nicht Strafe herausfordert.’ Stooss (1893), p. 15.
17.
Art 52 ‘Wer jemanden vorsätzlich zum Selbstmord bestimmt oder ihm dazu Hülfe leistet, wird mit Gefängnis von 3 Monaten bis zu 1 Jahr bestraft.’ Stooss (1894), p. 38.
18.
Art 102 ‘Wer aus selbstsüchtigen Beweggründen jemanden zum Selbstmord verleitet oder ihm dazu Hülfe leistet, wird, wenn der Selbstmord ausgeführt oder versucht wurde, mit Zuchthaus bis zu fünf Jahren oder mit Gefängnis bestraft.’ Bundesblatt (1918) Schweizerisches Strafgesetzbuch, Entwurf des Bundesrates an die Bundesversammlung (BBI 1918 IV 103) p. 137.
19.
Guillod and Schmidt (2005), p. 29.
20.
‘Die Selbsttötung ist im modernen Strafrecht kein Vergehen und es liegt keine Veranlassung vor, etwa aus bevölkerungspolitischen Gesichtspunkten auf das frühere Recht zurückzukommen. Aber auch die Überredung zum Selbstmord und die Beihülfe bei einem solchen kann eine Freundestat sein, weshalb hier nur die eigennützige Verleitung und Beihülfe mit Strafe bedroht wird, so z. B. die Überredung einer Person zum Selbstmord, die der Täter zu unterstützen hat oder die er zu beerben hofft (Art. 102).’ (The term ‘Freundestat’ has been translated as ‘friendly-deed’ by the author.) Bundesblatt (1918) Botschaft des Bundesrates an die Bundesversammlung zu einem Gesetzesentwurf enthaltend das schweizerische Strafgesetzbuch (BBI 1918 IV 1), p. 32.
21.
Bundesblatt (1918) Botschaft des Bundesrates an die Bundesversammlung zu einem Gesetzesentwurf enthaltend das schweizerische Strafgesetzbuch (BBI 1918 IV 1), p. 32.
22.
Guillod and Schmidt (2005), p. 29.
23.
Hafter (1912), p. 399.
24.
Mathwig (2010), p. 145.
25.
Within the debate on the right to die, the predominant perception of assisted suicide is still within a medical framework. However, relatively newer concepts, such as ‘existential suffering’ or ‘tiredness of life’, pull the debate away from the medical sphere. This will be mentioned in further detail in Sect. 3.2 ‘The Netherlands’.
26.
311.0 Swiss Criminal Code of 21 December 1937 (1 July 2020).
27.
Hurst and Mauron (2017), p. 199.
28.
Andorno (2013), p. 246.
29.
Lewy (2011), pp. 89–90.
30.
(2007) Es gibt ein Leben vor dem Tod. In: Neue Zürcher Zeitung. https://www.nzz.ch/es_gibt_ein_leben_vor_dem_tod-1.587887.
31.
EXIT - Deutsche Schweiz, Werden Sie Mitglied. https://pv.exit.ch/register.
32.
A doctor, who is a specialist in palliative care, did not only criticize the fact that the suicide companions were incompetent, but also the fact that the EXIT-affiliated physicians were neither psychiatrists nor specialists in palliative care. Borasio (2015), p. 1736.
33.
EXIT - Deutsche Schweiz (2021) EXIT Haupt-Infobroschüre “Selbstbestimmt bis ans Lebensende”, 3rd edn. EXIT – (Deutsche Schweiz), Zurich. https://exit.ch/downloads/, p. 20.
34.
EXIT - Deutsche Schweiz, Statuten. https://exit.ch/verein/der-verein/statuten/, Art 2.
35.
EXIT - Deutsche Schweiz (2021) EXIT Haupt-Infobroschüre “Selbstbestimmt bis ans Lebensende”, pp. 18–19.
36.
EXIT - Deutsche Schweiz (2021) EXIT Haupt-Infobroschüre “Selbstbestimmt bis ans Lebensende”, p. 20.
37.
(2004) Exit lockert Moratorium für Sterbebegleitung. In: SWI swissinfo.ch. https://www.swissinfo.ch/ger/exit-lockert-moratorium-fuer-sterbebegleitung/4194608.
38.
EXIT - Deutsche Schweiz (2021) EXIT Haupt-Infobroschüre “Selbstbestimmt bis ans Lebensende”, p. 21.
39.
Suter D (2012) EXIT (Deutsche Schweiz) 1982–2012: Ein Überblick: 30 Jahre Einsatz für Selbstbestimmung. Sutter B (ed) EXIT (Deutsche Schweiz), Zurich. https://exit.ch/fileadmin/user_upload/download/broschueren/exit_30-Jahre-Broschuere_DE.pdf, p. 9.
40.
EXIT - Suisse Romande (2021) Bulletin EXIT No 74. https://www.exit-romandie.ch/nos-bulletins-fr1263.html, p. 13.
41.
EXIT - Suisse Romande (2020) Bulletin EXIT No 72. https://www.exit-romandie.ch/nos-bulletins-fr1263.html, pp. 11, 15.
42.
EXIT - Suisse Romande (2021) Bulletin EXIT No 74, pp. 11–12.
43.
Burkhardt (2011) L’assistance au décès à l’aube du XXIème siècle. Privatdozent Thesis, University of Geneva, doi: 10.13097/archive-ouverte/unige:14584, p. 111.
44.
Lewy (2011), p. 103.
45.
Lewy (2011), p. 105.
46.
See Sect. 3.5 ‘Germany’ for recent developments that might change this situation.
47.
Dignitas (2020) Members of DIGNITAS by Country of Residency. http://www.dignitas.ch/images/stories/pdf/statistik-mitglieder-wohnsitzstaat-31122020.pdf.
48.
These amounts do not include taxes and are subject to changes. A member requesting suicide assistance is provided with an invoice including all expenses, and payment is accepted upfront. Dignitas, Information-Brochure. http://www.dignitas.ch/images/stories/pdf/informations-broschuere-dignitas-e.pdf.
49.
Dignitas (2021) Rückblick 2020 und Ausblick 2021. http://www.dignitas.ch/images/stories/pdf/medienmitteilung-29012020.pdf, p. 3.
50.
Identical requirements to those of EXIT; Dignitas, Information-Brochure, p. 6.
51.
Dignitas (2014) How Dignitas Works. http://www.dignitas.ch/images/stories/pdf/so-funktioniert-dignitas-e.pdf, p. 12.
52.
After a letter written by cantonal physician Dr Ulrich Gabathuler (head of the cantonal office of public health) to Dignitas, informing that ‘he would consider any prescription for NaP after only one doctor’s consultation to be violation of good medical practice…[and] he would take disciplinary action against any doctor who wrote such a prescription after only one consultation’, Dignitas changed its practice as of 1 February 2008. Dignitas (2014) How Dignitas Works, p. 15.
53.
For a descriptive explanation of these four cases, see Ogden et al. (2010), pp. 174ff.
54.
(2008) Mit Luftballon-Gas in den Tod. In: Neue Zürcher Zeitung. https://www.nzz.ch/mit_luftballon-gas_in_den_tod-1.691954.
55.
Dignitas, Accompanied Suicide of Members of Dignitas, by Year and by Country of Residency 1998–2020.
56.
Sperling discusses the ‘social attitudes within Switzerland towards suicide tourism’ that reveals different attitudes towards EXIT and Dignitas. While EXIT is respected more, Dignitas is perceived to be ‘fanatic’. However, Sperling also states that Dignitas’ reputation has been improving recently. Sperling (2019), pp. 146–158.
57.
Lewy (2011), p. 107.
58.
Leidig (2005), p. 1160.
59.
Frith (2004) Couple who died after suicide clinic visit “not terminally ill”. In: The Independent. https://www.independent.co.uk/news/world/europe/couple-who-died-after-suicide-clinic-visit-not-terminally-ill-733208.html.
60.
Cox (2009) The Report - Dignitas: Assisted Suicide in Switzerland. In: BBC. https://www.bbc.co.uk/sounds/play/b00jdnsl.
61.
(2009) Sterbehilfe für kerngesunde Frau. In: Der Bund. https://www.derbund.ch/zeitungen/schweiz/sterbehilfe%2D%2Dfuer-kerngesunde-frau/story/24525418.
62.
(2010) Dignitas schickte Schizophrenen in den Tod. In: Tages Anzeiger. https://m.tagesanzeiger.ch/articles/20026089.
63.
Lewy (2011), p. 108.
64.
Strebel (2007) Eine Insiderin klagt an. In: Beobachter. https://www.beobachter.ch/gesellschaft/sterbehilfe-eine-insiderin-klagt.
65.
In an interview to the Atlantic, Mr Minelli said that he stores the urns in the trunk of his car and then disposes of them by throwing them into the lake. Former employees, including Mrs Wernli, stated that this was a usual practice at Dignitas. (2010) Dozens of Urns with Human Ashes Found in Lake Zurich. In: HeraldNet. https://www.heraldnet.com/news/dozens-of-urns-with-human-ashes-found-in-lake-zurich/.
66.
Bütikofer (2010) Dignitas-Mitglied: Mehrere 100000 Franken für Freitod bezahlt. In: Aargauer Zeitung. https://www.aargauerzeitung.ch/panorama/vermischtes/dignitas-mitglied-mehrere-100000-franken-fuer-freitod-bezahlt-8663015.
67.
The Zurich Administrative Court found no obstacles for Dignitas to carry out suicide assistance services in an industrial zone. The Court stated that the public interest in enforcing an authorization requirement did not outweigh the private interests of Dignitas and its members, especially considering that assisted suicide cannot be carried out in hotels or cars. Case on the Blue Oasis [2007] Verwaltungsgericht des Kantons Zürich VB.2007.00472.
68.
Sillgitt (2007) Letzte Ausfahrt Parkplatz. In: Der Spiegel. https://www.spiegel.de/panorama/sterbehilfe-letzte-ausfahrt-parkplatz-a-516121.html.
69.
(2018) Dignitas-Gründer Minelli vor Bezirksgericht Uster. In: Top Online. https://www.toponline.ch/news/zuerich/detail/news/dignitas-gruender-minelli-vor-bezirksgericht-uster-0088378/.
70.
(2018) Freispruch für Minelli - aber kein Freipass. In: Zürcher Oberländer. https://zueriost.ch/bezirk-pfaffikon/pfaffikon/freispruch-fuer-minelli-aber-kein-freipass/1063802.
71.
Hasler (2018) Er hat sich nicht bereichert: Dignitas-Gründer freigesprochen. In: Tages Anzeiger. https://www.tagesanzeiger.ch/zuerich/region/er-hat-sich-nicht-bereichert-dignitasgruender-freigesprochen/story/23093108.
72.
Betty (2009) Call Dignitas to Account. In: The Guardian. https://www.theguardian.com/commentisfree/2009/apr/03/assisted-suicide-mental-health. Mr Minelli had made the same point in the memorandum to the Select Committee of the Assisted Dying for the Terminally Ill Bill, which was appointed by the House of Lords to prepare a report on the matter. Select Committee of the Assisted Dying for the Terminally Ill Bill, Assisted Dying for the Terminally Ill Bill (HL 2004-05, 86-I, II, III) Voll II: Evidence, p. 635.
73.
Minelli (2008), p. 155.
74.
Minelli (2008), p. 155.
75.
Falconer (2010) Death Becomes Him. In: The Atlantic. https://www.theatlantic.com/magazine/archive/2010/03/death-becomes-him/307916/.
76.
Cook (2011) Swiss Back off Restrictions on Assisted Suicide. In: BioEdge. https://www.bioedge.org/bioethics/bioethics_article/swiss_back_off_restrictions_on_assisted_suicide.
77.
Bosshard (2008), p. 464.
78.
Although there were some cases, in which other methods were used to assist with suicide, they drew negative attention from the public and were strictly investigated. NaP is officially the only method used by the assisted suicide organizations and it seems as though it is the only method that has general public approval.
79.
Schwarzenegger (2007), p. 7.
80.
Pentobarbital is listed under Schedule III of the Convention as a substance that requires a licence for its distribution (Art 8) and is only available with prescription, which is ‘issued in accordance with sound medical practice’ (Art 9). UN General Assembly, Convention on Psychotropic Substances of 1971, 9 December 1975, A/RES/3443.
81.
812.21 Swiss Federal Act on Medicinal Products and Medical Devices of 15 December 2000 (1 August 2020) (Therapeutic Products Act, TPA); 812.121 Swiss Federal Act on Narcotics and Psychotropic Substances of 3 October 1951 (1 February 2020) (Narcotics Act, NarcA).
82.
Switzerland, 812.121.1 Ordinance on Narcotics Control of 25 May 2011 (1 January 2013) Art 3(2)(b). The list of controlled substances is prepared by the Federal Department of Home Affairs (FDHA) under: Switzerland, 812.121.11 Ordinance of the FDHA on the Lists of Narcotics, Psychotropic Substances, Precursors and Auxiliary Chemicals of 30 May 2011 (15 December 2020) Annex I.
83.
Ordinance on Narcotics Control Art 46(1).
84.
TPA Art 26(2).
85.
Petermann (2008), p. 1416.
86.
SAMS, Portrait. https://www.samw.ch/en/Portrait.html.
87.
Foederatio Medicorum Helveticorum is the professional association for Swiss physicians. The Code of Professional Conduct lists under Annex 1 all the SAMS Guidelines that are binding for its members. FMH (1997, last updated 2020) Standesordnung Der FMH. https://www.fmh.ch/ueber-die-fmh/statuten-reglemente.cfm#i112408.
88.
Bosshard (2008), pp. 464–465.
89.
SAMS (1976) Medizinisch-ethische Richtlinien für die Sterbehilfe. All SAMS Medical-ethical Guidelines can be found under https://www.samw.ch/de/Ethik/Richtlinien.html.
90.
SAMS (1981) Medizinisch-ethische Richtlinien für die Sterbehilfe.
91.
SAMS (1995) Medizinisch-ethische Richtlinien für die ärztliche Betreuung sterbender und zerebral schwerst geschädigter Patienten, s. 2.2.
92.
SAMS Guideline’95, s. 3.4.
93.
SAMS (2004, updated 2013) Medizinisch-ethische Richtlinien - Betreuung von Patientinnen und Patienten am Lebensende, s. 1; the Guideline’04 was updated in 2013, but paragraphs related to assisted suicide remained the same.
94.
SAMS Guideline’04, s. 2; Ruth (2011), p. 45.
95.
SAMS Guideline’04, s. 4.1.
96.
SAMS Guideline’04, s. 2.2.1.
97.
Ruth (2011), p. 50.
98.
SAMS Guideline’04, s. 4.1.
99.
According to the study, Swiss physicians were generally accepting of assisted suicide, especially in cases of severely suffering terminal patients (78%). In cases of patients with severe pain caused by a chronic illness, acceptance remained around 60%. In the absence of any somatic illness, mentally ill patients and otherwise healthy advance-aged patients, the level of acceptance dropped remarkably (30% and 20% respectively). Overall the study reveals that individual circumstances of the patient and a formerly established physician-patient relationship affect the ethical acceptability of assisted suicide. Brauer et al. (2015), pp. 1–8.
100.
Swiss National Science Foundation & NRP 67 (2017) Synthesis Report NRP 67: End of Life. http://www.nfp67.ch/en/News/Pages/11121-news-nfp67-synthesis-report.aspx, p. 33. NRP 67 started in 2011 and consisted of 33 separate projects examining end-of-life aspects in Switzerland. The report shines light on different aspects of dying with dignity and problematic areas, providing policy recommendations.
101.
SAMS (2018) Medizin-ethische Richtlinien - Umgang mit Sterben und Tod.
102.
SAMS Guideline’18, s. 2.3.
103.
SAMS Guideline’18, s. 2.4.
104.
SAMS (2019) Medizin-ethische Richtlinien - Urteilsfähigkeit in der medizinischen Praxis, s. 3.9.
105.
SAMS Guideline’18, s. 6.2.1.
106.
FMH (2018) Medienmitteilung: Ärztekammer befürwortet eine partnerschaftliche Tarifrevision. https://www.fmh.ch/files/pdf21/medienmitteilung_aerztekammer_befuerwortet_eine_partnerschaftliche_tarifrevision.pdf.
107.
FMH (2018) Stellungnahme: Richtlinien “Umgang mit Sterben und Tod”. https://www.fmh.ch/files/pdf20/Stellungnahme_der_FMH_Richtlinien_Umgang_mit_Sterben_und_Tod.pdf.
108.
Barnikol (2018), pp. 1392–1396.
109.
AGEAS (2018), p. 1451 (author’s translation).
110.
Kaiser (2018), p. 1363.
111.
Vuilleumier-Koch (2019), p. 419.
112.
Aeschlimann (2018), p. 1452 (author’s translation).
113.
Säuberli (2019), p. 202.
114.
Achermann (2018), p. 1614.
115.
Stalder (2019), p. 66; Supported by Bär et al. (2019), p. 202.
116.
Luchsinger (2018), p. 1399 (author’s translation).
117.
Scheidegger (2018), p. 1613 (author’s translation).
118.
Bosshard (2008), p. 474.
119.
Ernst (2001), pp. 293–295.
120.
NCE (2005) Beihilfe zum Suizid. Stellungnahme Nr. 9/2005. Reports of the NCE can be found under https://www.nek-cne.admin.ch/de/publikationen/stellungnahmen/.
121.
Centre Hospitalier Universitaire Vaudois (CHUV) (2007), pp. 14–19.
122.
Hôpitaux Universitaires de Genève (HUG) (2007), pp. 21–23.
123.
SAMS (2006) Zur Praxis der Suizidbeihilfe in Akutspitälern: die Position der SAMW. https://www.samw.ch/de/Ethik/Themen-A-bis-Z/Sterben-und-Tod/Hintergrund-Sterben-Tod.html.
124.
CEC (2007) Suizidbeihilfe in Akutspitälern: die Haltung der Zentralen Ethikkommission der SAMW. https://www.samw.ch/de/Ethik/Themen-A-bis-Z/Sterben-und-Tod/Hintergrund-Sterben-Tod.html.
125.
Universitätsspital Zürich (2007), pp. 28–29.
126.
Although the duties of the Kantonsarzt (cantonal physician) vary in each canton, their main responsibility is to serve public health, including enforcement of legislation on narcotics. Hauri, Aufgaben der Kantonsärzte. In: VKS/AMCS. https://www.vks-amcs.ch/de/home/merkblaetter/aufgaben-der-kantonsaerzte.
127.
Bosshard (2008), p. 475; Lewy (2011), p. 90.
128.
Zurich Case [1999] Verwaltungsgericht des Kantons Zürich VB.99.00145, (2000) AJP 474.
129.
Zurich Case, 475.
130.
Zurich Case, 475.
131.
Zurich Case, 476.
132.
This was a comment made by the Court in reference to the ‘recognized rules of medical science’ under NarCA Art 11. At the time of this decision, TPA and the Ordinance on Narcotics Control were not in force, both of which explicitly require personal examination and awareness of the state of the patient before writing a prescription for controlled substances. See footnotes no. 81 and 82.
133.
Zurich Case, 476–477.
134.
Aargau Case [2005] Verwaltungsgericht des Kantons Aargau BE 2003.00354-K3.
135.
301.100 Aargau Cantonal Health Act of 10 November 1987 (before the amendment of 20 January 2009) (GesG-Aargau) Art 23(3).
136.
Pretty v the United Kingdom App no 2346/02 ECHR 2002-III; For an analysis of the Pretty Case, see Sect. 4.1.3 ‘The Pretty Case’.
137.
NarcA Art 11(1); GesG-Aargau Art 22(1).
138.
Aargau Case, 310–315.
139.
Aargau Case, 316–318.
140.
Aargau Case, 320.
141.
Aargau Case, 327.
142.
Dr X [2005] BGer 2P.310/2004.
143.
Dr X Case, [4.3].
144.
Dr X Case, [4.3.2]-[4.3.3].
145.
Dr Y [2008] BGer 2C_191/2008.
146.
The Zurich Department of Health discontinued the Senior citizens’ permit (Seniorenbewilligung) authorization as of 2018. Physicians over the age of 70 will have to apply for a regular license to practice medicine and comply with all requirements. The decision has been strongly criticized. See Kuhn (2019), pp. 663–665.
147.
810.1 Zurich Cantonal Health Act of 4 November 1962 (before the amendment of 2 April 2007) (GesG-Zürich) Art 8(1).
148.
Dr Y Case, [3.2].
149.
Haas [2006] BGer 2A.48/2006 & 2A.66/2006, BGE 133 58; The analysis of the Federal Supreme Court’s judgment can be found under Sect. 4.1.4 ‘The Haas Case’.
150.
Dr Y Case, [5].
151.
Lewy (2011), p. 109.
152.
(2007) Doctor Sentenced over Assisted Suicides. In: SWI swissinfo.ch. https://www.swissinfo.ch/eng/doctor-sentenced-over-assisted-suicides/5988876.
153.
Bosshard (2008), p. 476.
154.
Lewy (2011), p. 110.
155.
Baumann [2009] BGer 6B_14/2009 & 6B_48/2009.
156.
Walther (2014) Leidenschaftlich Klar. In: Humanistischer Pressedienst. https://hpd.de/node/18453; Dr Baumann wrote a book about his experience with assisted suicide, see Baumann (2014).
157.
Dignitas v Swissmedic [2008] BGer 2C_839/2008.
158.
Dignitas v Swissmedic Case, [2]-[3].
159.
ERAS, which stands in translation for the Real Right of Self-Determination, is an association established in May 2015 that aims to realize the right to self-determination in practice. According to ERAS, every competent individual should have access to medication when and if he or she chose to end his or her life. ERAS, Home. https://www.verein-eras.ch/de/home.
160.
The Cantonal Medical Service is a division within the Department of Health that is responsible for checking whether ‘healthcare professionals and people who work in healthcare and medical institutions fulfil their professional duties and responsibilities properly’. Department of Health - Canton Zurich, About Us. https://www.zh.ch/en/gesundheitsdirektion.html.
161.
ERAS and others [2018] BGer 2C_608/2017. The applicants informed the Court on 23 May 2018 that they lodged an application with the ECtHR complaining of the lengthy duration of the procedures. The ECtHR gave an inadmissibility decision based on the lack of victim status. ERAS (2019) Abschlägiger Bericht aus Strasbourg. https://www.verein-eras.ch/de/detail-reflexe?id=57.
162.
Case of Eras and others, [6.5.2] (author’s translation).
163.
(2019) Sterbehelferin Erika Preisig wegen Medikament-Verstössen verurteilt. In: SWI swissinfo.ch. https://www.swissinfo.ch/ger/alle-news-in-kuerze/sterbehelferin-erika-preisig-wegen-medikament-verstoessen-verurteilt/45085538.
164.
Mansour (2019) A Genève, le médecin d’Exit coupable d’avoir repoussé les limites du suicide assisté. In: Le Temps. https://www.letemps.ch/suisse/geneve-medecin-dexit-coupable-davoir-repousse-limites-suicide-assiste.
165.
The guidelines applicable at the time of the incident were the Guideline’04. It is doubtful the outcome would have been any different under the Guideline’18. The wife’s decision to end her life was motivated by fear of outliving her husband. Whether this situation would amount to an unbearable suffering within the meaning of the SAMS Guideline’18 is highly questionable. Even if so, Dr Beck had failed to get a detailed expert psychiatric assessment of the wife and did not ask for a third party confirmation whether the requirements of assisted suicide were met. Although the Criminal Court had not argued the wife’s decision-making capacity, Dr Beck’s conduct would still have been contrary to the SAMS Guideline’18 and TPA for not obtaining an expert psychiatric assessment.
166.
Citroni (2020) Le vice-président d’Exit Suisse romande condamné en appel après un suicide assisté. In: RTS.ch. https://www.rts.ch/info/suisse/11288726-le-vice-president-d-exit-suisse-romande-condamne-en-appel-apres-un-suicide-assiste.html.
167.
See the Federal Supreme Court’s decision under Sect. 4.1.5 ‘The Gross Case’.
168.
A study showed that between the years 1990–2000, 22% of assisted suicides with EXIT were non-terminal cases. However, the number of criminal prosecutions or professional proceedings does not correspond to this percentage. This does not reflect the approach in the Zurich Case or the SAMS Guidelines of the time period. Fischer et al. (2008), p. 813.
169.
Motion 94.3370 Victor Ruffy (1994) Sterbehilfe. Ergänzung des Strafgesetzbuches (Swiss National Council).
170.
The Report had unanimously recommended passive and indirect active euthanasia to be regulated. The majority had recommended an addendum to Article 114 of the Criminal Code to legalize those exceptional situations for direct active euthanasia, while the minority opposed to any sort of relaxation. Although the Report refers to EXIT and its activities, it does not make any recommendation related to assisted suicide, except for stating that it is not a medical activity. Also the Report refers repeatedly to the SAMS Guidelines, which is another indication to the Guidelines’ importance. Arbeitsgruppe Sterbehilfe (1999) Bericht der Arbeitsgruppe an Das Eidg. Justiz- und Polizeidepartement. https://www.bj.admin.ch/bj/de/home/gesellschaft/gesetzgebung/archiv/sterbehilfe.html.
171.
While discussing passive and indirect active euthanasia, the Federal Council had recognized the SAMS Guidelines, however stating that an area that ‘affects life as the highest legal asset, should be regulated by the democratically legitimized legislator’. It is also noteworthy to mention that church positions were taken in to consideration in the report. Bundesrat (2000) Bericht des Bundesrates zum Postulat Ruffy, Sterbehilfe. Ergänzung des Strafgesetzbuches. https://www.bj.admin.ch/bj/de/home/gesellschaft/gesetzgebung/archiv/sterbehilfe.html, p. 14 (author’s translation).
172.
Parlamentarische Initiative 00.441 Franco Cavalli (2000) Strafbarkeit der aktiven Sterbehilfe. Neuregelung (Swiss National Council).
173.
Parlamentarische Initiative 01.407 Dorle Vallender (2001) Verleitung und Beihilfe zur Selbsttötung. Neufassung von Artikel 115 StGB (Swiss National Council).
174.
Die Kommission für Rechtsfragen des Nationalrates (2001) Medienmitteilung: Sterbehilfe - Schmuggel und organisiertes Wirtschaftsverbrechen. In: Schweizer Parlament. https://www.parlament.ch/press-releases/Pages/2001/mm_2001-07-05_000_02.aspx.
175.
Motion 01.3523 Guido Zäch (2001) Sterbehilfe. Gesetzeslücke schliessen statt Tötung erlauben (Swiss National Council).
176.
Swiss Parliament (2001) Amtliches Bulletin Nationalrat, Wintersession 11. Tagung der 46. Amtsdauer, pp. 1819–1835.
177.
Swiss Parliament (2003) Amtliches Bulletin Ständerat, Sommersession 19. Tagung der 46. Amtsdauer, pp. 616–618; Motion 03.3180 Komission für Rechtsfragen SR (2003) Sterbehilfe und Palliativmedizin (Swiss Council of State).
178.
FDJP (2006) Sterbehilfe und Palliativmedizin – Handlungsbedarf für den Bund? https://www.bj.admin.ch/bj/de/home/gesellschaft/gesetzgebung/archiv/sterbehilfe.html.
179.
FDJP (2006) Medienmitteilung: Sterbehilfe: Geltendes Recht durchsetzen. https://www.bj.admin.ch/ejpd/de/home/aktuell/news/2006/2006-05-311.html.
180.
SAMS (2006) Schreiben der SAMW an den Bundesrat zur Zulassung und Beaufsichtigung von Sterbehilfeorganisationen. https://www.samw.ch/de/Ethik/Themen-A-bis-Z/Sterben-und-Tod/Hintergrund-Sterben-Tod.html.
181.
FDJP (2007) Ergänzungsbericht zum Bericht “Sterbehilfe und Palliativmedizin – Handlungsbedarf für den Bund?” https://www.bj.admin.ch/bj/de/home/gesellschaft/gesetzgebung/archiv/sterbehilfe.html, para. [2.4].
182.
Some of these legislative attempts were: Motion 05.3352 FDP-Liberale Fraktion (2005) Expertenarbeiten zum Thema Sterbehilfe (Swiss National Council); Parlamentarische Initiative 06.453 Christine Egerszegi-Obrist (2006) Regelung der Sterbehilfe auf Gesetzesebene (Swiss National Council); Motion 07.3163 Hansruedi Stadler (2007) Gesetzliche Grundlage für die Aufsicht über die Sterbehilfeorganizationen (Swiss Council of States); Standesinitiative 08.317 Aargau (2008) Beihilfe zum Suizid. Änderung von Artikel 115 StGB; Standesinitiative 10.306 Basel-Landschaft (2010) Gesamtschweizerische Regelung der Suizidbeihilfe; Swiss Parliament (2012) Amtliches Bulletin Nationalrat, Herbstsession 5. Tagung der 49. Amtsdauer, pp. 1668–1674; Interpellation 14.3817 Francine John-Calame (2014) Sterbehilfe. Gesetzlicher Rahmen und Verhinderung von Auswüchsen (Swiss National Council); Standesinitiative 17.315 Neuenburg (2017) Bedingungen für die Suizidhilfe.
183.
FDJP (2009) Organisierte Suizidhilfe: Vertiefte Abklärungen zu Handlungsoptionen und –Bedarf des Bundesgesetzgebers. https://www.bj.admin.ch/bj/de/home/gesellschaft/gesetzgebung/archiv/sterbehilfe.html.
184.
Bundesrat (2011) Bericht über Palliative Care, Suizidprävention und organisierte Suizidhilfe. https://www.bj.admin.ch/bj/de/home/gesellschaft/gesetzgebung/archiv/sterbehilfe.html.
185.
NCE (2018) Mission. https://www.nek-cne.admin.ch/en/about-us/mission/.
186.
NCE (2005) Beihilfe zum Suizid. Stellungnahme Nr. 9/2005, p. 47.
187.
NCE (2005) Beihilfe zum Suizid. Stellungnahme Nr. 9/2005, pp. 53–58.
188.
NCE (2005) Beihilfe zum Suizid. Stellungnahme Nr. 9/2005, pp. 63–64.
189.
NCE (2005) Beihilfe zum Suizid. Stellungnahme Nr. 9/2005, pp. 63–64.
190.
NCE (2006) Sorgfaltskriterien im Umgang mit Suizidbeihilfe. Stellungnahme Nr. 13/2006.
191.
FDJP, ‘Report 2009’ (n 183) 25–27.
192.
NCE (2010) Vernehmlassungsantwort der NEK-CNE zu den bundesrätlichen Vorschlägen für eine Änderung von Art. 115 StGB/Art. 119 MStG. https://www.nek-cne.admin.ch/inhalte/Themen/Vernehmlassungsantworten/Vernehmlassungsantwort_NEK-CNE_Suizidbeihilfe_definitiv.pdf.
193.
Die Oberstaatsanwaltschaft des Kantons Zürich and EXIT Deutsche Schweiz (2009) Vereinbarung über die organisierte Suizidhilfe. https://static.nzz.ch/files/4/7/6/EXIT-Vereinbarung2_1.2980476.pdf.
194.
Case on the EXIT Agreement [2010] BGer 1C_438/2009, BGE 136 II 415.
195.
Ackeret (2019) Die Sterbehilfe in der Schweiz ist längst ausser Kontrolle. In: SWI swissinfo.ch. https://www.swissinfo.ch/ger/standpunkt_die-sterbehilfe-in-der-schweiz-ist-laengst-ausser-kontrolle/44599878.
196.
Swiss National Science Foundation & NRP 67 (2017) Synthesis Report NRP 67: End of Life, p. 33.
197.
Postulat 18.3554 Ida Glanzmann-Hunkeler (2018) Suizidhilfe in der Schweiz (Swiss National Council).
198.
Interpellation 17.3845 Sylvia Flückiger-Bäni (2017) Ausweitung der Sterbehilfe (Swiss National Council).
199.
NCE (2006) Sorgfaltskriterien im Umgang mit Suizidbeihilfe. Stellungnahme Nr. 13/2006, p. 3 (author’s translation).
200.
This was one of the reasons that weighed against regulation in FDJP (2006) Sterbehilfe und Palliativmedizin – Handlungsbedarf für den Bund? p. 46; Bundesrat (2011) Bericht über Palliative Care, Suizidprävention und organisierte Suizidhilfe, p. 34.
201.
See Nisnevich (2012), p. 35.
202.
Broeckaert and Janssens (2005), p. 35.
203.
Kimsma and Van Leeuwen (1993), p. 24.
204.
Cohen-Almagor (2004), p. 24. Since neither the Dutch jurisprudence nor the Dutch literature make any specific distinction between euthanasia and assisted suicide, the term euthanasia will refer to both physician-assisted dying practices under this section unless otherwise expressed.
205.
Alexander (1949), p. 45.
206.
Scherer and Simon (1999), p. 55.
207.
Cohen-Almagor (2004), p. 35.
208.
RTE (2020) Annual Report 2019, p. 17; All RTE annual reports can be found at https://english.euthanasiecommissie.nl/the-committees/documents/publications/annual-reports/2002/annual-reports/annual-reports.
209.
van den Berg (1978), the original first edition was published in Dutch in 1969.
210.
Fenigsen (1990), p. 236.
211.
BWBR0001854 Criminal Code of 3 March 1881 (before the amendment of 1 April 2002) English translation available at https://www.legislationline.org/documents/section/criminal-codes/country/12/Netherlands/show.
212.
Postma [1973] Rechtbank Leeuwarden ECLI:NL:RBLEE:1973:AB5464.
213.
Nederlandse Vereniging voor een Vrijwillig Levenseinde (NVVE), founded in 1973, aims for the advancement of end-of-life decision as a human right. NVVE, About NVVE. https://www.nvve.nl/about-nvve.
214.
Griffiths et al. (1998), p. 52.
215.
Thomasma et al. (1998), p. 7.
216.
Otlowski (1997), p. 396.
217.
KNMG Working Group on Euthanasia (1975), p. 15.
218.
Wertheim [1981] Rechtbank Rotterdam ECLI:NL:RBROT:1981:AB7817; Griffiths et al. (1998), p. 59.
219.
The Board of Procurators-General is the governing body of the Netherland’s Public Prosecution Service. It is tasked with developing the national investigation and prosecution policy of the Public Prosecution Service. Openbaar Ministerie, College van Procureurs-Generaal – Opdrachten. https://www.om-mp.be/nl/colpg/college-van-procureurs-generaal-opdrachten.
220.
Griffiths et al. (1998), p. 59.
221.
Schoonheim [1984] Hoge Raad ECLI:NL:HR:1984:AC8615.
222.
Dutch Criminal Code Art 40 ‘Any person who commits an offence under the compulsion of an irresistible force shall not be criminally liable.’
223.
Otlowski (1997), p. 398.
224.
Elders and Wöretshofer (1992), p. 227.
225.
Cohen-Almagor (2004), p. 40.
226.
Otlowski (1997), pp. 410–411.
227.
KNMG (1984), p. 995.
228.
Griffiths et al. (2008), p. 31.
229.
Leenen (1986), p. 350.
230.
Schoonheim [1986] Gerechtshof’s-Gravenhage ECLI:NL:GHSGR:1986:AC8621.
231.
Otlowski (1997), p. 401.
232.
Leenen (1987), p. 201.
233.
Cohen-Almagor (2004), p. 41.
234.
Pols [1984] Rechtbank Groningen ECLI:NL:RBGRO:1984:AB7546.
235.
Pols [1984] Gerechtshof Leeuwarden ECLI:NL:GHLEE:1984:AC2140.
236.
Welie (1992), pp. 431–432.
237.
Pols [1986] Hoge Raad ECLI:NL:HR:1986:AC9531.
238.
Leenen (1989), pp. 523–524.
239.
Kimsma and Van Leeuwen (1993), pp. 22–23.
240.
van der Maas et al. (1991).
241.
KNMG (1990), pp. 1303–1301.
242.
Dillmann and Legemaate (1994), p. 84.
243.
van Delden et al. (1993), p. 26.
244.
van der Maas et al. (1991), p. 673.
245.
ten Have and Welie (1996), pp. 101–102.
246.
Dillmann and Legemaate (1994), p. 86; Gevers (1996), p. 332.
247.
BWBR0005009 Burial Act of 7 March 1991.
248.
Dillmann and Legemaate (1994), pp. 84–85.
249.
Thomasma et al. (1998), p. 11.
250.
Onwuteaka-Philipsen et al. (2003), pp. 395–399.
251.
van der Wal et al. (1996), p. 1707.
252.
Griffiths et al. (2008), p. 32; The RTE will be explained further under Sect. 3.2.2 ‘The New Legal Framework of 2002: Euthanasia Act’.
253.
KNMG, Over SCEN. https://www.knmg.nl/advies-richtlijnen/scen/over-scen.htm.
254.
Jansen-van der Weide et al. (2004), pp. 372–373; Jansen-van der Weide et al. (2007), p. 106.
255.
Sneiderman and Verhoef (1996), pp. 393–396.
256.
Sneiderman and Verhoef (1996), pp. 396–398.
257.
de Vries (2004), p. 379.
258.
Chabot [1994] Hoge Raad ECLI:NL:HR:1994:AD2122.
259.
Sneiderman and Verhoef (1996), pp. 398–402.
260.
Sneiderman and Verhoef (1996), p. 403.
261.
Griffiths (1995a), pp. 236–239.
262.
Griffiths (1995a), pp. 236–239.
263.
Sneiderman and Verhoef (1996), pp. 403–405.
264.
Medical Disciplinary Tribunal (1995), p. 674 (Griffiths’ translation at Griffiths (1995b), p. 895).
265.
Griffiths et al. (2008), p. 36.
266.
Brongersma-RB [2000] Rechtbank Haarlem ECLI:NL:RBHAA:2000:AA7926.
267.
de Vries (2004), pp. 384–386.
268.
Hagenouw (2000) Nooit: u vraagt en arts draait. In: Trouw. https://www.trouw.nl/nieuws/nooit-u-vraagt-en-arts-draait~b9e7d35b/ (Griffiths’s translation at Griffiths et al. (2008), p. 36.
269.
Brongersma-GH [2001] Gerechtshof Amsterdam ECLI:NL:GHAMS:2001:AD6753.
270.
Brongersma-HR [2002] Hoge Raad ECLI:NL:HR:2002:AE8772.
271.
KNMG (2011) Position Paper: The Role of the Physician in the Voluntary Termination of Life. https://www.knmg.nl/advies-richtlijnen/knmg-publicaties/publications-in-english.htm, p. 14.
272.
Griffiths et al. (2008), p. 39.
273.
de Vries (2004), p. 388.
274.
Otlowski (1997), p. 402.
275.
BWBR0012410 Termination of Life on Request and Assistance with Suicide (Review Procedures) Act of 10 April 2001. English translation available at https://www.ieb-eib.org/ancien-site/pdf/loi-euthanasie-pays-bas-en-eng.pdf. The version provided under this link is from 2002, before the amendments of 2012, 2014, 2018 and 2020. However, these amendments did not bring major changes that are relevant here. The only relevant change is that the members of the RTE are no longer appointed for a term of 6 years, but 4.
276.
Dutch Burial Act sec 7(2).
277.
Dutch Burial Act sec 10(2); The RTE is regulated under Chapter III sections 3–19 of the Dutch Euthanasia Act.
278.
RTE, The Committees. https://english.euthanasiecommissie.nl/the-committees/the-committees.
279.
Dutch Euthanasia Act sec 4(1).
280.
A step-by-step explanation of this process can be found at RTE, Review Procedure. https://english.euthanasiecommissie.nl/review-procedure.
281.
Dutch Euthanasia Act sec 17(1); All annual reports can be found at https://english.euthanasiecommissie.nl/the-committees/annual-reports.
282.
RTE (2019) Euthanasia Code 2018. https://english.euthanasiecommissie.nl/the-committees/code-of-practice.
283.
RTE (2020) Lichte stijging aantal euthanasiemeldingen. https://www.euthanasiecommissie.nl/actueel/nieuws/2020/4/17/jaarverslag-2019.
284.
Dutch Euthanasia Act sec 2(2), 2(3), 2(4).
285.
KNMG (2012) Guidelines for the Practice of Euthanasia and Physician-Assisted Suicide. https://www.knmg.nl/advies-richtlijnen/knmg-publicaties/publications-in-english.htm.
286.
RTE (2019) Euthanasia Code 2018, p. 24.
287.
RTE (2019) Euthanasia Code 2018, p. 22.
288.
RTE (2019) Euthanasia Code 2018, pp. 52–53.
289.
Psychiatric illnesses might often have biological correlates. There are researches aiming to give neurophysiological explanations to psychiatric illnesses. See Rietschel (2014).
290.
Griffiths et al. (2008), p. 113.
291.
RTE (2019) Annual Report 2018, p. 38; Also addressed in RTE (2019) Euthanasia Code 2018, pp. 25–27.
292.
RTE (2019) Euthanasia Code 2018, p. 26.
293.
NVvP (2018) Levensbeëindiging op verzoek bij patiënten met een psychische stoornis. https://richtlijnendatabase.nl/richtlijn/levensbeeindiging_op_verzoek_psychiatrie/startpagina_-_levensbe_indiging_op_verzoek.html.
294.
Griffiths et al. (2008), p. 40.
295.
van Oijen [2004] Hoge Raad ECLI:NL:HR:2004:AP1493.
296.
Griffiths et al. (2008), pp. 40–41.
297.
van Oijen [2003] Gerechtshof Amsterdam ECLI:NL:GHAMS:2003:AF9392.
298.
Griffiths et al. (2008), pp. 40–41.
299.
Griffiths et al. (2008), pp. 217–226.
300.
Griffiths et al. (2008), pp. 227–228.
301.
See Verhagen (2006).
302.
NVK (2014) Richtlijn: Levensbeëindiging bij pasgeborenen, actieve. https://www.nvk.nl/themas/kwaliteit/richtlijnen/richtlijn?componentid=6881303&tagtitles=Neonatologie.
303.
Beoordelingscommissie Late Zwangerschapsafbreking en Levensbeëndiging bij Pasgeborenen, Over ons. https://www.lzalp.nl/over-ons.
304.
Rietjens et al. (2008), p. 813.
305.
See Tännsjö (ed) (2004); In this book, ‘Terminal Sedation: Euthanasia in Disguise?’, several authors discuss whether terminal sedation is used as a substitute for euthanasia. One of the authors, Helga Kuhse, calls terminal sedation ‘slow euthanasia’.
306.
McIntyre (2019) Doctrine of Double Effect. In: Zalta EN (ed) The Stanford Encyclopedia of Philosophy. https://plato.stanford.edu/archives/spr2019/entries/double-effect/.
307.
McIntyre (2019) Doctrine of Double Effect; Fohr (1998), p. 319; Badarau et al. (2019), p. 57.
308.
van Kolfschooten (2003), pp. 1352–1353.
309.
van der Heide et al. (2007), p. 1960.
310.
Sheldon (2003), p. 465.
311.
Rietjens et al. (2006), p. 750.
312.
Rietjens et al. (2006), pp. 751–752.
313.
Rietjens et al. (2006), p. 751.
314.
KNMG (2009) Guideline for Palliative Sedation. https://www.knmg.nl/advies-richtlijnen/knmg-publicaties/publications-in-english.htm.
315.
KNMG (2009) Guideline for Palliative Sedation, p. 55.
316.
KNMG (2009) Guideline for Palliative Sedation, p. 20.
317.
The Guideline refers to a refractory symptom when ‘none of the conventional modes of treatment is effective or fast-acting enough, and/or if these modes of treatment are accompanied by unacceptable side-effects.’ KNMG (2009) Guideline for Palliative Sedation, p. 22.
318.
KNMG (2009) Guideline for Palliative Sedation, pp. 24–25.
319.
KNMG (2009) Guideline for Palliative Sedation, pp. 25–27.
320.
KNMG (2009) Guideline for Palliative Sedation, pp. 31–33.
321.
KNMG (2009) Guideline for Palliative Sedation, p. 30.
322.
KNMG (2009) Guideline for Palliative Sedation, pp. 66–69.
323.
KNMG (2009) Guideline for Palliative Sedation, p. 51.
324.
Griffiths et al. (2008), pp. 42–43.
325.
The KNMG refers to continuous sedation as a ‘radical medical procedure’. KNMG (2009) Guideline for Palliative Sedation, p. 7.
326.
Janssens et al. (2012), p. 667.
327.
Swart et al. (2012), p. 262.
328.
Rietjens et al. (2019), pp. 1367–1372.
329.
Heijltjes (2020), pp. 841–843.
330.
Enthoven (2017) Deur staat open voor euthanasietoerisme. NJB 38:2035. https://www.njb.nl/blogs/deur-staat-open-voor-euthanasietoerisme/.
331.
Enthoven states that, before the change, the Government’s website stated ‘The Act is only applicable to people who have a medical relationship with a physician who is subject to Dutch law. This means that people who do not reside in the Netherlands cannot apply for euthanasia or physician-assisted suicide under the Act.’ Enthoven (2017) Deur staat open voor euthanasietoerisme.
332.
Government of the Netherlands, Is euthanasia allowed? https://www.government.nl/topics/euthanasia/is-euthanasia-allowed.
333.
Hagens et al. (2014), p. 462.
334.
Hagens et al. (2017), p. 543.
335.
Hagens et al. (2021), p. 45.
336.
de Einder, Historie van Stichting de Einder. https://www.deeinder.nl/de-einder/organisatie/historie/.
337.
Griffiths et al. (2008), p. 47.
338.
Schoonman et al. (2014), pp. 844–845.
339.
Expertisecentrum Euthanasie, Over ons. https://expertisecentrumeuthanasie.nl/over-ons/.
340.
Griffiths et al. (2008), p. 73.
341.
RTE (2019) Annual Report 2018, p. 13.
342.
Case on Dementia [2019] Rechtbank Den Haag ECLI:NL:RBDHA:2019:9506.
343.
Cheng (2018) Dutch probe “appalling” euthanasia of dementia patient. In: Associated Press. https://apnews.com/article/8278f8a6224a47e88b46ea434eda26b4.
344.
RTE (2016) 2016-85, Elderly-Care Specialist, Dementia, Not Acted in Accordance with the Due Care Criteria. https://english.euthanasiecommissie.nl/judgments/dementia/documents/publications/judgments/2016/2016-85/2016-85.
345.
RTE (2016) 2016-85, Elderly-Care Specialist, Dementia, Not Acted in Accordance with the Due Care Criteria.
346.
Mahase (2019).
347.
Case on Dementia-RB, [5.3].
348.
Case on Dementia [2020] Hoge Raad ECLI:NL:HR:2020:712, [5.3.2]; Sheldon (2020).
349.
Case on Dementia-HR, [4.9].
350.
RTE (2019) Euthanasia Code 2018, pp. 38–39.
351.
RTE (2019) Euthanasia Code 2018, p. 45.
352.
RTE (2019) Euthanasia Code 2018, p. 40.
353.
Doughty (2014) Don’t make our mistake: As assisted suicide bill goes to Lords, Dutch watchdog who once backed euthanasia warns UK of ‘slippery slope’ to mass deaths. In: Daily Mail. https://www.dailymail.co.uk/news/article-2686711/Dont-make-mistake-As-assisted-suicide-bill-goes-Lords-Dutch-regulator-backed-euthanasia-warns-Britain-leads-mass-killing.html.
354.
Cook (2018) Dissent in Dutch Euthanasia Bureaucracy. In: BioEdge. https://www.bioedge.org/bioethics/dissent-in-dutch-euthanasia-bureaucracy/12569.
355.
2002009590 Belgian Act on Euthanasia of 28 May 2002 (23 March 2020) (amended 10 November 2005, 24 February 2014 and 15 March 2020); English translation without the amendment of 15 March 2020 can be found in Jones et al. (2017), pp. 305–315.
356.
2002022737 Belgian Act on Patients’ Rights of 22 August 2002 (31 December 2018); 2002022868 Belgian Act on Palliative Care of 14 June 2002 (21 March 2018).
357.
1867060850 Belgian Criminal Code of 8 June 1867 (4 May 2020).
358.
Cohen-Almagor (2009), p. 188.
359.
Broeckaert (2001), p. 95.
360.
Broeckaert (2001), p. 95.
361.
ACB was established in 1993 as an independent committee to provide opinions on questions raised in the fields of healthcare, biology and medicine upon request from authorities or on its own initiative. In 1996, the ACB had divided its organization into six commissions, one of which dealt with euthanasia, and received its first assignment on the matter of end-of-life decisions. FPS Public Health, About Us. https://www.health.belgium.be/en/about-us-1.
362.
ACB (1997) Opinion No 1 of 12 May 1997 Concerning the Advisability of a Legal Regulation on Euthanasia. https://www.health.belgium.be/en/opinion-no-1-legal-regulation-euthanasia, p. 1.
363.
ACB (1997) Opinion No 1, p. 1.
364.
ACB (1997) Opinion No 1, p. 2.
365.
See Sect. 3.2.1 ‘Until 2002’ for the Dutch Jurisprudence.
366.
ACB (1997) Opinion No 1, p. 2.
367.
ACB (1997) Opinion No 1, p. 3.
368.
ACB (1997) Opinion No 1, p. 3.
369.
ACB (1997) Opinion No 1, p. 4.
370.
ACB (1999) Opinion No 9 of 22 February 1999 Concerning Active Termination of the Lives of Persons Incapable of Expressing Their Wishes. https://www.health.belgium.be/en/opinion-no-9-active-termination-lives-persons-incapable-expressing-their-wishes.
371.
ACB (1999) Opinion No 9, p. 6.
372.
ACB (1999) Opinion No 9, pp. 10–12.
373.
‘Hopeless situation’ refers to when a patient in a terminal stage has ‘no prospect of any recovery’ with only a few hours or days to live. However, a situation can still be hopeless even if the patient is not in an immediate terminal stage but nevertheless has no hopes of recovery. ACB gives the example of a newborn suffering from an incurable illness with only few years to live, patients in a persistent vegetative state or patients with dementia. While it can take years for death to take its course in these cases, there is an irremediable illness that will ultimately cause death. ACB (1999) Opinion No 9, p. 3.
374.
ACB (1999) Opinion No 9, pp. 13–14.
375.
It is assumed that the patient had previously requested the termination of his or her life under such circumstances.
376.
ACB (1999) Opinion No 9, pp. 14–15.
377.
ACB (1999) Opinion No 9, pp. 15–16.
378.
ACB (1999) Opinion No 9, p. 17.
379.
Jans (2005), p. 170.
380.
Broeckaert (2001), pp. 99–101; Jans (2005), p. 170.
381.
Broeckaert and Janssens (2005), pp. 38–42.
382.
Lewy (2011), pp. 73–74; Jans (2005), p. 172.
383.
Jans (2005), p. 172.
384.
Nys (2017), p. 12.
385.
Cohen-Almagor (2009), p. 196.
386.
Physicians have to be registered with the Ordomedic to practice medicine in Belgium. The National Council is the body of the Ordomedic responsible with the establishment of principles, which form the code of medical ethics. It is also responsible to give the Government advice on medical matters. Ordomedic, Wie zijn we? https://www.ordomedic.be/nl/orde/wie-zijn-we/.
387.
Ordomedic (2000) Implication médicale dans le cadre de la vie finissante – Euthanasie, a087001. https://ordomedic.be/fr/avis/ethique/euthanasie/implication-medicale-dans-le-cadre-de-la-vie-finissante-euthanasie.
388.
Deliens et al. (2000), p. 1810.
389.
Deliens et al. (2000), pp. 1809–1810.
390.
Deliens et al. (2000), p. 1811.
391.
Deliens et al. (2000), p. 1809.
392.
Another report based on the same study from 1998 focused on the general practitioners role in end-of-life decisions: Bilsen (2004), p. 286.
393.
Lewy (2011), p. 70.
394.
Cohen-Almagor (2009), p. 189.
395.
Adams and Nys (2003), pp. 353–354.
396.
MacKeller (2017), p. 222.
397.
Cohen et al. (2006), p. 667.
398.
Adams and Nys (2003), p. 373.
399.
Lewy (2011), p. 82.
400.
Saad (2017), p. 184.
401.
Nys (2017), pp. 9–10.
402.
Nys (2005), p. 40.
403.
Nys (2005), p. 40.
404.
Ordomedic (2003) Avis relatif aux soins palliatifs, à l’euthanasie et à d’autres décisions médicales concernant la fin de vie, a100006. https://ordomedic.be/fr/avis/deontologie/consentement-eclaire/avis-relatif-aux-soins-palliatifs-a-l-euthanasie-et-a-d-autres-decisions-medicales-concernant-la-fin-de-vie.
405.
CFCEE (2004) Rapport Euthanasie 2004, p. 24; All reports of the CFCEE can be found at https://organesdeconcertation.sante.belgique.be/fr/organe-d’avis-et-de-concertation/commission-federale-de-controle-et-devaluation-de-leuthanasie.
406.
Nys (2017), p. 1011; Montero (2017), pp. 36–37.
407.
‘Emancipated minors are those minors who, in accordance with Belgian law, are legally competent to autonomously make decisions that touch upon their person, as a result of marriage that, subject to the provision of weighty reasons by the minor, is approved by the juvenile court or, when they have reached the age of 15, on the basis of an order by the juvenile court.’ Van Assche et al. (2019), p. 243.
408.
2020040680 Act amending the Belgian legislation on euthanasia of 15 March 2020, sec 3 (author’s translation).
409.
Hope (2020) Catholic hospitals forcing palliative care on patients who request euthanasia. In: The Brussels Time. https://www.brusselstimes.com/belgium/94850/catholic-hospitals-forcing-palliative-care-on-patients-who-request-euthanasia-legal-right-filter-bishops-morgen-tijd/.
410.
Hope (2020) Parliament Approves Change to Euthanasia Law. In: The Brussels Time. https://www.brusselstimes.com/news/belgium-all-news/98832/parliament-approves-change-to-euthanasia-law-advance-directive-living-will/. Acc
411.
Temmerman (2015) Als je als ziekenhuis abortus en euthanasie weigert, moet je het ook durven zeggen. In: De Morgen. https://www.demorgen.be/es-bdff7b1b.
412.
Heneghan (2016) Catholic nursing home fined thousands in euthanasia case. In: The Tablet. https://www.thetablet.co.uk/news/5792/catholic-nursing-home-fined-thousands-in-euthanasia-case.
413.
The Council of State is Belgium’s Administrative Supreme Court and is divided into two sections: Legislation, which is an advisory body providing advice to the Parliament on legislative proposals, and Administrative Litigation, which is the judicial body. Council of State, Proceedings. http://www.raadvst-consetat.be/?page=procedure&lang=en.
414.
Belgian House of Representatives (2020) Proposition de loi modifi ant la loi du 28 mai 2002 relative à l’euthanasie, en ce qui concerne la suppression de la durée de validité de la déclaration anticipée - Avis du Conseil d’État No 66.816/AG – 66.817/AG du 29 Janvier 2020, Doc 55 0523/011. https://www.lachambre.be/FLWB/PDF/55/0523/55K0523011.pdf, pp. 15–17.
415.
Committees of the Senate or the Chamber of Representatives examine legislative proposals and can organize hearings to this end. Temporary committees can be set up to discuss specific legislative proposals. Belgian Senate, Introduction in Belgian Parliamentary History. https://www.senate.be/english/federal_parliament_en.html, para. 5.3.
416.
Sec 12(2) ‘The patient is involved in the exercise of his/her rights with due regard for his/her age and maturity. The rights summarised in this Law can be independently exercised by the patient who is a minor if (s)he can be considered as being able to reasonably assess his/her best interests.’ English translation by the Federal Commission on Patients Rights (2007) Patients’ rights – an invitation to dialogue available at https://www.health.belgium.be/en/health/taking-care-yourself/patient-related-themes/patients-rights, p. 15.
417.
Verenigde Commissies voor de Justitieen voor de Sociale Aangelegenheden (2013) Hoorzittingen Euthanasie, Zitting 2012–2013. https://www.senate.be/actueel/homepage/docs/euthanasie.pdf, pp. 117, 121, 160.
418.
Belgian Senate (2013) Proposition de loi modifiant la loi du 28 mai 2002 relative à l’euthanasie en vue de l’étendre aux mineurs, Session de 2012–2013, Doc 5-2170/1. https://www.senate.be/www/webdriver?MItabObj=pdf&MIcolObj=pdf&MInamObj=pdfid&MItypeObj=application/pdf&MIvalObj=83890023, pp. 2–3.
419.
Ordomedic (2003) Avis relatif aux soins palliatifs, à l’euthanasie et à d’autres décisions médicales concernant la fin de vie (author’s translation).
420.
Montero (2017), p. 41; van Gool and de Lepeleire (2017), p. 185; van de Walle (2017), p. 6.
421.
Watson (2014), p. g1633.
422.
(2020) Fin de vie des enfants : une loi inutile et précipitée. In: La Libre Belgique. https://www.lalibre.be/debats/opinions/fin-de-vie-des-enfants-une-loi-inutile-et-precipitee-52e93c5b3570e5b8eeea1a00.
423.
CFCEE (2018) Rapport Euthanasie 2018, p. 12.
424.
CFCEE (2019) Euthanasie - Chiffres de l’année 2018. https://organesdeconcertation.sante.belgique.be/fr/documents/euthanasie-chiffres-de-lannee-2018. CFCEE (2020) Euthanasie - Chiffres de l’année 2019. https://organesdeconcertation.sante.belgique.be/fr/documents/euthanasie-chiffres-de-lannee-2019, p. 1.
425.
Pousset et al. (2010) cited in Verenigde Commissies voor de Justitieen voor de Sociale Aangelegenheden (2013) Hoorzittingen Euthanasie, p. 4.
426.
Pousset et al. (2010), p. 549.
427.
Pousset et al. (2010), p. 551.
428.
Case on the 2014 Amendment [2015] Cour constitutionnelle Judgment No 153/2015, English translation of the case as provided under the Court’s official website has been used and can be found at http://www.const-court.be/public/e/2015/2015-153e.pdf.
429.
Case on the 2014 Amendment, [7]-[8].
430.
1994021048 Belgian Constitution of 17 February 1994 (17 March 2021) relevant articles have not changed since the date of this case, English translation available at https://www.dekamer.be/kvvcr/pdf_sections/publications/constitution/GrondwetUK.pdf. Art 22bis regulates children’s rights: ‘Each child is entitled to have his or her moral, physical, mental and sexual integrity respected. Each child has the right to express his or her views in all matters affecting him or her, the views of the child being given due weight in accordance with his or her age and maturity. Each child has the right to benefit from measures and facilities which promote his or her development. In all decisions concerning children, the interest of the child is a primary consideration. […]’
431.
United Nations, General Assembly, Convention on the Rights of the Child, 20 November 1989, United Nations, Treaty Series, vol 1577, 3.
432.
Case on the 2014 Amendment, [20].
433.
Case on the 2014 Amendment, [21].
434.
Case on the 2014 Amendment, [22].
435.
Case on the 2014 Amendment, [23].
436.
Case on the 2014 Amendment, [24.5].
437.
Case on the 2014 Amendment, [24.7].
438.
Case on the 2014 Amendment, [25].
439.
Case on the 2014 Amendment, [28].
440.
Case on the 2014 Amendment, [26].
441.
Ordomedic (2019) Directives déontologiques pour la pratique de l’euthanasie des patients en souffrance psychique à la suite d’une pathologie psychiatrique, a165002. https://ordomedic.be/fr/avis/ethique/euthanasie/directives-deontologiques-pour-la-pratique-de-l-euthanasie-des-patients-en-souffrance-psychique-a-la-suite-d-une-pathologie-psychiatrique.
442.
Ordomedic (2019) Directives déontologiques pour la pratique de l’euthanasie des patients en souffrance psychique à la suite d’une pathologie psychiatrique, para. 1.
443.
Ordomedic (2019) Directives déontologiques pour la pratique de l’euthanasie des patients en souffrance psychique à la suite d’une pathologie psychiatrique, para. 2.
444.
Ordomedic (2019) Directives déontologiques pour la pratique de l’euthanasie des patients en souffrance psychique à la suite d’une pathologie psychiatrique, para. 3.
445.
Ordomedic (2019) Directives déontologiques pour la pratique de l’euthanasie des patients en souffrance psychique à la suite d’une pathologie psychiatrique, para. 4.
446.
A patient with a psychiatric illness might possess the legal capacity of discernment, but oftentimes, the patient’s judgment can be influenced by his or her mental state. The National Council uses the term ‘effective capacity’ to refer to this distinction.
447.
Ordomedic (2019) Directives déontologiques pour la pratique de l’euthanasie des patients en souffrance psychique à la suite d’une pathologie psychiatrique, para. 5. The Flemish Association for Psychiatry (VVP) has mostly followed the guidelines of its Dutch counterpart, NVvP. Due to the delicate nature of psychiatric cases, the guidelines provide specific guidance on how to determine capacity in psychiatric patients in accordance with medical ethics. Details will not be mentioned here. VVP (2017) Hoe omgaan met een euthanasieverzoek in psychiatrie binnen het huidig wettelijk kader? https://vvponline.be/bibliotheek.php?item=451&s=Presentatie_en_lezing.
448.
Ordomedic (2019) Directives déontologiques pour la pratique de l’euthanasie des patients en souffrance psychique à la suite d’une pathologie psychiatrique, para. 6.
449.
Verhofstadt et al. (2020), p. 378.
450.
Verhofstadt et al. (2020), p. 379.
451.
Verhofstadt et al. (2020), p. 378.
452.
Verhofstadt et al. (2020), p. 381.
453.
Verhofstadt et al. (2020), pp. 380–381.
454.
Brothers of Charity was first founded in 1807 in Belgium and is now active in 30 countries. Its general administration is in Rome. Brothers of Charity, Founder. https://brothersofcharity.org/who-are-the-brothers/founder/?lang=en; For the Belgian branch’s information see Broeders van Liefde, Wie zijn we? https://broedersvanliefde.be/wie-zijn-we.
455.
See text to footnote no. 412.
456.
Thijs (2017) Euthanasie mag nu ook van Broeders van Liefde. In: De Morgen. https://www.demorgen.be/nieuws/euthanasie-mag-nu-ook-van-broeders-van-liefde~b4e72386/. The 2017 statement is no longer on the official website. However, an English translation of the statement can be found at Protection of Conscience Project (2017) Brothers of Charity: Vision of Euthanasia Adjusted. https://www.consciencelaws.org/religion/religion053-001.aspx.
457.
Brothers of Charity (2017) The Vatican’s Response to the Issue of Euthanasia with the Organization of the Brothers of Charity in Belgium. https://brothersofcharity.org/the-vaticans-response-to-the-issue-of-euthanasia-with-the-organization-of-the-brothers-of-charity-in-belgium/?lang=en; Brothers of Charity (2017) Press Release from the Brothers of Charity Generalate, Rome. https://brothersofcharity.org/press-release-from-the-brothers-of-charity-generalate_02_10_2017/?lang=en.
458.
Ladaria (2020) Letter to the Superior General of the Congregation of the “Brothers of Charity”, Regarding the Accompaniment of Patients in Psychiatric Hospitals of the Congregation’s Belgian Branch. http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20200330_lettera-fratellidellacarita-belgio_en.html.
459.
LEIF, LEIFartsen en het LEIFartsenforum. https://leif.be/vragen-antwoorden/leifartsen/.
460.
Le Forum EOL, Origine et Objectifs. http://www.eol.admd.be/.
461.
CFCEE (2004) Rapport Euthanasie 2004, p. 7.
462.
CFCEE (2006) Rapport Euthanasie 2006, p. 15; CFCEE (2008) Rapport Euthanasie 2008, p. 15; CFCEE, (2010) Rapport Euthanasie 2010, p. 15; CFCEE (2012) Rapport Euthanasie 2012, p. 7; CFCEE (2014) Rapport Euthanasie 2014, p. 7; CFCEE (2016) Rapport Euthanasie 2016, p. 14; CFCEE (2018) Rapport Euthanasie 2018, p. 2; CFCEE (2020) Rapport Euthanasie 2020, p. 2.
463.
CFCEE (2014) Rapport Euthanasie 2014, p. 27.
464.
In a comparative study, fear of legal consequences as a reason to reject a patient’s euthanasia request had decreased from 23.4% in 2007 to 2% in 2013. Dierickx et al. (2015), p. 1705.
465.
CFCEE (2004) Rapport Euthanasie 2004, p. 8; CFCEE (2006) Rapport Euthanasie 2006, p. 15; CFCEE (2008) Rapport Euthanasie 2008, p. 15; CFCEE (2010) Rapport Euthanasie 2010, p. 15; CFCEE (2012) Rapport Euthanasie 2012, p. 8; CFCEE (2014) Rapport Euthanasie 2014, p. 8; CFCEE (2016) Rapport Euthanasie 2016, p. 6; CFCEE (2018) Rapport Euthanasie 2018, p. 3; CFCEE (2020) Rapport Euthanasie 2020, p. 3.
466.
CFCEE (2006) Rapport Euthanasie 2006, p. 22.
467.
CFCEE (2020) Rapport Euthanasie 2020, p. 40.
468.
CFCEE (2016) Rapport Euthanasie 2016, pp. 53–57.
469.
Ordomedic (2001) Euthanasie, a094007. https://ordomedic.be/fr/avis/ethique/euthanasie/euthanasie-1.
470.
CFCEE (2016) Rapport Euthanasie 2016, p. 10.
471.
Saad (2017), p. 204.
472.
The Bland Case was about the withdrawal of life-sustaining treatment from a patient who was in a persistent vegetative state with no hopes of recovery. After a distinction was made between euthanasia and withdrawal of treatment, the House of Lords accepted that there was no duty to continue treatment if there was no prospect of improvement. Although the omission would cause death, withdrawing life-sustaining treatment was lawful since treatment was no longer in the best interest of the patient. Airedale NHS Trust v Bland [1993] UKHL 17, [1993] AC 789.
473.
HL Deb 9 May 1994 Vol 554 Col 1349, col 1354.
474.
United Kingdom, Assisted Dying for the Terminally Ill HL Bill 17, Session 2003-04.
475.
HL Deb 10 March 2004 Vol 658 Cols 1316–1324.
476.
Select Committee of the Assisted Dying for the Terminally Ill Bill, Assisted Dying for the Terminally Ill Bill (HL 2004-05, 86-I, II, III).
477.
HL Deb 7 July 2009 Vol 712 Cols 596–636.
478.
United Kingdom, Coroners and Justice Act 2009 (1 February 2010) sec 59. The reason behind this re-enactment was, with technological developments and cybersuicide in mind, to ‘simplify and modernise the language of sec 2 of the 1961 Act to increase public understanding and to reassure people that the provision applies as much to actions on the internet as to actions offline’, rather than a reaction against assisted suicide in the context of the right to die. HC Deb 26 January 2009 Vol 487 Col 35, col 68.
479.
Local Authority v Z [2004] EWHC 2817 (Fam).
480.
Local Authority v Z Case, [12]-[13].
481.
Hedley J quotes Hoffman LJ stating ‘A conflict between the principles of the sanctity of life and the individual’s right of self-determination may therefore require a painful compromise to be made. In the case of the person who refuses an operation without which he will certainly die, one or other principle must be sacrificed. We may adopt a paternalist view, deny that his autonomy can be allowed to prevail in so extreme a case, and uphold the sanctity of life. Sometimes this looks an attractive solution, but it can have disturbing implications. Do we insist upon patients accepting life-saving treatment which is contrary to their strongly held religious beliefs? Should one force-feed prisoners on hunger strike? English law is, as one would expect, paternalist towards minors. But it upholds the autonomy of adults. A person of full age may refuse treatment for any reason or no reason at all, even if it appears certain that the result will be his death.’ Bland Case, 827.
482.
Local Authority v Z Case, [21].
483.
Local Authority v Z Case, [18].
484.
de Cruz (2005), p. 262.
485.
Williams (2010), p. 182.
486.
R (Purdy) v the Director of Public Prosecutions [2009] EWCA Civ 92, para. 12.
487.
Contrary to the House of Lords, the ECtHR had found interference with Mrs Pretty’s rights under Article 8, which was nevertheless justifiable under paragraph 2. See Sect. 4.1.3.3.3 ‘On Article 8 of the Convention’.
488.
Purdy Case-CA, [54].
489.
Purdy Case-HL. Purdy was the last judgment given by the House of Lords before the Supreme Court was established.
490.
Purdy Case-HL, [23].
491.
DPP (2018) The Code for Crown Prosecutors. https://www.cps.gov.uk/publication/code-crown-prosecutors. The fifth edition (2004) referred to in the Purdy Case can be found at https://1library.net/document/qo50p4my-the-code-for-crown-prosecutors.html.
492.
DPP (2004) The Code for Crown Prosecutors, para. 4.14.
493.
The DPP’s decision on prosecution in Daniel James’s case is no longer available on the Crown Prosecution Service’s (CPS) website. The details of the decision can be found at: Mullock (2009).
494.
Purdy Case-HL, [34]-[39]. In the House’s Pretty judgment, Lord Hope had given a dissenting opinion finding an engagement of Article 8 of the Convention, with which the ECtHR had agreed. Pretty v Director of Public Prosecutions and Secretary of State for the Home Department [2001] UKHL 61, [2002] 1 AC 800, [100]; Pretty Case, [64].
495.
Purdy Case-HL, [41]. Lord Hope also cites Hasan and Chaush v Bulgaria, in which the ECtHR had stated, ‘In matters affecting fundamental rights it would be contrary to the rule of law, one of the basic principles of a democratic society enshrined in the Convention, for a legal discretion granted to the executive to be expressed in terms of an unfettered power. Consequently, the law must indicate with sufficient clarity the scope of any such discretion conferred on the competent authorities and the manner of its exercise.’ Hasan and Chaush v Bulgaria [GC] App no 30985/96 ECHR 2000-XI, [84].
496.
Purdy Case-HL, [46].
497.
Purdy Case-HL, [53].
498.
Purdy Case-HL, [55].
499.
Purdy Case-HL, [63].
500.
Keown (2013), p. 46.
501.
Cartwright (2009), p. 474.
502.
Williams (2010), p. 192.
503.
Cleary (2010), p. 304.
504.
DPP (2010, updated 2014) Suicide: Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide. https://www.cps.gov.uk/legal-guidance/suicide-policy-prosecutors-respect-cases-encouraging-or-assisting-suicide#a01.
505.
DPP (2010, updated 2014) Suicide: Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide, para. 45.
506.
DPP (2010, updated 2014) Suicide: Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide, para. 43.
507.
DPP (2010, updated 2014) Suicide: Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide, para. 8.
508.
DPP (2010, updated 2014) Suicide: Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide, para. 43.10.
509.
R (Nicklinson and another) v Ministry of Justice, R (AM) v Director of Public Prosecutions [2014] UKSC 38, [2015] AC 657.
510.
Nicklinson Case-SC, [9]-[11].
511.
R (Nicklinson and another) v Ministry of Justice, R (AM) v Director of Public Prosecutions [2013] EWCA Civ 961 [124]-[148].
512.
Nicklinson Case-CA, [185]-[186].
513.
Nicklinson Case-SC, [249].
514.
Nicklinson Case-SC, [141].
515.
Nicklinson Case-SC [143], [193], [251], [323]. The Court did not hesitate to express their expectation from the DPP to resolve the confusion concerning paragraph 43.14, though she was not bound to follow Lord Judge CJ’s interpretation. ‘Given that, in an important respect, the 2010 Policy does not appear to reflect what the DPP intends, it seems to me inevitable that she will take appropriate steps to deal with the problem, particularly in the light of the impressive way in which her predecessor reacted to the decision in Purdy. However, if the confusion is not sorted out, then, at least in my view, the court’s powers could be properly invoked to require appropriate action, but, as I have said, it seems very unlikely that this will be necessary.’ [146].
516.
The GMC is responsible for the medical practice and qualification of physicians in the UK and, according to the Medical Act 1983, sets the medical standards to be followed in the practice of the medical profession. GMC, Our role and the Medical Act 1983. https://www.gmc-uk.org/about/what-we-do-and-why/our-mandate.
517.
R (AM) v General Medical Council (Martin v GMC) [2015] EWHC 2096 (Admin).
518.
GMC (2013) Guidance for the Investigation Committee and case examiners when considering allegations about a doctor’s involvement in encouraging or assisting suicide. https://www.gmc-uk.org/-/media/documents/dc4317-guidance-for-ftp-decision-makers-on-assisting-suicide-51026940.pdf.
519.
GMC (2013, last updated 2015) When a patient seeks advice or information about assistance to die. https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/when-a-patient-seeks-advice-or-information-about-assistance-to-die; See also GMC (2014) Revised guidance for doctors on giving advice to patients on assisted suicide. https://www.gmc-uk.org/-/media/documents/12%2D%2D-revised-guidance-for-doctors-on-assisted-suicide_pdf-80652843.pdf.
520.
GMC (2013) Guidance for the Investigation Committee and case examiners when considering allegations about a doctor’s involvement in encouraging or assisting suicide, para. 10.
521.
GMC (2013) Guidance for the Investigation Committee and case examiners when considering allegations about a doctor’s involvement in encouraging or assisting suicide, para. 19.
522.
GMC (2013, last updated 2015) When a patient seeks advice or information about assistance to die, para. 6.b.
523.
Martin v GMC Case, [42].
524.
Martin v GMC Case, [41].
525.
Pretty Case, [76].
526.
Purdy Case-HL, [63].
527.
Nicklinson Case-SC, [111] (Lord Neuberger), [186] (Lord Mance), [205] (Lord Wilson), [301] (Lady Hale), [335] (Lord Kerr).
528.
Downie (2016), p. 95.
529.
United Kingdom, Assisted Dying (No 2) HC Bill 7, Session 2015-16.
530.
HC Deb 11 September 2015 Vol 599 Col 653, Cols 656–724.
531.
HC Deb 11 September 2015 Vol 599 Col 653, Col 674.
532.
R (Conway) v Secretary of State for Justice [2017] EWHC 640 (Admin) [5].
533.
R (Conway) v Secretary of State for Justice [2018] EWCA Civ 1431; R (Conway) v Secretary of State for Justice [2018] UKSC B1.
534.
R (Newby) v Secretary of State for Justice [2019] EWHC 3118 (Admin) [40], [42].
535.
(2020) Assisted dying: Terminally ill man’s judicial review rejected. In: BBC. https://www.bbc.com/news/uk-england-leicestershire-51311089.
536.
(2019) Paralysed Leeds man Paul Lamb loses “right to die” case. In: BBC. https://www.bbc.com/news/uk-england-leeds-50852790.
537.
United Kingdom, Assisted Dying HL Bill 69, Session 2019-21.
538.
HC Deb 23 January 2020 Vol 670 Col 186WH, Col 200WH.
539.
Dignity in Dying (2019) Dignity in Dying Poll. In: Yonder. https://yonderconsulting.com/poll/dignity-in-dying/. The question asked was: ‘Currently it is illegal for a doctor to help someone with a terminal illness to end their life, even if the person considers their suffering unbearable and they are of sound mind. A proposed new law would allow terminally ill adults the option of assisted dying. This would mean being provided with life-ending medication, to take themselves, if two doctors were satisfied they met all of the safeguards. They would need to be of sound mind, be terminally ill and have 6 months or less to live, and a High Court judge would have to be satisfied that they had made a voluntary, clear and settled decision to end their life, with time to consider all other options. Whether or not you would want the choice for yourself, do you support or oppose this proposal for assisted dying becoming law?’
540.
BMA (2016) End-of-Life Care and Physician-Assisted Dying: 3 - Reflections and Recommendations. https://www.bma.org.uk/advice-and-support/ethics/end-of-life/end-of-life-care-and-physician-assisted-dying-project, p. 65ff.
541.
BMA (2016) End-of-Life Care and Physician-Assisted Dying: 3 - Reflections and Recommendations, pp. 71–73.
542.
While 43.4% thought the position should remain opposed, 31.6% thought the RCP should be supportive and 25% were neutral. The RCP defines assisted dying as physician-assisted suicide for terminally ill patients. RCP (2020) The RCP Clarifies Its Position on Assisted Dying. https://www.rcplondon.ac.uk/news/rcp-clarifies-its-position-assisted-dying.
543.
BMA (2021) How have the law and BMA policy developed over the past twenty years? https://www.bma.org.uk/media/4401/bma-pad-policy-law-and-timeline-aug-2021.pdf.
544.
For the purposes of the survey, capable adult patients who ‘have either a terminal illness or serious physical illness causing intolerable suffering that cannot be relieved’ are considered eligible for physician-assisted suicide. BMA (2020) Physician-Assisted Dying Survey. https://www.bma.org.uk/advice-and-support/ethics/end-of-life/physician-assisted-dying-survey, p. 10.
545.
BMA (2020) Physician-Assisted Dying Survey, p. 21.
546.
BMA (2020) Physician-Assisted Dying Survey, p. 22.
547.
BMA (2020) Physician-Assisted Dying Survey, pp. 22–23.
548.
BMA (2020) Physician-Assisted Dying Survey, p. 37.
549.
BMA (2021) Physician-Assisted Dying. https://www.bma.org.uk/advice-and-support/ethics/end-of-life/the-bmas-position-on-physician-assisted-dying.
550.
Almost 47% of the members, who have ended their lives through the assistance of Dignitas, are from Germany. Dignitas, Accompanied Suicide of Members of Dignitas, by Year and by Country of Residency 1998–2020.
551.
Kamann (2014) Befördert Sterbehelfer Kusch sich selbst ins Aus? In: Welt. https://www.welt.de/politik/deutschland/article127971004/Befoerdert-Sterbehelfer-Kusch-sich-selbst-ins-Aus.html; Schmidt and Ulrich (2009) Court Expected to Rule on Assisted Suicide Case. In: Spiegel. https://www.spiegel.de/international/germany/deadly-business-court-expected-to-rule-on-assisted-suicide-case-a-602390.html.
552.
The states of Saarland, Thüringen and Hessen had submitted a proposal in 2006. BR-Dr 230/06. Later, the Federal Government submitted a draft proposal in 2012. BT-Dr 17/11126.
553.
German Criminal Code of 13 November 1998 (19 June 2019), English translation by (Micheal Bohlander, revised and updated by Ute Reusch) the German Federal Ministry of Justice and Consumer Protection and the German Federal Office of Justice available at https://www.gesetze-im-internet.de/englisch_stgb/index.html.
554.
In the original German text, the adjective used for ‘recurring pursuit’ is geschäftsmäßig, to which the literal translation is ‘business-like’. The translator’s choice to use the term ‘recurring pursuit’ is perhaps to capture the intention behind the section. Using the word ‘business’ might give the false impression that only commercial suicide assistance would be criminalized. However, the legislator’s intention was to prohibit acts that were not necessarily commercial ‘but designed to be repeated’. BT-Dr 18/5373, p. 2 (author’s translation). Nevertheless, the author will use the direct translation of geschäftsmäßig: business-like.
555.
Art 1(1) ‘Human dignity shall be inviolable. To respect and protect it shall be the duty of all state authority.’
Art 2(1) ‘Every person shall have the right to free development of his personality insofar as he does not violate the rights of others or offend against the constitutional order or the moral law.’
Art 2(2) ‘Every person shall have the right to life and physical integrity. Freedom of the person shall be inviolable. These rights may be interfered with only pursuant to a law.’ Basic Law of the Federal Republic of Germany of 23 May 1949 (1 January 2021) English translation by (Christian Tomuschat, David P Currie, Donald P Kommers and Raymond Kerr, in cooperation with the Language Service of the German Bundestag) the German Federal Ministry of Justice and Consumer Protection and the German Federal Office of Justice available at https://www.gesetze-im-internet.de/englisch_gg/index.html.
556.
BT-Dr 18/5373, pp. 2–3, 10.
557.
BT-Dr 18/5373, p. 17 (author’s translation).
558.
BT-Dr 18/5373, pp. 11–12.
559.
BT-Dr 18/5373, p. 17.
560.
BT-Dr 18/5373, p. 19.
561.
Stiller (2020), pp. 252–257.
562.
German Act on the Trade of Narcotic Drugs of 28 July 1981 (9 June 2021) (Narcotic Drugs Act) English translation available at https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/Gesetze_und_Verordnungen/GuV/N/Narcotic_Drugs_18_12_2009.pdf.
563.
See Sect. 4.1.5 ‘The Koch Case’.
564.
Koch (2) [2017] BVerwG 3 C 19.15, [24].
565.
Koch (2) Case, [26].
566.
Koch (2) Case, [29]-[30].
567.
Koch (2) Case, [27]-[28].
568.
Koch (2) Case, [31] English translation available at the Federal Administrative Court’s website https://www.bverwg.de/en/020317U3C19.15.0.
569.
Koch (2) Case, [32].
570.
Koch (2) Case, [34]-[36].
571.
Koch (2) Case, [37]-[38].
572.
Koch (2) Case, [42].
573.
Müller-Neuhof (2018) Wie die Regierung beschloss, das höchstrichterliche Urteil zu ignorieren. In: Der Tagesspiegel. https://www.tagesspiegel.de/politik/sterbehilfe-wie-die-regierung-beschloss-das-hoechstrichterliche-urteil-zu-ignorieren/22928052.html.
574.
di Fabio (2017) Erwerbserlaubnis letal wirkender Mittel zur Selbsttötung in Existenziellen Notlagen - Rechtsgutachten zum Urteil des Bundesverwaltungsgerichts vom 2. März 2017-3 C 19/15. https://www.bfarm.de/SharedDocs/Downloads/DE/Service/Presse/Rechtsgutachten.pdf?__blob=publicationFile&v=2, pp. 99ff.
575.
BT-Dr 19/1860.
576.
BT-Dr 19/2090.
577.
BT-Dr 19/9847.
578.
Since the Federal Administrative Court’s judgment on 2 March 2017 until 10 May 2020, there had been 174 applications, none of which were approved. BT-Dr 19/19411.
579.
Case against the Federal Institute [2019] BVerwG 3 C 6.17, [5].
580.
Basic Law Art 4(1) ‘Freedom of faith and of conscience and freedom to profess a religious or philosophical creed shall be inviolable.’ Art 4(2) ‘The undisturbed practice of religion shall be guaranteed.’ Art 6(1) ‘Marriage and the family shall enjoy the special protection of the state.’
581.
Case against the Federal Institute, [17]-[26].
582.
[2020] BVerfG 1 BvL 2/20.
583.
Case on Sec 217 [2020] BVerfG 2 BvR 2347/15.
584.
Case on Sec 217, [207], [209], English translation available at the Federal Constitution Court’s website https://www.bundesverfassungsgericht.de/e/rs20200226_2bvr234715en.html.
585.
Case on Sec 217, [210].
586.
Case on Sec 217, [212]-[213].
587.
Case on Sec 217, [228]-[277].
588.
Case on Sec 217, [277].
589.
Case on Sec 217, [278]-[297]. The Court also referred to the sample Professional Code of Conduct for German Physicians published by the German Medical Association. In its last version from 2018, Article 16 clearly prohibits assisted dying. Bundesärztekammer (2018) (Muster-)Berufsordnung für die in Deutschland tätigen Ärztinnen und Ärzte. https://www.bundesaerztekammer.de/recht/berufsrecht/muster-berufsordnung-aerzte/muster-berufsordnung/.
590.
Case on Sec 217, [300].
591.
Case on Sec 217, [301].
592.
Basic Law Art 12(1) ‘All Germans shall have the right freely to choose their occupation or profession, their place of work and their place of training. The practice of an occupation or profession may be regulated pursuant to a law.’
593.
Case on Sec 217, [312].
594.
Case on Sec 217, [313].
595.
Case on Sec 217, [337]-[342].
596.
(2020) Sterbehilfe auf Agenda des Deutschen Ärztetages. In: aerzteblatt.de. https://www.aerzteblatt.de/nachrichten/sw/Sterbehilfe?s=sterbehilfe&p=1&n=1&nid=116866.
597.
DJ Fabo [2019] Italian Constitutional Court Judgment No 242/2019. Fabiano Antoniani, also known as DJ Fabo, was left with tetraplegia after a car accident in 2014. Marco Cappato drove him to Switzerland, where DJ Fabo would receive suicide assistance from Dignitas. After he informed the authorities, Mr Cappato was prosecuted in Italy for assisting DJ Fabo.
598.
DJ Fabo Case, [2.3.1], English translation of the case as provided on the Court’s official website has been used and can be found at https://www.cortecostituzionale.it/documenti/download/doc/recent_judgments/Sentenza_n_242_del_2019_Modugno_en.pdf.
599.
DJ Fabo Case, [2.3.8].
600.
Martuscelli (2021) Italian authorities clear way for country’s first assisted suicide. In: Politico. https://www.politico.eu/article/italy-authorities-first-assisted-suicide/.
601.
Austrian Case on Assisted Suicide [2020] VfGH G 139/2019-71 31, English translation of the case as provided under the Court’s official website has been used and can be found at https://www.vfgh.gv.at/downloads/G_139-2019_EN_shortened_Version_Website.pdf.
602.
Austrian Case on Assisted Suicide, p. 33.
603.
Austrian Case on Assisted Suicide, p. 33.
604.
Austria, Federal Act on the Establishment of Dying Wills (Bundesgesetz über die Errichtung von Sterbeverfügungen – Sterbeverfügungsgesetz, StVfG) BGBI. I Nr. 242/2021, 31 December 2021.
605.
Bernal-Carcelén (2020), p. 113.
606.
Spain, The Organic Law for the Regulation of Euthanasia (Ley Orgánica 3/2021, de 24 de marzo, de regulación de la eutanasia) BOE no 72, 25 March 2021, 34037–34049.
607.
Demony (2020) Pro-Euthanasia Bills Get Green Light in Portugal, Negotiations Ahead. In: Reuters. https://www.reuters.com/article/idUSKBN20E2F4.
608.
Ireland, Dying with Dignity Bill 24 of 2020; Hurley (2020) Dáil Passes Dying with Dignity Bill Aimed at Legalising Assisted Dying. In: RTÉ. https://www.rte.ie/news/politics/2020/1007/1170121-dying-with-dignity/.
609.
Canadian Criminal Code, RSC 1985, c C-46 (before the amendment of 16 June 2016).
610.
Canadian Charter of Rights and Freedoms, Part I of the Constitution Act, 1982, Schedule B to the Canada Act 1982 (UK), 1982, c 11.
611.
Amyotrophic lateral sclerosis (ALS), which is also called motor neuron disease or Lou Gehrig disease, causes progressive destruction of the nerve cells leading to the loss of muscle functions over time and eventual paralyses. Although there is no harm to the mental capacities of the patient, the disease has no treatment, and death is inevitable, which is usually by suffocation as the breathing muscles lose their function. Death is usually expected within 3 to 5 years after the onset of the disease. Editors of Encyclopedia Britannica (2020) Amyotrophic Lateral Sclerosis. In: Encyclopædia Britannica. https://www.britannica.com/science/amyotrophic-lateral-sclerosis.
612.
Rodriguez v British Columbia (Attorney General) [1992] 18 WCB (2d) 279, [1993] BCWLD 347.
613.
Burke v Prince Edwards Island (1991) 93 Nfld PEIR 356 (Supreme Court-Trial Division of Prince Edward Island). The applicant, who was a prisoner at the time, had attempted suicide, and after being rescued, he had started fasting with the intention to end his life. The officials wanted to force-feed him, and the applicant claimed force-feeding was in violation of his Charter rights, claiming s 7 had guaranteed a right to die. Although the judgment was given expeditiously without elaborative assessment, the Court agreed with the applicant that force-feeding or treatment against his will was a violation of s 7. However, the Court rejected the argument that a right to die was inherent within s 7.
614.
Rodriguez Case-BCSC, 6–23.
615.
R v Morgentaler (1988) 1 SCR 30 (SCC). The Morgentaler Case concerned three doctors who performed illegal abortions under s 251 of the Criminal Code (in force at the time of the decision) that required abortions to be performed only at accredited hospitals and with a certification acquired by the Therapeutic Abortion Committee. Approval for an abortion was given only when the pregnancy endangered the health of the woman. This led women who wished to end their pregnancy in the absence of health issues to search for other means that sometimes meant abortions performed by non-professionals. Dr Morgentaler and two of his colleagues believed that the Criminal Code was restricted women’s rights and challenged the law based on the Canadian Charter. By a majority of five to two, the Supreme Court found a violation of s 7 of the Charter. From the majority, CJ Dickson and J Lamer stated: ‘State interference with bodily integrity and serious state-imposed psychological stress, at least in the criminal law context, constitutes a breach of security of the person […] Forcing a woman, by threat of criminal sanction, to carry a foetus to term unless she meets certain criteria unrelated to her own priorities and aspirations, is a profound interference with a woman’s body and thus an infringement of security of the person.’ (32–33) J Wilson further stated: ‘To be able to decide what to do and how to do it, to carry out one’s own decisions and accept their consequences, seems to me essential to one’s self-respect as a human being, and essential to the possibility of that contentment. Such self-respect and contentment are in my judgment fundamental goods for human beings, the worth of life itself being on condition of having or striving for them. If a person were deliberately denied the opportunity of self-respect and that contentment, he would suffer deprivation of his essential humanity.’ (164–165) The two other judges in the majority only found the procedural requirements inconvenient as they caused delays in receiving necessary medical treatment, ultimately violating s 7. They kept their argument limited to cases where the pregnancy endangered the health of the woman, unlike the other three judges.
616.
Rodriguez v British Columbia (Attorney General) (1993) CanLII 1191 (BCCA) [50].
617.
Rodriguez Case-BCCA, [60].
618.
Rodriguez Case-BCCA, [75].
619.
If there is a violation of a Charter right that is not in accordance with the principles of fundamental justice, such a violation might nevertheless be justified under sec 1. Whether or not a violation is justified by sec 1 is determined through ‘the Oakes test’. According to the Oakes test, any restriction to a Charter right (1) must pursue a pressing and substantial objective, and (2) must be proportionate to its objective. A restriction is proportionate if there is a rational connection between the objective and the means to achieve it, if there is minimal impairment to the relevant Charter right and if the effects of the restriction are proportional. R v Oakes (1986) 1 RCS 103 (SCC) 105–106; Rodriguez Case-BCCA, [82].
620.
CJ McEachern listed a detailed procedural order that included, among other things, the confirmation of Mrs Rodriguez’s autonomous and well-considered decision to end her life, the terminal and hopeless nature of her illness, and the unbearable physical or severe psychological suffering experienced by her. The authenticity of her decision had to be confirmed by an independent psychiatrist. The final act that ended Mrs Rodriguez’s life was to be carried out by herself. Rodriguez Case-BCCA, [100]-[110].
621.
Rodriguez Case-BCCA, [142]-[144].
622.
Rodriguez Case-BCCA, [168].
623.
Rodriguez Case-BCCA, [172].
624.
Rodriguez v British Columbia (Attorney General) (1993) 3 SCR 519 (SCC) 543.
625.
Rodriguez Case-SCC, 584–585.
626.
Rodriguez Case-SCC, 588.
627.
Rodriguez Case-SCC, 588–589.
628.
Rodriguez Case-SCC, 590–591.
629.
Rodriguez Case-SCC, 597–598.
630.
Law Reform Commission of Canada (1982) Euthanasia, Aiding Suicide and Cessation of Treatment, Working Paper 28. http://www.lareau-law.ca/LRCWP28.pdf, pp. 52–55.
631.
Law Reform Commission of Canada (1983) Euthanasia, Aiding Suicide and Cessation of Treatment, Report 20. http://www.lareau-law.ca/LRCReport20.pdf; For a critical analysis of Working Paper 28 and Report 20 see Samek (1984).
632.
Rodriguez Case-SCC, 600–601.
633.
See Sect. 4.1.1 ‘The R v UK Case’.
634.
Rodriguez Case-SCC, 601–605.
635.
Rodriguez Case-SCC, 605–608.
636.
Rodriguez Case-SCC, 612.
637.
Rodriguez Case-SCC, 613–615.
638.
Rodriguez Case-SCC, 544.
639.
Andrews v Law Society of British Columbia (1989) 1 SCR 143 (SCC).
640.
Rodriguez Case-SCC, 545–546.
641.
Rodriguez Case-SCC, 549–551.
642.
Rodriguez Case-SCC, 552.
643.
Rodriguez Case-SCC, 559–560.
644.
Rodriguez Case-SCC, 561.
645.
Rodriguez Case-SCC, 567–569.
646.
Rodriguez Case-SCC, 578–580.
647.
Rodriguez Case-SCC, 616.
648.
Rodriguez Case-SCC, 617.
649.
Rodriguez Case-SCC, 618.
650.
Rodriguez Case-SCC, 601, cited by J McLachlin at 623.
651.
Rodriguez Case-SCC, 624.
652.
Rodriguez Case-SCC, 625–626.
653.
Rodriguez Case-SCC, 626–628.
654.
Rodriguez Case-SCC, 629.
655.
Rodriguez Case-SCC, 630.
656.
Rodriguez Case-SCC, 631.
657.
Carter v Canada (Attorney General) 2015 SCC 5, [2015] 1 SCR 331.
658.
Carter Case-SCC, [12]-[13].
659.
Spinal stenosis occurs when the narrowing of the spaces within the spine causes pressure to the nerves. Symptoms can vary depending on the severity and location. Mayo Clinic (2020) Spinal Stenosis. https://www.mayoclinic.org/diseases-conditions/spinal-stenosis/symptoms-causes/syc-20352961.
660.
Carter Case-SCC, [17]-[18].
661.
Apart from s 241(b), the applicants had challenged ss 14, 21, 22 and 222 of the Criminal Code as well. The applicants were accompanied by the British Columbia Civil Liberties Association (BCCLA), a non-governmental organization that raises funds and takes an active part in litigation on matters of civil liberties and human rights. The Notice of Civil Claim submitted by the applicants to the Supreme Court of British Columbia can be found at BCCLA (2012) Carter v Canada Case Documents. https://bccla.org/2012/12/carter-et-al-v-attorney-general-of-canada/.
662.
Carter v Canada (Attorney General) [2012] BCSC 886 (BCSC) [232]-[307].
663.
Carter Case-BCSC, [357].
664.
Carter Case-BCSC, [358].
665.
Carter Case-BCSC, [359]-[645].
666.
Carter Case-BCSC, [685].
667.
Carter Case-BCSC, [739], [746].
668.
Carter Case-BCSC, [660].
669.
Carter Case-BCSC, [680], [683].
670.
Carter Case-BCSC, [883].
671.
Carter Case-BCSC, [1009]-[1383].
672.
Carter v Canada (Attorney General) [2013] BCCA 435 (BCCA) [322]-[324].
673.
Carter Case-BCCA, [171], [177].
674.
Carter Case-SCC, [44].
675.
Carter Case-SCC, [45]-[48].
676.
Carter Case-SCC, [58]; Carter Case-BCSC, [1322].
677.
Carter Case-SCC, [62].
678.
Carter Case-SCC, [66].
679.
Carter Case-SCC, [67]; citing AC v Manitoba (Director of Child and Family Services) 2009 SCC 30, [2009] 2 SCR 181, [39].
680.
Carter Case-SCC, [67]; The majority in the AC Case used the phrase ‘the right to decide one’s own fate’ AC v Manitoba Case, [40].
681.
Carter Case-SCC, [69]; citing J Smith Carter Case-BCSC, [1326].
682.
Carter Case-SCC, [72]; referring to Canada (Attorney General) v Bedford 2013 SCC 72, [2013] SCR 1101, [96]-[123].
683.
Carter Case-SCC, [74]-[78]; referring to Carter Case-BCSC, [1190].
684.
Rodriguez Case-SCC, 595.
685.
Carter Case-SCC, [79]-[80]. This was another important difference between Rodriguez and Carter. In Rodriguez, only J McLachlin had made this distinction. Under the analysis of principles of fundamental justice, the burden of proof is on the individual who claims there has been an interference with his or her Charter rights. The State carries the burden of proof under sec 1 when demonstrating that such interference is necessary in light of the societal interests. Bedford Case, [123]-[129].
686.
Carter Case-SCC, [84].
687.
Carter Case-SCC, [86]; referring to Carter Case-BCSC, [1136].
688.
Carter Case-SCC, [88].
689.
The Court nevertheless agreed with J Smith that the deprivation caused by the prohibition on physician-assisted suicide was severe. Carter Case-SCC, [90].
690.
Carter Case-SCC, [95]-[96]; see R v Oakes Case.
691.
Carter Case-SCC, [97]-[98].
692.
Carter Case-SCC, [100].
693.
Carter Case-SCC, [103].
694.
Carter Case-SCC, [108].
695.
Carter Case-SCC, [110]-[113].
696.
Carter Case-SCC, [114]-[115].
697.
Carter Case-SCC, [120].
698.
Carter Case-SCC, [121].
699.
‘No person is entitled to consent to have death inflicted on him, and such consent does not affect the criminal responsibility of any person by whom death may be inflicted on the person by whom consent is given.’
700.
Referring to an ‘irremediable’ condition, the Court noted that the patient could not be forced to receive a treatment that was unacceptable to them. Carter Case-SCC, [127]-[129].
701.
Canada, Parliament (11 Dec 2015) Journals of the Senate, 42nd Parl, 1st Sess, No 6, p. 55; Canada, Parliament (11 Dec 2015) Journals of House of Commons, 42nd Parl, 1st Sess, No 7, p. 50.
702.
Canada, Parliament, Special Joint Committee on Physician-Assisted Dying (Feb 2016) Medical Assistance in Dying: A Patient-Centred Approach, 42nd Parl, 1st Sess; An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) 2016.
703.
Downie and Scallion (2018), pp. 24–25; McMorrow (2018), pp. 86–87.
704.
BCCLA (2016) Lamb v. Canada Case Documents. https://bccla.org/our_work/lamb-v-canada-case-documents/.
705.
BCCLA (2019) RELEASE: BC Supreme Court adjourns BC Civil Liberties Association’s assisted dying case. https://bccla.org/news/2019/09/release-b-c-supreme-court-adjourns-b-c-civil-liberties-associations-assisted-dying-case/.
706.
Downie (2019) A Watershed Month for Medical Assistance in Dying. In: Policy Options- Institute for Research on Public Policy. https://policyoptions.irpp.org/magazines/september-2019/a-watershed-month-for-medical-assistance-in-dying/.
707.
AB v Canada (Attorney General) 2017 ONSC 3759, 139 OR (3d) 139, [79]-[83].
708.
Truchon c Procureur général du Canada 2019 QCCS 3792 [764]-[767] (this judgment is only enforceable in the province of Quebec).
709.
An Act to amend the Criminal Code (medical assistance in dying) 2021.
710.
Canadian Criminal Code (after the amendment of 17 March 2021) sec 241.2(2.1); Government of Canada (2021) Medical assistance in dying. https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html.
711.
Canadian Regulations for the Monitoring of Medical Assistance in Dying, SOR/2018-166 (1 November 2019).
712.
Health Canada (2021) Second Annual Report on Medical Assistance in Dying in Canada, 2020. https://www.canada.ca/en/health-canada/services/medical-assistance-dying/annual-report-2020.html, p. 14.

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Derya Nur Kayacan

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Kayacan, D.N. (2022). The Right to Die in Practice. In: The Right to Die with Dignity. European Union and its Neighbours in a Globalized World, vol 6. Springer, Cham. https://doi.org/10.1007/978-3-031-04516-5_3

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Published: 21 June 2022
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