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Regulating euthanasia

These are the common positions people take on the question of regulating euthanasia.

It's not possible to regulate euthanasia

Euthanasia opponents don't believe that it is possible to draft laws and guidelines that will prevent the abuse of euthanasia.

It's possible but very difficult

Those in favour of euthanasia think that there is no reason why euthanasia can't be controlled by proper regulation, but even they fear that regulations won't deal with people who want to implement euthanasia for bad motives.

This is little different from the position with any crime. The law prohibits murder, but that doesn't stop bad people committing murders.

Nonetheless, people worry that whatever regulations are put into place they won't stop patients, particularly vulnerable ones, being pressured to choose death when they would rather live for a few more weeks.

Some rules are better than none

It's hard to think that creating a structure to regulate euthanasia will have a worse result than not having any regulations at all.

This argument goes that since euthanasia will continue to take place, even though it's illegal, it would surely be better to make it legal and regulate it so as to minimize abuse.

A similar argument was used as part of the case for making abortion legal. It's not that convincing if it's the only argument.

However, vulnerable patients might be better protected than they are at present if there were set procedures and rules that had to be followed for euthanasia.

Indeed, a patient who feared that they were under pressure to decide in favour of euthanasia would be able to gain help and support by initiating the formal procedures involved in regulated euthanasia - something that they cannot do now.

What would good regulations look like?

For safeguards to be meaningful and effective, they have to involve investigations of the patient's psyche, his family dynamics and the financial implications of his death, among with more obvious things such as the patient's medical condition and the likely course of the disease.

In order to ensure that requests are properly considered, by the patient, the family and the authorities, regulations need to build in a time-period for reconsideration.

Proper regulation must also make sure that a patient was receiving good palliative care before a request for euthanasia is considered.

Although the procedures outlined above are time-consuming and expensive, that does not mean that they are impractical.

Existing systems of legalised euthanasia

The Oregon approach

The US state of Oregon legalised physician-assisted suicide in 1998. During the first three years, only around 2 people a month used this to end their lives. This was partly because of the severe conditions that had to be satisfied before a request for euthanasia could be granted:

• patient must be resident in Oregon
• patient must be aged over 18
• patient must make 2 oral and 1 written request for euthanasia
• there must be at least 15 days between the first and the last request
• patient must be terminally ill with a life expectancy of less than 6 months
• this prognosis must be confirmed by a second consultant physician
• both doctors must confirm that the patient is capable of making this decision
• both doctors must confirm that the patient does not have medical condition that impairs their judgement
• patient must self-administer the lethal medication

About 30% of patients who started the process died before it was completed. 19 patients in the period who were given access to lethal medication decided not to use it. One survey showed that 45% of patients who were given good palliative care changed their mind about euthanasia.

Another reason for the low take-up was the difficulty of finding a doctor who go along with the request: The Oregon Health Division reported that only a fifth of physicians of control patients dying of similar terminal illnesses would have prescribed a lethal medication if asked.

The Dutch approach

In the Netherlands voluntary euthanasia and assisted suicide are still criminal offences, but doctors are exempt from criminal liability in certain circumstances. The Netherlands Criminal Code Article 293, paragraph two, stipulates that the doctor:

• must be convinced that the patient has made a voluntary and well-considered request to die
• must be convinced that the patient is facing interminable and unendurable suffering
• has informed the patient about his situation and his prospects
• together with the patient, must be convinced that there is no other reasonable solution
• has consulted at least one other independent doctor who has seen the patient
• and given his written assessment of the due care requirements as referred to in the points above
• has helped the patient to die with due medical care

The Dutch law also permits euthanasia for non-adults. Children of 16 and 17 can make their own decision, but their parents must be involved in the decision-making process regarding the ending of their life. For children aged 12 to 16, the approval of parents or guardian is required.

If a patient can no longer express their wishes, but made a written statement containing a request for termination of life before they became incompetent, a doctor is allowed to carry out their request providing the other conditions are met.

Two thirds of the requests for euthanasia that are put to doctors are refused. Neither doctors nor nurses can ever be censured for failing to comply with requests for euthanasia.