Physician Assisted Dying

Assisted dying (sometimes also assisted death) is where the patient himself or herself ultimately takes the medication. Euthanasia, by contrast, is usually where the doctor administers the medication to the patient. Assisted suicide includes people who are not terminally ill, but who are being helped to commit suicide, whereas assisted dying refers to people who are already dying. “euthanasia” can sometimes be used as a broad term to cover a range of actions.

United States: PAD: Oregon, Washington, Vermont, California, Colorado and the District of Columbia: The Netherlands: Assisted suicide and voluntary euthanasia are legal where a person has lasting and unbearable suffering. Belgium: Voluntary euthanasia is legal for patients who suffer untreatable, constant and unbearable physical or mental suffering. Luxembourg: Voluntary euthanasia is legal for patients who suffer a terminal or incurable illness. Assisted suicide is also legal. Canada: In June 2016 the Canadian Parliament passed Medical Assistance in Dying Bill Colombia: Voluntary euthanasia is legal for terminally ill patients Switzerland: voluntary euthanasia and assisted suicide are illegal under Swiss criminal law, but assisted suicide routinely occurs (assisted suicide will only be an offence if it is carried out for ‘selfish motives’).

Public support in the United States has plateaued since the 1990s (range, 47%-69%) In Western Europe, an increasing and strong public support; in Central and Eastern Europe, support is decreasing In the United States, less than 20% of physicians report having received requests for euthanasia or physician-assisted suicide, and 5% or less have complied In Oregon and Washington state, less than 1% of licensed physicians write prescriptions for physician-assisted suicide per year In the Netherlands and Belgium, about half or more of physicians reported ever having received a request; 60% of Dutch physicians have ever granted such requests Between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal

More than 70% of cases involved patients with cancer Typical patients are older, white, and well-educated Pain is mostly not reported as the primary motivation. A large portion of patients receiving physician-assisted suicide in Oregon and Washington reported being enrolled in hospice or palliative care, as did patients in Belgium In no jurisdiction was there evidence that vulnerable patients have been receiving euthanasia or physician-assisted suicide at rates higher than those in the general population.

Eligibility: ALL of Age 18+ Ordinarily resident in Victoria, hold citizenship or PR Have capacity with respect to VAD (decision is their own, voluntary, not due to undue influence or coercion) If assessing practitioner uncertain re capacity: must refer to appropriate specialist for Ax Dx with an incurable disease, illness or medical condition that is advanced, progressive and will cause death expected within weeks or months, not longer than 12 months      Causes suffering that cannot be relieved in a manner the person deems tolerable

Cannot request VAD in an ACF – safeguard Capacity requirement likely to exclude eg. persons with dementia - felt to be a necessary safeguard Mental illness alone does not satisfy criteria Disability alone does not satisfy criteria- although mental illness or disability, in the setting of meeting other eligibility criteria, is not a reason for exclusion Suffering judged by the individual - physical, psychological, social, spiritual, loss of autonomy & control