62 The Economist November 13th 2021
International
AssisteddyingDeath on demand
S
hortly beforeÁngel Hernández hand
ed his wife the glass of barbiturates that
would kill her, he asked her once again if
she wanted to die. “The sooner the better,”
she replied. Ravaged as María José Carras
co’s body was by multiple sclerosis, she
struggled to swallow the poison. In the end
she forced it down through a straw.
Ms Carrasco’s death in 2019 provoked a
media storm in Spain. In Madrid the inves
tigating judge initially referred the case to
a court that specialises in violence against
women. The prosecutor pushed for Mr
Hernández, then 70, to serve six months in
prison. But on June 25th Spain enacted a
law allowing those with a “serious or in
curable illness” or a “chronic or incapaci
tating” condition to seek help to end their
own lives. Twelve days later, Mr Hernán
dez was acquitted.
In much of the West public opinion has
long favoured assisted dying. In 2002 60%
of Spaniards supported voluntary eutha
nasia, a share which had risen to 71% by- Writ large, secularisation and
increasingly liberal values have solidified
support. But so has personal experience,
particularly that of babyboomers who,
having witnessed their parents’ suffering,
are fighting for the right to deaths of their
own choosing.
Change has been rapid. Assisted dying
is now legal or decriminalised in at least a
dozen countries, with legislation or court
challenges pending in many others (see
map on next page). On November 5th Por
tugal’s parliament approved a revised bill
which would allow those with “grave, in
curable and irreversible” conditions to re
ceive help to end their lives (the constitu
tional court had in March blocked an earli
er version as being too imprecise). Other
largely Catholic countries such as Chile,
Ireland, Italy and Uruguay are also moving
towards enshrining a right to die. In Belgi
um, Colombia and the Netherlands gov
ernments have broadened assisteddying
laws to include terminally ill children.
After years of struggle, activists and
politicians have found ways through or
around reluctant legislators. The right to
die has been ticked through American ballot boxes, squeezed through Australian leg
islatures, and gavelled through Canadian
and European courts. Proponents are us
ing public consultationsand petitions to
demonstrate public support. And growing
evidence from countries with assisteddy
ing laws has assuaged fears it will become
easy to “kill granny”. The changes are
snowballing as advocates in one country
learn from their counterparts elsewhere.
Assisted dying is still rare. Most cases
are cancerrelated, and the number of
deaths is tiny. But they are nonetheless
changing how people think about dying. In
some countries assisted dying has been ex
tended to those with mental disorders and
dementia, and even to old people who feel
tired of life. A clandestine network of baby
boomers who share methods to kill them
selves has sprung up on the internet. Even
some proponents are beginning to worry
about a slippery slope.
Thirty years ago assisted dying was ille
gal everywhere bar Switzerland. But in 1997
the American state of Oregon approved the
Death with Dignity Act, initiating a spate of
liberalisation. In Oregon two doctors must
agree that a patient is of sound mind and
has less than six months to live before he
or she can receive the lethal drugs. These
must be administered by the patient
(known as physicianassisted dying) rath
er than injected by a doctor (voluntary eu
thanasia). Around 2,000 people have died
under the law (roughly 250 of them last
year, see chart 1), with no wrongful deathsA MSTERDAM AND OTTAWA
In the West, assisted dying is rapidly becoming legal and accepted