The Economist - USA (2021-11-13)

TheEconomistNovember13th 2021 International 63

reported.Versionsofthelawarenowon
thebooksoftenstates,hometoa fifthof
Americans,aswellasinWashington,dc.
Oregon’srulesarebeingcopiedinterna­
tionally,with some modifications. New
Zealand’sOregon­stylelawcameintoef­
fect onNovember 7th.In Australia,the
stateofVictoriapassedasimilarlawin
2017,andsincethenallbutoneofAustra­
lia’ssixstateshavefollowedsuit.InBrit­
ain,anOregon­stylebillpasseditssecond
readingintheHouseofLordsinOctober.
Buttobecomelawitwouldalsoneedthe
supportoftheHouseofCommonsandthe
government,whichlooksunlikely.Three­
quartersofBritonssupporta righttodie,
butonly35%ofmps do.
Somecampaignersarecircumventing
cautiousrepresentativesbygoingthrough
thecourts.InFebruaryPeru’sconstitution­
alcourtruledthattheMinistryofHealth’s
refusaltohelpa womanwithdegenerative
polioendher lifeviolatedher rightsto
“dignity”and“autonomy”. Severalcoun­
tries, such as Austria,are beginningto
fleshouta rulingbytheEuropeanCourtof
HumanRightsin 2011 thatpeoplehavethe
rightto decidethetimeandmannerof
theirdeaths.AfterGermany’shighestcourt
declaredin 2020 thata banonrepeatedly
helpingothersdiewasunconstitutional,
DignitasGermany,a non­profitorganisa­
tion,begantohelppeoplekillthemselves.
Evenaftera legislatureorcourtopens
thedoortoassisteddying,thosepursuing
theoptioncanfacehighhurdles.With 68
safeguards,Victoria’slawexcludessomeof
thepeopleit wasintendedtohelp.Doctors
areforbidden tobringupassisteddying
withtheirpatients,somanydonotknowit
isanoption.Colombiadecriminalisedvo­
luntaryeuthanasiain1997,butisonlynow
regulatingthepractice.Asa result,many
Colombiandoctorsrefusetogetinvolved
forfearofprosecution.Approvalisrare
andcanbewithdrawn.
Despitesuchstrictures,theexpansion

oftherighttodieisnotwithoutcontrover­

sy.InCanada,theSupremeCourtruledin

2015 thata banonmedicalassistanceindy­

ing(maid) violatedthenationalCharterof

Rights.NowmaidisavailabletoallCana­

dianswhosufferfromchronicphysicalill­

nessordisability.Uniquely,thelawallows

patients to determine what constitutes

“unbearable”suffering.In 2020 only6%of

writtenrequestsformaidwererefused.

Someadvocatesforthedisabledargue

thattheamendedlawdevaluesthelivesof

those withdisabilities.It’s “literallyun­

thinkable”thatmaidwouldbedoledout

insteadonthebasisofrace,sexoranyoth­

er protected characteristic, says David

Shannon,a quadriplegiclawyerwhocam­

paignsagainstassisteddying.Butothers

arguethatthefoundationsofthedisability

movementlieincreatingthefreedomto

makeone’sownchoices.

OpponentsalsofearthatCanadamay

enduphelpingpeopledie beforeithas

helpedthemlive.Disabledpeoplewhodo

notgetenoughsupportmaychoosetodie

becausesocietyhasfailedthem,criticsar­

gue.Theyworrythismayproveparticular­

lytrueforpeoplewhoseliveshavebeen

filled with abuse, racism and poverty,

thoughdatafromAmericashowthatthose

whochooseassisteddeathareoverwhelm­

inglymiddle­class,whiteandeducated.

From2023,Canadawillextendmaidto

thosewhosuffer solelyfrommentalill­

ness,onthegroundthattodootherwise

woulddiscriminate.ManyCanadiansfind

thistroubling(seechart2).Theyworrythat

doctorsmayindulgethesuicidalurgesthat

area symptomofmanypsychiatricdisor­

ders:oneintenschizophrenicskillthem­

selves,somestudiesreckon.Othersques­

tionwhethera patientcouldhavetriedev­

erypossibletreatmentwhenthemedical

andsocialunderstandingofmentalillness

issorudimentaryandmental­healthser­

vicesaresoofteninadequate.Mostpeople

underestimatehowseriousanintractable

psychiatricconditioncan be,saysMona

Gupta, a Québécoise psychiatrist and

bioethicist.Theyseedepictionsofmental

illnessinpopularculturebuthavenever

metanyoneseverelyaffected.

Theonlywayout

JohnScully,whohaslivedwithseverede­

pressionandptsdfordecades,agrees.At

homeatnightinToronto,MrScully,whois

80,ishauntedbythehorrorshewitnessed

asa warcorrespondent:thedeadtornapart

byvultures,theak 47 scopedtoshoothim.

Healsoexperiencesphysicalpain.“There

isnocure,”hesays.Nineteenshockthera­

pies,countlessmedicationsandsixstints

asa psychiatricpatienthavefailedtobring

himrelief.The“onlyhelpavailable”,hebe­

lieves,isassisteddying.Heseesitasa far

moredignifiedchoicethansuicide,which

hehasattemptedtwice,andhethinksit

wouldbelesspainfulforhisfamily.

Likeotherbioethicists,DrGuptathinks

mentaldisordersshould be seeninthe

samelightasotherconditionsthatcreate

chronicpain.Fordoctors,shesays,theas­

sessment process would be much the

same:distinguishingbetweenanimpul­

sivedeath­wishanda consideredone,and

determiningifa patientismentallycom­

petent.Suchcasesarerare.In 2020 inthe

Netherlands,only 88 peoplewithmental

illnesses—12%ofallthosewhomadere­

quests—had their requests for help ap­

provedbyaeuthanasiaclinic.Manyare

heartenedbysimplyhavingtheoption.

Canadaismakingthesamemistakesas

the Netherlands, reckons Theo Boer, a

Dutch ethicist who once supported his

country’s euthanasia laws. Since Dutch

doctorspushedtolegaliseassisteddying

20 yearsago,hebelievesthatvoluntaryeu­

thanasiahasgonefrombeinga “lastresort

topreventa terribledeathtoa lastresortto

preventa terriblelife”.Voluntaryeuthana­

Source:TheEconomist

Liveandhelpdie

Assisteddying

Canada

US

Colombia

Ireland

Bel.,Neth.&Lux.

Italy

France

Switzerland

Austria

Germany

Portugal

NewZealand

Australia

Spain

Washington

Oregon

←Hawaii

California DC

NewJersey

Montana

Maine

NewMexico

Colorado

Vermont

Britain

Tasmania

Victoria

WA Queensland

SA

NT

Peru

Chile Uruguay

Legalduringorbefore 201

Legalisedafter201

Billsinprogress/significant

publicdebatein 2021

Final choices

Oregon, United States, patients who have died

from ingesting a lethal dose of medication

Source:OregonHealthAuthority *Medicare,Medicaidor other

1

2019

2020

250200150100500

By illness

Heart/circulatorydisease Other

Cancer Neurological disease Respiratory disease

2019

2020

250200150100500

By insurance type

Private Government* None Unknown