Thought Archive

End of Life

Voluntary Assisted Dying (VAD) — Global Overview

02 Sept 2025

Voluntary Assisted Dying (VAD) — Global Overview

Voluntary Assisted Dying (VAD) — Global Overview

Intro

Voluntary Assisted Dying (VAD), also called medical assistance in dying (MAiD) or euthanasia, refers to the practice of a terminally ill person choosing to end their life with medical assistance under a regulated framework. It is a controversial but increasingly common option in end-of-life care.

Key Points

  • VAD is legal in Australia, Canada, New Zealand, several European countries, and select US states.
  • Safeguards usually require multiple medical assessments, waiting periods, and independent review boards.
  • Debates focus on autonomy vs. protection, slippery slope concerns, and the role of doctors.
  • Laws vary widely — some limited to terminal illness, others include chronic suffering or psychiatric conditions.

Australia

  • All states have now passed VAD laws (NSW last, 2023–24). Territories are reviewing.
  • Eligibility: incurable illness, expected death within 6–12 months, capacity to decide.

United Kingdom

  • VAD remains illegal under the Suicide Act 1961.
  • Debate ongoing in Westminster; Crown dependencies (Jersey, Isle of Man) are considering reform.

Europe

  • Netherlands: Euthanasia Act since 2002; includes unbearable suffering, not limited to terminal illness.
  • Belgium: Similar to Netherlands; includes psychiatric illness and minors under strict rules.
  • Luxembourg, Spain, Portugal: Recently legalized with safeguards.
  • Switzerland: Assisted suicide permitted since 1940s, widely used.
  • Austria: Legal since 2022.
  • France: Debating.

North America

  • Canada: MAiD since 2016, expanded 2021. Very broad scope (not only terminal).
  • United States: 11 states + DC allow physician-assisted dying (Oregon first, 1997).

Latin America

  • Colombia: Constitutional court recognized right to euthanasia (1997), regulated since 2015.
  • Chile, Uruguay: Bills under debate.

Asia & Oceania

  • New Zealand: Legal since 2021 (End of Life Choice Act).
  • Asia: Generally prohibited; strong cultural and religious opposition.

Ethical & Practical Debates

  • Safeguards vs. autonomy: Protecting vulnerable people from pressure vs. respecting choice.
  • Expansion risks: Canada shows scope can grow beyond terminal illness.
  • Medical ethics: Some doctors refuse participation; conscience clauses are common.
  • Social trust: Families, prisons, and disability advocates raise unique concerns.

Patient Considerations

  • Eligibility: Usually requires terminal illness, decision-making capacity, informed consent.
  • Process: Application → multiple assessments → waiting period → final consent.
  • Alternatives: Palliative care, hospice, pain management.
  • Withdrawal: Consent can be withdrawn at any time.

FAQ

Q: Is voluntary assisted dying legal in the UK?
A: Not yet — it remains illegal, though reform is debated.

Q: How is VAD different from assisted suicide?
A: VAD often involves a doctor administering the medication; assisted suicide may mean the patient self-administers.

Q: Can prisoners access VAD?
A: Rarely, but yes — some jurisdictions (e.g. Australia, Belgium) have allowed it, sparking ethical debate.