End of Life
Voluntary Assisted Dying — Global Overview
2025-09-17
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.
Where It’s Legal
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.
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