France may be 10th country to legalize assisted dying: Process and legal variations

France plans to draft an “end of life” bill by the end of 2023, which could legalize assisted death processes such as assisted suicide or euthanasia. If the country goes through with a bill or future law, they would follow several other countries and localities that have legalized forms of assisted dying—and perhaps motivate more to follow.

Where is assisted dying legal?

Switzerland was the first country to legalize forms of assisted death in the 1940s, according to Reuters. Since the 2000s, nine more countries have adopted different forms of assisted death, including Australia, Austria, Belgium, Canada, Columbia, Luxembourg, the Netherlands, New Zealand, and Spain, according to Forbes.

Assisted dying is legal in several US states, too—but is not legal at the federal level. States that allow forms of the practice include California, Colorado, Washington, DC, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington. Oregon was the first state to legalize assisted dying practices in 1997, Montana next in 2009, and the others following more recently, in the later part of the 2010s, according to Forbes.

What does assisted dying involve?

Assisted dying refers to a broad range of processes through which medical tools or professionals can assist in a person’s death. Where legal, they are often used in instances where a person with a terminal illness chooses to end their life rather than continue to suffer through their condition but are not limited to this definition.

Depending on the place and the definition, people with certain mental illnesses or non-terminal physical conditions may be eligible for assisted death.

Some places allow only the patient themselves to request forms of assisted death, whereas others allow designated family members to do so also.

Some forms and terminology around assisted dying include:

Assisted Suicide: Assisted suicide allows medical professionals to equip a patient with means—usually a drug—to kill themselves. The law allows for the patient, and not the physician, to administer the medication. This was the first legalized form of assisted dying, adopted by Switzerland in 1940.

Death with Dignity: The “Death with Dignity Act” was introduced to the US in 1997, starting with Oregon. This allowed terminally ill patients to end their life with a lethal medication, prescribed by a doctor but self-administered. According to Forbes, this term may be controversial because it implies that other forms of death are undignified.^[]

Euthanasia: Euthanasia can include self-administered or physician-administered death, at a person’s request. According to Forbes, this terminology can be unfavorable for some people as it is also a term that can be associated with genocides, the Holocaust, or for actions involving non-human deaths, like putting down a pet.

Physician Assisted Death (PAD): PAD is similar to assisted suicide, but allows for the physician or clinician to administer a lethal medication to a patient.

Medical Assistance in Dying (MAID): MAID can include self-administered or physician-administered death.

All of these processes are controversial, as demonstrated by the inconsistency in laws allowing and prohibiting them across states and countries.

But Kristen Fuller, MD, MDLinx board member and former emergency care doctor, suggests they could be less controversial if more people were educated on the details of the processes. 

"Many individuals do not understand what this topic encompasses and falsely assume that patients can make the decision to end their life,” says Fuller. 

“Some individuals assume that physicians are playing the ‘God’ role in medical aid in dying,” Fuller adds, which can inspire questions like: Should doctors have the right to make this decision? 

Among other misunderstandings, she says people are not always aware that the practice is voluntary by the patient, pain-free, and that “there are actually certain criteria the patient and physician must pass in order to qualify for medical aid in dying.”

As a physician, she is an advocate for the processes as they allow patients to make independent decisions about their level of suffering and end-of-life care, she says.

“Once you go through the long process of a patient who is at the end of life and is suffering, it changes your perspective,” Fuller says. “At the end of the day, we are there to help patients live and also help patients transition to the end of life in the most peaceful and humane way possible.”