Euthanasia and assisted suicide: what does really distinguish these two practices of planned death?
Several European countries (particularly France and the United Kingdom) are currently considering the legalization of certain forms of “assisted death.” Slovenia has just authorized assisted suicide, while excluding the practice of euthanasia. This raises the interesting question of what distinguishes euthanasia from assisted suicide, given that both practices involve voluntarily causing the death of a patient at their request.
Is assisted suicide a more regulated form of planned death than euthanasia?
The legalization of assisted suicide is often presented as a way of allowing death on demand while regulating it more strictly and effectively than in the case of euthanasia primarily because the patient takes their own life.
Euthanasia vs. assisted suicide: two (not so) distinct methods
At first glance, assisted suicide does indeed differ from euthanasia in many ways. However, changes in practices and legal standards show us that the two methods are not always so easy to distinguish.
1° Self-administration of poison vs. administration by a third party
Firstly, the distinction is clear in terms of the act itself: in the case of assisted suicide, the person ends their own life (even when they are given the means to do so), while euthanasia involves death being caused by a third party.
However, some jurisdictions that in principle only allow assisted suicide show tolerance towards “indirect active euthanasia”: as has already been observed in Switzerland, in cases where the person is no longer physically capable of self-administering the lethal substance (by injection or ingestion), the administration of the lethal substance by a third party (in particular a doctor) is accepted.
2° Optional vs. mandatory involvement of the medical profession
A second distinction relates to the different degrees of involvement of caregivers, particularly doctors, in the process of death: only euthanasia would require the direct participation of the doctor in the lethal act. Although the physician does not, in principle, perform the lethal act in the case of assisted suicide, their close involvement in the procedure is nevertheless real and decisive: as in the case of euthanasia, the approval of at least one physician is always required for the patient's request for assisted suicide to be accepted and for them to be given the means to take their own life.
In countries that allow both euthanasia and self-administered lethal substances (such as Canada and Belgium), in practice the overwhelming majority of euthanasia cases are carried out by a doctor via lethal injection, while a tiny proportion of patients take their own lives.
3° Criteria v. Absence of criteria related to the patient's condition
Euthanasia and assisted suicide can also be distinguished in terms of eligibility criteria related to the patient's condition. Under euthanasia laws, conditions of suffering and illness are invariably required - although these are often interpreted subjectively in practice. In the case of assisted suicide, however, these medical criteria are not systematic and vary from jurisdiction to jurisdiction: unlike Oregon and other states in the US or elsewhere, Swiss law, for example, does not stipulate any conditions related to the patient's condition, leaving these to the discretion of the organizations that perform assisted suicides, as well as to the guidelines issued by medical federations and academies.
However, the increasing subjectivity of the conditions set out in euthanasia laws - or, more precisely, their interpretation - is contributing to a gradual shift towards euthanasia as death on demand, based on personal criteria of suffering (including existential suffering) that cannot be questioned by the medical profession. From this perspective, euthanasia could potentially eventually correspond to a “right to commit suicide” without any particular medical reason.
4° Place where the lethal act is performed
A final possible distinguishing criterion concerns the places where the planned death is carried out. In the case of assisted suicide in Switzerland, the act is not initially carried out in healthcare facilities. However, there is a trend towards assisted suicide being carried out in hospitals and retirement homes. Conversely, euthanasia, particularly in Belgium, tends to be practiced increasingly in non-medical settings, especially at home.
These different trends and developments thus reflect a kind of double convergence between the two practices: assisted suicide now includes a more or less significant medical dimension, particularly in terms of the degree of involvement of healthcare professionals; conversely, euthanasia is gradually moving away from an exclusively medical setting, not only in terms of where it is performed, but also, more fundamentally, in terms of the degree of control exercised by doctors over a patient's eligibility for euthanasia.
