The ECHR reiterates that no country is obliged to legalize euthanasia or assisted suicide

The difference between cessation of treatment and "medically assisted death”

In its decision, the Court uses the expression "medically assisted death", which encompasses "assisted suicide and voluntary euthanasia, where these acts are carried out in a regulated and medically assisted setting". As the law currently stands in Hungary, patients may refuse treatment where the illness will lead to death in the near future. In this case, the applicant claimed that, given the nature and course of his illness, palliative care and the possibility of stopping treatment would cause him unbearable suffering. The applicant complained that he was the victim of discrimination because the law did not offer him the possibility of hastening his death, whereas it did, in his view, offer it to terminally ill patients who were dependent on life-sustaining treatment. He therefore invoked Article 14 in conjunction with Article 8 of the Convention.

The Court reiterated that the cessation of treatment at the end of life must be assessed in the light of respect for the right to life and to free and informed consent, and not as a right to die. In one case, life ends naturally, without unreasonable obstinacy; in the other, death is intentionally induced.

Praise for palliative care

The judges point out that "access to high-quality palliative care, including access to effective pain treatment, is in many situations - and undoubtedly in the patient's case - essential to ensure a dignified end to life" for the patient.

More specifically, the Court stated that, according to expert evidence, palliative options such as palliative sedation "enable [patients] to die peacefully".

Moreover, in the present case the applicant did not put forward any argument to suggest that the palliative care available to him in Hungary would not alleviate his suffering.

Furthermore, with regard to the applicant's argument of existential suffering, which in his view could not be relieved by palliative care, the Court acknowledged the real and serious nature of such suffering, but pointed out that existential suffering was above all a personal, evolving and subjective experience. For this reason, the Court considers that it cannot use this criterion to justify an obligation to legalize aid in dying under Article 8 of the Convention.

The slippery slope to legalizing euthanasia or assisted suicide 

In its defence, the Hungarian Government emphasised the risk of a slippery slope if Mr Karsai were granted what the Court termed "assisted medical death". In the name of equal treatment, such an act could be claimed by any person in a similar situation. On this point, the Hungarian Government emphasised the inconsistency of authorising this lethal act in the name of personal freedom and then limiting it only to the terminally ill or the physically disabled. It also points to the inevitable pressure that the possibility of such an outcome would place on those eligible for euthanasia or assisted suicide in a context of budgetary pressure on the healthcare system. 

The Government also stresses the inadequacy of the response offered by "medically assisted death", whose irreversible nature makes it impossible to take account of the changing wishes of terminally ill patients, who, with the help of palliative care, are learning to cope with the difficulties they encounter. 

The problem of a broad interpretation of the concept of privacy 

In his partly dissenting opinion, Judge Wojtyczek highlights the fact that reliance on the concept of privacy and self-determination in matters of life and death is based on "the implicit assumption that the value and meaning of one's own life depend on individual choices, [and] in fact contributes to exacerbating the suffering that arises from a subjective feeling that life has no meaning. The more death on demand becomes an available option in practice, the more difficult it is to preserve the meaning of life". The Polish judge also points to the economic and family context, which can create pressures on vulnerable people that legal frameworks are powerless to counter.

As Judge Wojtyczek points out, Article 2 of the Convention emphasises that no one shall be deprived of his or her life intentionally. The exceptions to this prohibition do not mention euthanasia and physician-assisted suicide. However, despite recognising that there is no right to assisted suicide or euthanasia, the ECHR tends to give a merely subjective and circumstantial meaning to the "right to life". Confirming its recent case law on the subject, the Court considers that the right to life cannot be interpreted as in itself prohibiting the conditional decriminalisation of "medically assisted death", provided that it is "accompanied by appropriate and sufficient safeguards to prevent abuse and thus ensure respect for the right to life". 

Whatever the ECHR's interpretation of the right to life, this right is de facto incompatible with the possibility of assisted suicide or euthanasia.