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Feature Assisted Dying

Demedicalisation: radically reframing the assisted dying debate—an essay by Lucy Thomas

BMJ 2020; 371 doi: (Published 30 September 2020) Cite this as: BMJ 2020;371:m2919

Linked Essay

The bench: reflections on an incurable diagnosis and control at the end of life—an essay by Paul Cosford

Linked BMJ Opinion

"Last rights" makes the case for assisted dying

  1. H Lucy Thomas, consultant in public health and specialty doctor in palliative care
  1. Hertfordshire, UK
  1. lucy.thomas21{at}

Lucy Thomas questions why assisted dying is framed as a medical solution to a medical problem and proposes demedicalising the debate

Medically assisted dying currently exists as a legal medical procedure for patients meeting defined eligibility criteria in six countries, one Australian state, and nine US states, and pressure is mounting to extend the practice to other countries.

The current eligibility criteria vary considerably, from unbearable physical or mental suffering in the presence of an incurable (but not necessarily terminal) illness, disorder, or disability to the presence of a terminal illness (variously defined) without any judgment of suffering (box 1). But what they all have in common is an assumption that the desire to end life in the presence of an eligible medical condition is a medical problem requiring a medical solution—and fundamentally different from the desire to end life in all other circumstances.

Box 1

Medical eligibility criteria for assisted dying in different jurisdictions

  • Terminal illness:

    • Death expected within six months—US states where the practice is legal; Colombia; and Victoria, Australia

    • Death expected within 12 months—Victoria, in the case of a neurodegenerative condition

    • Prognosis not defined—Luxembourg; Switzerland*

  • Serious and incurable illness, disease, or disability (does not have to be terminal)—Belgium, Netherlands, Canada**

  • Unbearable physical or mental suffering—Netherlands, Belgium, Luxembourg, Colombia, Canada

  • *In Switzerland assisted dying has not been legalised, but assisted suicide is not a crime. However, only doctors are permitted to prescribe the lethal drug, and they must work within professional guidelines, which require that a patient be “approaching end of life.”

  • **In Canada an initial requirement that even though an illness need not be terminal natural death must be “reasonably foreseeable” was ruled unconstitutional by the Supreme Court in Quebec in 2019.


Why medical eligibility criteria?

Advocates of medically assisted dying rarely explain why, if the key values at stake are compassion and autonomy, the right to an assisted death should be …

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