Euthanasia practices and their consequences have been studied for nearly thirty years (7). While euthanasia and physician-assisted suicide remain controversial and societal and legislative debates continue, more than 200 million people worldwide now live in jurisdictions that allow some form of euthanasia (Figure 1), and many more states and countries are considering legalization (2,7). Although the characteristics of practice vary according to case law and existing laws require close monitoring, those who do not have laws can benefit from the experience of others to stimulate societal debate, and research data remains essential. Assisted suicide, in which a person is given the means to end his or her life, has been legal in Switzerland since 1942, but active euthanasia is not allowed. Ethical debates about euthanasia are complex and persistent. Proponents argue that the practices preserve the autonomy and self-determination of an individual at the end of life and allow people to choose a dignified death (5). Proponents also believe that euthanasia and assisted suicide are sometimes the only ways to alleviate unbearable suffering and that quality of life takes precedence over quantity of life (5). Proponents cite euthanasia as an important option in the care of the dying, where doctors can facilitate death safely than suicide cannot do by other methods (8). Conversely, opponents argue that euthanasia and physician-assisted suicide practices violate the medical code and the Hippocratic Oath that all physicians take, harming the patient-physician relationship and undermining public trust in the health care system (5). They argue that suffering, however intolerable, can be alleviated by adequate palliative care and/or terminal sedation, and warn that vulnerable populations, including the disadvantaged and disabled, are driven to premature death (5). The “slippery slope” argument is also used by opponents who suggest that inevitable and unwanted expansion will take place once euthanasia and/or physician-assisted suicide are legalized and the practices lead to mistakes, abuses, and violations of the rights of vulnerable populations (35, 36).

Religious opposition, often based on the principle of the sanctity of life, is also common (5). In September 2004, the Groningen Protocol was drafted, which establishes the criteria for euthanasia of children without criminal prosecution of the doctor. [82] The Australian state of Victoria passed voluntary euthanasia laws in November 2017 after 20 years and 50 failed attempts. The issue is currently being discussed in a number of European countries, while in recent years more and more countries have changed their laws to decriminalize or legalize the means of voluntarily ending life. It is important not to confuse passive euthanasia with the interruption of life-sustaining treatment in the best interests of the individual. The latter can be part of palliative care and is not necessarily euthanasia. Passive euthanasia was ruled legal after a landmark court decision in 2010. This means that a medical professional can legally stop maintaining vital functions at a patient`s request if they understand the consequences stated by their doctor, and the administration of a lethal substance is also illegal. [104] In 2001,[78] the Netherlands passed a law legalizing euthanasia, including physician-assisted suicide.

[79] This legislation codifies the twenty-year-old convention not to prosecute physicians who have committed euthanasia in very specific cases and circumstances. The Ministry of Public Health, Welfare and Sport states that this practice “allows a person to end his life in dignity after receiving all types of palliative care available”. [80] The United Nations has reviewed and commented on the Dutch euthanasia law. [81] The number of countries that have legalized euthanasia or euthanasia, usually under strict conditions, is increasing. It is available in a growing number of countries and jurisdictions, but not in the UK, where it remains banned. The Belgian Parliament legalized euthanasia on May 28, 2002. [13] [14] Other countries in the region have developed similar euthanasia laws, but the laws have not been approved, as in El Salvador and Venezuela. Other NGOs advocating and against various measures related to euthanasia can be found all over the world. Among supporters, perhaps the main NGO is the British Dignity in Dying, the successor to the (voluntary) Euthanasia Society.

[125] In addition to professional and religious groups, there are NGOs in various countries that oppose euthanasia.[126] .