The Canadian Supreme Court’s decision on Friday to overturn a 1993 ban on doctor-assisted suicide gives the federal and provincial governments a year to work out details that will affect individuals hoping to bring about their own deaths in Canada.
A big question: Will Canada choose to allow assisted suicide, euthanasia, or both? And will the country allow non-residents to take advantage of whichever they offer?
The case argued that no one can stop an able-bodied person from ending their life, so preventing a terminally-ill patient from receiving the help they needed to do so should be considered a discriminatory act.
The ruling states that Canadian provinces can no longer "prohibit physician-assisted death" in consenting patients with incurable (if not terminal) diseases that cause "enduring and intolerable suffering." This actually leaves a lot of room for interpretation, and the supreme court has given officials one year to hammer out the details before the ban is lifted.
Legal euthanasia allows a doctor to administer lethal drugs to a patient (or deprive them of those necessary to their survival) in order to quicken their death. In June 2014, Quebec passed the Act Respecting End-of-Life Care, which is meant to allow euthanasia by the end of 2015. Counter-intuitively, this nationwide ruling in support of the right to die might actually be bad news for the Quebec law: Many nations and states that support the right to die still ban doctor-administered euthanasia in favor of doctor-assisted suicide. If Canadian governments make the same call, the 2014 law could be in jeopardy.
Physician-assisted suicide has seen wider legalization, probably because it seems less likely to be misused. Laws that allow this option state that a patient has to take the lethal medication themselves. They often have to make multiple requests for the drugs and go through a waiting period. In the United States, getting a prescription for drugs intended for suicide takes a lot of jumping through hoops. But in the end, it's the patient — not the doctor — who makes the final decision, often in the privacy of their own home and on their own schedule.
Vermont, Oregon and Washington state all have laws in place to support physician-assisted suicide. Additional allowances exist in other states: In 2009, a Montana court ruled that physicians who assist mentally sound, terminally ill, consenting patients in ending their lives shouldn't be held criminally liable. And in New Mexico, a judge recently ruled that seeking aid in dying is a terminally ill patient's constitutional right (though the state attorney general has since appealed the decision).
"If a doctor is allowed to give a patient a lethal injection, the doctor is the last actor," Alan Meisel, a bioethicist at the University of Pittsburgh, told Vox.com. "In Oregon and Washington, the patient is the last actor. And that lets them reserve the right not to act at all."
U.S. citizens have already indulged in "suicide tourism." Brittany Maynard, a 29-year-old with terminal brain cancer, famously moved to Oregon from California so that she could get help ending her own life. On Nov. 1, after completing her "bucket list" and surrounded by family, she took a fatal dose of barbiturates prescribed to her by a doctor. Maynard made many statements to the news media about her decision, using her illness and chosen method of death as a platform to promote wider understanding and legalization.
But Canada is unlikely to become the next go-to destination unless it promises less red tape than U.S. states, where residency is easy to obtain. And then there's Switzerland: A recent study found that 611 non-Swiss individuals (from 31 different countries) visited Switzerland to die between 2008 and 2012.
That's not very surprising. While several European countries allow euthanasia, assisted suicide or both, Switzerland has the most lenient right-to-die laws of all. It's the only country that doesn't require any specific criteria for suicide-aid candidates. So organizations are allowed to provide drugs and counseling to help anyone end their life -- even if they aren't physically ill.
Given the strong emphasis on illness and the patient-doctor relationship in Canada's ruling, it's highly unlikely that the country would adopt such a liberal suicide policy. But it's up to Canada's federal and provincial governments to determine just how much influence on the rest of the world this ruling will have.