Page last updated at 13:12 GMT, Wednesday, 11 February 2009

Euthanasia: a continent divided

Europe is deeply split over how it treats its terminally ill. The divisions were exposed on one day in March 2008, when Belgian writer Hugo Claus ended his life under medical supervision in Antwerp and French former teacher Chantal Sebire died at home, having lost a legal battle to choose her time of dying.

Here, the BBC News website shows the patchwork of different laws in force across Europe.

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Chantal Sebire's final days may trigger a change in French law.

Her face horribly disfigured, she had fought in vain for the right to take a lethal dose of prescribed barbiturates, surrounded by her family at a time of her choosing.

Refused by a court in Dijon the right to die under medical supervision, she was found dead at home.

According to prosecutors, she had taken a "deadly dose" of barbiturates.

Chantal Sebire
French authorities revealed Chantal Sebire died of a drug overdose
French law had already been changed after a mother and doctor were unsuccessfully prosecuted for ending the life of her tetraplegic son, Vincent Humbert, in his twenties.

Under the "end of life" law, doctors are advised to avoid taking extreme measures to keep dying or brain-dead patients alive.

Active euthanasia, even at a patient's request, remains illegal.

Foreign Minister Bernard Kouchner (a former doctor) is one of a number of senior politicians who favour a legal right to euthanasia in rare cases. He argued it was wrong that Chantal Sebire should have to "commit suicide in a clandestine way, which would cause suffering to everyone, especially her loved ones".


Belgium legalised euthanasia in 2002, the second EU country to do so after the Netherlands.

That change in the law enabled a Belgian doctor, Professor Pete Hoebeke, to invite Chantal Sebire (from France - case outlined above) to end her life at his hospital in Ghent.

Hugo Claus
Hugo Claus was able to choose the time and place of his death

He revealed that five foreigners "in great suffering" had already come to Belgium to die, taking advantage of EU rules allowing patients to seek care in another member state if it was unavailable at home.

Hugo Claus, 78, chose his own moment of death because he did not want to continue suffering from Alzheimer's disease.

He took advantage of Belgium's liberal euthanasia law, which grants a doctor the right to help end a patient's life.

Luxembourg's parliament has voted to legalise euthanasia, after a passionate public debate. It is a predominantly Catholic country and the medical profession was broadly against the legislation.

In December 2008, Prime Minister Jean-Claude Juncker pushed for the constitution to be re-worded so that Grand Duke Henri would merely enact laws, rather than approve them, after a row over euthanasia legislation.

The grand duke signalled that he would not sign the euthanasia bill into law even though the Chamber of Deputies approved it in February 2008.

The proposed new law on euthanasia and assisted suicide would allow those with incurable conditions to die if they asked repeatedly to do so and had the consent of two doctors and a panel of experts.


In 2002, the Netherlands was the first country in the world to legalise euthanasia, although it had been widely tolerated since the early 1970s.

The rules are strict and cover only patients with an incurable condition who face unbearable suffering.

The patient has to be in full possession of mental faculties and each case has to have a second medical opinion before euthanasia is carried out in a medically appropriate way. After the event, it is referred to a regional review committee including a doctor, a legal expert and a medical ethicist.

Active euthanasia: taking deliberate action such as an injection to end a patient's life
Passive euthanasia: withdrawing medical treatment with the deliberate aim of ending life
Assisted suicide: providing the means, eg medicine, to allow a patient to end their own life

In recent years the number of Dutch cases has been around 2,000 a year, but experts suggest there may be a growing preference for an alternative method known as "deep sedation", which does not involve either euthanasia or suicide.

This involves a patient in the final stages of life being given drugs for a continuous period, usually by a family doctor. It is favoured by those with terminal cancer and raises no legal issues as the drugs do not cause death.

Euthanasia of new-borns and late abortions is illegal in the Netherlands, but a commission was set up to examine whether or not to regulate the practice of ending the lives of new-born babies classed as "seriously suffering".

Assisted suicide is tolerated in the Netherlands, but two members of a group set up to offer people "professional help" have been sentenced to jail terms.

In March 2008, a group of scientists and psychiatrists announced they were publishing a book containing advice on helping people end their lives quickly and without pain.


Euthanasia is illegal, but Italian law upholds a patient's right to refuse care and the potential contradiction has resulted in several cases which have divided Italians.

The debate is especially passionate in Italy, where the Roman Catholic Church, which is deeply opposed to euthanasia, still holds great sway.

In 2006, Piergiorgio Welby - a terminally-ill man with a severe form of muscular dystrophy - died after a protracted legal dispute during which he described his life as torture.

Piergiorgio Welby in hospital in 2006
Piergiorgio Welby's case highlighted the divide among Italians

A judge had ruled that he did not have the right to have his respirator removed, and when anaesthetist Mario Riccio switched off his life support he was investigated by a judge for "consensual homicide". He was eventually cleared and the judges involved called on politicians to change the law.

In July 2007 came the case of Giovanni Nuvoli, a 53-year-old former football referee with advanced muscular dystrophy, who died after going on hunger strike because he was not allowed his request to die without suffering.

Police prevented his doctor, Tommaso Ciacca, from switching off his respirator. Former Health Minister Livia Turco said at the time that it was time Italy had a law "which allows sick people to express their will".

Then in July 2008, a court in Milan awarded the father of Eluana Englaro, a 38-year-old woman who has been in a permanent vegetative state since a car crash in 1992, the right to disconnect her feeding tubes.

The judges ruled that doctors had proved Ms Englaro's coma was irreversible. They also accepted that, before the accident, she had expressed a preference for dying over being kept alive artificially.

Eluana Englaro (undated file photo)
Ms Englaro opposed being kept alive artificially, her father says

Prime Minister Silvio Berlusconi tried to intervene after doctors at a private geriatric clinic began to withhold her food, issuing an emergency decree barring doctors halting nutrition to patients in a coma.

However, President Giorgio Napolitano refused to sign it, and three days later, before the Senate could enact a new law barring doctors halting nutrition to patients in a coma, Ms Englaro died.

Following her death, senators agreed to expedite work on a draft law to clarify end-of-life issues.

"There's a will to urgently agree on end-of-life legislation," Health Minister Maurizio Sacconi said.


Passive euthanasia is now possible in Sweden because of new medical guidelines which allow doctors to halt life-extending treatment if a patient asks.

Swedish law says doctors should respect the will of patients and should not kill them. Doctors had previously interpreted that as banning them from withholding treatment.

But the rules were reassessed after a 35-year-old man who had spent years on a respirator was unable to persuade doctors to turn off his life-support and travelled to Switzerland to end his life.

The Swedish Society of Medicine now advises doctors to respect the wishes of patients who are capable of making their own decisions, well-informed and aware of all the alternatives.

Swedish doctors are not generally in favour of euthanasia. A recent survey suggested that 84% of them would never consider helping a patient die, even if the patient asked for it and it was legal.


Assisted suicide is not illegal in Switzerland and can have the involvement of non-physicians.

Hundreds of Europeans have travelled to Zurich to end their lives because of Dignitas, an organisation set up in 1998 to help people with terminal illnesses.

They are provided with a lethal dose of barbiturates which they have to take themselves.

But Dignitas was forced to move from the flat it was using because of opposition from residents in the area.

At one point, those using its services were told to use hotel rooms and, according to one report, one man decided to die in his car.

According to Swiss law, a person can be prosecuted only if helping someone commit suicide out of self-interested motivation.

Dignitas' staff work as volunteers.


Euthanasia is a deeply divisive political and religious issue in Spain.

Socialist Prime Minister Jose Luis Rodriguez Zapatero legalised same-sex marriage in his first term of office, but a campaign promise to set up a congressional committee on euthanasia was not followed through.

In 2007, the Socialists joined the opposition Popular Party in voting against the legalisation of euthanasia as a way of ensuring the right to a dignified death.

Although opinion polls suggest popular support for euthanasia, Spain has been rocked by a high-profile case involving allegations of sedation causing the premature deaths of 400 terminally ill patients.

In 2005, Madrid anaesthetist Luis Montes and several other doctors at a hospital in Leganes were placed under investigation by a regional health chief.

It was not until early 2008 that all 15 doctors were cleared of any wrongdoing, but the case is reported to have led many doctors to have shied away from sedating patients out of fear of court action.


Euthanasia has long been a taboo subject in Germany because of the Nazi programme of so-called euthanasia, which targeted thousands of men, women and children considered handicapped or mentally ill.

The law on assisted suicide is not clear. While no longer illegal, it cannot involve a doctor because that would violate the code of professional medical conduct and might contravene a doctor's legal duty to save life.

Many of the clients who travel to Switzerland to seek help in suicide are Germans and, at one point, Dignitas suggested it might set up a German office in Hanover.

Former Hamburg Justice Minister Roger Kusch, who left politics to campaign for the right to assisted suicide, has come up with his own way around German law.

A patient would be attached to an intravenous drip with two syringes, one with an anaesthetic, the other with a lethal substance. While a doctor would insert the needle, it would be up to the patient to take the fatal step of pressing the button.

German medical professionals and church figures have criticised the idea.


An important distinction in English, Welsh and Scottish law exists between active euthanasia and passive euthanasia.

Since 1993, "omissions" - ie actions to remove life-saving care - have not been not illegal.

That followed a ruling in the case of Anthony Bland, who had been left severely brain-damaged at the Hillsborough Stadium football disaster four years earlier.

Daniel James
Daniel James was paralysed during a rugby training session

As the law stands in England, Wales and Scotland, deliberate or "active" euthanasia will normally leave anyone assisting suicide or death liable for murder.

Several recent attempts to persuade the courts to change the law have failed.

In 2007, the House of Lords rejected a proposal to give doctors the right to prescribe drugs that terminally ill patients in severe pain could use to end their own lives.

The bill was put forward after Diane Pretty, a woman with terminal motor neurone disease, fought for the right to allow her husband to help her end her life.

She lost her case in the European Court of Human Rights in Strasbourg, before she died in a hospice in May 2002.

In March 2008, veteran Scottish politician Margo MacDonald, who suffers from Parkinson's disease, told fellow members of the Scottish Parliament that she wanted to have the right to end her own life if her condition deteriorated.

She called for a public debate on assisting terminally ill people to end their lives.

In December 2008, the new Director of Public Prosecutions, Keir Starmer QC, sent a strong signal that in the meantime, people who helped seriously ill or disabled relatives to die would not be charged.

Mr Starmer decided not to prosecute the parents of Daniel James, a rugby player who was paralysed from the shoulders down when a scrum collapsed on him.

He tried to commit suicide three times before persuading his parents to help him travel to Switzerland to die at a Dignitas clinic (see Switzerland, above).

Although there was sufficient evidence to charge Mr James's parents, a prosecution would not be in the public interest, Mr Starmer said.


Poland is a predominantly Catholic country and has strongly condemned euthanasia.

In 2007, Poland's then conservative government argued that plans for a Europe-wide day of protest against the death penalty should be met with parallel condemnation of abortion and euthanasia.

It also raised the prospect that the European Charter of Fundamental Rights - which is a legally binding part of the Lisbon Treaty - could pave the way for euthanasia.

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