Mednotes

L4 Ethics Euthanasia and physician assisted suicide

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aliasesL4 Ethics Euthanasia and physician assisted suicide

35 min read

Overview

This lecture covers euthanasia and assisted dying in New Zealand, centred on the End of Life Choice Act 2019. It first fixes the terminology, separating assisted dying from the long-legal practices of withdrawing or withholding treatment and from palliative sedation therapy. It then traces how the Act became law, sets out its eligibility criteria and procedural steps, and reviews the service data since implementation. The second half examines the ethical arguments (compassion, autonomy, and the combined “joint view”), the empirical evidence on public, medical student and doctor attitudes and on why patients request assisted dying, and closes on the unresolved question of where the line falls: what should count as unbearable suffering, and how far autonomy extends.

Terminology and basic distinctions

  • Etymologically, “euthanasia” means good death. The term now covers a range of practices and people contest which words are appropriate.
  • Withdrawing or withholding treatment has been and remains legal in many circumstances. It can happen at the person’s request (potentially through an advance care plan) or because doctors decide the treatment provides no further benefit. Examples: turning off life support, deciding not to attempt CPR. This is not the subject of the lecture.
  • Suicide is not illegal in New Zealand, but assisting a person to commit suicide was, and outside the Act still is, illegal.

Three practices to distinguish:

  • Assisted suicide / assisted dying: providing a competent person, at their voluntary request, with the means to end their life, which that person uses themselves. Example: a doctor giving a patient a prescription for a lethal drug. Previously illegal in NZ, legal since the EoLC Act.
  • Voluntary euthanasia: a person ends the life of another person at their request. Example: a doctor administering a lethal drug to a patient who asks for it. Previously illegal, legal since the EoLC Act.
  • Non-voluntary euthanasia: a person ends the life of another person who is unable to make a request. Example: a doctor administering a lethal drug to a severely impaired newborn, or to a patient with advanced dementia. This remains illegal.

Although all three were previously illegal, all three have historically occurred in NZ on occasion, and prosecuted cases have generally drawn light sentences.

Palliative care, palliative sedation and double effect

  • The goal of palliative care is to improve the quality of life of people who are dying. It recognises the multi-dimensional nature of suffering and involves a multidisciplinary approach.
  • Palliative care acknowledges the dying process and seeks neither to postpone nor to hasten death. It has traditionally been opposed to euthanasia.
  • Palliative sedation therapy is the option of last resort in palliative care: reducing a patient’s consciousness until their pain is relieved. It may be intermittent or permanent unto death.
  • The doctrine of double effect, formulated by Aquinas, states that if the only way of relieving a person’s pain will also bring about that person’s death, the act of doing so is not murder. It has been broadly accepted by the medical community and was long invoked to justify potentially lethal doses of pain relief in the terminal phase.
  • As it happens, there is little evidence that conventional palliative care practice does in fact hasten death (see Ekström et al, BMJ 2014, on the safety of benzodiazepines and opioids in very severe respiratory disease).

Contested terminology

  • Proponents generally prefer “aid-in-dying”, “assisted dying” and related variants over “assisted suicide”, because they regard ending one’s life in these conditions as morally different from suicide.
  • Opponents reject the distinction and add that such phrases confuse the action with palliative care.
  • The Act itself defines assisted dying as either (a) administration by an attending medical practitioner or attending nurse practitioner of medication to the person to relieve their suffering by hastening death, or (b) self-administration by the person of medication to relieve their suffering by hastening death.
  • By contrast, Euthanasia-Free NZ describes “assisted dying” as an umbrella term for assisted suicide and voluntary euthanasia, and calls it, along with “end of life choice”, “end of life options”, “dying with dignity”, “death with dignity”, “right to die”, “aid in dying” and “mercy killing”, a euphemism intended to make the practices sound vague and less offensive.

The international situation

  • The number of jurisdictions permitting some form of euthanasia or assisted suicide has steadily increased in recent years.
  • Oregon legalised assisted suicide in 1994. The Netherlands passed a law permitting euthanasia and assisted suicide in 2002.
  • The permitting conditions vary. Most require the person be currently competent. Some require a terminal illness (Oregon), others specify intolerable, irremediable suffering (the Netherlands). Other conditions and processes are also specified.
  • Europe as mapped in the lecture: legal in some countries, partially legal by court decision in others, under discussion elsewhere. In Italy and Germany the practice was decriminalised by the Constitutional Court but not formally legalised. In France a bill has passed through parliament (BBC: “French MPs approve assisted dying law with strict rules after years of argument”). In Portugal implementation of the law is paused for reviews. Austria and Switzerland permit only voluntary assisted dying, not medical (that is, practitioner-administered) euthanasia.

How the End of Life Choice Act became law

Sequence of events:

  1. 2015: the Lecretia Seales case reignited public debate. Seales sought a High Court declaration that it would not be unlawful for her GP to help her die. Justice Collins concluded this required an act of parliament.
  2. 2016: a Health Select Committee inquiry received a then record 22,000 submissions. Its report was released in August 2017.
  3. June 2017: David Seymour’s End of Life Choice Bill was drawn from the parliamentary ballot (the members’ bills ballot).
  4. 13 December 2017: the Bill passed its first reading on a personal vote, then went to the Justice Committee.
  5. The Justice Committee received a new record 39,159 submissions and released its report on 9 April 2019.
  6. 26 June 2019: the Bill passed its second reading, following substantial debate and a number of amendments.
  7. The New Zealand First Party made its support conditional on the Act being subject to a popular referendum.
  8. 17 October 2020: the referendum was held alongside the general election. The Act received 65.1% support.
  9. A year was allowed to prepare for implementation, so the Act came into force on 7 November 2021.

Key points of the Act: eligibility

An eligible person is one who:

  • is aged 18 years or over; and
  • has New Zealand citizenship (Citizenship Act 1977) or is a permanent resident (section 4, Immigration Act 2009); and
  • suffers from a terminal illness likely to end their life within 6 months; and
  • is in an advanced state of irreversible decline in physical capability; and
  • experiences unbearable suffering that cannot be relieved in a manner the person considers tolerable; and
  • is competent to make an informed decision about assisted dying.

All criteria must be met. Assisted dying will not be provided unless both the attending medical practitioner (AMP) and an independent medical practitioner (IMP) reach the opinion that the person meets these criteria.

A person is not eligible by reason only that they:

  • suffer from any form of mental disorder or mental illness; or
  • have a disability of any kind; or
  • are of advanced age.

Key points of the Act: the process

  • A health practitioner cannot initiate the process (section 10). In this respect the law overrides Right 6(1) of the Code of Rights: the provider cannot inform the patient of this option.
  • The patient requests. The AMP then informs them of their prognosis and the impact of assisted dying, among other things.
  • The AMP must ensure the patient knows their options (including palliative care), knows they can change their mind at any time, is not being pressured, and has had the opportunity to discuss the decision with others while understanding they are not obligated to discuss it with anyone. The AMP is to encourage the patient to talk with others.
  • After the request is confirmed the AMP gives the patient a form to sign (someone else may sign if they are unable). The completed form is sent to the Registrar, an employee of the Ministry of Health appointed by the Director General, who oversees the operation of the Act (section 27).
  • The AMP then considers eligibility and sends a form to the Registrar reporting their opinion. If the AMP’s opinion is that the person is eligible (or would be if determined competent), the opinion of an IMP is also sought.
  • If either the AMP or the IMP is unsure whether the patient is competent, a psychiatrist is engaged to assess the patient.
  • If any one of the medical practitioners involved thinks the patient is ineligible, assisted dying does not go ahead.
  • If the person is eligible they are informed, they set the date and time, and a form is sent to the Registrar.
  • Before the chosen date the AMP must advise the person about the methods of administration (section 19(2)(a)): ingestion triggered by the person; intravenous delivery triggered by the person; ingestion through a tube triggered by the attending medical or nurse practitioner; injection administered by the attending medical or nurse practitioner.
  • The doctor or nurse must advise the Registrar 48 hours beforehand, and the Registrar checks everything has been done properly.
  • Under section 20(5) the attending medical or nurse practitioner must be available to the person until they die, or arrange for another practitioner to be. Section 20(6): “available” means in the same room or area as the person, or not in the same room or area but in close proximity.
  • If the patient has been given the medication but changes their mind, it must be taken away immediately.

Conscientious objection

  • Section 8(1): a health practitioner is under no obligation to assist a person wishing to exercise the option of assisted dying if the practitioner has a conscientious objection to providing that assistance.
  • Section 9(2): in that case the AMP must tell the person of their conscientious objection, and of the person’s right to ask the SCENZ Group for the name and contact details of a replacement medical practitioner.
  • The rules for conscientious objection to abortion are slightly different, and are worth comparing.

Service data since implementation

From the Assisted Dying Service annual report, 1 April 2025 to 31 March 2026.

Applications and assisted deaths by reporting period (open applications carried over / new active applications / assisted deaths):

  • 2021-2022: 206 open / no new-application bar shown / 66 assisted deaths
  • 2022-2023: 45 / 807 / 328
  • 2023-2024: 111 / 834 / 344
  • 2024-2025: 71 / 1,066 / 472
  • 2025-2026: 125 / 1,164 / 486

Both new applications and assisted deaths have risen year on year.

Demographics of the 1,164 new applicants in 2025-2026:

  • Ethnicity: NZ European/Pākehā 944 (81.10%), Other 154 (13.23%), Māori 57 (4.90%), Asian 29 (2.49%), Pacific peoples 9 (0.77%), not stated 0.
  • Sex: male/tāne 611 (52.49%), female/wāhine 553 (47.51%), gender diverse 0.
  • Age: 65-84 years 713 (61.25%), 85+ years 222 (19.07%), 45-64 years 203 (17.44%), 18-44 years 26 (2.23%).
  • Diagnosis: cancer 739 (63.49%), not known 135 (11.60%), neurological condition 97 (8.33%), chronic respiratory disease 93 (7.99%), multiple co-morbidities 71 (6.10%), cardiovascular condition 56 (4.81%), other organ failure 31 (2.66%).
  • Receiving palliative care at application: yes 926 (79.55%), no 238 (20.45%).
  • Reported a disability at application: yes 76 (6.53%), no 1,088 (93.47%).

Assessing arguments: truth and validity

  • Classic syllogism: (1) all swans are white; (2) there are swans in New Zealand; therefore (c) the swans in New Zealand are white.
  • In assessing an argument, consider both truth and validity: whether the propositions are true, and whether the inferences follow.
  • Example of a bad argument: (1) people overseas are receiving assisted dying just because they are old; therefore (c) New Zealand should not permit assisted dying. The conclusion does not follow from the single premise.
  • Making it valid requires two further premises: (2) how assisted dying is practised overseas is how it will be practised in New Zealand; (3) we should not provide assisted dying to people just because they are old. Even then the argument is not sound for factual reasons: premise 1 is currently false and premise 2 is questionable.

The arguments in support

The most common arguments centre on two ethical concepts, compassion and autonomy. Their application is difficult to disentangle, and they may or may not carry equal weight depending on one’s background values. The introduction to the End of Life Choice Bill read: “The motivation for this Bill is compassion. It allows people who so choose, and are eligible under this Bill, to end their lives in peace and dignity, surrounded by loved ones.”

The argument from compassion

  1. If a person is suffering we should provide the best help possible.
  2. There are times when the best help possible is to end the life of that person.
    Therefore: there are times when we should end the life of a person who is suffering.

Key questions for it:

  • It is difficult to say when premise 2 applies, that is, when ending a person’s life is the best or only help available.
  • Is it true that we should always help? The principle of non-maleficence is about stopping lest your help makes matters worse.
  • There may be ethical reasons not to help a person, if the help required creates other problems.

The argument from autonomy (“my life, my choice”)

  1. In a liberal, secular, pluralist democracy people should be free to do what they choose so long as their actions do not harm others.
  2. The choice to end one’s life does not harm others.
    Therefore: in such a democracy a person should be free to end their life if they choose to.

Comments on it:

  • It does not fit with how we respond to some situations where a person chooses to end their life, for example youth suicide. That said, most people find a clear intuitive distinction between the kinds of cases.
  • The choice, and making the option lawful, may in fact be harmful to others.

The joint view

  • The standard argument combines autonomy and compassion (or beneficence): assisted dying is justified because the person both chooses it and because it is in their best interests. This is what is said to distinguish assisted dying from suicide, since suicide is not in a person’s best interests.
  • The final judgment about best interests is usually given to doctors, but there are no or few uncontroversial objective criteria. The judgment is very difficult to make at the practical level, and also difficult to make clear at the policy level (see van Tol, Rietjens and van der Heide 2012 on empathy and the application of the “unbearable suffering” criterion in Dutch practice).
  • In the absence of objective criteria many conclude it should be up to the patient to decide. However, this collapses the joint view into the autonomy-only view.

Where is the line? The assist-prevent continuum

  • Are we clear on the difference between life-ending decisions society should support and those it should prevent?
  • Many proponents of law change also regard suicide prevention as very important. Equally, even opponents of law change might accept that there could be situations where it would be acceptable to kill a person to save them from pain.
  • The conditions under which a death might be hastened can be placed on a continuum of relative moral acceptability. At one end sit situations where we should hasten death (example given: a man burning on the pyre). At the other end sit situations where we should prevent hastened death (example given: teen suicide). The central question is where the line falls that separates early deaths we should allow or assist from those we should prevent.

Evidence on attitudes

Public opinion

  • New Zealand surveys and polls since around 2000 have consistently reported roughly 60% to 75% support for a law change. These typically describe a person close to death and experiencing untreatable pain.
  • A 2017 Horizon poll of 1,274 people aged 18+ from the HorizonPoll panel (95% confidence level) asked about a law change allowing medical practitioners to assist people to die where the request comes from a mentally competent patient aged 18 or over with end-stage terminal disease and irreversible unbearable suffering, for example cancer. 46% strongly supported and 29% supported, giving 75% support.
  • A parallel question about irreversible but non-terminal conditions, for example motor neuron disease, drew only slightly lower support at 66%.
  • The 2020 referendum result fit with these findings.
  • Problem with the polls: we do not know how much respondents know about the matter. For example, how many are aware of the option of palliative sedation therapy, or of the purported problems, and would knowing change their answers?

Citizens’ jury (Otago, 2018)

  • 15 people randomly selected from the electoral roll were informed about the issue by recognised experts, heard arguments for and against, and deliberated together (Walker et al 2020).
  • Pre and post responses to the question “Suppose a person has a painful incurable disease. Do you think that doctors should be allowed by law to end the patient’s life if the patient requests it?”, on a scale from 1 (definitely no) to 7 (definitely yes):
    • No change: jurors 1, 2 and 3 (all 7), juror 10 (4), juror 15 (1).
    • Moved toward “definitely yes”: jurors 4, 5 and 6 (6 to 7), jurors 7 and 8 (5 to 7), juror 9 (4 to 7).
    • Moved toward “definitely no”: juror 11 (7 to 1), jurors 12 and 13 (5 to 1), juror 14 (4 to 1).
  • Informed deliberation moved views in both directions, and several movements were large.

Doctors and medical students

  • Local and international studies have found that a majority of doctors oppose euthanasia and assisted dying, with opposition strongest among palliative care specialists (Emanuel et al, JAMA 2016).
  • New Zealand medical students’ support declines across year levels (Nie et al 2021): 2nd year yes ~65%, no ~15%, unsure ~21%; 3rd year yes ~63%, no ~20%, unsure ~18%; 4th year yes ~51%, no ~24%, unsure ~24%; 5th year yes ~40%, no ~33%, unsure ~26%.
  • McCormack et al’s 2011 systematic review of doctors’ views found conflicting results as to whether increased work with the dying and palliative medicine specialty negatively influence opinion. The qualitative data gave these reasons for doctors’ opposition:
    • Palliative care is an adequate alternative
    • Concern about appropriate safeguards
    • Concern about the involvement of doctors
    • The mechanisms of a slippery slope
    • Concerns about the assessment of low mood and mental capacity
    • Debate over the meaning and balanced degree of patient autonomy

Important

A first-year doctor described being asked by the son of a dying patient with advanced alcohol-related liver cirrhosis whether things could be ended sooner to end the suffering. The doctor had already increased the frequency of charted fentanyl and the patient was on a syringe driver. He explained that this is not something we do, that we let nature take its course, that we do not prolong things, and that a range of medications can relieve symptoms and remove as much distress as possible. After about 15 minutes the son accepted this. The doctor noted the question threw him at first, but that having “my line in the sand” made him comfortable. (Quote from Sinead Donnelly’s MMedSc, 2020; see Donnelly and Walker 2021.)

Why people request assisted dying

  • Oregon and Washington data (Emanuel et al 2016). Reported annual cases: Oregon 2015, 132 physician-assisted suicides out of 35,598 total deaths (0.39%); Washington 2015, 166 out of 52,028 total deaths in 2014 (0.32%).
  • End-of-life concerns given, Oregon 1998-2015 versus Washington 2009-2015: losing autonomy 91 / 90; less able to engage in activities making life enjoyable 89 / 89; loss of dignity 68 / 76; losing control of bodily functions 48 / 51; burden on family, friends or caregivers 41 / 53; inadequate pain control or concern about it 25 / 36; financial implications of treatment 3 / 9. Pain is therefore not the leading reason.
  • Systematic review of the wish to hasten death (Rodríguez-Prat et al 2017): in the context of advanced disease the wish to hasten death emerges as a reaction to physical, psychological, social and existential suffering, all of which impacts on the patient’s sense of self, of dignity and of meaning in life. The wish can hold different meanings for each individual and can serve functions other than communicating a genuine wish to die. Understanding its reasons, meanings and functions is crucial for drawing up and implementing care plans that meet individual needs.

The ambiguous role of the assessing doctor

  • There is evidence that healthcare providers struggle with their role in maintaining the distinction between deaths to assist and deaths to prevent, and that providers apply criteria in variable ways (Winters et al 2025 on Canadian MAiD assessors; van Tol et al 2012). The conceptual tension shows in the ongoing debate about what the eligibility criteria should be.
  • Some argue the solution is to make assisted dying available to anybody who autonomously chooses it. Schüklenk (2024, p. 348): “Good societies ought to respect and support the end-of-life desires and choices of their citizens. If a decisionally capable person has made a considered choice to seek an assisted death, suicide is legal, that request is stable over a reasonable period of time, and it is voluntary, a good society ought to assist such people in ending their lives as peacefully as is feasible.”

Unresolved: what counts as unbearable suffering, and how far does autonomy go?

Rising numbers

  • Euthanasia and assisted suicide per 1,000 deaths, 2007 to 2017 (Borasio, Jox and Gamondi, Lancet 2019). In 2007 approximate rates were Netherlands ~16, Belgium ~5, Switzerland ~4, Oregon ~2. By 2017 the labelled values were Netherlands 43.9, Belgium 21.1, Switzerland 15.3, Oregon 3.9. All four rose, the Netherlands highest and rising most steeply, Oregon lowest and rising only slightly.
  • In the Netherlands the percentage of deaths by euthanasia rose from 1.3% in 2003 to 6% in 2025.
  • In Canada there were 10,029 medically assisted deaths in 2021, a 35% increase on 2020, and 16,499 in 2024, which was 5.1% of all deaths.
  • Theo Boer, who spent nine years on a Dutch regional evaluation committee, has suggested people have begun viewing aid-in-dying as a right rather than an option of last resort.

Pressure on healthcare providers

  • Ruben van Coevorden, a pioneer of euthanasia in the Netherlands, agrees with Boer. He describes being called as a SCEN doctor to a woman dying with terrible stomach pains whose family “practically pinned me to the wall” demanding he give her the injection immediately. He found her treatment was not working, that she was on the wrong type of laxatives and was terribly constipated, and organised a palliative regime that made her more comfortable, for which the family were extremely grateful. She was close to dying anyway, but it allowed a better goodbye.
  • One reading is that this shows the system working. Others are concerned by the observation that doctors in these situations are ill-equipped and under pressure.

Expanding criteria

  • Canada’s law initially required that death be “reasonably foreseeable”. Some disabled persons argued this was discriminatory in not making assisted dying available to those suffering with degenerative diseases (the Nicole Gladu and Jean Truchon challenge, lawyer Jean-Pierre Ménard). The law was changed in response in 2021. The intention had been to expand the criteria in 2024 to cover people whose only underlying medical condition is a mental illness, but there has been a further deferral (Webster, Lancet 2022).
  • In the Netherlands, D66 MP Pia Dijkstra proposed in December 2016 extending assisted suicide to anyone over 75 who no longer wants to live, even if not ill. The bill would make it legal to arrange the death of anyone with an “intrinsic and consistent” wish to die, granted and carried out by a registered end-of-life practitioner (doctor, nurse or psychologist) who must seek a second opinion. Safeguards included: the wish to die must be confirmed in a second interview at least two months after the original request, and the case reviewed by an independent commission, as currently happens with euthanasia.
  • Sean Davison, a New Zealand scientist who helps people to die and who featured with a “death pod” on the cover of the NZ Listener (1-7 April 2023, headline “Murder or mercy?”), argued: “I think it is good that people are encouraged to get help, but they might not want it. It’s really up to them”; “Only the person experiencing knows how much they are suffering”; “It is human nature not to turn our backs on another human’s suffering.”
  • Loneliness and financial difficulty are cited by some patients as reasons their life is unbearable (Torjesen, BMJ 2015; the case of Les Landry, an applicant for Medical Aid in Dying in Canada). What the appropriate medical response to that should be is left open.

Palliative care and social support

  • Points on palliative care raised in the lecture: health services should do everything reasonably possible to relieve suffering and improve or maintain quality of life; improving access to hospice palliative care should be a government priority with adequate funding; all people should be aware of options for palliative and end of life care as part of individualised care planning, including advance care plans; prescribers should consult specialist palliative care services as necessary; the palliative care workforce needs to increase to provide quality care and prevent avoidable bad deaths and unnecessary suffering.
  • The concern about vulnerable persons goes back to the fundamental tension between respecting a person’s choices and an obligation to intervene when a person feels their life is no longer worth living and wants to die, that is, to help them change their mind.
  • Some are concerned that if health services or social supports erode, more people will be left in situations where their suffering is intolerable and be moved to opt for euthanasia. This may not be considered a problem with the End of Life Choice Act, because of the requirements that a person have “a grievous and irremediable medical condition” and be “in an advanced state of irreversible decline in capability”, the explicit exclusion of mental health related reasons, and the safeguards against coercion. Of course, our law might not stay the same.

Self-test

  1. Distinguish assisted suicide, voluntary euthanasia and non-voluntary euthanasia, and state which of the three remains illegal in New Zealand.
  2. Explain why withdrawing or withholding treatment is not what is meant by assisted dying, and give two examples of it.
  3. Define palliative sedation therapy and state its place in palliative care.
  4. State the doctrine of double effect, say who formulated it, and explain what the evidence says about whether conventional palliative care hastens death.
  5. Explain why the terms “assisted dying” and “assisted suicide” are contested, giving the position of each side.
  6. List the six eligibility criteria for assisted dying under the End of Life Choice Act.
  7. List the three characteristics that, by themselves, do not make a person eligible under the Act.
  8. Describe the steps of the assisted dying process from the patient’s request to the setting of a date, naming the practitioners involved at each point.
  9. What does the Act say about who may initiate a discussion of assisted dying, and which patient right does this override?
  10. List the four methods of administration the attending medical practitioner must advise the person about, indicating who triggers each.
  11. What must happen 48 hours before administration, what does “available” mean under section 20(6), and what happens if the patient changes their mind after receiving the medication?
  12. Describe the obligations of a health practitioner who has a conscientious objection to assisted dying.
  13. Outline the sequence by which the End of Life Choice Bill became law, from the Seales case to the Act coming into force, with the key dates and the referendum result.
  14. According to the most recent Assisted Dying Service annual report, how many new active applications and assisted deaths were there in 2025-2026, and what proportion of applicants had cancer and were already receiving palliative care?
  15. Set out the argument from compassion as a syllogism and give two problems with it.
  16. Set out the argument from autonomy as a syllogism and give two comments made against it.
  17. Explain the joint view and the problem that arises when objective criteria for best interests are lacking.
  18. What is the assist-prevent continuum, and what question does it pose?
  19. What level of public support have New Zealand polls reported since around 2000, and what objection was raised to relying on such polls?
  20. Describe what happened to jurors’ views in the 2018 Otago citizens’ jury.
  21. Describe the pattern of medical students’ support for euthanasia/assisted dying across year levels, and list four reasons the McCormack review gave for doctors’ opposition.
  22. Using the Oregon and Washington data, explain whether pain is the primary reason people choose assisted dying, citing the top three reported end-of-life concerns.
  23. What did the systematic review by Rodríguez-Prat et al conclude about the wish to hasten death, and why does that matter clinically?
  24. Describe the trend in euthanasia and assisted suicide rates in the Netherlands, Belgium, Switzerland and Oregon between 2007 and 2017, and give the Netherlands and Canada figures cited for recent years.
  25. Describe two ways in which eligibility criteria have been expanded or proposed for expansion overseas.
  26. A patient who meets none of the Act’s clinical criteria says their life is unbearable because of loneliness and financial difficulty. Explain what tension this case illustrates and how the End of Life Choice Act is said to respond to it.
  27. Integrative: using the compassion and autonomy arguments, the joint view and the evidence on why people request assisted dying, explain why the question of where to draw the line remains unresolved.

Answers

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