There are essentially three models of assisted dying around the world:
-
- The ‘Oregon model’ – since 1997 – this is broadly the model that has operated in Oregon since 1997, without change, and is the model envisaged by other countries and other US states that are contemplating assisted dying legislation, such as New Zealand, Ireland, the UK and various other states of the US. This is the model (again with some variations) which is being pursued in Australia.
-
- The ‘Benelux’ model – since 2002 – this is the model followed in the Netherlands, Belgium and Luxembourg. Other countries around the world that are looking at assisted dying laws do not intend to use this model.
-
- Switzerland – since 1942 – a unique case.
Following is more information about each of these models.
Oregon

The Death with Dignity Act (DWDA) began operation in 1997. It allows terminally ill Oregon residents to obtain and use prescriptions from their physicians for self-administered, lethal medications. Under the Act, ending one’s life in accordance with the law does not constitute suicide. The DWDA specifically prohibits euthanasia, where a physician or other person directly administers a medication to end another’s life.
To request a prescription for lethal medications, the patient must be:
-
-
- An adult (18 years of age or older),
- A resident of Oregon,
- Capable (defined as able to make and communicate health care decisions), and
- Diagnosed with a terminal illness that will lead to death within six months.
Patients meeting these requirements are eligible to request a prescription for lethal medication from a licensed Oregon physician. To receive a prescription for lethal medication, the following steps must be fulfilled:
-
-
- The patient must make two oral requests to his or her physician, separated by at least 15 days.
-
- The patient must provide a written request to his or her physician, signed in the presence of two witnesses.
-
- The prescribing physician and a consulting physician must confirm the diagnosis and prognosis.
-
- The prescribing physician and a consulting physician must determine whether the patient is capable.
-
- If either physician believes the patient’s judgment is impaired by a psychiatric or psychological disorder, the patient must be referred for a psychological examination.
-
- The prescribing physician must inform the patient of feasible alternatives to DWDA, including comfort care, hospice care, and pain control.
-
- The prescribing physician must request, but may not require, the patient to notify his or her next-of-kin of the prescription request.
To comply with the law, physicians must report to the Department of Human Services (DHS) all prescriptions for lethal medications. Reporting is not required if patients begin the request process but never receive a prescription. In 1999, the Oregon legislature added a requirement that pharmacists must be informed of the prescribed medication’s intended use.
Physicians and patients who adhere to the requirements of the Act are protected from criminal prosecution, and the choice of DWDA cannot affect the status of a patient’s health or life insurance policies. The Oregon Revised Statutes specify that action taken in accordance with the DWDA does not constitute suicide, mercy killing or homicide under the law.
Physicians, pharmacists, and health care systems are under no obligation to participate in the DWDA.
The operation of the law in Oregon is closely monitored by the Health Department, as well as by academic research and has operated without abuse since its introduction. It is reported that about 40% of patients who have been prescribed a lethal dose do not end up using it because they find the possession of it provides reassurance which has a palliative effect.
Between the passage of the law in 1997 and 2016, a total of 1545 people were written prescriptions under the DWDA in Oregon, and 991 patients died from ingesting the lethal medications. The majority of the patients had cancer and were elderly, white, and well-educated. Almost all patients were in palliative care, and almost all took the medications at home after telling loved ones of their decision.
It is also reported that it is relatively rare for patients to apply for assistance under the DWDA because they were suffering from inadequate pain palliation. The most common reasons were related to quality of life, autonomy, and dignity.
The Netherlands

The Termination of Life on Request and Assisted Suicide (Review Procedures) Act, commonly known as the Euthanasia Act was passed in The Netherlands in 2002. The main aims of the policy are:
- to create legal certainty for doctors caught in conflicting obligations;
- to provide transparency in the practice of euthanasia and public scrutiny; and
- to safeguard, monitor and promote the care with which medical decisions about termination of life on request are taken and the quality of such decisions by bringing matters into the open and applying uniform criteria in assessing every case in which a doctor terminates life.
Euthanasia remains a criminal offence. However, both voluntary euthanasia and voluntary assisted dying are not punishable if the attending physician acts in accordance with statutory due care criteria (below).
The patient has no ‘right to euthanasia’ and doctors are not obliged to comply with requests for euthanasia. The patient has to go through an application process for voluntary euthanasia and voluntary assisted dying. Voluntary euthanasia and voluntary assisted dying are supported by the Royal Dutch Medical Association. There is general support in the Dutch community for voluntary euthanasia.
Because of the stringent conditions it is not legally possible for non-residents of the Netherlands to request euthanasia.
Due care criteria
When dealing with a patient’s specific request for voluntary euthanasia or voluntary assisted dying, doctors must observe the following due care criteria. They must:
-
- be satisfied that the patient’s request is voluntary and well-considered;
- be satisfied that the patient’s suffering is unbearable, with no prospect of improvement;
- inform the patient of his or her situation and further prognosis;
- discuss the situation with the patient and come to the joint conclusion that there is no other reasonable solution;
- consult at least one other physician with no connection to the case, who must then see the patient and state in writing that the attending physician has satisfied the due care criteria listed in the four points above; and
- exercise due medical care and attention in terminating the patient’s life or assisting in his/her death.
Only once all these criteria have been fulfilled may the physician proceed to perform voluntary euthanasia or assist the patient to die.
In the Netherlands voluntary assisted dying is available to minors. Patients between 12 and 15 years of age require the consent of their parents to make a request; patients aged 16 and 17 can make a request but the parents have to be involved in the discussions. 80% of patients in this age group are cancer patients.
The Act requires physicians to report assisted deaths to the municipal coroner, who then sends a report to the Public Prosecutor. The relevant regional voluntary euthanasia review committee (comprising a doctor, lawyer and ethicist) receives both these reports. If the statutory due care criteria are met, the review committee will close the case; if not met, the review committee will notify the Public Prosecutor and Health Inspectorate. These bodies will decide if action against the doctor will be taken.
Switzerland

Switzerland is the only country in the world that allows non-citizens to receive an assisted death. Article 115 of the Swiss Penal Code which came into effect in 1942 considers assisting a death not to be a crime if it is done for altruistic reasons and the applicant meets strict criteria:
-
- 18 years or over
- capable of sound judgement; able to consent to the procedure
- able to administer the lethal substance to themselves
- does not have a mental illness (people with a suspected psychiatric illness must have an in-depth medical report prepared by a psychiatrist that establishes that they are fully competent to make the request.)
In 2018 the Swiss Academy of Medical Sciences issued new guidelines that make assisted dying a normal part of doctors’ medical responsibilities – see 6.2.1 Assisted Suicide and the Glossary of SAM – Swiss Guidelines on management of dying and death (2018).
For more information about the provision of assisted dying in Switzerland to people who are not Swiss citizens or permanent residents of Switzerland see the answer to the question below: ‘COULD I GO TO SWITZERLAND TO HAVE AN ASSISTED DEATH?’