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Assisted dying, also known as assisted suicide, is a topic of serious debate around the world. It is a procedure in which a person chooses to end their own life with the assistance of others.
There are some countries in which assisted dying is already legal, while many other countries are engaged in conversation as to whether or not it should be legalised. At the time of writing, more than 400 million people have the legal right to access assisted dying worldwide.
Assisted dying is a sensitive topic. In this article, we’ll explain a bit about what it means, and we’ll also tell you how it may affect your life insurance policy.
Assisted dying is also known as assisted suicide. It is the process of a person voluntarily ending their own life with the help of another person.
A person may consider assisted dying when they are living with chronic, untreatable and unbearable pain that is affecting their quality of life, and/or if they have been diagnosed with a terminal illness.
Assisted dying is different to euthanasia, although the two terms are sometimes used interchangeably.
Assisted dying is when a person helps another person to die with their consent. The person dying is then able to choose the time and means of their death. They are also able to change their mind.
Euthanasia is when a person helps another person to die without their consent. For instance, if a patient has diminished brain function and a physician sees no hope of recovery, they may work with the patient’s family to decide on a course of euthanasia.
Assisted dying can be an active or a passive act. In active acts, a third-party performs an action that directly results in the person’s death, for instance by administering a lethal dose of a drug.
In passive acts, a third-party intentionally does nothing to prevent a person’s death, for instance by ceasing life support and allowing the patient to pass away of natural causes.
In some cases, a person may not be able to execute their suicide through their own power, for instance if the person has become physically incapacitated. They may therefore call upon another person to perform an action that will either result in their death, or directly end their life. Or, they may direct a person responsible for their care to stop taking action that keeps them alive.
In other cases, a person may be able to perform the decisive action themselves, but will depend upon another person to provide them with the means to end their own life.
In Scenario A, a woman living with motor neurone disease has become physically paralysed. She may live for several months, but will never recover the use of her body. She communicates to her healthcare provider that she wishes to pass away. A doctor administers a lethal dose of sedatives intravenously. The woman quickly falls into a coma and the doctor makes no attempt at medical intervention. The woman passes away shortly after. This is an example of an active assisted death, because the doctor performed an action that directly and intentionally resulted in the patient’s death.
In Scenario B, a man has been admitted to palliative care for cystic fibrosis. He has experienced irreversible respiratory failure and is being kept alive through the use of breathing apparatus. He communicates to his doctor that he wishes to pass away. The doctor switches off the breathing apparatus and the man passes away. This is typically considered a case of passive assisted death, because the patient dies of an illness that would have eventually ended his life, although the doctor may still be considered an active participant due to the fact they took direct action in turning off the apparatus.
In Scenario C, a man with stage 4 pancreatic cancer has been told he has only a few months to live. It is likely his death will involve extreme pain. He visits a private clinic that supports assisted suicide. A doctor provides the man with a lethal dose of a fast-acting barbiturate dissolved in water and tells the man that, if he drinks the solution, he will end his own life. The man chooses to drink the solution and passes away a short while later. Even though the patient took the decisive action that resulted in their death, this is still considered a case of active assisted death, because the doctor’s intervention was what ultimately contributed to the patient’s death.
Assisted dying is a legal and moral grey area, especially because no two assisted deaths are ever the same. In some countries, assisting in another person’s suicide is considered tantamount to murder or manslaughter.
In other countries, the act is decriminalised under certain conditions. Only a few countries explicitly allow assisting in another person’s death, so long as the actions taken are within the confines of the law.
Different countries have different laws regarding assisted dying. These laws determine the cases and circumstances where assisted dying can be considered permissible.
Some countries explicitly allow assisted dying and have enshrined the right to assisted death in law. Other countries have simply decriminalised the practice, meaning there is no legal framework for physicians to work under but they can avoid prosecution for their actions. In other countries, assisting in another person’s suicide can be considered illegal and may incur legal penalties.
In countries where assisted dying is legal, the law usually states that a patient must present with an illness that is causing intolerable pain diminishing their quality of life, and that there is no hope of the patient recovering.
Some of the countries that allow assisted dying under these criteria include:
Assisted dying will be legal in all Australian states from 3 November 2025, when the Australian Capital Territory will become the final state to pass its assisted dying bill. The exact law around assisted dying differs by state, although in all cases, it is permitted so long as a person is suffering from unbearable pain with no hope of recovery.
Belgium legalised assisted dying in 2002, becoming the second country to do so. Belgian law states that a person must be in persistent and unbearable physical or psychological pain due to an incurable illness, and that the request for assisted suicide must be deliberate, voluntary and made in writing. The assisted suicide must then be approved by at least two physicians and performed by a physician.
Canada has gradually loosened restrictions on assisted dying since 2016, meaning it is now legal to seek assisted death in Canada, so long as a patient has an irreversible illness that causes unbearable physical suffering. The disease does not necessarily need to be terminal. The request must be approved by at least two physicians. From 2027, Canada seeks to also legalise assisted dying in the case of mental illnesses.
Colombia legalised medical aid in dying in May 2022. Doctors in Colombia can administer life-ending drugs to patients with incurable conditions that are unable to live a “dignified life.” Previously, the law in Colombia restricted cases of assisted dying only to those with terminal illnesses, but the law now extends to any patient of sound mind with a mental or physical illness causing immense distress who is capable of requesting assisted suicide.
Cuba legalised euthanasia in December 2022. The final draft of the law stated that people could request medical intervention in death through “limitation of therapeutic effort, continuous or palliative care, and valid procedures that end life.” This is taken to mean that doctors in Cuba can medically support a patient in their suicide or administer the means to end their life themselves.
Luxembourg approved the Right to Die with Dignity Act in 2009. A person can submit a request for assisted suicide so long as they have an incurable mental or physical illness with no hope of recovery that causes them unbearable suffering. The patient also has a right to decide how they would like to die.
Euthanasia and assisted suicide are legal in the Netherlands so long as the procedure is carried out by a licensed physician with the approval of the municipal pathologist. The patient must be experiencing unbearable suffering with no hope of recovery. The Act extends to patients as young as 12, who can request assisted dying with their parents’ consent.
Assisted dying is permitted under Spanish law. A person making a request must be an adult with an incurable illness that causes “intolerable suffering”, and be “fully aware and conscious” when making their request. The request must be approved by at least two physicians.
Switzerland was the first country to legalise assisted dying and euthanasia, in a law dating as far back as 1918. The Swiss Criminal Code permits all cases of assisting in another person’s suicide so long as the third party has “non-selfish motives,” and so long as the patient plays an active role in ending their own life. Therefore, it is not strictly necessary for a person to seek the consent or input of a physician.
However, it is illegal for anyone, including a physician, to administer the means of ending a patient’s life themselves. Many non-profit organisations exist in Switzerland to support patients who have made a decision to end their life – some will only act in cases where a patient has been diagnosed with a terminal illness.
It is currently illegal to assist in another person’s suicide in the UK, and carries a prison sentence of up to 15 years.
The UK Government is seeking to change the law to allow certain cases of assisted dying. The bill is currently being developed.
In other countries, assisted dying may be considered legal or decriminalised under certain exceptional circumstances.
This typically covers only patients who already have a terminal illness and wish to end their lives before the illness runs its natural course. It may also involve legal precedents that theoretically permit assisting in another person’s suicide, but are not explicitly enshrined in law.
Examples of these countries include:
Austria legalised assisted dying in January 2022. Patients who have a terminal illness can choose to terminate their lives early so long as they have the consent of two physicians, one of whom must be a palliative medicine expert.
Patients must undergo a psychiatric evaluation before being considered for assisted suicide. Aiding another person’s suicide without going through the due process can result in a jail sentence of five years.
As of 2024, assisted death has been decriminalised in Ecuador. This means that doctors can no longer be prosecuted if they assist in ending the life of a patient who is living with a serious and chronic illness. The law is still in draft stage.
While Estonia has declared “committing suicide is a right,” and that therefore assisted suicide should also be a right, it has not yet legislated on the criteria under which assisted suicide should be made legal.
Germany re-legalised assisted dying in February 2020. Although not yet formally legislated, the revised law will seek to make physician-assisted suicide legal. Until then, it remains a constitutional right for people in Germany to seek assisted death in certain circumstances.
In Italy, assisted dying is legal. A patient who is experiencing overwhelming pain is able to request medical support to help them take their own life, however the patient must be the one to take the final action. Euthanasia remains illegal, meaning a doctor or other third party cannot be the one to administer the lethal action to a patient.
Portugal legalised assisted dying in 2023. Patients must have a terminal illness that causes immense suffering. The law only applies to Portuguese nationals and residents. The act has courted considerable controversy in Portugal, and many parties in opposition to the government have promised to repeal it in future elections.
Assisted suicide is permitted in the states of California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, Washington and Washington D.C. The laws differ by state, however most mandate that the patient must have a terminal illness.
Assisted death is a serious decision. Countries that allow assisted death typically require the patient to undergo extensive evaluations prior to approving the request.
This can include:
Even at the point of terminating a patient’s life, it is important that the patient reaffirms their intentions. Physicians in countries that allow assisted suicide may also withdraw their consent to act in support of a patient’s decision for any reason.
Even so, there are several circumstances under which a person may choose to end their life. This usually occurs when the patient is:
Some of the circumstances under which a person may seek assisted suicide include:
If a person has an illness or injury that causes them constant, unbearable pain, they may seek to terminate their life early. In many countries that allow assisted dying, the cause of this pain must be untreatable and lifelong.
A person who has a serious illness that is certain or almost certain to result in their death may seek assisted dying as a means to ‘go out on their own terms.’ The Australian Centre for Health Law at Queensland University of Technology found that the most common reason people sought assisted death was because of:
In many countries, a person whose quality of life has been severely diminished has grounds to seek assisted dying. The grounds for what counts as a diminished quality of life are subjective, but typically mean the patient has lost autonomy, dignity or the ability to do the things they love.
This could be because the person has been disabled or paralysed by an injury, or an illness such as motor neurone disease (MND). A study in the Netherlands found that 32% of patients with MND sought assisted dying.
It’s not just physical pain that can lead a patient to seek assisted death. Neurological illnesses are the second-most common cause for patients to seek assisted death (8.1%). A study in the Netherlands and Belgium found that a small but significant percentage of patients seeking assisted death (around 1–3%) cited Alzheimer’s as the primary cause.
As more countries start to allow assisted dying, life insurance providers are weighing up how it affects their policies.
The key question for insurers is whether assisted dying counts as a form of suicide, or a natural form of death.
Since insurers typically have standard exclusions for suicide in their terms and conditions, there are many cases where a person who dies of suicide may not be eligible for life insurance.
Right now, most insurers view assisted dying as a form of suicide. This means it may be subject to the same limitations. It’s now up to life insurance providers to create special terms in their policies to cover instances of assisted dying.
But this is made challenging by the special circumstances surrounding assisted dying. In a fast-changing legal context, it can be difficult to judge assisted dying equally around the world. Life insurers therefore need to consider factors such as:
Insurers must also be aware of other concerns, such as if the beneficiary receiving the benefit assisted in the act, and whether their participation was legal.
Ultimately, life insurance providers do not want to stand in the way of assisted dying. But they must also design their policies in a way that is fair.
At the moment, most insurers – including us at William Russell – write a clause into their policies that life insurance will only cover death by suicide after the policy has been held for over a year. Since assisted dying is considered a form of suicide, that clause still applies.
So, while policies may change in the future, for now it’s important to read and understand your policy wording and speak to your life insurance provider in order to understand policies around assisted dying.
We’d like to clarify our own position on the matter.
While we recognise the unique circumstances around assisted dying, like other insurance providers, we treat it in the same way as suicide.
This means we cannot honour claims where a person has died through assisted suicide if the death occurred within the first 12 months of their policy, or in the 12 months following an increase in coverage.
For clarity, we exclude all claims where the cause of death is judged as suicide or attempted suicide, or comes about through self-inflicted injuries, whether or not the person was mentally sound at the time, in the first year of a policy.
However, it’s important to say that this is only the case for now. We remain open to updating our policy terms in the future.
At William Russell, we are able to offer one alternative to support people with terminal illnesses. This is our terminal illness benefit, which is included with all group and individual international life insurance policies.
This benefit allows you to take your full life insurance payment early if you have been diagnosed with a terminal condition and have been told you have less than 12 months to live.
If you are eligible to take an early payment of your life insurance under the terms of our terminal illness benefit, you could take the money and then undergo an assisted death without any loss of compensation.
While we understand that not all people who choose an assisted death have a terminal illness, and others may have a prognosis of longer than 12 months, we hope this new terminal illness benefit can go some way towards supporting many of those people who choose to undergo an assisted death.
It’s possible that they will. The legality of assisted dying is still a matter of debate in many countries around the world. This makes it challenging for international life insurance companies to create policies that benefit people who choose an assisted death.
In the future, we expect to see many advances in assisted dying legislation, which could help to remove some of the barriers we face. This could allow us to update our policies.
As more countries start to fully legalise assisted dying, we will start to see more formal approaches towards assisted dying pathways, which will be enshrined in law and therefore considered legitimate means of death. The most desirable outcome will be to separate assisted death from the notion of suicide entirely.
This is a fast-changing area of legislation and one that we continue to monitor closely. We are working hand-in-hand with our partners to stay informed of the potential impacts and to design our policies in a way that benefits our members.
At William Russell, we’ve been providing international life insurance to people all over the world for more than 30 years.
If you have any questions about what our life insurance covers, contact our friendly team today—we’d be more than happy to help.
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