End-of-Life Care and Assisted Dying

What does the future of End-of-Life Care and Assisted Dying look like? In our increasingly advanced societies, with longer and longer life spans, what are the likely developments for our end-of-life care and life-termination scenarios?

5 December 2024
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To answer these questions we have engaged the Shaping Tomorrow platform and scanned the future for: End-of-Life Care and Assisted Dying.

Take a look at the following services and insights:

• some essential Questions & Answers

• a Narrative focused on what we can do today

• a 2035 Scenario - What may we be aiming for through today's initiatives

• twelve emerging trends that provide inspiration and overview

• a Shaping Tomorrow Futures Card

Each of which has been created in less than a minute.

Questions & Answers

The following two questions are simply selected by the user from a list of 25 questions. A mouse-click on each of the questions will instantly create the answers based on the validated, continuously updated sources on the Shaping Tomorrow platform.

Q1: Should physicians, as healers, be involved in assisting patients who wish to bring about their own death?

The role of physicians in assisted dying is highly contentious. Assisted dying laws vary globally, with some countries allowing it under strict regulations, such as in Canada and certain U.S. states like California. In Canada, the Medical Assistance in Dying (MAiD) program is growing quickly, reflecting societal acceptance and the legal rights of patients to seek a dignified death The Hub.

Concerns about ethical dilemmas are significant, with debates about potential coercion of vulnerable individuals The Independent. The issue hinges on balancing patient autonomy with ethical responsibilities, necessitating comprehensive legislation to mitigate possible abuse or unintended consequences.

Q2: How do different countries regulate physician-assisted dying?

Countries regulate physician-assisted dying through diverse legal frameworks, each reflecting cultural, ethical, and historical considerations:

• Netherlands: The Netherlands allows euthanasia and physician-assisted suicide under strict criteria, including unbearable suffering with no prospect of improvement, often documented by multiple medical opinions Government of the Netherlands.

• Belgium: Similar to the Netherlands, Belgium has legalized euthanasia with guidelines requiring voluntary, well-considered, and repeated patient requests, along with medical oversight.

• Canada: Canada's Medical Assistance in Dying (MAiD) program permits eligible adults to seek assistance in dying, with criteria including grievous and irremediable medical conditions Health Canada.

• United States: In the U.S., physician-assisted dying is legal in a few states like Oregon, California, and Washington, often involving residency requirements and mental health evaluations Oregon Health Authority.

• Switzerland: Unlike most countries, Switzerland permits assisted suicide without a physician prescript, as long as there are no self-interests involved, regulated mainly by non-profit organizations BBC News.

These countries illustrate a spectrum of approaches, each shaped by specific regulatory and ethical considerations.

A Narrative focused on the Legal and Ethical Debates in Assisted Dying

The following commentary is presented to you through a single click on our Narative Service.

Legal and Ethical Debates in Assisted Dying

• Assisted dying laws are being carefully deliberated to ensure ethical frameworks and protect vulnerable groups.

• In Jersey, assisted dying could be available to residents by 2025. (The Guardian)

Assisted dying laws are under significant discussion across various regions, with increasing momentum towards legalizing them under specific conditions. In Jersey, assisted dying could be available to residents by 2025, but there is concern about ensuring protections against a 'duty to die,' as discussed by The Guardian.

Similarly, the UK's potential legislation has prompted warnings about the risks and ethical concerns of expanding such laws beyond terminally ill patients, as observed in countries like Canada and the Netherlands, which have debated potential expansions to include conditions like dementia, as CathNews reports.

While the idea of assisted dying gains traction, there are arguments and fears about its impact on society's values and vulnerable groups. Critics, as highlighted by CARE, warn that such laws could devalue human life and pose risks of coercion, particularly to the disabled and marginalized individuals. There are cautionary voices within the medical community, advising on the ethical ramifications and the potential for misuse of assisted dying frameworks. These concerns are echoed in debates from regions like Canada, where recent expansions of euthanasia laws are being critically examined, as noted by ABC News.

Countries like the United States offer insights into the long-term application of assisted dying laws, showing that robust legal frameworks can prevent a 'slippery slope.' A California doctor asserts that the state's End of Life Option Act has been implemented without descending into ethical ambiguity, a perspective shared with The Guardian.

Meanwhile, in the UK, legislative debates continue, with some fearing that newly proposed bills could lead to exploitative practices, as outlined in Spiked, which highlights opposition from conservative groups concerned about such slippery slopes. As global perspectives on assisted dying evolve, the conversations underscore the complex balance between compassion, choice, and societal ethics.

A 2035 Scenario - The Evolving Landscape of Assisted Dying Laws by 2035

The following scenario is created using our Scenario Service and selecting a ‘Confident' / ‘2035' scenario.

The Evolving Landscape of Assisted Dying Laws by 2035

As we approach the year 2035, the dialogue around assisted dying continues to evolve, reflecting a balance between personal autonomy and societal safeguards. In many jurisdictions, the legal frameworks put forth over the past decades have been refined to address the ethical complexities surrounding assisted dying. Jurisdictions like Jersey, which pioneered the move to legalize assisted dying in 2025, have become models for effectively integrating proactive choice with protective measures against potential abuses, such as the feared 'duty to die'.

Meanwhile, in regions like the Australian Capital Territory, the revolutionary measures that allowed lawyers to make decisions for incapacitated patients have facilitated new discussions about the rights and guardianship over individuals with dementia and other cognitive disabilities. This legal construct has sparked interest worldwide, as it prompts critical analysis of decision-making boundaries and the role of legal proxies in end-of-life care decisions.

The California model continues to be upheld as a benchmark, with its careful considerations intended to prevent the expansion of laws to non-terminal cases, a primary concern noted through retrospective analysis of Canada's and the Netherlands' more liberal approaches. The UK's journey toward integrating such measures has been marked by debates focusing on the spectrum of competency and consent, underscoring a narrative that favors preserving the dignity and autonomy of terminally ill patients, while guarding against the exploitation of vulnerable groups.

Discussions on assisted dying are increasingly tied to broader healthcare strategies, including investments in palliative care, which ensure comprehensive patient support up to life's end. Such integrative approaches reveal a maturing societal perspective that recognizes the multifaceted aspects of aging with dignity and the complex needs of diverse populations.

A Trends' Overview

We've shared each of these elements from the Shaping Tomorrow platform to keep you updated about the variety of formats now available to you and your organization and the insights they provide individually and collectively.

Stay curious,
Matthew Richardson
CEO, Shaping Tomorrow