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Petition: Request for the Legalization of Euthanasia, First Draft, Supplementary Materials ② International System Model and Ensuring Safety

  • Writer: リップディー（RiP:D)
    リップディー（RiP:D)
  • Dec 2
  • 4 min read

[Petition: Request for the Legalization of Euthanasia, First Draft, Supplementary Material ② International System Model and Ensuring Safety]



I. Countries that Allow Euthanasia and Physician-Assisted Dying: An Overview of the Legal System


In recent years, there are several countries, primarily in Europe and North America, that have established systems for active euthanasia or assisted dying (AD/AS) for patients suffering from terminal illnesses or serious conditions with no hope of recovery. There is also growing interest in considering these at the political level.

These countries ensure the transparency and safety of their systems through strict legal and procedural frameworks.

Below are some representative countries and the characteristics of their systems.

 

Country/Region

Acceptable forms

Main conditions, procedures and safety measures

Netherlands

Legalize both active euthanasia and assisted suicide

There are strict conditions, such as "unbearable suffering," "no prospect of improvement," "the patient's voluntary and considered wishes," "diagnosis and consent by multiple doctors," and "obligation to report by an independent review organization."

Belgium

Legalizing active euthanasia

Eligibility criteria include "medically irrational illness," "unbearable pain," and "clear request from the patient." The country is also one of the countries that clearly defines the conditions for application to minors.

Switzerland

Assisted suicide is permitted (but active euthanasia is not permitted)

Patients administer lethal drugs themselves. There is no commercial or selfish motive. Support may be provided through organizations.

Spain

Legalization (euthanasia and assisted suicide)

The legislation was enacted relatively recently (enacted in 2021). Requests must be made in writing by the patient themselves, and there are reconfirmation, procedures, and review systems in place.

Others (e.g. North America, Latin America, etc.)

Assisted suicide or limited medical assistance in dying is permitted in some cases

Conditions vary by country and region, but the general requirements include "life expectancy prediction," "patient's wishes," and "doctor, multiple doctors, or review."

Please refer to our website for details on each country, including the procedure and eligibility requirements.


(Note: The above table shows representative examples. Since the systems and applicable conditions of each country are constantly being revised, it is necessary to check the latest information.)




II. Standard procedures and institutional design for safety and abuse prevention – International common elements


According to academic research reports and system reports comparing systems in various countries, the following basic elements and procedures are essential to ensure safety and prevent abuse.


  • Voluntary and considered patient expression : A patient's own willingness, information and understanding to request euthanasia or assisted suicide.


  • Diagnosis and consent from multiple doctors : In addition to your primary doctor, seek the diagnosis and opinions of another doctor or multiple doctors and carefully confirm whether the requirements are met.


  • Clarification of medical conditions : Strict eligibility criteria have been established, such as terminal illness with no hope of improvement, incurable disease, or intolerable physical or mental suffering.


  • Introduction of a third-party organization or review committee : Establishing checks and reporting obligations by an independent ethical review committee or auditing organization to ensure the transparency and fairness of the system.


  • Written consent and record-keeping : Written consent, multiple confirmations, and legal documentation reduce the scope for future disputes and abuse.


  • Publication of annual reports and statistics : Data including the number of cases performed, target diseases, age and gender, and review process will be made public to maintain public scrutiny and transparency.


All of these are international best practices for achieving both institutionalized risk management and peace of mind and security.




III. Achievements and Challenges of the International Institutional Model – Achievements and Points to Note


  • According to international reports, in countries where euthanasia and assisted suicide have been institutionalized, they are becoming established in society as "one of the options" rather than an exception to medical care.

    In particular, it has contributed to patient dignity, self-determination, and coping with pain at the end of life.


  • On the other hand, ethical debate, social consensus, education of medical professionals, clarification and strict adherence to implementation standards, and transparent management are essential for the operation of the system. It has been pointed out that if the system design remains vague, there is a risk of abuse and ethical issues.


  • Furthermore, even in countries that have introduced such systems, they are being carefully implemented in medical settings and society, with regular reviews and ongoing reporting systems, making it clear that not only is it important to establish a system, but also that "post-implementation management and verification" is also important.




IV. Reference points for system design in Japan: Lessons from international models


Taking into account the international institutional models and safeguards presented in this document, the following points should serve as guidelines for Japan's legislative considerations:


  1. Strict application conditions and procedural standards are clearly stated :

    Mandatory measures include confirmation of patient consent, multiple doctor diagnoses, and the establishment of an independent review organization.


  2. Establishing a transparent reporting and statistics system :

    Maintain public trust by disclosing the number of cases, target diseases, and review process.


  3. Education for medical professionals and society and establishment of ethical guidelines :

    Proper training for medical professionals, formulating public guidelines, and ensuring a forum for discussion


  4. Coexistence of euthanasia and palliative care systems :

    It is clearly stated that euthanasia is not the only option, but that it also coexists with other options such as palliative care and hospice.


  5. Phased and careful implementation :

    Initially, the program will be limited to cases of terminal illness or clear medical conditions, with a trial system and mandatory reporting.


This will make it possible to adapt the technology to Japan's medical and social welfare systems while ensuring ethics, safety, and social acceptability.



V. Conclusion

Countries that have legalized and institutionalized euthanasia and assisted suicide internationally have put in place strict procedures and safeguards to protect patients' dignity and right to self-determination while maintaining systems that prevent abuse.

In Japan, too, it is possible and necessary to carefully and transparently design a system while fully referring to these international models and safeguards.


We hope that this Supplementary Material 2 will be an important reference in your consideration of petitions and legislation.




Appendix (Petition: Request for the Legalization of Euthanasia, First Draft, Supplementary Materials ② International System Model and Ensuring Safety)

(Countries that have legalized euthanasia: World map)

(Example from Europe)

A world map of European countries that have legalized euthanasia and countries that are discussing it at the political level.

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