People who choose voluntary assisted dying often face terminal, incurable or debilitating illnesses that cause severe physical or psychological suffering. For many, the decision involves not only pain but also concerns about independence, dignity and quality of life.
Research on medical assistance in dying and euthanasia indicates that many people seeking these options have advanced, irreversible illnesses or conditions that significantly limit their ability to live independently or engage in meaningful activities.
Although voluntary assisted dying is legally permitted in a growing number of countries, it remains controversial. The debate centres on the tension between personal autonomy and relief from suffering, on one hand, and the protection of human life and vulnerable people, on the other.
Beyond physical pain
Physical pain can be an important factor in decisions about assisted dying, but psychological and existential concerns also play a significant role. These may include losing physical abilities, becoming dependent on others for basic care, losing control over bodily functions and fearing further deterioration or distress in the final stages of an illness.
Some people consider assisted dying when symptoms or psychological distress cannot be adequately relieved through standard medical or palliative care. Others are particularly concerned about losing independence, being unable to care for themselves or experiencing a decline in quality of life.
The circumstances behind these decisions are complex and can involve medical, psychological, social and personal considerations. Requests therefore require careful assessment of an individual's condition, decision-making capacity, wishes and available alternatives, including palliative and hospice care.
Eligibility requirements vary by jurisdiction. Where access is limited to terminally ill patients, applicants may need a prognosis of six months or less to live. Other jurisdictions have different criteria, but requirements commonly include decision-making capacity, a voluntary and informed request, independent medical assessments and safeguards such as waiting periods.
Serious illnesses associated with requests for voluntary assisted dying include amyotrophic lateral sclerosis (ALS), cancer, advanced heart and lung diseases, and certain neurodegenerative conditions. The relevant eligibility rules and medical procedures differ across jurisdictions.
Three types of end-of-life choices
When people seek control over the timing and circumstances of their deaths, their choices may fall into three broad categories: medical aid in dying, voluntary euthanasia, and voluntarily stopping eating and drinking. These options differ in their procedures, legal status and the role of healthcare professionals.
Medical aid in dying (MAID), also known in some jurisdictions as physician-assisted dying or death with dignity, allows eligible individuals to request and self-administer prescribed medication intended to end their lives. In many US jurisdictions where it is legal, eligibility is generally limited to mentally capable adults with a terminal illness and a prognosis of six months or less. Specific requirements vary.
A key distinction is that the individual administers the medication themselves. Legal safeguards may include repeated requests, confirmation of the diagnosis and prognosis, assessments of decision-making capacity and procedures to ensure the request is voluntary and informed.
Voluntary euthanasia differs because a healthcare professional administers medication intended to end the person's life at their explicit and competent request. It is permitted in several countries and jurisdictions, subject to varying eligibility criteria and safeguards.
Voluntarily stopping eating and drinking (VSED) involves a person's voluntary decision to stop consuming food and fluids, eventually resulting in death. Medical and palliative care may be provided to relieve discomfort. Its legal and clinical context differs from that of assisted dying involving medication.
A growing but uneven global practice
Voluntary assisted dying is legally permitted in a growing number of countries and jurisdictions, although the precise forms allowed and the applicable safeguards vary. Estimates cited in the research indicate that more than 400 million people live in places where some form of the practice is legal.
In the United States, medical aid in dying is available in a number of states and the District of Columbia under specified conditions. Public attitudes also vary: polling cited in the research found that about six in 10 US adults considered the practice morally acceptable or did not regard it as a moral issue.
The medical circumstances associated with assisted dying also differ. Research has found that ALS is associated with comparatively high rates of voluntary assisted dying, while cancer remains a common diagnosis among assisted-dying cases, partly because it affects a much larger population than many other serious illnesses.
The proportion of deaths involving assisted dying varies considerably between countries. Reported figures for 2023 included 5.4 per cent of deaths in the Netherlands, 4.7 per cent in Canada and 3.6 per cent in Belgium. The practice accounts for a smaller share of deaths in some other jurisdictions.
Autonomy, safeguards and ethical concerns
Supporters of voluntary assisted dying emphasise personal autonomy, relief from otherwise intolerable suffering, dignity at the end of life and the importance of clear legal safeguards.
Opponents raise concerns about protecting vulnerable people, the sanctity of life, medical ethics and the possibility that eligibility could expand beyond its original limits. They also stress the importance of accessible palliative care and support for people living with serious illnesses.
These competing considerations continue to shape laws and public debate around the world. Even where voluntary assisted dying is legal, it remains a sensitive and deeply personal issue involving medical evidence, individual circumstances, ethical principles and legal protections.
Joseph Chamie is a consulting demographer, a former director of the United Nations Population Division and the author of numerous publications on population issues.