On January 19, 2024, during the prime time program of the pro-Kremlin “Sezoni TV,” the guest, archpriest Giorgi Razmadze spoke about euthanasia. The archpriest notes that in European countries where euthanasia is legalized, sickness is equated with death. Giorgi Razmadze’s claim creates the impression that euthanasia is an alternative to taking care of a sick person, and if someone does not want to take care of a sick person, they can be put to sleep. According to the archpriest, in the future, the European Union will demand the Georgian authorities to adopt a law on euthanasia – “putting a person to sleep” – similar to various other European countries.
Giorgi Razmadze, Archpriest: “As I mentioned before about euthanasia, the next step will definitely be, as it is in the Netherlands, Sweden, and various European countries, equating the sick with death… When this issue arises in Georgia and the European Union requires the Georgian authorities to adopt such terrible laws, this barrier will be crossed and people will say why should we, for example, spend our income on diapers, food, and care, isn’t it better to put the sick to sleep?!”
The statements voiced by archpriest Giorgi Razmadze regarding euthanasia are manipulative and some of them are false: 1) In all EU countries where euthanasia is legal, there are strict regulations regarding the procedure. A person must personally request euthanasia and at the same time have severe, incurable health problems that cause unbearable suffering. In addition, euthanasia is not considered an absolute right of the patient and he can be refused to receive the procedure. 2) The European Union does not require member states to implement legislation related to euthanasia, there is no uniform directive that the members of the Union must implement. In the countries of the European Union where any specific form of euthanasia is allowed, the process of legalization was carried out at the level of local legislation.
Active euthanasia is legalized and available in only a few EU member states, and in a few only assisted suicide is legal. In all cases, the main criterion for the availability of euthanasia is an unbearable condition caused by a health-related problem, for which there is no hope of relief or improvement, and the end of life by euthanasia is valued as the only way to end suffering. It is also obligatory to perform euthanasia at the personal request of the patient. The patient must make the euthanasia decision thoughtfully without the influence and interference of others. In all countries, euthanasia has quite strict regulations and criteria, and it is not considered an absolute right of the patient. If the criteria are not met, the patient may be refused euthanasia.
It should be noted that the European Union does not have any unified recommendations and directives regarding the issue, and the responsibility of taking care of citizens’ health care in this case rests with the member states. In 2017, the Italian MEP, Mara Bizzotto, asked the European Commission whether it would consider the possibility of making recommendations to member states on euthanasia without overstepping its powers. According to the response of the European Commission, health care, including the care of terminally ill patients, and the mentioned ethical issues are the responsibility of the member states. Accordingly, the commission does not intend to make recommendations on this matter.
EU countries have different regulations regarding euthanasia
Before discussing the regulations related to euthanasia in EU countries, it should be noted that several different forms of euthanasia can be distinguished. There is active and passive euthanasia. Active euthanasia refers to the death of a person as a result of the actions of a medical professional, such as a doctor giving a patient a lethal dose of medication. Passive euthanasia involves withholding life-sustaining treatment for a patient in a hopeless situation (eg, turning off the ventilator). There is also indirect euthanasia, which involves giving drugs (such as morphine) to relieve the patient’s suffering, which may hasten their death. It should be noted here that the right to refuse any treatment, including life-sustaining treatment, is widespread in many different countries. Assisted suicide is also distinguished from active euthanasia – when a person kills himself with the help of another person, usually a medical worker – the medical worker makes the medicine necessary for suicide available to the patient, but the patient takes the medicine himself.
The Netherlands
The first country in the European Union and the world where euthanasia became legal in 2002 was the Netherlands. Both active euthanasia and assisted suicide are legal in the Netherlands. A number of criteria must be met for the euthanasia procedure to be performed. The doctor must make sure that the patient’s request is voluntary, and that his condition is unbearable without the prospect of improvement. The patient should be fully informed about his health condition. The physician is also required to consult with at least one other independent physician who will also evaluate the patient and certify in writing that all necessary criteria are met. In addition, it is necessary to inform the emergency council about each case, which examines each case and evaluates the doctor’s actions. It should be noted that receiving euthanasia is not an absolute right and the patient can be refused the procedure, besides, no doctor is obliged to perform the euthanasia procedure. In such a case, the doctor must notify the patient in advance of the refusal so that another doctor can be found. In the Netherlands, euthanasia is allowed for minors above 12 years of age. In the case of adolescents between 12 and 16 years of age, parental consent is mandatory. In the case of 16- and 17-year-olds, parental consent is not mandatory, but they must be involved in the decision-making process. It should be noted that it is planned to allow euthanasia for children under 12 years old. According to the government statement, the changes are expected to affect 5-10 children a year who suffer excruciatingly from various diseases, there is no hope of improvement and palliative care does not bring relief, in such cases ending life is the only reasonable alternative to the child’s suffering.
Belgium
In certain cases, euthanasia was decriminalized in Belgium in 2002. It is mandatory that the patient be able to state his wishes, be in an incurable medical condition, and suffer constant, unbearable, and unrelieved physical or psychological suffering as a result of an incurable medical condition. It is necessary that the request for euthanasia be voluntary, without external pressure, and repeated several times. As in the Netherlands, in Belgium euthanasia is not an absolute right and the patient may be refused, and no doctor is obliged to perform euthanasia if he or she is against it.
Since 2014, euthanasia has been available for minors in Belgium. It should be noted that the minor must have the ability to judge his/her situation, experience physical suffering, and must have a health problem that will lead to death in the near future. In the case of minors, psychological suffering is not a sufficient criterion for accepting euthanasia. Parental consent is also required.
It is also possible to declare the wish for euthanasia in advance in writing, which implies consent to perform euthanasia in the future in a state when the patient is in a comatose state and there is no possibility of coming out of this state.
Luxembourg
Euthanasia and assisted suicide are also decriminalized in Luxembourg. The relevant legislation was adopted in 2009. According to the law, a patient who wants euthanasia must be of legal age and of legal capacity when making the request. The request must be voluntary and made without external pressure. The patient must have a severe, incurable, and terminal medical condition and experience constant and intolerable physical or mental suffering with no prospect of improvement. In turn, the doctor is obliged to provide the patient with information about his/her health condition and alternatives to euthanasia, to make sure that the request is complied with and the patient believes that he has no other solution. It is necessary to have several interviews with the patient at reasonable intervals to thoroughly assess the patient’s condition and ensure that the patient repeatedly expresses a wish for euthanasia; According to Luxembourg law, it does not matter which disease causes the patient’s unbearable condition, although the world’s experience shows that most cases of euthanasia requests are related to late-stage cancer and neuromuscular diseases that cause paralysis in the terminal state.
In matters related to euthanasia, there is also a National Commission for Control and Evaluation in Luxembourg. The commission is obliged to ensure the correct implementation of the legislation. Euthanasia requests are registered with the commission, and after performing the procedure, the doctor is obliged to fill in the appropriate report so that the commission can consider whether the procedure was in compliance with the law. Once in two years, the commission prepares a report on the legislation.
Spain
Both Euthanasia and assisted suicide are allowed in Spain. It is mandatory that when requesting euthanasia, a patient with a serious and incurable disease causing unbearable suffering must be of legal age and able to act. In Spain, euthanasia is available to citizens, residents, and those who have lived in the country for more than 12 months. The patient should have written information about his/her health condition, other options, including palliative care, and available benefits. As in other countries, the treating doctor can refuse to perform the procedure itself, at which point the patient can refer to another doctor. It is also worth noting that euthanasia requests are also reviewed by the evaluation commission – a team of doctors, nurses, social workers, and psychologists, in order to assess whether all the necessary conditions for euthanasia have been met. Patients can appeal to the evaluation commission even in cases when their application was rejected. The patient can refuse euthanasia at any time.
Austria
In 2020, the Austrian Constitutional Court ruled that the criminalization of assisted suicide is unconstitutional. Accordingly, the legislation regulating assisted suicide came into force in 2022. Active euthanasia is not allowed in Austria. Assisted suicide can be requested by an adult capable person who has a serious or terminal illness and whose condition is unbearable. After the request, the patient’s condition is assessed by two doctors, one a family or treating doctor, and the other a doctor with qualifications in palliative care. The patient’s illness and decision-making capacity must also be confirmed. Both doctors evaluate the latter independently, for additional security, psychiatrists and psychologists may be involved in the evaluation process. There is a 12-week waiting period to ensure that the decision is final. According to studies related to suicide, this period is necessary to overcome the crisis phase. For people in the terminal phase of the disease, who have a few weeks left to live, the waiting period is reduced to two weeks.
Germany
Active euthanasia is banned in Germany and is a sensitive issue due to the country’s past. During the Nazi regime, more than 200,000 people with various disabilities were killed as a result of forced euthanasia. However, indirect and passive euthanasia is allowed in the country.
In 2020, the German Constitutional Court ruled that the criminalization of assisted suicide as a service is unconstitutional. According to the court, a person has the right to self-determination and autonomy, which includes the right to end one’s own life at one’s own will. Accordingly, assisted suicide is allowed and the doctor can provide the necessary medication to the patient. According to German law, suicide is not a crime, therefore assisting suicide is not considered a crime. It should be noted that the work on the issues and regulations related to assisted suicide is still ongoing. In the summer of 2023, two bills designed to regulate the practice failed in the Bundestag.
Several organizations in Germany help people with assisted suicide. For example Verein Sterbehilfe (Association for Assisted Suicide) and German Society for Dying with Dignity. These two organizations assisted nearly 400 people in assisted suicide in 2022, the vast majority of them had serious illnesses.
Portugal
In the spring of 2023, the Portuguese Parliament supported the legalization of euthanasia in limited cases. The process took 3 years and the parliament had to overcome several vetoes of the country’s president. However, the government has not yet approved a protocol related to euthanasia. In November 2023, it became known that due to the upcoming elections in the spring of 2024 and the complexity of the issue, the Portuguese Ministry of Health decided to leave the approval of the regulations and protocol related to euthanasia to the next government.
Archpriest Giorgi Razmadze notes that euthanasia is also legal in Sweden, although active euthanasia is prohibited by law in Sweden. The practice of assisted suicide is not accepted either. Assisted suicide is not punishable by law in Sweden; however, if a doctor prescribes medication for the purpose of suicide, his/her license may be revoked.
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