Australian lawmakers in the state of Victoria will debate a bill to allow medically assisted dying, a highly controversial issue fraught with arguments over who, if anyone, should be able to decide the timing of his or her own death.
Victoria's lower house of parliament passed legislation October 20 that would allow what the bill calls "voluntary assisted dying." The 47-37 vote came after contentious debate that lasted more than 24 hours.
Once the bill was passed, Victoria Premier Daniel Andrews told reporters he was "very proud" of the vote.
"We have taken a very big step towards giving many, many Victorians the dignity and compassion they have been denied for far too long," Andrews said.
The vote in the upper house, the 40-member Legislative Council, is also expected to be close. Australian reports said 19 members of the upper house supported the bill, 11 were thought to oppose it, and the votes of the remaining 10 were uncertain.
Those who oppose assisted dying — including the Roman Catholic Church, as well as the Melbourne Anglican Diocese, in the area affected by next week's vote — urge the medical community to concentrate on developing better palliative care. The term means making a patient as comfortable as possible when an illness cannot be cured.
Five nations have legalized assisted dying: Belgium, Canada, Columbia, Luxembourg and the Netherlands.
Assisted death usually involves issuance of prescription for drugs that will end life at the time and place of the patient's choosing. Most patients eligible for it are terminally ill and near death.
But patients in other circumstances have argued that they, too, should be able to choose assisted dying, including psychiatric patients and elderly people in good health who feel that they have completed their lives and are ready to go.
In 2014, Belgium became the first nation to expand access to assisted dying to include terminally ill children, although not those with psychiatric disorders. It does allow mentally ill adults access to that option, although not all doctors are keen on granting it.
The Associated Press reported that, in Belgium, the mental illnesses most common among people who request euthanasia are depression, personality disorder and Asperger's syndrome. Belgians with dementia can also request the medications used for assisted dying.
In addition to the countries that allow assisted dying, which is defined as hastening the process for a patient who is already dying, assisted suicide — death for someone who is not terminally ill — is legal in Switzerland, Germany, Japan, Canada, and six U.S. states plus Washington, D.C.
Most of those places do not grant foreigners permission to apply for assisted suicide, but Switzerland does, which has led to a growing number of people traveling to Switzerland to seek it — an act given the macabre nickname "suicide tourism."
A study of "suicide tourists" from 2008 to 2012, published in the Journal of Medical Ethics, said 611 people went to Switzerland, mostly to Zurich, in those four years to seek help in ending their lives. Forty-four percent of those cases were from Germany, and 21 percent were from Britain. Twenty-one of those people were from the United States.
Forty-seven percent of those foreign patients cited neurological diseases as the reason they wanted to end their lives; 25 percent cited rheumatic or connective tissue diseases. Only 3 percent to 4 percent cited mental illness.
In none of the places where assisted dying is legal are all requests for assistance granted.
A Netherlands-based study published in 2015 in the Journal of the American Medical Association noted that the rates of requests granted between 1990 and 2011 ranged from 32 to 45 percent.
And issuance of a prescription for the drugs used in assisted death does not always mean the patient will use them. In the U.S. state of Oregon, only about a third of the people issued permission to end their lives end up using the prescription to do so.
In the Victorian parliament, the legislation would set the legal age for assisted dying at 18 and above, and the illness the patient suffers from must be "causing suffering that cannot be relieved in a manner that is tolerable to the person."
Former Australian Prime Minister Paul Keating voiced disapproval of the measure the day it passed in the lower house. He called the vote a "truly sad moment for the whole country." He said he hoped the upper house would reject the bill, or in his words, "beat this deeply regressive legislation."
The current Australian prime minister, Malcolm Turnbull, has said he has reservations about assisted dying but will not stand in the way of the Victorian parliament.