According to this paragraph from Wikipedia we find out that:

voluntary euthanasia was legalized in Colombia (in 1997),[69] the Netherlands (in 2002), Belgium (in 2002), Luxembourg (in 2008),[70] and Canada (in 2016).

So, there is only a handful of countries that allow assisted euthanasia.

From this answer we find out that:

patient autonomy is considered a key value in modern medical ethics

Question: considering above information, why is voluntary euthanasia allowed in so few countries?

In order to make the question more answerable, I will make the following reductions (based on feedback from comments and answers):

  • geographically narrowing - only for those countries where patient autonomy (Western countries mainly) really matters
  • applicability reduction - for cases where the disease is clearly terminal with great suffering

An example is Oregon State which has Death with Dignity Act:

Death with Dignity Act which allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose. The Oregon Death with Dignity Act requires the Oregon Health Authority to collect information about the patients and physicians who participate in the Act, and publish an annual statistical report.

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    The on-topic answer to this would be "because there is no political will to legalize assisted suicide". But that's likely not the answer you are looking for. If you are looking for ethical and moral arguments for or against assisted suicide, then this website is really not the right place to ask for it. That would be more of a topic for philosophy.SE. If you are asking for individual reasons by individual politicians in every country in the world, then your question would be too broad. Can you specify what kind of answer you expect to this question? – Philipp Mar 8 '17 at 14:57
  • I am looking for the political answer, of course :) – Alexei Mar 8 '17 at 15:04
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    What "political answer"? That's likely a different one in each of the 190 countries where assisted suicide is illegal. – Philipp Mar 8 '17 at 15:04
  • @Philipp - actually, there's likely main trends that cover a vast majority of countries, especially ones that are Abrahamic religion heritaged. Main reasons/arguments aren't too numerous – user4012 Mar 8 '17 at 15:07
  • I am referring to those countries where patient autonomy actually is important. Vaccination question received a great answer in spite of the "problem of the 190 countries". – Alexei Mar 8 '17 at 15:14

Medical ethics in many countries do not allow for either euthanasia or physician-assisted suicide. In those countries, physician's believe there role is to extend life and improve quality of living. Euthanasia and physician-assisted suicide do not extend life or improve its quality. However, in some places physicians are free to use their own judgment about what is appropriate.

Professional organizations typically codify medical ethics in their country or region. There is also a World Medical Association that works to provide ethical guidelines for physicians in all countries. I'll review medical ethics in the United States, Canada, and the World Medical Association to show that euthanasia and physician-assisted suicide are generally incompatible with medical ethics.

Finally, there are definitely countries whose medical ethics do allow for it, so this explanation should not be construed to be a complete causal theory.

United States - Not Allowed

In the United States the professional association for physicians is the American Medical Association. Their professional ethics guidelines include sections on physician-assisted suicide and euthanasia.

Regarding physician-assisted suicide:

Physician -assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.

Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.

Regarding euthanasia:

Euthanasia is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Euthanasia could readily be extended to incompetent patients and other vulnerable populations.

Canada - Allowed by Medical Ethics

According to the Canadian Medical Association, physician's are free to decide on their own whether to practice euthanasia or physician-assisted suicide. Although their ethical axioms don't directly address either of these things, they do provide guidance. Their guidance is that physician's are free to exercise their judgment, so long as it complies with their ethical obligations (to the well-being of the patient, patient autonomy, to obey the law, etc.)

The same document says that Canadian law does not allow for these (as of the time of writing), but that the guidelines are intended to apply even if the law changes.

World Medical Association - Not Allowed

The World Medical Association promulgates professional ethics for physicians globally. They have publications about euthanasia and physician-assisted suicide: their medical ethics do not allow for either.

The WMA Statement on Physician-Assisted Suicide is pretty straight-forward:

Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient.

Similarly, their Declaration on Euthanasia says:

Euthanasia, that is the act of deliberately ending the life of a patient, even at the patient's own request or at the request of close relatives, is unethical. This does not prevent the physician from respecting the desire of a patient to allow the natural process of death to follow its course in the terminal phase of sickness.

  • I believe the Hippocratic Oath has a line in it. Also in the US several states have laws allowing and I presume doctors openly practicing euthanasia. – user9389 Mar 8 '17 at 16:21
  • This question addresses the medical ethics side, not the legal side. The law is outside the scope of this answer. I'll check out the Hippocratic Oath though. – indigochild Mar 8 '17 at 16:24
  • The Hippocratic Oath, at its core, is about "do no harm", which because life is rarely so clear-cut, usually gets translated into "choose that which does the least harm" -- cutting open a patient in order to perform life-saving surgery; re-break an arm that was improperly set and healed the wrong way and caused crippling disability and chronic pain. The euthanasia debates usually orbit the point where 'forcing the patient to continue to live' causes them more harm than allowing them to die peacefully - or even assisting in the latter. – Shadur Nov 18 '20 at 10:09

Patient autonomy may be a key medical value, it's not a key legislative value, and where those values conflict medical values must conform to the available law. For example, patient autonomy doesn't permit patients to not pay their medical bills.

As a practical matter, assuming euthanasia were indeed a settled and actual legal right, (or perhaps a de facto right, disguised by some euphemism), such a right might be abused, since not all patients would wish to exercise such a right.

Patients who are very ill may not be clear headed enough to make good decisions in such matters. Many patients haven't made plans to assign some trusted person to decide on their behalf, or worse, may not have anyone they would trust. Assuming their society then defaults to assigning the role of good decider upon some arbitrary person, (perhaps a seldom seen heir or bureaucrat), that decider might put their own or their businesses' interests before a patient's wishes.

If the heir would be enriched by death, or the institution would save a little money, the patient dies. If the heir is inconvenienced by death, or the institution finds them profitable, the patient lives. Conceivably indifferent heirs and indifferent institutions may themselves be in conflict. A wealthy patient's death might benefit a poorer heir, but lose the institution a most profitable bed.

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    Even in the case where the patient is clear-headed, they could still be pressured/hounded by others if they choose not to exercise this right. – Bobson Mar 8 '17 at 21:36
  • @Bobson, Agreed. Even clear headed patients are likely to have higher suggestibility than the healthy, and hence weaker sales resistance, (i.e. versus the selling of euthanasia), when pitted against stressful high pressure techniques. – agc Mar 9 '17 at 16:59

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