Ethics and law
Assisted dying and the implications for nurses
Mona Guckian Fisher, Former President of the International Federation of Perioperative Nurses, provides an insight into assisted dying around the World, highlighting the laws, safeguards, ethical tensions, and implications for nursing practice.
Assisted dying remains one of the most ethically complex and contested issues in contemporary healthcare. While it is illegal in many jurisdictions, a growing number of countries – including Canada, Australia, New Zealand, Spain, and Austria – have introduced legislation permitting some form of assisted dying in recent years. As a result, over 300 million people now live in regions where assisted dying is lawful under specific conditions. Despite this global shift, the issue continues
to provoke intense debate. Proponents emphasise patient autonomy and the right to avoid intolerable suffering, while opponents raise concerns about safeguarding vulnerable populations and the potential erosion of palliative care standards. For nurses, who play a central role in end-of-life care, these debates are not abstract. They carry direct ethical, professional, and emotional implications. This article critically examines assisted dying
laws across key jurisdictions, explores the ethical tensions underpinning the debate, and evaluates the implications for nursing practice. It argues that regardless of legal status, assisted dying fundamentally reshapes the meaning of care, placing nurses at the intersection of autonomy, compassion, and professional responsibility.
Defining assisted dying Clarity in terminology is essential: l Assisted suicide refers to situations where a patient self-administers life-ending medication.
l Euthanasia involves a clinician administering the medication.
l Assisted dying is often used as an umbrella term, particularly in policy discussions, to encompass both practices.1
These distinctions are crucial, as legal frameworks differ significantly depending on which practice is permitted.
The UK: legal prohibition and ongoing debate Assisted dying remains illegal in the United Kingdom under the Suicide Act 1961. However,
debate continues across political and public spheres. Recent proposals in Scotland were rejected in 2026, reflecting ongoing ethical and legislative division. The UK’s legal stance is heavily influenced by the principle of the sanctity of life, reinforced in cases such as R v Pretty, where the courts upheld the prohibition on assisted suicide despite arguments based on autonomy and human rights.2
Proposed legislation in England and
Wales has emphasised strict safeguards, including eligibility limited to terminally ill patients and judicial oversight. While proponents argue that such measures could ensure ethical application, critics question whether safeguards can fully protect vulnerable individuals from subtle coercion.3
The UK debate highlights
a central tension: whether the law should prioritise individual autonomy or collective protection.
The US: the Oregon model The United States offers one of the longest- standing examples of assisted dying legislation through the Oregon Death with Dignity Act. Under this model, assisted suicide is permitted for terminally ill adults expected to die within six months. Patients must be mentally competent, and eligibility must be confirmed by two
physicians. Importantly, the medication must be self-administered. Evidence suggests that many patients who obtain prescriptions do not ultimately use them, indicating that access alone may provide psychological reassurance.4 However, critics argue that incremental
changes – such as the removal of residency requirements – demonstrate how safeguards may evolve over time. This raises questions about whether initial restrictions can remain stable in the long term.5
Canada: expansion and the ‘slippery slope’ debate Canada’s Medical Assistance in Dying (MAiD) programme, introduced in 2016, has become central to global discussions. Initially restricted to terminal illness, eligibility was expanded in 2021 to include individuals experiencing intolerable suffering from non-terminal conditions. Approximately 4% of deaths in Canada now occur through MAiD, a significantly higher proportion than in jurisdictions such as Oregon.6
Critics argue that this expansion
reflects a “slippery slope,” suggesting that once legalised, eligibility criteria may broaden beyond original intentions. Concerns are particularly acute regarding future inclusion of mental illness as a sole qualifying condition.
June 2026 I
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