The Global Debate on Assisted Dying: Legal Layers, Ethical Dilemmas, and the Future of End-of-Life Choices

Date: 05 Mar 2025

Karen Jones

‘Nothing is certain, but death and taxes’ was said by Benjamin Franklin, who helped draft the Declaration of Independence, popularizing the phrase in 1789.

Tabloid front page images

The Global Landscape of Assisted Dying

Legal Complexities Across Jurisdictions

The debate surrounding assisted dying continues to spark controversy across legal, ethical, and societal lines but also with succession, criminal law, tax planning and insurance. For instance, Individuals assisting in assisted dying may be barred from inheriting from the deceased under forfeiture laws in jurisdictions like the Cayman Islands and the UK. However, it is not equal in each country as we see different speeds in laws. Some have concrete ways to deal with the matter, others are deep in debate with public emotions running high.

The Rise of a Considered Death – Public and Celebrity Interest

As longer lives become the norm’ though, even celebrities are becoming interested in the topic of a more considered death. Oliver Peyton OBE, known for his work as a restaurateur, founded ‘Exit Here’ in 2019, after losing his parents and discovering there was very little choice when it came to funerals. Exit Here offers a range of specially commissioned coffins and caskets and one-of-a-kind funeral receptions. In addition, the broadcaster Dame Esther Rantzen, who has lung cancer, said to the BBC that she has joined the Dignitas assisted dying clinic in Switzerland. She wants to save her relatives from experiencing traumatic memories at the final stages of her life. 

Assisted Dying Laws Around the World

In the UK, assisted or accompanied suicide is illegal, and doctors who assist suicides can be, investigated, prosecuted or jailed for up to 14 years, although the topic is being debated, with the hope of resolution in the coming years.  Assisted suicide in Switzerland has been legal since 1941, and Switzerland was the first country in the world to permit assisted dying. Dignitas, which is a not-for-profit organization or association in Switzerland, not a clinic, it says, accepts foreign patients for accompanied suicide. Between 1998 and 2023, Dignitas helped 571 British people die by assisted suicide. In 2023, 40 British people went to Dignitas.

Internationally, assisted dying legislation is also being introduced in several regions, including Guernsey, Jersey, the Isle of Man, and Scotland. Jersey has already approved proposals, and the law is expected to be debated further in late 2025. In the Isle of Man, the bill is in its final stages, with Royal Assent expected imminently. In other jurisdictions such as Austria, Luxembourg and Switzerland, as well as several U.S. states, assisted dying is already legal or dealt with in legal ways, under varying conditions, although eligibility criteria differ between these areas. Some jurisdictions extend eligibility beyond the terminally ill, allowing those experiencing ‘unbearable suffering’ to seek assisted death as well.

The Role of Technology: Sarco Pods and Ethical Concerns

Recent discussions in Europe have also focused on the legality of an invention, the Sarco pod, which are assisted suicide pods, now been deemed illegal for use, after some furore, in the Netherlands. While proponents argue that such technology offers a dignified and autonomous way for terminally ill individuals to end their lives, authorities maintain that their use constitutes unlawful assistance in suicide. This issue is further complicated by varying international laws, with some countries permitting assisted suicide under strict regulations while others impose severe legal penalties. As nations grapple with the moral, criminal, medical and legal implications of assisted dying, the discussion remains deeply divided between personal autonomy and the need for safeguards. The topic is also further complicated as it involves the medical industry and its regulatory bodies collaborating with and agreeing with the law. There is also a burden on courts where legal proceedings may delay decisions, conflicting with the six-month prognosis requirement.

As populations age, the topic is increasingly rising on public agenda’s, but it seems, like poverty, some illnesses like dementia are not equally proportioned around the world. The IMF says the centre of gravity for the global disease burden of dementia is shifting from advanced economies to low and middle-income countries, reflecting changes in the global distribution of older adults. Lower-middle-income countries will account for nearly 30 percent of the growth in dementia-related disability. Upper-middle-income countries will also account for a growing share (12 percent growth during 2019-2050). By contrast, the share in advanced economies will decrease by 30 percent. Dementia is also more common in women after menopause, particularly Alzheimer’s disease. This reduction is attributed to education about lifestyle and health in the West.

Lawyers’ Perspectives on End-of-Life Choices

The UK’s Terminally Ill Adults (End of Life) Bill: Potential Changes and Challenges

Sheilagh Magee, Partner in the Reading office of Broadfield adds her view, “The ongoing debate over assisted dying in England and Wales is gaining increasing attention, particularly with the progression of the Terminally Ill Adults (End of Life) Bill 2024-2025, which is currently in the Committee stage of its journey through Parliament. The bill seeks to establish a legal ‘right to die,’ specifically addressing doctor-assisted suicide. Under this arrangement, the bill will give terminally ill adults with mental capacity who have less than 6 months to live, the right to request assistance from a doctor to end their life. After a series of safeguarding steps, a doctor may prescribe, but not administer, medication that would end a person’s life at their request. This is distinct from euthanasia, where the doctor acts directly to end the person’s life, either with or without their consent. At present, while suicide itself is no longer a crime, assisting someone in ending their life, whether through transport arrangements to places like Dignitas in Switzerland or providing other forms of help, remains a criminal offence. Furthermore, individuals convicted of assisting in an assisted death could be precluded from benefitting from the deceased’s will.”

Emma Geale, Principal Associate at law firm Mills & Reeve, Cambridge adds her view saying, “The law remains in the development stages and is subject to change for the UK but going forward, I expect there will be more and more conversations with clients about these subjects, alongside advance decisions and living wills. It is a subject many are concerned about.  However, the requirements are likely to be incredibly strict and therefore there is little that can be done before the situation arises.  Even those with degenerative conditions that expect they will fall within the requirements will have to wait until their condition has deteriorated considerably before they can proceed with the process. In terms of the expectation in the UK and English estate planning, it is important to note that the Bill is expected to have the following strict requirements. The individual must have the capacity to make the choice. They must be deemed to have expressed a clear, settled and informed wish, without having been subjected to any coercion or pressure. They must be expected to die within six months. Two independent doctors must assess the person at least seven days apart and be satisfied that they are eligible. A High Court judge must hear from one or both of the doctors. The judge can also ask questions of the dying person before making a ruling.”

Geale continues, “The main argument in favour of legalising assisted dying is to give people who are suffering the choice to die in a more dignified and comfortable manner than the current systems allow. The current system means terminally ill individuals must depend on palliative medicine to make them as comfortable as possible in their last moments. It does, of course, bring additional concerns over the risk of coercion and the exploitation of vulnerable elderly and sick individuals. The above requirements are intended to establish safeguards against some of these concerns. There are a few potential “risk” scenarios for example, if the burden of care on relatives becomes too extreme. In which case, the hope is that the law will be drafted to safeguard the needs of the individual against external burdens.” I ask if the process has become almost too difficult for people to understand. “I wouldn’t go so far as to say pointless – as I think it could be really appreciated by those who do meet the conditions, they are just perhaps few and far between.  However, I think there are two main challenges. You are right that the rules are so restrictive to make their application reasonably infrequent, as there are several medical conditions which will not be covered as they will be without a terminal diagnosis within six months.  An obvious example is locked in syndrome.  It’s the classic case for assisted dying but may not meet the requirements of a terminal diagnosis. In addition, the court system doesn’t have the capacity to handle these cases, so there are concerns about how these would be dealt with and whether it would take significant time to reach a hearing, which doesn’t necessarily align with the fact the person must have less than six months to live to be eligible to make an application.”

“There are a few potential “risk” scenarios for example, if the burden of care on relatives becomes too extreme. In which case, the hope is that the law will be drafted to safeguard the needs of the individual against external burdens.” I ask if the process has become almost too difficult for people to navigate. “I wouldn’t go so far as to say its impossible, as I think it could be really appreciated by those who do meet the conditions, they are just perhaps few and far between.  However, I think there are two main challenges. You are right that the rules are so restrictive to make their application reasonably infrequent, as there are several medical conditions which will not be covered as they will be without a terminal diagnosis within six months.  An obvious example is locked in syndrome.  It’s the classic case for assisted dying but may not meet the requirements of a terminal diagnosis. In addition, the court system doesn’t have the capacity to handle these cases, so there are concerns about how these would be dealt with and whether it would take significant time to reach a hearing, which doesn’t necessarily align with the fact the person must have less than six months to live to be eligible to make an application.”

Ethical Dilemmas in Assisted Dying

Legal and Ethical Risks: Disputes and Allegations in Assisted Dying Cases

John Annetts, Head of Wealth and Succession at law firm Howard Kennedy continues the theme, “Commentators have made clear that increased safeguards, including the oversight of the court, are essential to ensure that sick and vulnerable individuals are not effectively coerced into seeking help to end their lives.  Such safeguards are vital, most importantly for the protection of the vulnerable person themselves.  However, they are also important to avoid, where possible, disputes arising over whether a deceased had capacity to make an application for assistance to die, or whether coercion, dishonesty or other pressures brought to bear by potential beneficiaries of their estate led to them making the decision to end their lives.  Even where there was no such pressure, personal representatives could otherwise find that estate administration is held up by allegations that one or more beneficiaries’ interests in an estate should be forfeit under the public policy rule that prevents a person who has unlawfully killed someone, including by aiding or abetting, counselling or procuring suicide, from benefiting from their estate or otherwise.”

Succession Planning and Wealth Considerations

Jordan Constable, Senior Associate, Ogier, Cayman Islands says, “In jurisdictions such as the Cayman Islands where assisted dying is unlawful, there is a risk that persons who assist with euthanasia may fall foul of the forfeiture rule.  This common law rule is long established and disqualifies someone who commits manslaughter or is found to have aided and abetted suicide from benefitting under a discretionary trust or through inheritance from the Estate of the person who they helped to die.  This may impact effective estate planning should, for instance, a family member be found to have assisted with travel to a country where assisted dying is lawful or to have otherwise facilitated a planned death.”

The Future of Assisted Dying Laws Worldwide

Assisted Dying in the USA: A Politically Divided Issue

In the USA the matter seems clearer in terms of estate planning but there are legal definitions that make the topic complicated. Joshua Rubenstein, Partner and National Chair, Private Wealth, Katten, based in New York says, “Control over one’s own body is a politically divided issue in the U.S.  Euthanasia, like abortion, is by and large regulated at the state level.  Suicide, like homicide, is criminal in all 50 states (of course by definition, one cannot be criminally prosecuted for a successful suicide).  Involuntary euthanasia is similarly illegal in all 50 states.  Passive euthanasia, so allowing someone to decline further medical treatment, however, is legal in all 50 states.  Assisted suicide is somewhere in between and is legal in about ten states.  It is ironic that while we can put our beloved pets out of their misery, in most states we cannot assist our dying loved ones in ending their misery for fear of criminal prosecution for a final act of kindness.  When life ends, like when life begins, are areas in which some people believe that society has a right to tell you what to do.”

Living Wills, Healthcare Proxies, and Planning for End-of-Life Decisions

Rubenstein continues, “When clients ask us about this topic, we handle it with so-called ‘living wills,’ in which they make an informed decision to decline medical treatment under certain stated conditions, such as their condition is terminal, they have no brain activity. We also use a “health care proxy,’ in which you appoint someone to make medical decisions for you if a doctor determines that you cannot make those decisions yourself, for instance in the case of Alzheimer’s.” Rubenstein adds, “Living wills and healthcare proxies in the US are widely used and accepted and almost never go wrong. Except where current spouse and children by prior marriages, disagree as to health care decisions being made for parents.”

Dr Ariel Sergio Davidoff, Founder of Davidoff Law in Switzerland talks about the potential fines or jail time, “Intentional homicide shall be liable to a custodial sentence of no less than five years. Killing on request for honourable reasons, namely out of compassion, kills a person at the latter’s earnest and urgent request, shall be punished with a custodial sentence of up to three years or a fine. Instigation of and aiding and abetting in suicide for selfish reasons, incites someone to commit suicide or aids them in doing so, will be punished with a custodial sentence of up to five years or a fine.”

Davidoff explains Swiss law, “Under Swiss law, anyone who merely provides a person who is willing to commit suicide with the means to do so, while that person is aware of the implications of their plan at the relevant time, will not be punished. The control over the act stays with the person committing suicide. Caution is particularly called for because the moment the person helping with suicide injects the lethal substance, the offence changes from non-punishable assisted suicide to punishable active euthanasia.” This means the action which directly causes death should be performed by the one wishing to die.

Sarco pods – the debate continues.

“In Switzerland, Sarco pods are legal, as anyone who merely obtains the means to commit suicide for a person who knows the consequences of their intention at the relevant time remains unpunished. The suicidal person is therefore responsible for the act. However, on the same day the Sarco death capsule was used for the first time in Schaffhausen, the Federal governing body, the Federal Council said that the new Sarco business model is not legally allowed. Although the public prosecutor’s office is currently conducting investigations, it is not clear whether this form of assisted suicide is permitted or not.”

Life insurance – will they or won’t they pay out?

Davidoff continues, “Travelling to another country to utilise such a capsule can have significant implications for life insurance policies. Life insurance coverage concerning assisted suicide varies by jurisdiction and the specific terms of the policy. In regions where assisted dying is legal and conducted in compliance with local laws, life insurance policies often treat such deaths similarly to natural causes, ensuring beneficiaries receive the intended benefits. ​However, if an individual travels abroad to undergo assisted suicide, the legality of the procedure in the destination country becomes crucial. If the procedure is illegal or falls outside the legal framework of the country where it occurs, life insurance companies may classify the death as suicide, potentially affecting the payout. Policies typically have clauses addressing suicide, especially within a specified period after the policy’s initiation, which could lead to claim denials. ​Additionally, the act of traveling to another jurisdiction for assisted suicide might be viewed differently by insurance providers, depending on the laws of both the home country and the destination country. It’s essential to thoroughly review the terms of the life insurance policy.”

The Future of Assisted Dying Laws and the Ongoing Debate

The future of assisted dying laws remains uncertain, with ongoing debates shaping policies across different jurisdictions. While some nations are moving toward legalizing assisted dying under strict regulations, others remain steadfast in their opposition, citing ethical concerns and the risks of coercion. The case of suicide pods exemplifies the complexity of this issue, as technological advancements challenge existing legal frameworks. Ultimately, as laws evolve, a balance must be struck between an individual’s right to die with dignity and the necessity of protecting vulnerable individuals from undue influence or exploitation but also the relatives. The conversation surrounding assisted dying is far from over, and its resolution will likely continue to reflect the broader moral and legal complexities of end-of-life choices.

Editor note: Actress and disability rights activist Liz Carr has a documentary “Better Off Dead” on BBC which illustrates a greater threat of poor decision making, on this issue, to those with disability.

You can also read about the surge in family disputes

Subscribe to the Citywealth Weekly Newsletter to learn more about Private Wealth Management.