Euthanasia and physician-assisted suicide: what about in Europe?

INTRODUCTION: End-of-life legislation, because of its bioethical, medico-legal, and judicial implications, is heatedly disputed in Europe and throughout the world, engendering a variety of legal end-of-life care options in different countries. We thought it could be interesting to compare the Italian law with current European legislation regulating end-of-life matters. EVIDENCE ACQUISITION: A systematic search of the Medline, Cochrane Central, Scopus, Web of Science, and Science Direct databases was conducted using the search words: "euthanasia", "law", "Europe", and "assisted suicide". The search word "euthanasia" was entered singly or in combination with each of the other search terms. EVIDENCE SYNTHESIS: To date, only three countries in Europe (Belgium, the Netherlands, and Luxembourg) have legalized euthanasia, and four countries (Switzerland, France, Austria, Germany) permit only assisted suicide. Acceptance by the general public of euthanasia and assisted suicide increased in 11 of 13 European countries between 1981 and 2008, in parallel with a decrease in religiosity (except for Italy and Holland) and an increase in secularization. There was also a trend toward a correlation between an increase of the value of self-determination in important life issues and an increase in acceptance of euthanasia. CONCLUSIONS: This review shows that end-of-life decisions constitute a challenge for political governance and bioethical deliberation in modern liberal democracies. It appears that in certain situations, euthanasia is perceived more as a means to reduce health care costs rather than an ethical question regarding self-determination.