We surveyed 20 locations around the world and found the most common diseases associated with voluntary assisted dying

More and more countries are legalizing voluntary assisted dying. This allows a doctor, or sometimes a nurse, to administer life-ending drugs to an eligible person who asks for it.

From 2023 282 million people lived in regions where voluntary assisted dying is legal. In jurisdictions such as the Netherlands, Belgium and Oregon, such laws have been in place for decades. Other countries including Canada, Spain, Modern Zealand and Australia recently underwent reforms.

The legalization trend continues. Several countries are actively considering this issue, with robust public support. In November, the British House of Commons supported the Assisted Dying Act for the first time, after years of unsuccessful attempts.

Debates on voluntary assisted dying are often highly polarized. Understanding the factors that cause assisted death is crucial for evidence-based debates and improving care for people with earnest illnesses.

In recent researchWe reviewed data on people receiving voluntary assisted dying in 20 jurisdictions around the world. In particular, we checked what diseases they suffered from.

What are the rules?

Legal regulations regarding voluntary assisted dying vary by country (and what is it called also different).

In countries such as Australia and Modern Zealand, voluntary assisted dying is only available to terminally ill people. For example, in Australia the person must have an advanced, progressive disease that is generally expected to result in death within a specified time frame (6 to 12 months, depending on condition).

Countries such as the Netherlands, Spain and Canada also allow access for eligible people with non-terminal conditions. Canada allows voluntary assisted dying for people with ‘intolerable disease’heavy and beyond repair” conditions. Although a person’s condition does not have to be terminal, additional security applies when a person’s natural death is not “reasonably foreseeable”.

That said, voluntary assisted dying for terminal illnesses remains infrequent. In 2023 95.9% of people who used voluntary assistance in dying in Canada had a reasonably foreseeable natural death.

Who can administer the medicine? also different. In the United States and Switzerland, medications must be taken on your own, usually by swallowing liquid (called “self-administration”).

In Quebec, Canada – doctors or nurses must administer itwhich is usually done intravenously. In several jurisdictions including AustraliaBoth self-administration and practitioner administration are available.

Our research

Together with an international team of researchers, we took a look what role the disease plays in voluntary assisted dying. We analyzed publicly available data from 20 jurisdictions in eight countries from 1999 to 2023.

Overall, the majority of people who used voluntary assistance in dying had cancer (66.5% of cases). In second place were neurological diseases (8.1%), followed by heart diseases (6.8%) and lung diseases (4.9%).

We also looked at the proportion of people with each condition who used voluntary assistance in dying compared to dying in other ways. Although rates of voluntary assisted dying and eligibility criteria vary by location, rates of specific diseases were surprisingly consistent across regions and time periods.

For example, people from amyotrophic lateral sclerosis (ALS) – a infrequent, progressive and fatal disease that damages the brain and spinal cord – was characterized by the highest rate of voluntary assisted dying. People with ALS used voluntary assistance in dying almost seven times more often than people with cancer.

Meanwhile, cancer patients were four times more likely to utilize voluntary assistance in dying than those with lung disease and ten times more likely than those with heart disease.

What does this tell us?

Cancer and amyotrophic lateral sclerosis (ALS), which appear to be the main reasons people choose voluntary assisted dying, have little in common. But both often cause faster damage to health and a greater perceived loss of dignity than other conditions.

Our findings coincide with other research This shows that people typically request voluntary assisted dying because they have lost autonomy, dignity, or the ability to do things that are meaningful to them.

Critics of voluntary assisted dying fear that people could be forced to choose this option. One concern is that people will choose assisted dying because of: lack of palliative care. This refers to specialist care and treatment that helps people with earnest, life-limiting conditions live comfortably and fully.

Interestingly, people with lung or heart disease are less likely to utilize palliative care than people with cancerour study found that they are less likely to utilize voluntary assistance in dying. If impoverished access to services was the cause of voluntary assisted dying, we would expect higher rates of heart and lung disease.

Likewise the latest data from Canada AND Australia show that the majority of people who request voluntary assisted dying receive palliative care.

Where to from here?

Our research does not rule out that some cases may be influenced by a number of factors, including impoverished access to services. However, it helps clarify common misconceptions about the causes of voluntary assisted dying.

Further research should investigate why cancer and amyotrophic lateral sclerosis account for the largest proportion of cases. If voluntary assisted dying is primarily about rapid decline and loss of dignity, we need to focus on recent ways to support patients facing these challenges.

And while voluntary assisted dying may promote autonomy and compassion by allowing sufferers to choose when and how they die, our findings do not diminish the importance of protecting vulnerable people.

Hearty safeguards to ensure that decisions are voluntary and that only authorized people have access to them, as well as high-quality palliative and supportive care, are crucial in any voluntary assisted dying system.

This article was written with contributions from Brandon Heidinger, a medical student at the University of Western Ontario.