In 1992, Sue Rodriguez forced the right-to-die debate into the spotlight in Canada.
In a video statement played to members of Parliament, the Victoria woman, diagnosed with Lou Gehrig's disease in 1991, asked legislators to change the law banning assisted suicide.
"If I cannot give consent to my own death, whose body is this? Who owns my life?" she said.
The Supreme Court of Canada ultimately ruled against Rodriguez, but her struggle galvanized the public. Rodriguez committed suicide in 1994 with the help of an anonymous doctor.
In Canada, as in most countries, assisted suicide is illegal. But there seems to be a growing movement toward changing the law in many parts of the world.
What is the difference between assisted suicide and euthanasia?
Assisted suicide occurs when a person — typically someone suffering from an incurable illness or chronic intense pain — intentionally kills himself with the help of another individual.
For example, a doctor may prescribe drugs with the understanding that the patient plans to use them to overdose fatally. Or a doctor may insert an intravenous needle into the arm of a patient, who then pushes a switch to trigger a fatal injection.
Assisted suicide differs from euthanasia, in which someone other than the patient ends the patient's life as painlessly as possible.
Euthanasia may be active, such as when a doctor gives a lethal injection to a patient.
It can also be passive, in cases where a physician doesn't resuscitate a patient whose heart has stopped. Or it can happen when a doctor removes life-support equipment.
When did assisted suicide become a legal issue?
Philosophers have contemplated the concept of "a good death" since ancient times. However, individual choice over dying only surfaced in intense public debate in the 1970s.
Until then, anyone found guilty of attempted suicide in Canada — and in many other countries — could face jail time. The federal government decriminalized attempted suicide in 1972.
The legal right to turn down medical treatment emerged at the same time, as technological advances in medicine allowed doctors to keep patients alive longer.
A series of court cases in the 1970s won a mentally competent person's right to refuse medical intervention — a view now widely accepted.
The debate over patient autonomy now centres on issues of active euthanasia and assisted suicide, as patients who live in chronic intense pain or with a degenerative or terminal illness such as multiple sclerosis, AIDS or Alzheimer's disease fight for the right to die.
Why is it an issue?
People who want assisted suicide to be legalized believe that individuals should be able to control the time and circumstances of their own death. Some argue that actively causing one's own demise is no different from refusing life-saving treatment.
Opponents fear that vulnerable individuals may be coerced into assisted suicide to ease the financial burden of caring for them. They also worry that assisted suicide could ease pressure to provide better palliative care and find new cures and therapies.
Some religious opponents argue that God, not humans, should decide the time for death. And many medical professionals maintain it is never morally permissible for doctors to help kill a patient.
What is the law in Canada?
The Criminal Code of Canada outlaws suicide assistance, with penalties of up to 14 years in prison — but opponents have recently challenged the law's constitutionality in court.
The Rodriguez case was the most famous. The 42-year-old B.C. woman, who suffered from amyotrophic lateral sclerosis, or Lou Gehrig's disease, asked the Supreme Court of Canada in the early 1990s to be allowed to kill herself with a doctor's help.
She argued that the ban on assisted suicide violated the Constitution by curbing her rights of personal liberty and autonomy guaranteed in the Charter of Rights and Freedoms.
The court rejected her argument in 1993, ruling 5-4 that society's obligation to preserve life and protect the vulnerable outweighed her rights.
However, several judges suggested Canada's laws might need to be changed to help people like Rodriguez.
In December 2008, a Quebec jury acquitted Stéphan Dufour on a single charge of assisted suicide. Dufour had admitted to installing in a closet a rope, chain and dog collar that his uncle, Chantal Maltais, used to kill himself in September 2006.
Dufour was the first Canadian ever to stand trial by jury for assisted suicide.
What is the law in the U.S.?
Both Canada and the United States have long outlawed assisted suicide, charging people who help others kill themselves with murder, manslaughter and other offences.
Many U.S. states introduced specific laws prohibiting assisted suicide in the 1990s after Dr. Jack Kevorkian and others pushed the debate into the public spotlight.
Kevorkian, a retired Michigan pathologist, loudly advocated a person's right to die and invented an instrument — dubbed the "suicide machine" — that lets patients inject themselves intravenously with a lethal amount of potassium chloride.
Police charged him in the deaths of a number of people, but juries repeatedly let him off until 1999, when he was jailed for second-degree murder after helping a terminally ill patient to die.
Kevorkian was released from jail in June 2007 and said he had no regrets about conducting the assisted suicide.
Oregon is the first state with a law that specifically allows physician-assisted suicide, enacted in 1997.
Oregon's Death with Dignity Act was approved by voters in 1994 but blocked for three years by critics who challenged its constitutionality in the U.S. Supreme Court.
Oregon won, but again came under attack by then-U.S. Attorney General John Ashcroft, who threatened to revoke the licences of doctors who assisted suicides. The law was upheld by the U.S. Supreme Court in January 2006.
The state's strict rules governing assisted suicides stipulate that the patient must have been declared terminally ill by two physicians and must have requested lethal drugs three times, including in writing.
Washington adopted a ballot measure based on the Oregon law, called Initiative 1000, during the November 2008 election.
In December 2008, a Montana judge overturned that state's law prohibiting doctor-assisted suicide in a ruling on a case involving a man with terminal cancer. The state's attorney general plans to appeal the decision.
Texas has had a law since 1999 that allows hospitals and physicians to withdraw life support from terminally ill patients.
Legislators in California introduced a bill based on the Oregon law. The Compassionate Choices Act was first introduced 2005 and reintroduced in February 2007. It was shelved in June 2007.
Where are euthanasia and assisted suicide legal?
Only three places besides Oregon openly and legally authorize assisted suicide: the Netherlands, Belgium and Switzerland.
The Netherlands introduced specific legislation to legalize assisted suicide and active euthanasia in 2002, but the country's courts have permitted them there since 1984.
The Dutch laid out narrow guidelines for doctors: The patient, who must be suffering unbearably and have no hope of improvement, must ask to die. The patient must clearly understand the condition and prognosis and a second doctor must agree with the decision to help the patient die.
Belgium legalized euthanasia in 2002, but the laws seem to encompass assisted suicide as well.
Two doctors must be involved, as well as a psychologist if the patient's competency is in doubt. The doctor and patient negotiate whether death is to be by lethal injection or prescribed overdose.
Switzerland has allowed physician and non-physician assisted suicide since 1941, but prohibits euthanasia.
Three right-to-die organizations in the country help terminally ill people by providing counselling and lethal drugs. Death by injection is banned.
Elsewhere, many countries seem to show slow movement toward legalizing assisted suicide and euthanasia, including:
- Luxembourg, where legislation that would have permitted euthanasia was lost by a single vote in March 2003.
- Britain, where legislation that would have legalized assisted suicide for the terminally ill was defeated in the House of Lords in May 2006.