Diverging paths: how different countries have designed and implemented medically assisted dying

Abstract Issue Several European countries are debating or have recently legalised assisted dying. This includes France and the UK, which introduced bills in 2024 with discussions ongoing. Assisted dying is already permitted in several European countries, including Austria, Belgium, the Netherlands, Spain, and Switzerland. While the study takes no position on whether assisted dying should be permitted, it aims to support policymakers currently debating assisted dying by examining how existing legislation has impacted patients, professionals, and services internationally. Description This analysis systematically reviews literature and policy documents from nine OECD countries where assisted dying is legal, published between 2010-2024. It examines how assisted dying is delivered, health professionals’ roles, and how access has evolved. Key issues explored: How have systems balanced safeguards and access? How is professional objection managed? What impact has assisted dying services had on patients, staff and service delivery? Results We found wide variation in how assisted dying is organised across systems. All countries have similar pathways, but wide variation exists regarding eligibility criteria (e.g., terminal illness vs. enduring suffering), safeguards (e.g., waiting periods), and assessment procedures. Despite growing uptake, assisted deaths remain a small proportion of overall deaths in countries where legal (0.1 to 5.3% in 2023). Lessons Implementation choices affect access, public trust, and professional involvement. Assisted dying can require major system changes, including new clinical training, data collection and monitoring infrastructure. Balancing safeguards with access is a challenge across countries, and the implications need to be carefully considered. Key messages • There is a broad spectrum of legislation and practice across countries that affect access to assisted dying services, what roles and responsibilities professionals hold, and how safeguards are upheld. • As more countries consider assisted dying legislation, the countries with implementation experience offer critical learning.