Euthanasia

Carlo Focarelli

Content type: Product: Max Planck

Encyclopedia entries Encyclopedia of Public
Article last updated: International Law [MPEPIL]
October 2013

Subject(s):
Right to life Equality before the law Disability Genocide
Published under the auspices of the Max Planck Foundation for International Peace and the Rule of Law
under the direction of Rdiger Wolfrum.

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 A. Notion and Forms
1 The term euthanasia derives from two Greek words: e, meaning good, and thanatos, meaning
death. It thus etymologically refers to a gentle and easy death. Thus broadly understood,
euthanasia seems to date back to immemorial times. In ancient Greece it appears to have been an
accepted practice, advocated by several philosophers. Evidence also exists of euthanasia-related
practices in non-Western areas of the world. Eventually, Christianity strongly defended the sanctity
of life, thereby condemning both suicide and euthanasia.

2 The current debate on euthanasia is fuelled by medical and technological advances enabling
physicians to artificially prolong lifealong with pain and sufferingto the extent that the patients
themselves may believe that life is no longer a benefit. The question today is whether patients in
critical physical condition, such as an irreversible coma or a persistent vegetative state, or
terminally ill patients suffering from incurable illnesses such as cancer, AIDS, or motor neurone
disease, to name just a few, may be put to death in order to mercifully bring their unbearable pain
and suffering to an end.

3 Euthanasia may take several forms according to what the physician or other persons in control
of the patients care actually do in order to cause death. Some common distinctions and terms are
thus preliminarily needed for the clarification of different forms of euthanasia.

4 Eugenic euthanasia refers to the notorious Nazi programme code-named Aktion T 4 secretly
conducted during World War II which was aimed at selecting, ie eliminating, the so-called
Lebensunwertes Leben (life unworthy of life), namely the weak and handicapped, from society with
a view to purportedly improving the human species. Such practices, which may amount to an
international crime and in particular to genocide, are not at issue in the current debates
surrounding euthanasia.

5 Economic euthanasia consists of eliminating those who are incapable of taking care of
themselves, in particular the sick, deformed, senile, and mentally deficient, so as to relieve families
and society of their financial burden. Like eugenic euthanasia, no one today seriously advocates
this practice, though euthanasia critics stress that this result may covertly follow in practice once
other apparently more reasonable forms of euthanasia are legalized.

6 Passive euthanasia is generally defined as letting the patient die by an omission, eg by ceasing
or not starting life-saving treatment, including withdrawal of the necessary treatments to maintain
life, failure to treat severely deformed new-born babies, or to retrieve heart, kidney, or lung
support. It is generally claimed that in passive euthanasia the disease itself is the principal cause of
death. In contrast, active euthanasia is understood as deliberately killing the patient by way of an
act, usually a lethal injection. In this case, the principal cause of death is claimed to be the
physicians conduct. The distinction between acts and omissions is often upheld by criminal law,
which punishes actions more severely than omissions, though it attracts criticism from both
opponents and advocates of euthanasia. Opponents of euthanasia argue that remaining inactive is
ultimately a particular way of acting, and as a consequence they condemn both passive and active
euthanasia. Advocates of euthanasia stress that leaving patients in extreme pain and agony for
days or longer is hardly less ethically acceptable or beneficial to them than ending their life with a
lethal injection; consequently they approve of passive and active euthanasia likewise.

7 In voluntary euthanasia a person puts an end to the lives of competent patients at their request
or will. It is worth noting that in the current euthanasia debate, the consent of patients is always
regarded as fundamental, their autonomy and self-determination being the strongest argument in
favour of euthanasia. Concerns, however, have been expressed about the extent to which the
patients view is really free from external pressures. As a result, the consent of patients, though
necessary, is not generally regarded as sufficient, and strict conditions as to its scrutiny are
generally called for. Conversely, in non-voluntary euthanasia a person puts an end to the lives of

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 competent patients without their request or will, provided that the patient cannot and did not
previouslyby way of a living will, for exampleexpress consent. This is the typical case for
persons affected by chronic vegetative states or who require life support, as well as of deeply
incapacitated persons or babies. Here, it is the physician, either alone or in concert with the
patients relatives, who decides on behalf of the patient. In turn, involuntary euthanasia occurs
when death is caused against the patients wish, ie when patients are indeed able to express their
consent and use this ability precisely to dissent. This form of euthanasia is universally condemned.

8 Physician-assisted suicide consists of assisting an incurable and terminally-ill patient in

committing suicide when patients are not physically capable of doing so by themselves. Some hold
that physician-assisted suicide must be kept distinct from voluntary euthanasia on the grounds that
while killing is one thing, it is quite another thing to help someone commit suicide. Others contend
that physician-assisted suicide is ultimately equivalent to voluntary euthanasia for the same
reasons as there is no significant difference between passive and active euthanasia. Though
assisted suicide is generally understood as suicide aided by a physician, it may also take the form
of suicide assisted by a third person, normally a patients relative.

9 Finally, by indirect euthanasia is meant the causing of death through the prescription of drugs
such as painkillers prescribed in large doses that, even if only aimed at making pain bearable, have
in fact the effect of knowingly accelerating death. Here, death is a secondary effect of the fight
against pain.

B. Comparative National Legislation

10 In most countries euthanasia is prohibited in all its forms by norms incriminating murder and
murder-related practices, including assistance to suicide. These norms have been repeatedly but
unsuccessfully challenged in several countries by patients invoking constitutionally entrenched
rights, and only a right to refuse treatmenteven life-saving or life-sustaininghas been generally
recognized in national courts. It is a fact that most statistical inquiries show that public opinion is
generally in favour of at least certain forms of euthanasia. NGOs that advocate for and against
euthanasia-related policies are found throughout the world, including Dignity in Dying and Exit
International among advocates and many professional and religious groups and NGOs among
opponents (<http://www.euthanasia.com/page10.html> [31 March 2014]). Euthanasia and assisted
suicide bills have recently been defeated in a number of jurisdictions, such as in Canada, France,
Israel, New Hampshire, Scotland, and South Australia (see Saunders Six Countries, Six Defeats [8
February 2011]). On 29 April 2013 the Irish Supreme Court stated in Fleming v Ireland et al that
insofar as the Constitution, in the rights it guarantees, embodies the values of autonomy and
dignity and more importantly the rights in which they find expression, do not extend to a right of
assisted suicide and hence there is no constitutional right which the State, including the courts,
must protect and vindicate, either to commit suicide, or to arrange for the termination of ones life at
a time of ones choosing (at para. 114). Pro-euthanasia ads have been banned (see Alexander
Pro-euthanasia TV Ad Ban a Violation of Free Speech [13 September 2010]). However, a few
States have introduced legislation authorizing controlled euthanasia or assisted suicide on certain
conditions. This legislation has not infrequently been challenged on the basis of constitutionally
entrenched rights. Some examination of this legislation is necessary for a discussion on
euthanasia-related practices under international law.

1. Australia
11 The first place which legalized euthanasiaboth passive and active, as well as assisted
suicidewas the Northern Territory of Australia which passed the Rights of the Terminally Ill Act
1995, which entered into force on 1 July 1996. The law was soon overturned by the Euthanasia
Laws Act which was passed in the House of Representatives on 9 December 1996 and in the

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 Senate on 25 March 1997. It was only applied to four terminally ill persons. The law included a
number of safeguards and only applied to competent patients who had attained the age of 18 years
when no palliative care options were reasonably available. In such cases, doctors at the patients
request were authorized to prescribe a lethal substance that would either be given to the patient
for self-administration or be administered to the patient. The physician could at any time and for
any reason, refuse to give such assistance. Assisting in euthanasia is today a criminal offence in
Australia, although prosecutions have been rare.

2. United States
12 In the United States some forms of physician-assisted suicide have become legal, backed by a
referendum, in Oregon since 1997, when the Oregon Death with Dignity Act (OrRevStat 127, 800
995) was passed. The law permits terminally-ill adults of sound mind who are residents of Oregon,
with a prognosis of less than six months to live, to get a prescription medication for the purpose of
taking their own life. The physicians prescription is subject to a number of conditions, including an
oral requestreiterated no less than 15 days after making the initial requestand a written request
by the patient, a second medical opinion, the patients ability to make and communicate care
decisions, the verification that the patients judgment is not impaired by a psychiatric or
psychological disorder or depression, and the patients capacity to make an informed decision. In
these cases patients may obtain a lethal dose of barbiturates and can proceed to commit suicide.
Doctors are neither obliged to prescribe the lethal drugs, nor allowed to directly administer them.
Patients may at any time revoke their request. The law does not permit euthanasia, expressly
stipulating that nothing in the Act shall be construed to authorize a physician or any other person
to end a patients life by lethal injection, mercy killing or active euthanasia (section 3.14).

13 The Oregon law has been repeatedly challenged, most recently in 2001 by an Attorney
Generals Interpretive Rule stating that assisting suicide was not a legitimate medical purpose
under the Controlled Substances Act 1970 (21 USC 801). The Interpretive Rule itself, though, was
challenged in federal court and in 2006 the US Supreme Court in Gonzales v Oregon ([17 January
2006] 546 US 243), confirmed that the Interpretive Rule was invalid because it went beyond the
Attorney Generals authority under the Controlled Substances Act.

14 While active euthanasia is illegal throughout the United States, assisted suicide is legal in
Vermont, Washington and Montana. In Washington State the Death With Dignity Act was enacted
on 4 November 2008 (Wash Rev Code 70.245 [2009]), entered into force in March 2009,
substantially (albeit not entirely) similar to the Oregon Death with Dignity Act; in Montana the
Supreme Court found on 31 December 2009 in Baxter et al v Montana as a matter of statutory
interpretation that there was nothing in Montana Supreme Court precedent or Montana statutes
indicating that physician aid in dying is against public policy and held that under statutory law a
terminally ill patients consent to physician aid in dying constitutes a statutory defense to a charge
of homicide against the aiding physician when no other consent exceptions apply (paras 4950);
in Vermont, on 20 May 2013, a new law making physician-assisted suicide legal took effect.

3. The Netherlands
15 In the Netherlands euthanasia was introduced with the Wet toetsing levensbeindiging op
verzoek en hulp bij zelfdoding (Termination of Life on Request and Assisted Suicide (Review
Procedures) Act; (2001) Stb 194, 8), adopted on 12 April 2001 and entered into force on 1 April
2002. It applies to both active and passive euthanasia, and to assisted suicide if a number of
conditions are met. Previously, euthanasia and assisted suicide were formally prohibited in the
Netherlands under Arts 293 and 294 Penal Code (Neth), though they had been in fact tolerated for
more than 20 years. Arts 293 and 294 Penal Code (Neth) are still applicable when the conditions
set out by the law are not complied with. Such conditions include the existence of an informed,
voluntary, and well-considered request, lasting and unbearable suffering without prospect of

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 improvement, absence of other foreseeable alternative solutions, consultation with another
independent physician. The law does not apply to withholding or withdrawal of life-prolonging
treatment, to alleviation of pain and symptoms with an unintended life-shortening effect, to medical
interventions to terminate life without the patients explicit request, and to neonates. Minors aged
12 or older are covered by the law but stricter conditions must be met. Physicians have a duty to
report cases to a Review Committee. In September 2004 the Groningen Protocol was developed,
which sets out criteria to be met for carrying out child euthanasia without the physician being
prosecuted.

4. Belgium
16 In Belgium the Loi relative leuthanasie (Euthanasia Act [22 June 2002] Moniteur Belge 28515)
authorizing controlled euthanasia was passed on 28 May 2002 and entered into force on 20
September 2002. Unlike Dutch law, Belgian law does not apply to assisted suicide. Requirements to
be met under Art. 3 include: a patients attainment of the age of majority or being an emancipated
minor; constant and unbearable physical or mental suffering resulting in serious and incurable
disorder caused by illness or accident; a physicians verification of the patients capacity to
express a voluntary, repeated, and carefully considered request; existence of a written, dated,
and signed request; and consultation with another independent physician. In case the patient is
unconscious, a patients proxy may request the ceasing of medical treatment if proof is given that
this request derives from the patients expressed will. A federal commission is in charge of
reviewing the actual implementation of the law. In case the conditions laid down by the law are not
fulfilled, Arts 393, 394, and 397 Penal Code (Belg) on voluntary homicide, premeditated homicide,
and poisoning, as well as Arts 422 bis and 422 ter Penal Code (Belg) on assisted suicide apply. The
Belgian Federal Parliament is reportedly about to expand its policy to include access to euthanasia
for some gravely ill children (see Sheets Belgian Parliament Posed To Approve Child Euthanasia
Law [11 June 2013]).

5. Switzerland
17 Art. 114 Penal Code (Switz) prohibits voluntary euthanasia, but a lesser sentence compared to
homicide-related offences is provided. Article 115 Penal Code (Switz) prohibits incitement to commit
suicide or assistance to suicide for selfish reasons. This provision is generally considered a
contrario to allow assisted suicide if the author is not driven by a selfish motive and does not
require a physician to be involved or the recipient to be a Swiss national. Moreover, Art. 115 Penal
Code (Switz) is general in scope, ie not necessarily limitedas legislation in other countries
permitting assisted suicideto ill persons.

6. Luxembourg
18 On 16 March 2009 the Luxembourg Parliament approved a Law on Euthanasia and Assisted
Suicide (Mmorial A-No 46). Its Art. 14 inserts in Luxembourgs Penal Code (Law of 16 June 1879,
Mmorial 1879, 589, Pas 1879, 231) a new Art. 397-1 excluding the application of murder
provisions to a physician who has complied with the conditions of the Law. Article 1 defines
euthanasia as an act, performed by a physician, which intentionally ends the life of a person at his
or her express and voluntary request and assisted suicide as the fact that a physician
intentionally assists a person to commit suicide or provides the means to that end on the persons
express and voluntary request. Under Art. 2 (1) a physician will not be prosecuted for euthanasia
or assisted suicide where (a) the patient is an adult, capable and conscious at the time of the
request, (b) the request is made voluntarily, after reflection, repeatedly, and is not the result of
external pressure, (c) the patient suffers constant and unbearable physical or mental suffering
without hope of recovery, arising from a pathological illness or accident; and (d) the request is in
writing. Article 2 (2) requires the physician to comply with a number of conditions of form and

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 procedure. Under Art. 4 (3) a physician may provide euthanasia to a patient if this latter is in a state
of irreversible unconsciousness and suffering from a serious and incurable condition has drafted
and registered an end of life provision with the National Control and Assessment Commission
(NCAC). Article 15 stipulates that no physician may be compelled to perform euthanasia; should
the physician consulted refuse to perform euthanasia, then he/she must inform the patient of this
fact within 24 hours, and explain his or her reasons for refusing.

7. Canada
19 While it was illegal to aid and abet suicide under Section 241 (b) of the Criminal Code of
Canada, on 15 June 2012 British Columbias Supreme Court struck down the section in Lee Carter
and Hollis Johnson et al v Attorney General of Canada, arguing that it imposed unconscionably
discriminatory burdens on severely disabled individuals that were not valid under Sections 7 and
15 of the Charter of Rights and Freedoms. Canadian euthanasia and assisted suicide law is thus
currently uncertain (see Greer British Columbia Supreme Court Kills Assisted Suicide Ban [18 June
2012]). On 13 July 2012 the Government of Canada declared, through a Response of the Attorney
General of Canada to the British Columbia Supreme Court Decision on Assisted Suicide, that it
would appeal the decision on grounds, inter alia, that [t]he laws surrounding euthanasia and
assisted suicide exist to protect all Canadians, including those who are most vulnerable, such as
people who are sick or elderly or people with disabilities.

8. Colombia
20 On 20 May 1997, Colombias Constitutional Court ruled that no person can be held criminally
responsible for taking the life of a terminally ill patient who has given clear authorization to do so.
According to the Court si un enfermo terminal que se encuentra en las condiciones objetivas que
plantea el artculo 326 del Cdigo Penal considera que su vida debe concluir, porque la juzga
incompatible con su dignidad, puede proceder en consecuencia, en ejercicio de su libertad, sin
que el Estado est habilitado para oponerse a su designio, ni impedir, a travs de la prohibicin o
de la sancin, que un tercero le ayude a hacer uso de su opcin. No se trata de restarle
importancia al deber del Estado de proteger la vida sino de reconocer que esta obligacin no se
traduce en la preservacin de la vida slo como hecho biolgico (if a terminally ill person under
the objective conditions described in Art. 326 Penal Code comes to the conclusion that his life
should end because he considers it incompatible with his dignity, he may proceed accordingly, in
exercise of his freedom, while the State may neither oppose his plan, nor prevent by means of
prohibitions or sanctions that a third party help him make use of this option. This does not constitute
a pre-emption of the duty of the State to protect life, but acknowledges the fact that this
obligation does not translate into the preservation of life only as a biological fact [translation by the
editor]). The Court also urged legislative action in this area, but legislative efforts have not been
successful to date.

9. Mexico
21 On 22 April 2008, the Mexican Senate voted in favour of legalizing passive euthanasia, thereby
allowing physicians to withdraw life-sustaining medication from patients when the patient is in
palliative care and has been given less than six months to live. The consent from the patient or the
patients family is required. Active euthanasia remains prohibited.

10. India
22 On 7 March 2011 the Indian Supreme Court ruled in Aruna Shanbaug v Union of India et al in
favour of passive euthanasia by means of the withdrawal of life support to patients in a permanent
vegetative state (PVS). There being no statutory provision in our country as to the legal

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 procedure for withdrawing life support to a person in PVS or who is otherwise incompetent to take a
decision in this connection, the Court ruled that passive euthanasia should be permitted in our
country in certain situations, thus laying down the law in this connection which will continue to be
the law until Parliament makes a law on the subject. According to the Court (i) A decision has to be
taken to discontinue life support either by the parents or the spouse or other close relatives, or in
the absence of any of them, such a decision can be taken even by a person or a body of persons
acting as a next friend. It can also be taken by the doctors attending the patient. However, the
decision should be taken bona fide in the best interest of the patient (at para. 126).

C. International Law
23 International law tends to prohibit euthanasia-related practices, particularly by sanctioning the
right to life in several human rights treaties ( Life, Right to, International Protection), both
universal and regional. In addition, the United Nations Convention on the Rights of Persons with
Disabilities of 24 January 2007 prohibits certain forms of euthanasia ( Disabled People, Non-
Discrimination of). Amongst non-legally binding instruments prohibiting euthanasia the
Recommendation 1418 on the Protection of the Human Rights and Dignity of the Terminally Ill and
the Dying and Resolution 1859 on Protecting Human Rights and Dignity by Taking into Account
Previously Expressed Wishes of Patients adopted by the Parliamentary Assembly of the Council
of Europe (COE) on 25 June 1999 and on 25 January 2012, respectively, deserve consideration
(see paras 2829 below).

1. The Right to Life and the Right to Dignity in Human Rights Treaties
24 Euthanasia is considered by its opponents as a form of murder, or aiding and abetting suicide,
and incompatible with the right to life. The human rights treaty norms sanctioning the right to life are
generally construed as implying not only a negative obligation of contracting States to arbitrarily
deprive people of their life, but also a positive obligation to ensure that a persons life is not
arbitrarily deprived by private individuals. It is unquestioned that this positive obligation comprises
a duty to criminalize murder and murder-related practices. The question is whether both obligations
extend to euthanasia or at least to some of its forms. If they do, legislation authorizing controlled
euthanasia may be at variance with human rights treaty norms laying down the right to life.

25 Euthanasia is also frequently considered incompatible with the right to dignity ( Human
Dignity, International Protection), a right which is deemed to be generally recognized in both
international law and national constitutions, as well as with the right to non-discrimination
( Equality of Individuals), which is invariably set out in human rights treaties.

26 There were actually a number of concerns raised about the Dutch law legalizing euthanasia in
the Human Rights Committee[s] Concluding Observations of 27 August 2001, relating to the
report submitted by the Netherlands under Art. 40 International Covenant on Civil and Political
Rights (1966). According to the Human Rights Committee the system provided by Dutch law may
fail to detect and prevent situations where undue pressure could lead to the conditions laid down
by the statute being circumvented and, over time, such a practice may lead to routinization and
insensitivity to the strict application of the requirements in a way not anticipated. The Human Rights
Committee also observed that out of more than 2,000 cases reported to the Dutch Review
Committee a negative assessment was given only in three cases. Furthermore, the Human Rights
Committee was concerned that the new law was applicable to minors who had reached the age of
12 years. In 2009 the Human Rights Committee raised once again its concern by noting that under
the law on the Termination of Life on Request and Assisted Suicide, a physician can terminate a
patients life without any independent review by a judge or magistrate to guarantee that this
decision was not the subject of undue influence or misapprehension. Though a second physician
must give an opinion, even this can be obtained from a telephone hotline. So, too, there is no prior

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 judicial review of a physicians decision to terminate a patients life in circumstances where the
patient is not able to make the request for termination (Art. 6). The Committee thus urged that this
legislation be reviewed in light of the Covenants recognition of the right to life.

2. The UN Convention on the Rights of Persons with Disabilities

27 While traditional human rights treaties lay down the right to life and are silent on the specific
question of euthanasia, the recent UN Convention on the Rights of Persons with Disabilities adopted
on 24 January 2007 and entered into force 3 May 2008, contains a specific provision expressly
dealing with a euthanasia-related practice. Its Art. 25 (f) provides that States Parties shall prevent
discriminatory denial of health care or health services or food and fluids on the basis of disability.
This provision may be combined with Art. 10, which deals in general and traditional terms with the
right to life of disabled persons. The UN Convention on the Rights of Persons with Disabilities is
aimed at prohibiting discrimination against disabled persons, apparently including forms of eugenic
and economic euthanasia, but is silent on the point of whether or to what extent the patients
consent to euthanasia may be relevant.

28 More explicit formulations against euthanasia were actually proposed during the drafting
process, in particular by the United States and the Holy See. For example, at the fourth session
of the Ad Hoc Committee on 25 August 2004, the United States proposed adding to the then Draft
Art. 8 on the right to life the sentence and shall ensure that disability or perceived quality of life
shall not serve as a basis for infringement of the right to life (United Nations Daily Summary of
Discussions Related to Article 8), a proposal which was endorsed by the Holy See. In turn, the Holy
See proposed in 2005 the insertion in Draft Art. 21 on the right to health and rehabilitation a
sentence clearly aimed at prohibiting euthanasia: States Parties shall: k) ter ensure that persons
with disabilities not be denied medical, life-preserving treatment, as well as nutrition and hydration,
necessary to preserve or sustain that persons life, regardless of method of administration or
perceived quality of life (United Nations Contributions by Governments: Holy See). However,
these proposals found no place in the final text. The Netherlands made a declaration upon
signature on Art. 25 whereby The individual autonomy of the person is an important principle laid
down in Article 3 (a) of the Convention. The Netherlands understands Article 25 (f) in the light of this
autonomy. This provision is interpreted to mean that good care involves respecting a persishes
with regard to medical treatment, food and fluids.

3. UN Human Rights Council

29 At the Human Rights Council in Geneva the Holy See representative stated on 16 September
2011 in relation to the right to health of older persons that his delegation took strong exception to
a report at the meeting which referred to issues of patient autonomy in respect of deciding to end
life. He urged doctors and scientists to resist practices that shorten the life of the aged and sick,
practices that would turn out to be, in fact, forms of euthanasia (see UN Human Rights Council
Intervention by His Excellency Silvano M Tomasi, Permanent Observer of the Holy See to the
United Nations and Specialized Agencies).

4. COE Parliamentary Assembly Recommendation 1418

30 Euthanasia has been widely debated at the COE. Besides Recommendation No 779 on the
Rights of the Sick and Dying and Resolution No 613 on the Rights of the Sick and Dying (both of 29
January 1976), of particular importance is Recommendation No 1418 on the Protection of the
Human Rights and Dignity of the Terminally Ill and the Dying adopted by the COE Parliamentary
Assembly on 25 June 1999. This recommendation calls upon Member States to provide in domestic
law the necessary legal and social protection against threats to fundamental rights of the terminally
ill or dying persons, such as insufficient access to palliative care, artificial prolongation of the dying
process by either using disproportionate medical measures or by continuing treatment without a

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 patients consent, insufficient care and support for relatives and friends, insufficient allocation of
funds and resources, and social discrimination. It further recommends that the Committee of
Ministers encourage Member States to respect and protect the dignity of terminally ill or dying
persons by a number of measures, including recognition of the right to comprehensive palliative
care as well as the right to self-determination, and by upholding the prohibition against intentionally
taking the life of terminally ill or dying persons. This last commitment is expressly linked to the right
to life under Art. 2 European Convention for the Protection of Human Rights and Fundamental
Freedoms (1950) (ECHR) and to the explicit assumption that a terminally ill or dying persons wish
to die never constitutes any legal claim to die at the hand of another person and cannot of itself
constitute a legal justification to carry out actions intended to bring about death.

31 In 2001, 2003, and 2005 attempts were unsuccessfully made to overturn Recommendation
1418 by the Social, Health and Family Affairs Committee of the COE by proposing draft resolutions
recommending legislation which would exempt from prosecution doctors who agree to help
terminally-ill patients to terminate their life. Such proposals were invariably opposed by the
Committee on Legal Affairs and Human Rights of the COE and by the majority of the Parliamentary
Assembly. In Resolution 1859 of 25 January 2012 Protecting Human Rights and Dignity by Taking
into Account Previously Expressed Wishes of Patients, the COE Parliamentary Assembly
unambiguously stated, immediately after pointing out that it is not intended to deal with the issues
of euthanasia or assisted suicide, that Euthanasia, in the sense of the intentional killing by act or
omission of a dependent human being for his or her alleged benefit, must always be prohibited
(para. 5).

D. Case-Law of the European Commission and Court of Human

Rights
32 The most significant international case-law on euthanasia-related practices (notably on
assisted suicide) comes from the European Commission of Human Rights and more importantly from
the European Court of Human Rights (ECtHR). In general, while not excluding that a persons
choice to avoid what she considers will be an undignified and distressing end of her life does
constitute an interference with her right to respect for private life under Art. 8 ECHR, especially
considering that in an era of growing medical sophistication combined with longer life
expectancies, many people are concerned that they should not be forced to linger on in old age or
in states of advanced physical or mental decrepitude which conflict with strongly held ideas of self
and personal identity (see Pretty v United Kingdom para. 65; and Koch v Germany para. 51), the
ECtHR has never found so far that national restrictions on assisted suicide were unjustified under
Art. 8 ECHR. A succinct review of the Strasbourg monitoring bodies case law is in order.

33 In a decision of 4 July 1983, in the R v United Kingdom case, the European Commission on
Human Rights rejected as manifestly ill-founded an application submitted by a member of a pro-
euthanasia organization who had been convicted and sentenced to 18 months imprisonment for
aiding and abetting suicide and for conspiring to aid and abet suicide. Subsequently, in Widmer v
Switzerland ([ECommHR App 20427/92] [unreported]), which was decided on 10 February 1993,
the European Commission declared inadmissible an application submitted by a person who claimed
that his 82-year-old father had been the victim of passive euthanasia at the hospital where he had
died. An investigation made by the Swiss authorities had found that the measures taken at the
hospital were appropriate, though unsuccessful, and the case was dismissed. The European
Commission noted that the Swiss Penal Code punished attacks on life, particularly when death
originates in negligence or faulty improvidence. This was sufficient to conclude that the defendant
State had complied with the positive obligation to protect life. The European Commission expressly
observed that the Swiss lawmaker could not be criticized for having abstained specifically from
introducing a provision punishing passive euthanasia.

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 34 To date, the international leading case on euthanasia-related practices, more precisely on
assisted suicide, is the judgment of 29 April 2002, in Pretty v United Kingdom. The ECtHR rejected
an application submitted by Mrs Pretty, a woman suffering from motor neurone disease and
paralysed from the neck downwards who wished to be assisted in committing suicide by her
husband without him incurring criminal responsibility. In her view, a British law prohibiting aiding and
abetting in suicide, the Suicide Act 1961 (9 and 10 Eliz 2 c 60 (Eng)) was incompatible with Arts 2,
3, 8, 9, and 14 ECHR. The Court denied that Art. 2 ECHR had been violated, stating that the right to
life cannot be interpretedwithout a distortion of languageas implying a right to die and that it
was, rather, for the State to protect individuals against intentional deprivations of life. The ECtHR
also denied that Art. 3 ECHR had been violated, given that the applicant was not degradingly
treated by anyone, nor was she denied adequate care from the State medical authorities. Most
interestingly, the ECtHR found that Art. 8 (1) ECHR applied, stating that it was not prepared to
exclude that the applicants choice to avoid what she considers will be an undignified and
distressing end of her life does constitute and interference with her right to respect for private life
(Pretty v United Kingdom, para. 67; Privacy, Right to, International Protection), although the
ECtHR denied that the Suicide Act of 1961 (9 and 10 Eliz 2 c 60 [Eng]) was incompatible with Art. 8
(2) ECHR since it was aimed at protecting the rights and liberties of others, particularly those more
vulnerable in society. The ECtHR also denied that Art. 9 ECHR had been violated, holding that the
applicants claim did not involve a form of manifestation of a religion or belief given that the term
practice does not cover each act which is motivated or influenced by a religion or a belief
( Religion or Belief, Freedom of, International Protection). Finally, the ECtHR rejected the
relevance of Art. 14 ECHR arguing that the alleged discrimination between healthy persons who
can lawfully take their own life and persons like the applicant who could do so only by means of the
help of someone else was reasonable and justified, precisely because it was designed to protect
the rights of others.

35 Other decisions of the ECtHR worth mentioning, some of which did not reach the stage of
examination of the merits, include the decision of 26 October 2000 in the Sanles Sanles v Spain
case, the judgment of 7 December 2000 in the Zoon v Netherlands case, the decision of 18 April
2002 in the Litovchenko v Russia case, and the judgment of 9 March 2004 in the Glass v United
Kingdom case.

36 Ada Rossi and Others v Italy, decided by the ECtHR on 16 December 2008, deserves special
consideration. Following a road-traffic accident that occurred in 1992, an Italian national by the
name of EE had fallen into a coma. Her condition had subsequently developed into a vegetative
state spastic tetraplegia and loss of all higher cognitive function. In 1999, her father and guardian,
had gone to court seeking authorization to discontinue his daughters artificial nutrition and
hydration on the basis of his daughters personality and the ideas on life and dignity she had
allegedly expressed before the accident. In 2008, after many decisions of different courts, the
Milan Court of Appeal finally granted the authorization. A number of other Italian nationals and
associationsprecisely six Italian nationals represented by their guardians, six associations whose
membership consisted of the relatives and friends of severely disabled persons and of doctors,
psychologists, and lawyers who assisted the person concerned, as well as a human rights
associationthen lodged an application with the ECtHR claiming that the authorization granted to
EE constituted a precedent which might affect them. They invoked Arts 2, 3, and 6 (1) ECHR,
respectively the right to life, prohibition of inhuman or degrading treatment, and right to a fair trial.
The ECtHR declared the applications inadmissible on the grounds that the applicants had no direct
links with EE and could not be said to be victims, neither direct nor potential, of the alleged
violations.

37 More recently, in the Haas v Switzerland judgment of 20 January 2011 the ECtHR, after
developing Pretty to the effect that a right of an individual to decide how and when his life must
end is part of the right to privacy under Art. 8 ECHR on condition that the individual is able to freely
form his or her will on this and act accordingly, concluded that Switzerland did not violate Art. 8 in

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 denying the issuance of a lethal substance to the applicant for suicide purposes (paras 51, 55, and
61). In the Koch v Germany judgment of 2012 the ECtHR found Germany in breach of Art. 8 ECHR
because the German courts had refused to examine the merits of the claim originally brought by
the applicant before the domestic authorities, and hence on procedural grounds rather than on the
substance (paras 6572). Finally, in the Gross v Switzerland judgment of 2013, pending before the
Grand Chamber as of the time of writing, found Switzerland in breach of Art. 8 ECHR, in relation to
an applicant who did not suffer from any particular disease but merely desired not to grow old and
had complained that she was unable to obtain a lethal substance without a prescription, on
grounds that Swiss law, while providing the possibility of obtaining a lethal dose of sodium
pentobarbital on medical prescription, does not provide sufficient guidelines ensuring clarity as to
the extent of this right, without taking up a stance on the substantive content of such guidelines
(paras 67 and 69), Judges Raimondi, Joien, and Karaka dissenting.

E. Conclusion
38 It seems that an unconditional proposition that euthanasia is prohibited under international law
as inherently contrary to the right to life or to the right to dignity is not strictly accurate and that the
question of the admissibility of euthanasia under current international law needs some
qualifications.

39 First, the right to life understood as prohibiting certain forms of life deprivation which may relate
to extreme forms of euthanasia, such as genocide, is definitely part of contemporary international
law. On the other hand, the right to life as envisaged in human rights treaties is not absolute, as
witnessed by the fact that the death penaltyas well as several other forms of life deprivation,
including those resulting from legitimate acts of waris generally not considered per se
incompatible with the right to life. The inference of an absolute prohibition of euthanasia is even
more problematic on the basis of the right to dignity, if account is taken of the evanescent content
of such a right and of the fact that it is invariably invoked also by euthanasia advocates to support
the exact opposite inference. Nor can one be unmindful that even if a prohibition of euthanasia
were thus established, it might extend to certain forms of euthanasia and not to others. In fact, the
UN Human Rights Committee did express grave concerns about the Dutch law legalizing
euthanasia, but it did not state that euthanasia per se is inherently incompatible either with the right
to life as sanctioned by Art. 6 International Covenant on Civil and Political Rights or with its other
provisions.

40 Secondly, the 2007 UN Convention for the Protection of Persons with Disabilities does prohibit
at least some extreme forms of euthanasia. The Convention, however, has too recently entered
into force, and its actual impact on international law as a whole appears at present limited, at least
as regards euthanasia. It also exclusively deals with certain specific forms of euthanasia, leaving
room for conjecture as far as other forms are concerned. Admittedly, the Convention contains a
provision sanctioning the right to life, but this provision is drafted in general terms and lends itself to
the same interpretative uncertainties of similar provisions found in other human rights instruments.

41 Thirdly, undoubtedly Recommendation 1418 of the COE prohibits euthanasia, as defined

therein. This recommendation is not legally binding and a substantial minority in the Parliamentary
Assembly is strongly inclined towards overturning it. However, challenges against it have failed
hitherto. In fact, COE Parliamentary Assembly Resolution 1859 of 25 January 2012 stated, as
mentioned earlier, that [e]uthanasia, in the sense of the intentional killing by act or omission of a
dependent human being for his or her alleged benefit, must always be prohibited.

42 Finally, the ECtHR did hold that a law prohibiting assisted suicide did not raise or was not
incompatible with Arts 2, 3, 8, 9, and 14 ECHR, but it did not state that a law authorizing controlled
euthanasia or assisted suicide is a contrario inherently incompatible with one or more of those
provisions. Indeed, the ECtHR acknowledged that Art. 8 ECHR applies to assisted suicide, and that a

From: Oxford Public International Law (http://opil.ouplaw.com). (c) Oxford University Press, 2015. All Rights Reserved. Subscriber:
Oxford University Press - Master Gratis Access; date: 10 February 2017
 law prohibiting such a practice legitimately pursued the aim of protecting the rights of others, in
particular of the most vulnerable people in society. The ECtHR pointed out that in the specific case
under consideration the challenged law was a proportional measure to ensure the attainment of
that legitimate aim, but it did not rule out that under other circumstances national measures against
euthanasia may turn out to be incompatible with Art. 8 ECHR. In fact, once admitted that Art. 8 ECHR
applies to assisted suicide, the ECtHRs reasoning is essentially grounded in a balance between the
right to respect for private life, on the one hand, and other fundamental rights, including the right to
life, on the other. Nothing in Pretty, and in the subsequent ECtHRs case law, suggests that a
definite solution exists as to the compatibility of euthanasia-related practices per se with
fundamental human rights, including the right to life and the right to dignity. It clearly depends on
the development of comparative national legislation in the Member States of the COE, and the
ensuing margin of appreciation the ECtHR will be inclined to accord to national authorities in the
future, on the form of euthanasia-related practice under consideration and most importantly on the
circumstances of the concrete case. Elements such as the stage of the illness, the determination of
the patient, family circumstances and medical conditions, the precise wording of the specific
national law at issue, and its actual implementation, seem to be more relevant than abstract
reasoning on arguments ethically pro and against euthanasia-related practices per se.

Select Bibliography
JS Hohmann Der Euthanasie-Proze Dresden 1947: Eine zeitgeschichtliche Dokumentation
(Lang Frankfurt am Main 1993).
TJ Messinger A Gentle and Easy Death: From Ancient Greece to Beyond Cruzan Toward a
Reasoned Legal Response to the Societal Dilemma of Euthanasia (1993) 71 DenvULRev
175251.
J Keown Euthanasia Examined: Ethical, Clinical and Legal Perspectives (CUP Cambridge
1995).
D de Mildt In the Name of the People: Perpetrators of Genocide in the Reflection of Their
Post-War Prosecution in West Germany; the Euthanasia and Aktion Reinhard Trial Cases
(Nijhoff Amsterdam 1996).
M Otlowski Voluntary Euthanasia and the Common Law (Clarendon Oxford 1997).
G Zdenkowski The International Covenant on Civil and Political Rights and Euthanasia
(1997) 20 University of New South Wales Law Journal 17094.
G Dworkin RG Frey and S Bok Euthanasia and Physician-Assisted Suicide (CUP Cambridge
1998).
T Schirrmacher (ed) Lebensrecht fr jeden Menschen: AbtreibungEuthanasie
Gentechnik; Beitrge des 1. Europischen Forums Lebensrecht, Berlin 1998 (Verlag fr
Kultur und Wissenschaft Bonn 2000).
H Biggs Euthanasia, Death with Dignity and the Law (Hart Oxford 2001).
K Chatzikostas Die Disponibilitt des Rechtsgutes Leben in ihrer Bedeutung fr die
Probleme von Suizid und Euthanasie (Lang Frankfurt am Main 2001).
E Vermaat Euthanasie: Herhaalt de geschiedenis zich? Parallelen en verschillen met Nazi-
Duitsland (De Banier Utrecht 2001).
K Amarasekara and M Bagaric The Vacuousness of Rights in the Euthanasia Debate (2002)
6 IJHR 1944.
J Keown Euthanasia, Ethics and Public Policy: An Argument Against Legalisation (CUP
Cambridge 2002).
MA Sanderson Pretty v United Kingdom. App No 2346/02: European Court of Human Rights,
April 29, 2002 (2002) 96 AJIL 94349.
M Adams and H Nys Comparative Reflections on the Belgian Euthanasia Act 2002 (2003) 11
Medical Law Review 35376.
O De Schutter Laide au suicide devant la Cour europenne des droits de lhomme: A propos
de larrt Pretty c le Royaume-Uni du 29 avril 2002 (2003) 14 RTDH 71111.

From: Oxford Public International Law (http://opil.ouplaw.com). (c) Oxford University Press, 2015. All Rights Reserved. Subscriber:
Oxford University Press - Master Gratis Access; date: 10 February 2017
 B Hale A Pretty Pass: When Is There a Right to Die? (2003) 32 CLWR 114.
J Keown European Court of Human Rights: Death in StrasbourgAssisted Suicide, the Pretty
Case, and the European Convention on Human Rights (2003) 1 ICON 72230.
S Ost An Analytical Study of the Legal, Moral, and Ethical Aspects of the Living
Phenomenon of Euthanasia (E Mellen Lewiston 2003).
A Pedain The Human Rights Dimension of the Diane Pretty Case (2003) 62 CLJ 181206.
J Satz Nugent Walking into the Sea of Legal Fiction: An Examination of the European Court
of Human Rights, Pretty v United Kingdom and the Universal Right to Die (2003) 13
JTransnatlL&Poly 183212.
G Antonowicz Euthanasie, lalternative judiciaire (LHarmattan Paris 2004).
E Drogon The Right to Die with Dignity: Diane Pretty v the United Kingdom in T Gries and R
Alleweldt (eds) Human Rights within the European Union (BWV Berlin 2004) 99107.
J-Y Goffi Penser leuthanasie (Presses Univ de France Paris 2004).
N Ferreira Revisiting Euthanasia: A Comparative Analysis of a Right to Die in Dignity
(Zentrum fr Europische Rechtspolitik Bremen 2005).
M Nowak UN Covenant on Civil and Political Rights: CCPR Commentary (2nd edn Engel Kehl
2005).
M Pabst Battin Ending Life: Ethics and the Way We Die (OUP Oxford 2005).
J Peiffer Wissenschaftliches Erkenntnisstreben als Ttungsmotiv? Zur Kennzeichnung von
Opfern auf deren Krankenakten und zur Organisation und Unterscheidung von
Kinder-Euthanasie und T4-Aktion (Forschungsprogramm Geschichte der Kaiser-Wilhelm-
Ges. im Nationalsozialismus Berlin 2005).
E Verhagen and PJ Sauer The Groningen Protocol: Euthanasia in Severely Ill Newborns
(2005) 353 New England Journal of Medicine 95962.
E Wada A Pretty Picture: The Margin of Appreciation and the Right to Assisted Suicide
(2005) 27 LoyLAIntl&CompLRev 27589.
A Gilles La dignit des malades en fin de vie (rflexions partir de lArrt Pretty du 29 avril
2002) in CA Chassin (ed) La porte de larticle 3 de la Convention Europenne des Droits
de lHomme (Bruylant Bruxelles 2006) 181207.
C Merkel Tod den Idioten: Eugenik und Euthanasie in juristischer Rezeption vom
Kaiserreich zur Hitlerzeit (Logos Berlin 2006).
J Griffiths H Weyers and M Adams Euthanasia and the Law in Europe: With Special
Reference to the Netherlands and Belgium (Hart Oxford 2007).
R Huxtable Euthanasia, Ethics and the Law: From Conflict to Compromise (Routledge-
Cavendish London 2007).
DA Jones Approaching the End: A Theological Exploration of Death and Dying (OUP Oxford
2007).
MJ Lewis Medicine and Care of the Dying: A Modern History (OUP Oxford 2007).
P Lewis Assisted Dying and Legal Change (OUP Oxford 2007).
M Warnock and E Macdonald Easeful Death: Is There a Case for Assisted Dying? (OUP
Oxford 2008).
J Griffiths H Weyers and M Adams Euthanasia and the Law in Europe (Hart Oxford 2008).
E Luu Web-assisted Suicide and the First Amendment (2009) 36 Hastings Constitutional Law
Quarterly 30728.
D Price What Shape to Euthanasia after Bland? Historical, Contemporary and Futuristic
Paradigms (2009) The Law Quarterly Review 14274.
C Alexander Pro-euthanasia TV Ad Ban a Violation of Free Speech (13 September 2010)
<http://www.theage.com.au/national/proeuthanasia-tv-ad-ban-a-violation-of-free-speech-
20100912-1570f.html> (31 March 2014).
L Bartels and M Otlowski A Right to Die? Euthanasia and the Law in Australia (2010) 17
Journal of Law Medicine 53255.
J Chalmers Assisted Suicide: Jurisdiction and Discretion (2010) 14 The Edinburgh Law
Review 295300.

From: Oxford Public International Law (http://opil.ouplaw.com). (c) Oxford University Press, 2015. All Rights Reserved. Subscriber:
Oxford University Press - Master Gratis Access; date: 10 February 2017
 CC Cleary From Personal Autonomy to Death-on-demand: Will Purdy v DPP Legalize
Assisted Suicide in the United Kingdom? (2010) 33 BCIntl&CompLRev 289304.
KB OReilly Physician-assisted Suicide Legal in Montana, Court Rules (18 January 2010)
<http://www.amednews.com/article/20100118/profession/301189939/6/> (31 March 2014).
T Smets J Bilsen J Cohen ML Rurup and L Deliens Legal Euthanasia in Belgium:
Characteristics of All Reported Euthanasia Cases (2010) 48 Medical Care 18792.
P Merkouris Assisted Suicide in the Jurisprudence of the European Court of Human Rights: A
Matter of Life and Death in S Negri (ed) Self-determination, Dignity and End-of-life Care:
Regulating Advance Directives in International and Comparative Perspective (Nijhoff
Leiden 2011) 10726.
S Negri (ed) Self-determination, Dignity and End-of-life Care: Regulating Advance
Directives in International and Comparative Perspective (Nijhoff Leiden 2011).
P Saunders Six Countries, Six Defeats (8 February 2011)
<http://www.mercatornet.com/careful/view/8663> (31 March 2014).
M Tiedemann and JND Valiquet Euthanasia and Assisted Suicide: International Experiences
(8 April 2011) <http://www.parl.gc.ca/content/lop/researchpublications/2011-67-e.htm> (31
March 2014).
D Greer British Columbia Supreme Court Kills Assisted Suicide Ban (18 June 2012)
<http://www.courthousenews.com/2012/06/18/47546.htm)> (31 March 2014).
DM Pappas The Euthanasia/Assisted-suicide Debate (Greenwood Santa Barbara California
2012).
P Thielbrger Judicial Passivism at the European Court of Human Rights (2012) 19 Maastricht
Journal of European and Comparative Law 34147.
D Rietiker From Prevention to Facilitation? Suicide in the Jurisprudence of the ECtHR in the
Light of the Recent Haas v Switzerland Judgment (2013) 25 HarvHumRtsJ 85126.
CA Sheets Belgian Parliament Posed to Approve Child Euthanasia Law (11 June 2013)
International Business Times <http://www.ibtimes.com/belgian-parliament-posed-approve-
child-euthanasia-law-1301825#> (31 March 2014).

Select Documents
Ada Rossi and Others v Italy (ECtHR) Apps 55185/08, 55483/08, 55516/08, 55519/08,
56010/08, 56278/08, 58420/08 and 58424/08.
Aruna Shanbaug v Union of India et al (Indian Supreme Court) (7 March 2011) 4 SCC 454.
Baxter et al v Montana (Montana Supreme Court) (31 December 2009) MT 449.
COE Convention for the Protection of Human Rights and Fundamental Freedoms (signed 4
November 1950, entered into force 3 September 1953) 213 UNTS 221.
COE Committee of Ministers Protection of the Human Rights and Dignity of the Terminally Ill
and the DyingParliamentary Assembly Recommendation 1418 (1999) (27 March 2002)
CM/AS(2002)Rec1418finalE.
COE Parliamentary Assembly Recommendation No 779 (1976) on the Rights of the Sick and
Dying (29 January 1976).
COE Parliamentary Assembly Resolution No 1859 (2012) on Protecting Human Rights and
Dignity by Taking into Account Previously Expressed Wishes of Patients (25 January 2012).
COE Parliamentary Assembly Resolution No 613 (1976) on the Rights of the Sick and Dying
(29 January 1976).
Constitutional Court of Colombia, judgment No C-239/97 (20 May 1997) Spanish text at
<http://www.corteconstitucional.gov.co/relatoria/1997/c-239-97.htm>.
Fleming v Ireland et al (Irish Supreme Court) (29 April 2013) Appeal No 019/2013 (2013)
IESC 19.
Glass v United Kingdom (ECtHR) Reports 2004-II 25.
Gross v Switzerland (ECtHR) App 67810/10.
Haas v Switzerland (ECtHR) App 31322/07.

From: Oxford Public International Law (http://opil.ouplaw.com). (c) Oxford University Press, 2015. All Rights Reserved. Subscriber:
Oxford University Press - Master Gratis Access; date: 10 February 2017
 International Covenant on Civil and Political Rights (adopted 19 December 1966, entered into
force 23 March 1976) 999 UNTS 171.
Koch v Germany (ECtHR) App 497/09.
Law on Euthanasia and Assisted Suicide (Luxembourg, Mmorial A-No 46) original French
text at <http://www.legilux.public.lu/leg/a/archives/2009/0046/a046.pdf#page=7>.
Lee Carter and Hollis Johnson et al v Attorney General of Canada (British Columbia Supreme
Court) (15 June 2012) 2012 BCSC 886.
Lee Carter and Hollis Johnson et al v Attorney General of Canada Response of The
Attorney General of Canada to The British Columbia Supreme Court Decision on Assisted
Suicide (13 July 2012) at <http://www.justice.gc.ca/eng/news-nouv/nr-
cp/2012/doc_32769.html>.
Litovchenko v Russia (ECtHR) App 69580/01.
Pretty v United Kingdom (ECtHR) Reports 2002-III 155.
R v United Kingdom (ECommHR App 10083/82) (1983) 33 DR 270.
Sanles Sanles v Spain (ECtHR) Reports 2000-XI 479.
UN HRC Concluding Observations of the Human Rights Committee: Netherlands (27 August
2001) UN Doc CCPR/CO/72/NET.
UN HRC Concluding Observations of the Human Rights Committee: Netherlands (25 August
2009) UN Doc CCPR/C/NLD/CO/4.
UN Human Rights Council, Thematic Study on the Realization of the Right to Health of Older
Persons, Intervention by His Excellency Silvano M. Tomasi Permanent, Observer of the Holy
See to the United Nations and Specialized Agencies in Geneva at the 18th Session of the
Human Rights Council (16 September 2011) at
<http://www.holyseemissiongeneva.org/index.php?
option=com_content&view=article&id=8023:18th-session-of-the-human-rights-council-the-
right-to-health-of-older-person&catid=57:humanrights&Itemid=82>.
United Nations Convention on the Rights of Persons with Disabilities (adopted 13 December
2006, entered into force 3 May 2008) GAOR 61st Session Supp 49 vol 1, 65.
Zoon v Netherlands (ECtHR) Reports 2000-XII 283.

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