End-of-life decisions: the policy issue that will not die

In most jurisdictions, public policy regarding assisted death has not advanced beyond simple prohibition. However, this issue is increasingly likely to reach the policy agenda. Policy-makers may be tempted to turn for guidance to the three places in the world with developed policy or legislation: the Netherlands; the American state of Oregon; and the Northern Territory in Australia. A review of their legislation and relevant guidelines reveals that they rest on four shared assumptions: the neutral assessor status of physicians; the primacy of pain as a validator of requests for assisted death; the need to exclude depression from influencing the decision-making process; and the exclusion of non-clinical existential factors in granting access to assisted death. Recent research in health services raises questions as to the validity of each of these assumptions. This, in turn, has implications for future public policy on assisted death.