No right to physician-assisted death for applicant with motor neurone disease (ECtHR)

In Chamber's judgment in the case of Daniel Karsai v. Hungary (application no. 32312/23) the European Court of Human Rights held, by 6 votes to 1, that there had been no violation of Article 8 (right to respect for private and family life) of the European Convention on Human Rights; and no violation of Article 14 (prohibition of discrimination) in conjunction with Article 8. 

The case concerned the question of the asserted right to self-determined death of the applicant, who is a Hungarian national and has advanced amyotrophic lateral sclerosis (ALS) a type of motor neurone disease with no known cure. 

He would like to be able to decide when and how to die before his illness reaches a stage that he finds intolerable. He would need assistance, but anyone assisting him would risk prosecution, even if he died in a country which allowed physician-assisted dying. He complained of not being able to end his life with the help of others and of discrimination compared to terminally ill patients on life-sustaining treatment who are able to ask for their treatment to be withdrawn. 

The Court observed that there were potentially broad social implications and risks of error and abuse involved in the provision of physician-assisted dying. Despite a growing trend towards its legalisation, the majority of the member States of the Council of Europe continue to prohibit both medically assisted suicide and euthanasia. The State thus had wide discretion in this respect, and the Court found that the Hungarian authorities had not failed to strike a fair balance between the competing interests at stake and had not overstepped that discretion. 

Nevertheless, the Convention had to be interpreted and applied in the light of the present day. The need for appropriate legal measures should therefore be kept under review, taking into account the developments in European societies and in the international standards on medical ethics in this domain. The Court considered that high-quality palliative care, including access to effective pain management, was essential to ensuring a dignified end of life. 

According to the expert evidence heard by the Court, the available options in palliative care, guided by the European Association of Palliative Care’s revised recommendations, including the use of palliative sedation, were generally able to provide relief to patients in the applicant’s situation and allow them to die peacefully. Mr Karsai had not alleged that such care would be unavailable to him. 

As regards the alleged discrimination, the Court found that the refusal or withdrawal of treatment in end-of-life situations was intrinsically linked to the right to free and informed consent, rather than to a right to be helped to die, and was widely recognised and endorsed by the medical profession, and also laid down in the Council of Europe’s Oviedo Convention. 

Furthermore, refusal or withdrawal of life-support was allowed by the majority of the member States. The Court therefore considered that the alleged difference in treatment of the two categories was objectively and reasonably justified. (source: echr.coe.int/ photo:freepik.com)

Judgement is available here

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George Kazoleas, Lawyer

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