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Slovenia became the first Eastern European country to legalise assisted dying, amid an expansion of the end-of-life option across the continent.

Patients with terminal conditions will now have the choice to end their own lives. Assisted dying can refer either to active euthanasia, which is when a doctor deliberately ends their life, or assisted suicide, which is when medical personnel give patients the means to end their own lives.

In Slovenia, eligible patients will have access to assisted suicide, where they would have to ingest or inject a substance themselves, local media reported.

Patients will be required to express their intention to their doctor twice before submitting a formal request, which must be approved by an independent doctor. Their ability to make a decision will also be assessed by a psychiatrist.

Healthcare workers will retain the right to refuse to participate in the procedure.

Last year, 55 per cent of Slovenian voters backed assisted dying in a referendum. The proposal faced setbacks but was ultimately passed into law in July after repeated votes in the parliament.

Backlash was swift and fierce, prompting advocates to defend the new rule before it’s even been enacted.

“All of this is not a case of any kind of murder, which is a malicious act,” said Andrej Pleterski, a member of the Society Silver Thread, an association for dignified old age, and one of the bill’s co-authors.

“This law talks about the help in ending your own life,” he added. “It allows all people the end of life based on their own choice, whether they wish for some help to shorten it, and it also allows those who wish to have a natural end of life to ensure that they can”.

Opinions are divided in Slovenia

Tina Vuga lost her father just two months ago.

He received palliative care in the final days of his life, but was in serious pain until the end.

She believes that people should have the right to end their lives with less suffering.

“I find it crucial that in the 21st century we are finally ready for this step in our civilisation to give people the opportunity – I emphasise, the opportunity – that they can autonomously decide if and when they wish to end their own story,” Vuga said.

“We need to respect that time as well. And most of all, enable the people to go, leave in a way they wish, so they can keep their dignity,” she added.

Under the current version of the law, the public health insurance fund will pay for the procedure for Slovenian citizens and permanent residents with health insurance.

However, the law’s implementation could be delayed amid backlash from an opposition group called Coalition Against the Poisoning of Patients, which has collected 15,000 signatures to block it.

If it gathers 40,000 signatures within 35 days, a binding referendum will be held on whether to repeal the law.

Some Slovenians fear that vulnerable patients could be pressured into choosing assisted death or that such a law could be used to cut support for mental health or palliative care.

“Numerous people will feel encouraged with this law,” said Dr Bojana Beovic, president of the Medical Chamber of Slovenia.

“Their life is coming to an end, they are elderly, they do not feel they are useful in society, and the best thing is that they leave this world and their family members,” she said.

“The law is formed in a way that there is no method that is acceptable to the patient himself for relieving his troubles and improving his state”.

She also believes the law will divide the medical profession.

“It is highly probable that for many doctors it will be a conscientious objection issue, and, in the end, we might have a situation similar to that in Switzerland where this procedure is performed by a specific group of doctors,” Beovic added.

However, Pleterski said assisted dying should be considered one option for terminally ill patients, along with other types of medical care.

“Palliative care is, of course, something that is very important, but unfortunately, even at its best, it cannot help all people, and this is why it is in addition to this law [which] does not oblige or coerce anyone,” he said.

Assisted dying in Europe

Roughly 282 million people worldwide live in countries or regions that allow medical assistance in dying (MAID) with its use ranging from 0.1 per cent to 5.1 per cent of all deaths, according to a study published earlier this year in the journal JAMA Internal Medicine.

MAID can come in a few different forms. Active euthanasia and assisted suicide differ in terms of how involved a doctor is in the patient’s death, while passive euthanasia is the withdrawal or withholding of life-preserving treatments at the request of the patient or a family member.

Switzerland has allowed assisted suicide since 1942, but active euthanasia is not allowed. It is illegal to help someone die for self-serving reasons.

In Europe, countries such as Belgium, the Netherlands, Luxembourg, Spain, and Austria allow some form of assisted dying.

In recent years, lawmakers in France, Ireland, Italy, Iceland, and the United Kingdom have debated assisted dying policies.