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Adaptações na legislação, regulamentação e prática relativas à morte assistida durante a pandemia de COVID-19: algumas reflexões sobre dados disponíveis do Canadá, dos Estados Unidos, da Inglaterra e País de Gales e da Suíça

Cadernos Ibero-Americanos de Direito Sanitário (CIADS)
Objetivo: analisar como a pandemia de COVID-19 afetou o acesso e a prestação de serviços de morte assistida, e  como os marcos jurídicos, normativos e profissionais se adaptaram a esse contexto. Metodologia: o artigo se fundamenta  em temas recorrentes na literatura empírica, incluindo estudos, legislação, jurisprudência, orientações profissionais, publicações governamentais e debates parlamentares sobre a morte assistida no  Canadá, Estados Unidos, Inglaterra e País de Gales e Suíça. Resultados: as restrições impostas pela pandemia no Canadá e em alguns estados dos Estados Unidos intensificaram as barreiras já existentes relacionadas às avaliações de elegibilidade, à presença de familiares, às desigualdades geográficas e à necessidade de deslocamento. A telemedicina e a flexibilização de procedimentos contribuiram para a manutenção dos serviços de morte assistida legalmente autorizados, mas também suscitaram preocupações quanto a construção de vínculos entre profissionais e pacientes, às salvaguardas e à responsabilização profissional. lnglaterra e País de Gales são considerados caso contrastante, vez que a morte assistida permaneceu criminalmente proibida, enquanto as restrições de deslocamentos impostas durante a pandemia dificultaram o acesso ao suicídio assistido na Suíça. Considerações finais: A análise indica que as medidas adotadas em situações de emergência somente devem se tornar permanentes quando contribuírem para ampliar o acesso efetivo, preservando, ao mesmo tempo, elementos fundamentais como a voluntariedade, o consentimento informado, as salvaguardas relacionadas à elegibilidade e a supervisão pública.   Recebido: 07/07/2026 | Revisado: 21/09/2026 | Aprovado: 07/10/2026
DOI
10.17566/ciads.e2026043
Referências do artigo
1. Hillyard D, Dombrink J. Dying right: the death with dignity movement. New York: Routledge; 2001. 324 p. 2. Electoral Commission New Zealand. End of Life Choice Referendum [Internet]. Wellington: Electoral Commission; 2020 [cited 2026 Oct 12]. Available from: https://www.electionresults.govt.nz/electionresults_2020/referendums-results.html 3. Canada. Supreme Court of British Columbia. Carter v. Canada (Attorney General), 2012 BCSC 886. [s.l.], 2012 Jun 15 [cited 2026 Oct 12]. Available from: https://bccla.org/wp-content/uploads/2012/06/Carter-v-Canada-AG-2012-BCSC-886.pdf 4. Canada. Superior Court of Quebec. Truchon c. Procureur général du Canada, 2019 QCCS 3792. Montréal, 2019 Sep 11 [cited 2026 Oct 12]. Available from: https://www.canlii.org/judgmentTabs/history/?judgmentId=37480049&lang=en 5. World Health Organization. WHO Director-General's opening remarks at the media briefing – 5 May 2023 [Internet]. Geneva: World Health Organization; 2023 May 5 [cited 2026 Oct 12]. Available from: https://www.who.int/news-room/speeches/item/who-director-general-s-opening-remarks-at-the-media-briefing---5-may-2023 6. House of Commons Health and Social Care Committee. Assisted dying/assisted suicide: second report of Session 2023–24 [Internet]. London: House of Commons; 2024 Feb 29 [cited 2026 Oct 12]. Report No.: HC 321. Available from: https://publications.parliament.uk/pa/cm5804/cmselect/cmhealth/321/report.html 7. Canada. Criminal Code, R.S.C. 1985, c. C-46. An Act respecting the Criminal Law [cited 2026 Oct 12]. Available from: https://laws-lois.justice.gc.ca/eng/acts/c-46/page-1.html 8. Vermont. Vermont Statutes Annotated, title 18, chapter 113. Patient choice at end of life. Vermont General Assembly [cited 2026 Oct 12]. Available from: https://legislature.vermont.gov/statutes/fullchapter/18/113 9. Washington State. Revised Code of Washington, chapter 70.245. The Washington Death with Dignity Act. Washington State Legislature [cited 2026 Oct 12]. Available from: https://app.leg.wa.gov/rcw/default.aspx?cite=70.245 10. United Kingdom. Suicide Act 1961 (c. 60), (1961 Aug 3). An Act to amend the law of England and Wales relating to suicide, and for purposes connected therewith. London: The National Archives [cited 2026 Oct 12]. Available from: https://www.legislation.gov.uk/ukpga/Eliz2/9-10/60/section/2 11. United Kingdom. House of Lords. R v Cunningham [1982] AC 566. London, Jul 8, 1981[cited 2026 12 Oct]. Available from: https://vlex.co.uk/vid/r-v-cunningham-793681693 12. England and Wales. Court of Appeal (Criminal Division). R v Inglis [2010] EWCA Crim 2637. London, Nov 12, 2010 [cited Oct 12, 2026]. Available from: https://www.bailii.org/ew/cases/EWCA/Crim/2010/2637.html 13. Switzerland. Swiss Criminal Code, SR 311.0, of 21 December 1937 [cited 2026 12 Oct]. Available from: https://www.fedlex.admin.ch/eli/cc/54/757_781_799/en 14. Tong E, Nissim R, Selby D, Bean S, Isenberg-Grzeda E, Thangarasa T, et al. The impact of COVID-19 on the experiences of patients and their family caregivers with medical assistance in dying in hospital. BMC Palliative Care [Internet]. 2023 Jun 13 [cited 2026 12 Oct];22:70. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10261826/ doi:10.1186/s12904-023-01191-8 15. Wiebe E, Kelly M, McMorrow T, Tremblay-Huet S, Sum B, Hennawy M. How the experience of medical assistance in dying changed during the COVID-19 pandemic in Canada: a qualitative study of providers. CMAJ Open [Internet]. 2021 Apr 16 [cited 2026 12 Oct];9(2):E400-E405. Available from: https://www.cmajopen.ca/content/9/2/E400 doi:10.9778/cmajo.20200163 16. Tremblay-Huet S, McMorrow T, Wiebe E, Kelly M, Hennawy M, Sum B. The impact of the COVID-19 pandemic on medical assistance in dying in Canada and the relationship of public health laws to private understandings of the legal order. Journal of Law and the Biosciences [Internet]. 2020 [cited 2026 12 Oct];7(1):lsaa087. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7799035/ doi:10.1093/jlb/lsaa087 17. Oliver P, Wilson M, McLaren C, Jonquiere R. Providing legal assisted dying and euthanasia services in a global pandemic: lessons for ensuring service continuity. OMEGA - Journal of Death and Dying [Internet]. 2024 Aug [cited 2026 12 Oct];89(3):1253-1272. Available from: https://journals.sagepub.com/doi/10.1177/00302228221089120 doi:10.1177/00302228221089120 18. Stewart DE, Viens P, Muralidharan O, Kastanias P, Dembo J, Riazantseva E. E-survey of stressors and protective factors in practicing medical assistance in dying. Journal of Palliative Medicine [Internet]. 2021 Oct [cited 2026 12 Oct];24(10):1489-1496. Available from: https://journals.sagepub.com/doi/10.1089/jpm.2020.0664 doi:10.1089/jpm.2020.0664 19. Health Canada. Second annual report on medical assistance in dying in Canada 2020 [Internet]. Ottawa: Health Canada; 2021 Jun [cited 2026 12 Oct]. Available from: https://www.canada.ca/en/health-canada/services/medical-assistance-dying/annual-report-2020.html 20. Dion S, Wiebe E, Kelly M. Quality of care with telemedicine for medical assistance in dying eligibility assessments: a mixed-methods study. CMAJ Open [Internet]. 2019 Dec 13 [cited 2026 12 Oct];7(4):E721-E729. Available from: https://www.cmajopen.ca/content/7/4/E721 doi:10.9778/cmajo.20190111 21. College of Physicians and Surgeons of British Columbia. Practice standard: medical assistance in dying (version 7.2) [Internet]. Vancouver (BC): College of Physicians and Surgeons of British Columbia; 2022 May 10 [cited 2026 12 Oct]. Available from: https://www.cpsbc.ca/news/publications/college-connector/2024-V12-02/06 22. College of Physicians and Surgeons of British Columbia. Revised medical assistance in dying practice standard and FAQs published [Internet]. Vancouver (BC): College of Physicians and Surgeons of British Columbia; Feb 26, 2024 [cited Oct 12, 2026]. Available from: https://www.cpsbc.ca/news/revised-medical-assistance-dying-practice-standard-and-faqs-published 23. Dying With Dignity Canada, Canadian Association of MAiD Assessors and Providers. Guidance for virtual witnessing for a request for medical assistance in dying (MAiD) [Internet]. Toronto: Dying With Dignity Canada; 2020 Jun [cited 2026 12 Oct]. 7 p. Available from: https://camapcanada.ca/wp-content/uploads/2022/02/FINAL-Tele-witnessing-guide-June-26-2020-copy.pdf 24. College of Physicians and Surgeons of Nova Scotia. Temporary amendments to MAiD standard [Internet]. Halifax (NS): College of Physicians and Surgeons of Nova Scotia; 2020 Mar 31 [updated 2025 Dec 9; cited 2026 12 Oct]. Available from: https://cpsns.ns.ca/news/college-news/temporary-amendments-to-maid-standard/ 25. Canadian Association of MAiD Assessors and Providers. Guidance for assessors and providers of medical assistance in dying (MAiD) during the COVID-19 pandemic [Internet]. [s.l.]: Canadian Association of MAiD Assessors and Providers; 2020 Apr [cited 2026 12 Oct]. Available from: https://camapcanada.ca/wp-content/uploads/2022/02/Formatted-Final-MAiD-in-Covid-2.pdf 26. Dying With Dignity Canada. Find an independent witness for MAID [Internet]. Toronto: Dying With Dignity Canada; [s.d.] [updated 2024 May 27; cited 2026 12 Oct]. Available from: https://www.dyingwithdignity.ca/end-of-life-support/find-an-independent-witness-for-maid/ 27. Committee to Evaluate Telemedicine for Aid-in-Dying Requests in the Context of the Coronavirus Epidemic. Telemedicine policy statement [Internet]. [s.l.]: American Clinicians Academy on Medical Aid in Dying; 2020 Mar 25 [cited 2026 12 Oct]. Available from: https://www.acamaid.org/telemedicine/ 28. Aleccia J. Dying patients protest looming telehealth crackdown. STAT [Internet]. 2023 Apr 23 [cited 2026 12 Oct]. Available from: https://www.statnews.com/2023/04/23/dying-patients-protest-looming-telehealth-crackdown/ 29. World Federation of Right to Die Societies. Providing legal assisted dying and euthanasia services in a global pandemic: provider experiences and lessons for the future [Internet]. [s.l.]: World Federation of Right to Die Societies; 2021 Jan 31 [cited 2026 12 Oct]. Available from: https://wfrtds.org/wp-content/uploads/2021/02/Report-PAM-Survey-FINAL-.pdf 30. Crown Prosecution Service. Suicide: policy for prosecutors in respect of cases of encouraging or assisting suicide [Internet]. [s.l.]: Crown Prosecution Service; 2010 Feb updated 2014 Oct 16 [cited 2026 12 Oct]. Available from: https://www.cps.gov.uk/prosecution-guidance/suicide-policy-prosecutors-respect-cases-encouraging-or-assisting-suicide 31. United Kingdom. House of Lords. R (on the application of Purdy) v Director of Public Prosecutions [2009] UKHL 45. London, Jul 30, 2009 [cited Oct 12, 2026]. Available from: https://www.bailii.org/uk/cases/UKHL/2009/45.html 32. Dignitas. Accompanied suicide of members of DIGNITAS, by year and by country of residency 1998–2025 [Internet]. Zurich: Dignitas; 2025 [cited 2026 12 Oct]. Available from: https://dignitas.ch/wp-content/uploads/FTB-nach-Jahr-und-Domizil-1998-2025.pdf 33. Cabinet Office. Our plan to rebuild: the UK Government's COVID-19 recovery strategy [Internet]. London: HM Government; 2020 May 11 [cited 2026 12 Oct]. Available from: https://www.gov.uk/government/publications/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy 34. United Kingdom. House of Commons. Coronavirus regulations: assisted deaths abroad. Hansard [Internet]. 2020 Nov 5 [cited 2026 12 Oct];683. Available from: https://hansard.parliament.uk/Commons/2020-11-05/debates/A10D8E3C-C301-4163-890F-775B6E48F192/CoronavirusRegulationsAssistedDeathsAbroad 35. United Kingdom. House of Lords. Covid-19 regulations: assisted deaths abroad. Hansard [Internet]. 2020 Nov 10 [cited 2026 12 Oct];807. Available from: https://hansard.parliament.uk/Lords/2020-11-10/debates/9907DD7E-0857-41DA-A35E-D8B7DFEB3C12/Covid-19RegulationsAssistedDeathsAbroad 36. United Kingdom. The Health Protection (Coronavirus, International Travel) (England) Regulations 2020, SI 2020/568, 2020 Jun 2. Public health, England. London: The National Archives [cited 2026 12 Oct]. Available from: https://www.legislation.gov.uk/uksi/2020/568/contents/made 37. Clark P, Harding R, Chazan G, Dombey D, Shepherd C, Hughes L, et al. Britain's open borders make it a global outlier in coronavirus fight. Financial Times [Internet]. 2020 Apr 16 [cited 2026 12 Oct]. Available from: https://www.ft.com/content/91dea18f-ad0e-4dcb-98c3-de836b1ba79b?syn-25a6b1a6=1 38. Gregory A. My Dignitas flight to beat lockdown. The Times [Internet]. 2020 Oct 31 [cited 2026 12 Oct]. Available from: https://www.thetimes.com/uk/healthcare/article/my-dignitas-flight-to-beat-lockdown-m3gqtcsv7 39. SWI swissinfo.ch. Swiss impose entry ban for travellers from UK and South Africa [Internet]. 2020 Dec 21 [cited 2026 12 Oct]. Available from: https://www.swissinfo.ch/eng/politics/swiss-impose-entry-ban-for-travellers-from-uk-and-south-africa/46237718 40. My Death My Decision. Covid-19 has exposed the need for a review of our assisted dying laws, says MDMD to parliamentary human rights committee [Internet]. London: My Death My Decision; 2021 Jan 12 [cited 2026 12 Oct]. Available from: https://www.mydeath-mydecision.org.uk/2021/01/12/covid-19-has-exposed-the-need-for-a-review-of-our-assisted-dying-laws-says-mdmd-to-parliamentary-human-rights-committee/ 41. General Medical Council. When a patient seeks advice or information about assistance to die [Internet]. London: General Medical Council; 2013 Jan 31 [updated 2024 Dec 13; cited 2026 12 Oct]. Available from: https://www.gmc-uk.org/professional-standards/the-professional-standards/when-a-patient-seeks-advice-or-information-about-assistance-to-die 42. General Medical Council. Guidance for the Investigation Committee and case examiners when considering allegations about a doctor's involvement in encouraging or assisting suicide [Internet]. London: General Medical Council; 2013 Jan [cited 2026 12 Oct]. Available from: https://rcem.ac.uk/wp-content/uploads/2021/11/Guidance_for_Investigation-Committee_When_Considering_Allegations_About_a_-Doctor.pdf 43. British Medical Association. Responding to patient requests for assisted dying: guidance for doctors [Internet]. London: British Medical Association; 2019 Jun [cited 2026 12 Oct]. Available from: https://www.bma.org.uk/media/ob5pfuz0/bma-responding-to-patient-requests-for-assisted-dying-20250074.pdf 44. Royal College of Nursing. When someone asks for your assistance to die: RCN guidance on responding to a request to hasten death [Internet]. London: Royal College of Nursing; 2016 [cited 2026 12 Oct]. Available from: https://www.rcn.org.uk/-/media/Royal-College-Of-Nursing/Documents/Publications/Obselete/2021/April/005822.pdf 45. Vermont. An act relating to modifications to Vermont's patient choice at end of life laws, S.74 (Act 97), 2022 Apr 27. Vermont General Assembly [cited 2026 12 Oct]. Available from: https://legislature.vermont.gov/bill/status/2022/S.74 46. Patient Choices Vermont. More Vermonters qualifying for medical-aid-in-dying [Internet]. [s.l.]: Patient Choices Vermont; 2024 Jan 1 [cited 2026 12 Oct]. Available from: https://www.patientchoices.org/news-events/more-vermonters-qualify-medical-aid-in-dying 47. Vermont Department of Health. Report concerning patient choice at the end of life [Internet]. Burlington: Vermont Department of Health; 2024 Jan 15 [cited 2026 12 Oct]. Available from: https://legislature.vermont.gov/assets/Legislative-Reports/Patient-Choice-Legislative-Report-Final.pdf 48. Washington State. Washington Administrative Code, chapter 246-978. Death with Dignity Act requirements. Olympia: Washington State Legislature [cited 2026 12 Oct]. Available from: https://app.leg.wa.gov/wac/default.aspx?cite=246-978 49. Washington State. HB 1876, 2025-26 regular session. Concerning the requirements for accessing the Washington death with dignity act. Olympia: Washington State Legislature, 2025 Feb 7 [cited 2026 12 Oct]. Available from: https://app.leg.wa.gov/billsummary?BillNumber=1876&Year=2025 50. Center for Health Statistics, Disease Control and Health Statistics.. Report to the Legislature - 2024 Death with Dignity [Internet]. Olympia: Washington State Department of Health; 2025 Jul [cited 2026 12 Oct]. Available from: https://app.leg.wa.gov/ReportsToTheLegislature/Home/GetPDF?fileName=2024%20Death%20With%20Dignity%20Report_c04f2cd1-b32a-45a2-a0b3-a1d0e09ec986.pdf
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