Dániel Karsai, a prominent human rights lawyer in Budapest, Hungary, unsuccessfully argued that the criminalisation of physician-assisted dying (PAD) violated his rights under Articles 8 (right to respect for private and family life) and 14 (prohibition of discrimination) of the European Convention on Human Rights.

Mr Karsai has advanced amyotrophic lateral sclerosis (ALS), a type of motor neurone disease with no known cure. He has advocated for his right to decide when and how to die before his illness reaches a stage that he finds intolerable.

Under Hungarian law, anyone assisting him would risk prosecution, even if he died in a country which allows physician-assisted dying. He complained to the ECtHR 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compared to terminally ill patients on life-sustaining treatment who are able to ask for their treatment to be withdrawn.

In today’s Chamber judgment, 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 Council of Europe member states continue to prohibit both medically assisted suicide and euthanasia, the court observed.

Because of this, Hungary has wide discretion, and the Strasbourg 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.

However, the court acknowledged that the ECHR has to be interpreted and applied in the light of the present day, meaning the need for appropriate legal measures should 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, 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.

This is 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 was objectively and reasonably justified.