365 Pr egledni znans tv eni članek/ Article (1.02) Bogoslovni vestnik/Theological Quarterly 84 (2024) 2, 365—376 Besedilo pr eje t o/R eceiv ed:03/2024; spr eje t o/ Accep t ed:10/2024 UDK/UDC: 179.7(4-6EU) DOI: 10.34291/B V2024/02/ Ahlin © 2024 Ahlin Doljak, CC B Y 4.0 Sara Ahlin Doljak Voluntary Termination of Life and Conscientious Objection: A Comparative Review within the European Union and Slovenia Prostovoljna prekinitev življenja in ugovor vesti: primerjalni pregled v Evropski uniji in Sloveniji Abstract: This r e vie w analy ses euthanasia and ph y sician-assis t ed dea th acr oss the Eur opean Union (EU) t o e x amine their leg al par ame t er s and e thic al c oncerns. Ultima t ely , it c ompar es Slo v enia’ s leg al fr ame w ork t o tha t of EU member s t a t es in various regions. Only a few western EU member states legally allow euthanasia or physician- assis t ed suicide. Not able e x amples include Belgium, the Ne therlands, Lux em- bour g , and Spain. Ph y sician-assis t ed suicide, specific ally , is leg al in S witz erland, Germany, and Austria, while Portugal is also progressing toward legalizing euthanasia. These c oun tries ha v e enact ed la w s either permitting euthanasia in specific c ases or allo wing assis t ed suicide under s trict c onditions. On the other hand, southeastern and northern EU members, such as Finland, Bulg aria, and Slov enia, r emain opposed t o euthanasia and assis t ed suicide. Their opposition s t ems fr om his t oric al and cultur al f act or s, along with pr e v ailing be- lie f s r eg ar ding the sanctity of lif e and the r ole of medicine in end-of -lif e c ar e. The popula tions of these c oun tries ar e witnessing incr eased deba t e o v er the issue, particularly among those adv oc a ting f or t erminally ill pa tien ts’ righ t t o die with dignity. However, the legal framework in most of these countries re- mains unchang ed, with no sign ific an t leg al pr o visions f or euthanasia or ph y si- cian-assisted suicide. The curr en t g ener a tions in c oun tries wher e euthanasia is deba t ed ar e begin- ning t o sho w gr o wing support f or the pr actice. This shift r e flects e v olving vie w s on pa tien t aut onom y and suff ering a t the end of lif e. E thic al c oncerns, how e v er , persist across the EU, with divergent views on the legality and morality of such pr actice s. The f our bioe thic al pr inciple s – aut onom y , be ne fice nce , non-male fi- cence, and jus tice – pr o vide a fr ame w ork f or assessing these issues. Ne v erthe- less, the ultima t e decision on whe ther t o implemen t such pr actices in Slo v enia will r es t with its legisla tur e, which is r esponsible f or dr a fting healthc ar e-r ela t ed la w s and r egula tions. 366 Bogoslovni vestnik 84 (2024) • 2 Keywords: euthanasia, ph y sician-assis t ed dea th, c onscien tious objection, Slo v enia, EU law, bioethics Povzetek: Prispe v ek obr a vna v a e v t anazijo in pomoč pri pr os t o v oljnem k onč anju življenja v E vr op ski uniji (EU) t er pr oučuje z njima po v e z ane pr a vne okvir e in e tične pomislek e. Primerja tudi slov enski pr a vni okvir s tis tim v drž a v ah članic ah EU iz r azličnih r egij. Le nek aj z ahodnih drž a v članic EU e v t anazijo ali pomoč pri pr os t o v oljnem k onč anju življenja do v oljuje v okviru z ak onoda je. Gr e z a drž a v e Beneluk sa (Belgijo , Niz o z emsk o , Luk sembur g) in Španijo. P omoč pri pr os t o v olj- nem k on č anju življenja je uz ak onjena v Š vici (ni članic a EU), N emčiji in A v s triji; k njeni leg aliz aciji se pomik a tudi P ortug alsk a. Z ak onodaja t eh drž a v v specifič- n i h p ri meri h b o d i si d o v o l ju j e e v t an azi j o b o d i si o mo g o č a p o mo č p ri p r o s t o v o l j- nem k onč anju življenja pod s tr ogimi pog oji. P o drugi s tr ani jug o v zhodne in se v erne članice EU – k ot so Finsk a, Bolg arija in Slo v enija – e v t anaziji, pa tudi pomoči pri pr os t o v oljnem k onč anju življenja še vedno nasprotujejo. Njihovo nasprotovanje izhaja iz zgodovinskih in kulturnih deja vnik o v t er pr e vladujočih pr eprič anj o s v e t os ti življenja in vlogi medicine pri oskrbi ob k oncu življenja. Pr ebiv alci t eh drž a v so prič a in t enzivnim r azpr a v am o t ej t em i, zlas ti med tis ti- mi, ki z ag o v arjajo pr a vic o t erminalno bolnih pacien t o v do dos t ojne smrti. Pr a v- ni ok v ir v v e čini t e h dr ž a v os t aja ne spr e me nje n, tj. br e z bis tv e nih pr a v nih do- ločil v prid e v t anaziji ali pomoči pri pr os t o v oljnem k onč anju življenja. Gener a- cije v drž a v ah, kjer se o evt anaziji r azpr a vlja, t ej pr ak si z ačenjajo izk az ov a ti podpor o , ki nar ašč a. T a spr ememba odr až a spr eminjajoče se poglede na a v t o- nomijo pacie n t o v in tr plje nje ob k oncu življe nja. V e ndar pa e tični pomisle k i po v sej EU os t ajajo , saj glede z ak onit os ti in mor alnos ti t ak šnih pr ak s ob s t ajajo r az- lični pog le di. Ok v ir z a oce nje v anje t e h v pr ašanj nudijo š tir i bioe tična nače la – a v t onomija, dobr obit, nešk odo v anje in pr a vičnos t. Kljub t emu bo k ončna odlo- či t e v o t em, al i t ak šn e p r ak se v S l o v en i ji u v es ti, p r ep u ščen a n j en emu z ak o n o- d aj al cu , ki j e o d g o v o r en z a o b l i k o v an j e z ak o n o v i n p r ed p i so v s p o d r o čj a z d r a- vstvenega varstva. Ključne besede : e v t anazija, pomoč pri pr os t o v oljnem k onč anju življenja, z a vr ač anje pomoči, Slo v enija, pr a v o EU , bioe tik a 1. Introduction The t opic of v olun t ar y t e r m ina tion of lif e , c om m only r e f e r r e d t o as e uthanasia, is a sensiti v e issue tha t elicits opp osing vie w s acr oss v arious cultur al and leg al c on- t e x ts. Euthanasia is de fined as the in t en tional ending of a per son’ s lif e b y a me- dic al pr actitione r —pr e dominan tly ph y sicians—a t the e xplicit r e que s t of the pa ti- en t. The primar y r a tionale behind this pr actice is t o alle via t e unbear able suff ering e xperienced b y pa tien ts in critic al c onditions with no pr ospect of impr o v emen t (V an den Ber g e t al. 2022). 367 367 Sara Ahlin Doljak - Voluntary Termination of Life ... In line with the bioe thic al principle of aut onom y , Cambr a-Badii e t al. (2021) emphasiz e tha t euthanasia is mor ally jus tified as it empo w er s pa tien ts t o de t er- mine their f a t e, particularly during times of immense suff ering. This appr oach aligns with the principle of bene ficence, which enc our ag es healthc ar e pr o vider s t o mak e decisions tha t ma ximiz e pa tien t w elf ar e (Morrison and Air d 2020). Whi- le the pr ocedur e c an r elie v e pa tien ts of pain, it ma y inadv ert en tly c ause suff ering for their loved ones, thus raising concerns related to the bioethical principle of nonmale ficence, which r equir es healthc ar e s tr a t egies t o a v oid harming pa tien ts and their f amilies (2020). The men t al health impacts on friends and f amilies of pa tien ts who choose assis t ed dea th further c omplic a t e this e thic al landsc ape. Mor eo v er , this discussion mus t also inc orpor a t e the principle of jus tice, as it highligh ts the need f or equit able access t o euthanasia and the pot en tial dispari- ties in ho w diff er en t c oun tries implemen t these la w s. The c on flicting bioe thic al principles oft en lead t o e thic al dilemmas in clinic al se ttings. Despit e these c on- cerns, v olun t ar y t ermina tion of lif e is incr easingly r ec ogniz ed and applied, parti- cularly in w es t ern c oun tries. Euthanasia pr actices ha v e been in t egr a t ed in t o he- althcare systems in Europe, Australia, and North America, although Fontalis et al. (2018) not e signific an t v aria tions in how these pr actices ar e tr ea t ed acr oss na tions. Richar dson (2023) r aises additional c oncerns r eg ar ding inc onsis t encies in nur sing policies and guidelines, sug g es ting a lack of clear pr ocedur es. This article aims t o pr o vide a c ompr ehensiv e under s t anding of euthanasia, its applic a tion, and the le g al fr am e w or k s g o v e r ning it on an in t e r na tional sc ale , w ith a f ocus on Eur opean c oun tries. It will analy se the implemen t a tion of euthanasia within the Eur opean Union (EU) and off er a c ompar a tiv e r e vie w be tw een Slo v enia and other EU member states. This comparison will enable an assessment of the e ff ectiv eness of v arious euthan asia fr ame w ork s in Eur ope, po t en tially ser ving as benchmark s f or Slov enia t o dev elop appr opria t e and e ff ectiv e policies on this sensitiv e issue in the futur e. The mor al dilemma surr ounding euthanasia oft en leads t o the pr ovision f or c onscie n tious obje ction, allo wing pr actitione r s t o r e fuse t o pe r f or m spe cific du- ties based on per sonal belie f s. De Londr as e t al. (2023) de fine c onscien tious objec- tion as the r e fusal t o c arr y out leg ally sanctioned r oles and r esponsibilities tha t c on flict with on e’ s e thic al princ iples. F or e x ample, some ph y sicians ma y vie w v o- lun t ary t ermina tion of lif e as inc ompa tible with their e thic al v alues, cultur al norms, or w orldvie w , leading them t o decline participa tion in such pr ocedur es. A c ode of e thic s, such as the In t erna tional Code of E thics f or Nur ses (ICN), al- lo w s healthc ar e pr of essionals t o withdr a w fr om c ar e if a pr oposed action viola t es the ir m or al in t e g r ity (G r ac e e t al. 2 0 2 3 ). Le g al fr am e w or k s also suppor t c onsc ie n- tious objection in nur sing , pr ot ecting the e thic al principles of healthc ar e w ork er s. However, balancing respect for healthcare providers’ moral beliefs with ensuring pa tien t access t o leg ally a v ailable medic al ser vices is import an t. Thus, stakeholders must advocate for a more inclusive approach that encoura- g e s g r e a t e r nur se par tic ipa tion in t he de c ision-m ak ing pr oc e ss w hile s t r iv ing f or 368 Bogoslovni vestnik 84 (2024) • 2 c onsis t ency in the applic a tion of euthanasia acr oss Eur opean c oun tries. This w ould enhance the e thic al and leg al clarity of euthanasia pr actices, emphasizing tha t s y s t ems with mor e e fficien t euthanasia pr ocesses ar e not inher en tly superior . The goal should be to ensure consistency, compassion, and ethical integrity in the ap- plic a tion of euthanasia la w s acr oss diff er en t na tions. 2. Methodology The lit er a tur e sear ch will be s y s t ema tic and c ompr ehensiv e t o ensur e tha t the study incorporates credible, recent, and relevant sources to understand the phe- nomenon. The s tudy will f ocus on peer -r e vie w ed journal articles and g o v ernmen t r ec or ds (w eb sit es) t o g a ther k e y pr emises t o under s t and the applic a tion of eutha- nasia and c onscien tious objection. It pr e f er s peer -r e vie w ed sour ces bec ause the y are credible. Concisely, peer review allows scholars to evaluate their colleagues’ scholarly work to ensure that they meet the prerequisites to be published and con- sumed in schoo ls and pr of essio nal se ttings (Ha ff ar e t al. 2019). The g o v ernmen t r ec or ds also pr esen t cr edible da t a, including census and medic al in f orma tion, whi- ch c ould be used in the r e vie w . When in f orma tion is sc ar ce, c onsidering tha t not man y peer -r e vie w ed articles t alk about the pr ocedur e in Slo v enia, the r esear cher will use cr edible w eb sit es, especially fr om ne w s ag encies. In addition, the r e vi- ew will target sources that are not more than eight years old. The plan is to have mos t of the sour ces published thr ee y ear s ag o t o off er the la t es t e vidence about the phenomenon under study. Furthermore, the review will only target sources writt en in English. Articles writt en in f or eign languag es w ould r equir e tr ansla tion, which c ould be t edious and time-c onsuming. The r esear cher c ould also lose the original t e x t ’ s meaning thr ough tr ansla tion due t o omission and c ommission. The criteria will ensure that the review uses credible sources. The sear ch s tr at egy in the dat abases will be specific to ensur e that the r eview gets relevant sources. The research will obtain most of the scholarly work from Scopus Pr eview and its associat es lik e Elsevier Publication. The r esear cher will use k eyw or ds and phrases while searching the journals in the databases, which Table 1 highlights. Some of the not able k eyw or ds ar e euthanasia, v olun t ary t ermina tion of lif e, c onsci- en tious objection, EU c oun tries, and Slov enia. The r esear cher will use Boolean ope- rators like and, or, and not to combine the keywords to form phrases that would yi- eld c omple t e out c omes (the mos t r ele v an t sour ces). The r esear cher will sc an the sour ces t o r emo v e those tha t ar e t oo g ener al t o addr ess the r e vie w ’ s objectiv e adequately. Following this approach will increase the reliability of the sources. Keywords Key Phrases Euthanasia Applic a tions of euthanasia V olun t ar y t ermina tion of lif e The e thic al principles of v olun t ar y t ermina tion of lif e Conscien tious objection Ethical dilemmas that arise from euthanasia EU countries The applic a tion of c onscien tious objection 369 369 Sara Ahlin Doljak - Voluntary Termination of Life ... Slovenia The implemen t a tion of c onscien tious objection in EU c oun tries E ffic acy The implemen t a tion of c onscien tious objection in Slov enia Euthanasia la w s/legisla tion The EU la w s and r egula tions of euthanasia V olun t ar y t ermina tion of lif e la w/ legisla tion Slo v enia la w s and r egula tions of euthanasia and c onscien tious objection 3. European Union Framework 3.1 Legislation Overview Some EU member states have legalized euthanasia and physician-assisted suicide, sug g es ting tha t the c oncep t has g ained accep t ance in cert ain healthc ar e s y s t ems. However, this acceptance is not universal across all EU countries. While Emanuel et al. (2016) indic a t e tha t ther e has been gr owing support f or euthanasia, particularly in western Europe, this view requires more nuance. It is important to note that Scandinavian countries, despite having some of the most advanced and socially c onscious healthc ar e s y s t ems in Eur ope, ar e firmly opposed t o euthanasia. This opposition i n Sc andi na vi a demons tr a t es tha t the r esis t ance t o euthanasi a i s not exclusive to Central and Eastern European countries, where ethical and cultural v alues ma y also pla y a signific an t r ole. The claim that most EU states do not support physician-assisted suicide is in- c orr ect. In r eality , wher e euthanasia is leg aliz ed, ph y sician-assis t ed suicide is oft en leg aliz ed as w ell. Coun tries lik e Belgium, Lux embour g , the Ne therlands, and Spa- in ha v e la w s tha t permit both pr actices (Shenouda e t al. 2024) S witz erland is not part of the EU , though it allo w s ph y sician-assis t ed suicide under its o wn legisla ti- on. While Emanuel e t al. (2016) r eport tha t o v er 60% of euthanasia c ases in the Ne therlands and mor e than 50% in Belgium in v olv e ph y sician-assis t ed suicide, the pr ocedur e is primarily c onduct ed f or t erminally ill pa tien ts, particularly those with c ancer (Cheung e t al. 2020). Ho w e v er , this does not necessarily imply tha t mos t western EU countries fully embrace euthanasia, as ethical debates and legal re- s trictions c on tinue t o shape its applic a tion. S e v er al EU member s t a t es ha v e i n tr oduced l egi sla tion t o r egul a t e euthanasi a under specific c onditions. Acc or ding t o a 2017 r eport b y the Eur opean P arliamen t, euthanasia la w s diff er acr oss EU c oun tries. A t tha t time, euthanasia w as illeg al in It aly , wher e it w as punishable under Articles 579 and 580 of the Cons titution (Eu- r opean P arliamen t 2017; Marr one e t al. 2022). Ho w e v er , c oun tries such as the Ne therlands, Belgium, and Lux embour g ha v e alr eady leg aliz ed activ e euthanasia (Eur opean P arliamen t 2017). On the other hand, na tions lik e German y , S w eden, and Spain allo w ed the withdr a w al of lif e-sus t aining tr ea tmen ts—a pr actice tha t is oft en r e f err ed t o as passiv e euthanasia but is e thic ally dis tinct fr om euthanasia. The t e r m “passiv e e uthanasia” is pr oble m a tic and should be a v oide d. E thic is t s lik e P r of . T r on t e lj (2011) ha v e ar g ue d tha t this t e r m unjus tifiably include s e thic al- ly accep t able actions, such as disc on tinuing tr ea tmen t a t the end of lif e. These 370 Bogoslovni vestnik 84 (2024) • 2 pr actices ar e fu ndamen t ally diff er en t fr om euthanasia, wher e the in t en tion is t o activ ely end a pa tien t ’ s lif e. V ari a tio n s i n n a tio n al p o l i ci es o n eu th an asi a ari se p artl y d u e t o Articl e 2 o f th e EU Charter of Fundamental Rights, which guarantees the right to life but includes pr o visions tha t allo w fle xibility in member s t a t es’ legisla tion on euthanasia, par- ticularly in the c on t e x t of deg ener a tiv e illnesses (Eur opean P arliamen t 2017). Le- g al c ases in some Eur opean c oun tries ha v e se t pr eceden ts f or permitting assis t ed dea ths under s trict c onditions. F or e x ample, in It aly , sen t ence 242/2019 fr om the Cons titutional Court allo w s citiz ens t o r eques t medic ally assis t ed suicide under stringent requirements, such as having an irreversible and painful long-term con- dition while r e t aining men t al c apacity (Marr one e t al. 2022). In the Ne therlands, the pa th t ow ar d euthanasia’ s leg aliz a tion beg an in 1973, with the Supr eme Court ’ s 1984 decision giving doct or s the leg al manda t e t o end a pa tien t ’ s lif e upon r eques t, pr o vided cert ain c onditions ar e me t (Mr o z e t al. 2021). These examples highlight the diversity in how euthanasia is addressed across Europe. Some countries have opted for more permissive frameworks, while others main t ain s trict pr ohibitions, r e flecting the c omple x e thic al, cultur al, and leg al di- mensions of this issue. 3.2 Ethical Considerations The discussion up t o this poin t has f ocused lar g ely on the leg aliz a tion of euthana- si a. Ho w e v er , an o th er cri tic al asp ect th a t en t er s th e d eb a t e i s th e i ssu e o f c o n sci- en tious objection. As the pr actice of euthanasia bec omes mor e widespr ead, so too does the need to consider the rights of healthcare providers who may oppose participa ting in the pr ocedur e due t o e thic al or mor al c oncerns. Ther e ar e v arious ethic al c onsider a tions surr ounding c onscien tious objection in the c on t e xt of v olun t ary lif e t ermina tion. The in tr oduction section summariz es the main ethic al principles and deba t es surr ounding the action. Not ably , r es tricting pa- tien ts fr om r eques ting euthanasia or v olun t ary lif e t ermina tion denies them inde- pendence, which violates the bioethical principle of autonomy. This principle recom- mends that ph ysicians prioritiz e solutions that enhance the patient ’ s autonom y (Cam- br a-Badii et al. 2021). One w a y t o achiev e this is by allowing pa tien ts t o mak e cruci- al decisions about their c ar e or tr ea tmen t r egimens r egularly (K arlsen et al. 2020). Ho w e v er , the is sue bec omes mor e c omple x with the in tr oduc tion of c onscien- tious objection, as it r aises t ensions be tw een the aut onom y of the pa tien t and the e thic al in t egrity of healthc ar e pr of essionals. V alenz uela-Almada e t al. (2020) ar gue tha t c ons cien tious objection c an viola t e the bioe thic al principle of nonma- le ficence, as it ma y c ompel t erminally ill pa tien ts t o endur e pain un til dea th, den ying them a dignified end of lif e. Euthanasia c ould be seen as a mer ciful appr o- ach tha t r eliev es suff ering , y et the decision of a healthc ar e pr ovider t o r e fuse participa tion based on c onscience poses signific an t e thic al challeng es. De Lond r as e t al. (2022) c on t end tha t c onscien tious objectio n is mor ally jus ti- fied when vie w ed fr om a huma nis tic per spectiv e. The y ar gue tha t artificially t er- 371 371 Sara Ahlin Doljak - Voluntary Termination of Life ... mina ting a per son’ s lif e, which c onscien tious objection seek s t o pr e v en t, is inhe- r en tly une thic al. Mor eo v er , Manduc a-Bar one e t al. (2022) highligh t tha t c onsci- en tious objection c an help addr ess e thic al c oncerns r ela t ed t o euthanasia and ph y sician-assis t ed suicide, such as the pot en tial f or pa tien ts t o f eel c oer ced in t o accep ting these pr ocedur es due t o the high c os ts of ong oing medic al c ar e. The deba t e on c onscien tious objection r e v eals the divisiv e na tur e of this issue. Bano vić e t al. (2017) c onduct ed a r esear ch s tudy in Serbia (it is not a member of the EU) tha t f ound 56.8% of ph y sicians belie v e activ e euthanasia is e thic ally una- ccep t able, while 43.2% support ed alt erna tiv e solutions. This s tudy , along with the pr e vious ar gumen ts, demons tr a t es wh y some pr actitioner s ma y choose t o e x er- cise c onscien tious objection. 3.3 Case Studies of Euthanasia and Conscientious Objection Belgium has s trict r egula t or y fr ame w ork s tha t limit c onscien tious objection. The c o u n tr y i s amo n g th e E u r o p ean n a tio n s th a t h a v e fu l l y emb r aced eu th an asi a an d ph y sician-assis t ed suicide. Belgian la w s t a t es tha t a per son mus t be in a se v er e med i c al c o n d i tio n an d e xp eri en ci n g i mmen se p ai n t o q u al i f y f o r en d - o f -l i f e p r o- cedur es (V erhof s t adt e t al. 2024). Ho w e v er , in 2020, Belgium in tr oduced a c on- tr o v er sial la w tha t limits pr actitioner s’ c onscien tious objection (ADF In t erna tional 2022). The la w pr e v en ts healthc ar e or g aniz a tions and pr actitioner s fr om en f or- cing policies tha t r e fuse the pr actice within their pr emises (ADF In t erna tional 2022). This amendmen t led t o the Eur opean Court of Human Righ ts challenging the T om Mortier v s. Belgium c ase, which applied the ne w pr o vision (ADF In t er- na tional 2022). While the Belgian Euthanasia Act does not c ompel ph y sicians t o perf orm euthanasia or r ela t ed pr ocedur es, it manda t es tha t pr actitioner s who r e fuse a r eques t mus t tr ans f er the pa tien t ’ s medic al files t o another pr of essional sug g es t ed b y the pa tien t (De Hert e t al. 2023). This demons tr a t es tha t Belgium main t ains a legisla tiv e pillar tha t allo w s c onscien tious objection, but the ong oing amendmen ts c ould limit or e v en er adic a t e its applic a tion. Spain is another c oun tr y with la w s r egula ting euthanasia, assis t ed suicide, and c onsci en tious objection. R ecen tl y , S pai n’ s Court of Jus tice and parl i amen t passed a bill that legalized assisted suicide and euthanasia for individuals with severe, incur able, and debilit a ting dise ases (Libr ar y of Congr ess 2021). Support er s of the bi l l ci t ed c ons titu tion al pri nci p l es, such as the ri gh t t o sel f -de t ermi na tion an d the freedom to make conscious decisions. Nevertheless, Spain lacks a comprehensive leg al fr amew ork f or c onscien tious objection (HC et al. 2022). The la w permits pr actitioner s t o decide whe ther t o participa t e in euthanasia or assis t ed suicide, but the y mus t e xpr ess their ob jection in writing in adv ance (2022). The discussi- ons r e v e al tha t m an y EU c oun tr ie s lac k thor oug h la w s and r e g ula tions t o suppor t c onscien tious objection, lea ving healthc ar e pr ovider s’ v alues and belie f s inadequa- tely protected. In c on tr as t, some EU c oun tries lik e Bulg aria ha v e s trict la w s tha t punish indivi- duals, including pr actitioner s, who assis t other s in c ommitting suicide, making 372 Bogoslovni vestnik 84 (2024) • 2 eu th an asi a i l l eg al . Bu l g ari a, l o c a t ed i n S o u th eas t ern E u r o p e, r el i es o n Arti cl e 97 of the Health Act t o ban euthanasia in hospit als and healthc ar e se ttings (OHCHR 2024). Additionally , Article 127 of Bulg aria’ s Criminal Code imposes 1 t o 6 y ear s of imprisonment for those who assist or persuade others to commit suicide, in- cl u d i n g h eal th c ar e p r o f es si o n al s ( 2024) . T h es e l a w s el i mi n a t e th e n eed f o r c o n- scien tious objection s t a tut es c oncerning euthanasia since the pr actice itself is il- leg al. Bulg aria’ s la w s also disallo w c onscien tious objection in g ener al healthc ar e, oblig a ting ph y sicians and other healthc ar e pr actitioner s t o perf orm their duties without allowing personal beliefs to interfere. Finland, another EU member s t a t e, does not ha v e e xplicit legisla tion on eutha- nasia, although a lar g e portion of the popula tion supports the c oncep t as an e thi- c al w a y t o end the suff ering of t erminally ill pa tien ts in se v er e pain (Nieminen 2018). Despit e the ab sence of specific euthanasia la w s, Finland permits passiv e euthanasia under s trict c onditions (Bello and Hur s t 2022; K on tr o 2023). In such c ases, pa tien ts suff ering fr om incur able and pain ful diseases mus t clearly and v o- lun t arily e xpr ess their wish not t o c on tinue with lif e-pr olonging tr ea tmen ts. Since Finland lack s c ompr ehensiv e legisla tion on euthanasia, it also does not ha v e la w s g ov erning c onscien tious objection r ela t ed t o the ma tt er , indic a ting tha t this aspect remains largely unexplored in the country. 4. The Case of Slovenia 4.1 Legislations and Guidelines Slo v enia has legisla tion and pr o visions tha t guide end-of -lif e c ar e, although eutha- nasia and ph y sician-assis t ed suicide r emain c on t en tious t opics. Despit e the g ener al politic al c onsensus ag ains t these pr actices, curr en t legisla tion pr omot es human dignity and a peace ful dea th, particularly f or t erminally ill pa tien ts. Specific ally , the P a tien ts’ Righ ts Act allo w s individuals in se v er e c onditions t o r eject tr ea tmen t or lif e-sus t aining measur es, e v en if doing so c ould lead t o their dea th (V oljč 2019). W hile this la w doe s not activ e ly pr omot e e uthanasia, it doe s pe r mit t e r minally ill pa tien ts t o die b y withholding or withdr a wing tr ea tmen ts, r a ther than thr ough activ e means. However, as of now, Slovenia does not formally entertain the concept of eutha- nasia or ph y sician-assis t ed suicide. On 7 th Mar ch 2024, the Na tional Assembly decisively rejected a proposal to introduce voluntary end-of-life assistance in he- a lt hc a r e (U Z 2 0 2 4 ). A ft e r in t e nse de ba t e , 6 4 m e m be r s v ot e d in f a v our of t he pr o- posal and 9 v ot ed ag ains t it (2024). Consequen tly , the pr oposal w as deemed un- suit able f or further legisla tiv e c onsider a tion. N e v e r t he le ss, a r e f e r e ndum he ld in 2 0 2 4 pr o v ide d a sig nific an t m om e n t in the public disc our se. A t a 41.43% v ot er turnout, 54.89% of participan ts v ot ed in f a v o- ur of legalizing assistance in voluntary end-of-life decisions. This referendum gran- t ed parliamen t an indir ect manda t e t o dr a ft and pass r ele v an t legisla tion. Ho w e- 373 373 Sara Ahlin Doljak - Voluntary Termination of Life ... v er , the r e f er endum ques tion w as c onsider ed br oad and some wha t misleading , which ma y ha v e in fluenced the r esults. Despit e these nuances, the r e f er endum carries more weight than prior public opinion surveys, such as one conducted earli er in 2024, which f ound tha t 63.5% of 1, 000 r esponden ts support ed eutha- nasia (The Slo v e nian Tim e s 2 02 4 ). Ho w e v e r , this sur v e y did not ac cur a t e ly r e fle ct the vie w s of the en tir e popula tion, making the r e f er endum a f ar mor e critic al in- dic a t or of public sen timen t. Although ther e ar e s till signific an t legisla tiv e and e thic al barrier s, this r e f er en- dum r e flects a gr o wing portion of the Slo v enian popula tion tha t supports the righ t t o v olun t ar y end-of -lif e decisions. It no w f alls on the legisla tiv e body t o r espond t o this shift in public opinion and c onsider the de v elopmen t of appr opria t e la w s governing euthanasia and physician-assisted suicide. 4.2 Ethical and Cultural Context The cultur al and his t or ic al v alue s in flue nce the imple me n t a tion and r e g ula tion of euthanasia in Slo v enia. Slo v enian c ommunities, including chur ches, nur sing pr o- fessional bodies, and legislators, have consistently opposed euthanasia despite some pe ople be lie ving in the suit ability of the pr oce dur e unde r spe cific cir cum- s t ances. Specific ally , the Slov enian Na tional Medics E thics Committ ee is ag ains t the pr actice as it giv es ph y sicians the po w er t o t ak e the liv es of people (V oljč 2019). In additi on, r epr esen t a tiv es of r eligious c ommunities signed a join t s t a t emen t in December 2023 t o v oice their disagr eemen t with euthanasia (S T A 2023). Similarly , the Pentecostal Church, the Evangelical church, the Islamic Community, the Jews, the Catholic Church, the Macedonian Orthodox Church, and the Serbian Ortho- do x Chur ch said euthanasia is an e thic ally unaccep t able measur e (Ag ensir 2023). The y enc our ag e ph y sicians t o adop t pallia tiv e c ar e f or t erminally ill individuals (2023). The le ade r s said tha t the le g al in tr oduction of assis t e d suicide w ould di- r ectly enc our ag e pa tien ts t o end their o wn liv es. Thus, the cultur al and his t oric al nor ms and v alue s in Slo v e nia pr e v e n t the le g aliz a tion of activ e e uthanasia, which w ould bring c onscien tious objection in t o pr actice (Sulmas y 2021; Globok ar 2023). 4.3 Comparative Analysis Con tr ar y t o some w es t ern Eur opean na tions, the analy sis of Slo v enia sho w s tha t the c oun tr y lack s clear leg al fr ame w ork s f or euthanasia and c onscien tious objec- tion. While fiv e EU c oun tr ie s—Be lgium, the N e the rlands, Lux e mbour g , Ge rman y , Spain, and P ortug al—ha v e leg aliz ed euthanasia, mos t EU member s t a t es do not ha v e specific la w s r egula ting the pr actice (T r ejo-Gabriel-Galá n 2024; Mangino e t al. 2020 ; Cala ti e t al. 2021). Claims tha t cert ain c oun tries «all o w partial euthana- sia but oppose ph y sician-assis t ed suicide en tir ely» ar e inaccur a t e and misleading. Ther e is no such thing as partial euthanasia, and the t erms should not be c on fu- sed. Euthanasia in v olv es the activ e t ermina tion of lif e, wher eas legitima t e r e fu- sal or withdrawal of life-sustaining therapy, as allowed by laws such as Slovenia’s P a tien ts’ Righ ts Act, should not be c on fla t ed with euthanasia (Mor ciniec 2020). This confusion can unnecessarily complicate an already heated ethical debate. 374 Bogoslovni vestnik 84 (2024) • 2 Coun tries lik e Belgium and the Ne therlands, which ha v e fully embr aced eutha- nasia, ha v e in tr oduced la w s tha t limit c onscien tious objection b y healthc ar e pr o- f essionals t o ensur e access t o euthanasia f or eligible pa tien ts (Monsalv e 2023). Slo v enia, ho w e v er , diff er s gr ea tly fr om c oun tries lik e Belgium, the Ne therlands, and Luxembourg. These countries have integrated euthanasia into their healthca- r e s y s t ems and ha v e policies tha t r es trict c onscien tious objection t o uphold the pa tien t ’ s righ t t o euthanasia. In c on tr as t, Slo v enia’ s leg al fr ame w ork r e flects its cultur al and r eligious v alues, which tr aditionally oppose the pr actice of ending another per son’ s lif e, e v en out of c ompassion (Sulmas y 2021). Coun tries such as It aly , Finland, and Bulg aria shar e Slo v enia’ s s t ance ag ains t the leg aliz a tion of euthanasia. It aly has not leg aliz ed euthana sia but allo w s pa ti- en ts t o r e fuse tr ea tmen t under the c ons titutional principle of aut onom y (Marr o- ne e t al. , 2022). Slo v enia also e mplo y s the P a tien ts’ Righ ts Ac t, but this la w is f o- cused on pa tien t aut onom y and the r e fusal of lif e-sus t aining tr ea tmen t, not par- tial euthanasia as w as mis t ak enly sug g es t ed. Dr . V oljč’ s in t erpr e t a tion emphasiz es this dis tinction be tw een the r e fusal of tr ea tmen t, which is a legitima t e pa tien t righ t, and euthanasia, which in v olv es the activ e t ermina tion of lif e (Globok ar 2023; Mor ciniec 2020). While Slovenia currently opposes euthanasia, it may eventually evolve to in- clude legisla tion tha t supports both euthanasia and c onscien tious objection, ba- lancing pa tien t righ ts with the aut onom y of healthc ar e pr o vider s. Lik e Slo v enia, Finland lack s euthanasia-specific la w s, as the politic al class in both c oun tries c on- sider s it a non-issue. Ho w e v er , public opinion is gr adually shifting , and citiz ens in both na tions ar e beginning t o under s t and and support the r a tionale behind as- sis t ed dying (Sulmas y 2021). 5. Conclusion To summarize, euthanasia is a controversial and divisive topic, explaining why co- un tries ha v e diff er en t la w s tha t g o v ern the pr actice. Coun tries tha t leg aliz e the pr ocedur e w an t t o r educe the suff ering of t erminally ill pa tien ts. Ne v ertheless, as- sis t ed dying (euthanasia) r aises some e thic al c oncerns, which either align with or contravene some bioethical principles. Despite the EU members entertaining the pr actice and in tr oducing r egula tions t o implemen t it partially , some c oun tries lik e Belgium ha v e c ompr ehensiv e law s tha t guide its e x ecution and c onscien tious objec- tion. Slov enia’ s curr en t sociocultur al and his t oric al v alues mak e it t ough f or the le- gisla tur e t o cr ea t e specific la w s tha t pr omot e euthanasia and allow c onscien tious objection. This situa tion denies the pa tien ts and pr actitioner s the aut onom y t o de- cide whether to apply the procedure or not. In the future, researchers can conduct an empiric al s tudy t o quan tify the per ceptions and opinions in Slov enia, particularly in the politic al spher e, tha t oppose the ins titution of la w s tha t allow euthanasia. 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