A public health perspective on assisted dying and its different modalities

Assisted dying (encompassing euthanasia and assisted suicide) has emerged as a legally sanctioned option for end-of-life care in an increasing number of countries. Over 200 million people now live in jurisdictions permitting some form of assisted dying, with at least 12 countries having implemented national or subnational legislation as of May, 2025. Legal frameworks, terminology, and procedures remain highly heterogeneous, affecting how assisted dying is perceived, delivered, and monitored. Terminological variation and the absence of specific ICD codes impede international data comparability, limiting public health surveillance and cross-country learning. In jurisdictions permitting both euthanasia and assisted suicide, euthanasia accounts for most assisted deaths, suggesting that system-level factors, such as integration into hospital-based care, procedural routines, and access barriers, might shape uptake alongside individual preferences. Socioeconomic inequalities further influence access to assisted dying and broader end-of-life care, highlighting persistent equity challenges. This Viewpoint emphasises the need for harmonised terminology, transparent and comparable data, and clear standards of care to support ethical, equitable, and patient-centred implementation. Strengthening these foundations is essential for evidence-based policy and the responsible integration of assisted dying into public health systems.