The debate on medical aid in dying (MAID) or assisted dying in Portugal was revived around 10 years ago, after the creation of a civic movement for its decriminalization in 2015, and the public manifesto and petition to parliament (Assembleia da República, AR) that followed.
Following the debate on this petition in the AR, several parties presented bills. Their first vote in parliament took place in 2018, and the bills were rejected by just 5 votes. New proposals followed, from 5 parties, submitted to the AR in 2020, this time approved by a majority of 128 deputies out of 230. Merging of these proposals into one in January 2021 led to its approval by 136 deputies: for the first time in Portuguese history there was a decree favorable to MAID (Decree 109/XIV).
The parties in favor of the law were mostly left-wing (the exception was the Communist Party), which was joined by some right-wing liberals. The Decree essentially followed Dutch law but denied the possibility of MAID for minors under 18 and patients with a psychiatric illness.
The Decree was submitted to the President of the Republic (PR), a recognized opponent of the decriminalization of MAID, who sent it to the Constitutional Court (Tribunal Constitutional, TC), for preventive inspection, in March 2021. To make a long story short, between 2021 and 2023 the AR approved the assisted dying law 5 times, with the PR continuously opposing the law: with two vetoes for unconstitutionality, one political veto and the final devolution to AR. Finally, in May 2023, when he reached the limit of vetoes, the President finally enacted the law decriminalizing MAID, designated Law 22/2023 of May 25.
At this stage, the law, unlike previous versions, had established that voluntary euthanasia would only be carried out if the patient was unable to undergo “medically assisted suicide”; that is, the mode of self-administering by the patient of MAID was considered the norm and the mode of voluntary euthanasia, that is administering by the doctor, the exception, only possible in certain situations.
Over the years, the debate has led to an increase in the number of people who have made their living will (already legal since 2012) and the approval of a law that facilitated the use of terminal palliative sedation. However, a popular initiative for a referendum on the law was rejected in AR plenary.
The law should have been regulated (practical procedures established) after its approval and before it comes into force, but this was not done. The political instability that followed its approval, with the fall of two governments in November 2023 and in March 2025 further postponed the issue, aggravated by the fact that there was a change from a left-wing government to a right-wing one, which did not want to enact the law. They said they were waiting for results from the request for successive inspection of the law by the TC, raised by a group of conservative deputies, after the law was approved, and by the Provedoria de Justiça.
This TC ruling was issued on April 22, 2025. The court again recognizes that it is not unconstitutional to legislate MAID and considers only 3 articles unconstitutional, mainly related to procedural issues, without compromising fundamental standards which may require mere formal correction of the law according to some constitutionalists.
The country is engaged in a campaign for new legislative elections on May 18, 2025, and it is uncertain whether there will be a majority capable of moving forward with the correction and regulation of Law 22/2023 of May 25. The regulation may still face setbacks, depending not only on the majority that will exist in parliament, but also on the way it is presented by the government and whether it must be evaluated again by the PR and TC.
After 10 years of fighting, a law decriminalizing MAID has been passed, perhaps a more limited version than expected, but still an important achievement for our democracy. The law needs to be implemented into practice. Although we are on the right track, the goal still seems distant, unfortunately.
Gilberto Couto, MD
Degree in Medicine and Philosophy
Member of Comissão Coordenadora do Movimento «Direito a Morrer com Dignidade» Portugal
Portugal