take it. there are also procedures forbidden by the hippocratic oath which are in common practice today, such as abortion and execution. declaration of geneva the declaration of geneva is a revision of the hippocratic oath, first drafted in 1948 by the world medical association in response to forced (involuntary) euthanasia, eugenics and other medical crimes performed in nazi germany. it contains, "i will maintain the utmost respect for human life." international code of medical ethics the international code of medical ethics, last revised in 2006, includes "a physician shall always bear in mind the obligation to respect human life" in the section "duties of physicians to patients". statement of marbella the statement of marbella was adopted by the 44th world medical assembly in marbella, spain, in 1992. it provides that "physician-assisted suicide, like voluntary euthanasia, is unethical and must be condemned by the medical profession." concerns of expansion to people with chronic disorders a concern present among health care professionals who are opposed to pas, are the detrimental effects that the procedure can have with regard to vulnerable populations. this argument is known as the "slippery slope". this argument encompasses the apprehension that once pas is initiated for the terminally ill it will progress to other vulnerable communities, namely disabled people, and may begin to be used by those who feel less worthy based on their demographic or socioeconomic status. in addition, vulnerable populations are more at risk of untimely deaths because, "patients might be subjected to pas without their genuine consent". catholicism the roman catholic church acknowledges the fact that moral decisions regarding a person's life must be made according to one's own conscience and faith. catholic tradition has said that one's concern for the suffering of another is not a sufficient reason to decide whether it is appropriate to act upon voluntary euthanasia. according to the catechism of the catholic church, "god is the creator and author of all life." in this belief system god created human life, therefore god is the judge of when to end life. from the roman catholic church's perspective, deliberately ending one's life or the life of another is morally wrong and defies the catholic doctrine. furthermore, ending one's life deprives that person and his or her loved ones of the time left in life and causes grief and sorrow for those left behind. pope francis is the current dominant figure of the catholic church. he affirms that death is a glorious event and should not be decided for by anyone other than god. pope francis insinuates that defending life means defending its sacredness. the roman catholic church teaches its followers that the act of euthanasia is unacceptable because it is perceived as a sin, as it goes against one of the ten commandments. as implied by the sixth commandment, "thou shalt not kill (you shall not kill)," the act of assisted suicide contradicts the dignity of human life as well as the respect one has for god. additionally, the roman catholic church recommends that terminally ill patients should receive palliative care, which deals with physical pain while treating psychological and spiritual suffering as well, instead of physician-assisted suicide. judaism while preservation of life is one of the greatest values in judaism, there are instances of suicide and assisted suicide appearing in the bible and rabbinic literature. the medieval authorities debate the legitimacy of those measures and in what limited circumstances they might apply. the conclusion of the majority of later rabbinic authorities, and accepted normative practice within judaism, is that suicide and assisted suicide can not be sanctioned even for a terminal patient in intractable pain. the church of jesus christ of latter-day saints the church of jesus christ of latter-day saints (lds church) is against assisted suicide and euthanasia, and anyone who takes part in either is regarded as having violated the commandments of god. however the church recognizes that when a person is in the final stages of terminal illness there may be difficult decisions to be taken. the church states that "when dying becomes inevitable, death should be looked upon as a blessing and a purposeful part of an eternal existence. members should not feel obligated to extend mortal life by means that are unreasonable". neutrality there have been calls for organisations representing medical professionals to take a neutral stance on pas, rather than a position of opposition. the reasoning is that this supposedly would better reflect the views of medical professionals and that of wider society, and prevent those bodies from exerting undue influence over the debate. the uk royal college of nursing voted in july 2009 to move to a neutral position on pas. the california medical association dropped its long-standing opposition in 2015 during the debate over whether a physician assisted suicide bill should be introduced there, prompted in part by cancer sufferer brittany maynard. the california end of life option act was signed into law later that year. in december 2017, the massachusetts medical society (mms) voted to repeal their opposition to physician-assisted suicide and adopt a position of neutrality. in october 2018, the american academy of family physicians (aafp) voted to adopt a position of neutrality from one of opposition. this is contrary to the position taken by the american medical association (ama), which opposes it. in january 2019 the british royal college of physicians announced it would adopt a position of neutrality until two-thirds of its members think it should either support or oppose the legalization of pas. in september 2021, the largest doctors union in the united kingdom, the british medical association, adopted a neutral stance towards a change in the law on assisted dying, replacing their position of opposition which had been in place since 2006. american medical association code of ethics the american medical association (ama) opposes physician-assisted suicide. in response to the ongoing debate about pas, the ama has issued guidance for both those who support and oppose physician-assisted suicide. the ama code of ethics opinion 5.7 reads that "physician-assisted suicide is fundamentally incompatible with the physician's role as healer" and that it would be "difficult or impossible to control, and would pose serious societal risks" but does not explicitly prohibit the practice. in the ama code of ethics opinion 1.1.7, which the ama states "articulates the thoughtful moral basis for those who support assisted suicide", it is written that outside of specific situations in which physicians have clear obligations, such as emergency care or respect for civil rights, "physicians may be able to act (or refrain from acting) in accordance with the dictates of their conscience without violating their professional obligations." attitudes of healthcare professionals it is widely believed that physicians should play a significant role, usually expressed as "gatekeeper", in the process of assisted suicide and voluntary euthanasia (as evident in the name "physician-assisted suicide"), often putting them at the forefront of the issue. decades of opinion research show that physicians in the us and several european countries are less supportive of the legalization of pas than the general public. in the us, although "about two-thirds of the american public since the 1970s" have supported legalization, surveys of physicians "rarely show as much as half supporting a move". however, physician and other healthcare professional opinions vary widely on the issue of physician-assisted suicide, as shown in the following tables. studypopulationwilling to assist pasnot willing to assist pas canadian medical association, 2011canadian medical association (n=2,125)16% 16 44% 44 cohen, 1994 (nejm)washington state doctors (n=938)40% 40 49% 49 lee, 1996 (nejm)oregon state doctors (n=2,761)46% 46 31% 31 studypopulationin favor of pas being legalnot in favor of pas being legal medscape ethics report, 2014u.s.-based doctors54% 54 31% 31 seale, 2009united kingdom physicians (n=3,733)35% 35 62.2% 62.2 cohen, 1994 (nejm)washington state doctors (n=938)53% 53 39% 39 a 2019 survey of us physicians found that 60% of physicians answered 'yes' to the question "should pas be legalized in your state?" the survey discovered that physicians are concerned about a possible "slippery slope". 30% agreed that "pas/aid would lead to the legalization of euthanasia" and 46% agreed that "health insurance companies would cover pas/aid over more expensive, possibly life-saving treatments, like chemotherapy". the survey also found that physicians generally misunderstand why patients seek pas. 49% of physicians agreed that "most patients who seek pas/aid do so because of physical pain", whereas studies in oregon found that "the three most frequently mentioned end-of-life concerns were loss of autonomy (89.5%), decreasing ability to participate in activities that made life enjoyable (89.5%), and loss of dignity (65.4%)." in addition, the survey found uncertainty about the adequacy of safeguards. while 59% agreed that "current pas laws provide adequate safeguards", there was greater concern with respect to specific safeguards. 60% disagreed that "physicians who are not psychiatrists are sufficiently trained to screen for depression in patients who are seeking pas" and 60% disagreed that "most physicians can predict with certainty whether a patient seeking pas/aid has 6 months or less to live". the concern about adequate safeguards is even greater among oregon emergency physicians, among whom one study found that “only 37% indicated that the oregon initiative has enough safeguards to protect vulnerable persons." attitudes toward pas vary by health profession as well; an extensive survey of 3733 medical physicians was sponsored by the national council for palliative care, age concern, help the hospices, macmillan cancer support, the motor neurone disease association, the ms society and sue ryder care showed that opposition to voluntary euthanasia and pas was highest among palliative care and care of the elderly specialists, with more than 90% of palliative care specialists against a change in the law. a 1997 study by glasgow university's institute of law & ethics in medicine found pharmacists (72%) and anaesthetists (56%) to be generally in favor of legalizing pas. pharmacists were twice as likely as medical gps to endorse the view that "if a patient has decided to end their own life then doctors should be allowed in law to assist". a report published in january 2017 by npr suggests that the thoroughness of protections that allow physicians to refrain from participating in the municipalities that legalized assisted suicide within the united states presently creates a lack of access by those who would otherwise be eligible for the practice. a poll in the united kingdom showed that 54% of general practitioners are either supportive or neutral towards the introduction of assisted dying laws. a similar poll on doctors.net.uk published in the bmj said that 55% of doctors would support it. in contrast the bma, which represents doctors in the uk, opposes it. an anonymous, confidential postal survey of all general practitioners in northern ireland, conducted in the year 2000, found that over 70% of responding gps were opposed to physician-assisted suicide and voluntary active euthanasia. legality current status of assisted suicide around the world: physician-assisted suicide is legal legalized by court ruling, but not legislated or regulated physician-assisted suicide is illegal physician-assisted suicide is legal in some countries, under certain circumstances, including austria, belgium, canada, luxembourg, the netherlands, new zealand, spain, switzerland and parts of the united states (california, colorado, hawaii, maine, montana, new jersey, new mexico, oregon, vermont, washington and washington dc) and australia (new south wales, queensland, south australia, tasmania, victoria and western australia). the constitutional courts of colombia, germany and italy legalized assisted suicide, but their governments have not legislated or regulated the practice yet. australia laws regarding assisted suicide in australia are a matter for state and territory governments. physician assisted suicide is currently legal in all australian states: new south wales, victoria,south australia, western australia, tasmania and queensland. it remains illegal in all australian territories. under victorian law, patients can ask medical practitioners about voluntary assisted dying, and doctors, including conscientious objectors, should refer to appropriately trained colleagues who do not conscientiously object. health practitioners are restricted from initiating conversation or suggesting voluntary assisted dying to a patient unprompted. voluntary euthanasia was legal in the northern territory for a short time under the rights of the terminally ill act 1995, until this law was overturned by the federal government which also removed the ability for territories to pass legislation relating to assisted dying, however this was repealed in december 2022 with the passing of restoring territory rights act. the highly