April 3, 2026*
COMMENTARY
The famous lines from Kipling’s poem, “The Ballad of East and West,” are often taken out of context and interpreted to mean that there are irreconcilable differences between Eastern and Western cultures. Actually, the subsequent lines of the poem suggest the opposite, that these cultural divisions vanish when individuals of equal strength meet, “tho’ they come from the ends of the earth!"
Perhaps so—but in the matter of assisted suicide and euthanasia (AS/E), there are indeed serious and perhaps irreconcilable differences between many countries of the “West” and those of the Asian “East.” To be sure, the terms East and West are rough and imprecise designations. In broad terms, for the purposes of this discussion, we include in the West primarily the European countries, such as Belgium, Luxembourg and the Netherlands, along with the US, the UK, and Canada.
Some would include Australia and New Zealand. Included in the East are, among others, China, Japan, India, and Korea. But as we will explain, the terms East and West in this article refer primarily to historically different cultural, philosophical, and spiritual traditions—all of which have great bearing on the matter of AS/E. These matters are of more than academic interest to psychiatrists, since patients of Eastern and Western cultural heritage may view end-of-life care—often involving psychiatric interventions—quite differently.1
Implicit in our discussion is the premise that “assisted suicide” is, in fact, suicide, contrary to some proponents of so-called medical aid in dying (MAID). Indeed, we believe there is no clinically valid or reliable way to distinguish AS/E from suicide, as psychiatrists typically understand it. And while we are opposed to AS/E on medical-ethical grounds,2 this article will focus primarily on the cultural, religious, philosophical, and psychological factors that differentiate Eastern and Western values regarding AS/E.
The Spread of Assisted Suicide and Euthanasia: East vs West
AS/E has emerged as a legally sanctioned option for end-of-life care in an increasing number of countries. As of 2025, over 200 million individuals were living in jurisdictions permitting some form of assisted dying.3 Indeed, “As of May 2025, 12 countries have regulated assisted dying nationally or in selected jurisdictions, including Australia, Austria, Belgium, Canada, Colombia, Cuba, Luxembourg, the Netherlands, New Zealand, Spain, Switzerland, and some US states, and legislation is actively being discussed in other countries, including Ecuador, France, Germany, Ireland, Italy, Portugal, Slovenia, and the UK.”[3]
On the other hand, on March 17th, 2026, the Scottish Parliament voted 69 to 57 to reject an assisted suicide bill.[4] Additionally, on November 23,2025, the Slovenian people voted by referendum to rescind a previously passed assisted suicide law.5
AS/E deaths have risen steadily and substantially over the past decade, particularly in the use of euthanasia. Note that this trend has taken place exclusively in Western countries. Furthermore, “…there is currently no internationally comparable standard [in the West] regarding the quality of care, safeguards, and support that people receive when accessing assisted dying.”6
In contrast, to the best of our knowledge, no Asian country (as of March 2026) has legalized active euthanasia or physician-assisted suicide (PAS). That said, several Asian nations permit the withdrawal of life-sustaining treatment (sometimes confusingly called “passive euthanasia") under strict conditions. However, the direct administration of lethal substances by a physician remains illegal across the Asian continent, and the process of legalizing AS/E has met considerable resistance throughout Asia.6
The remainder of our article focuses on possible explanations for this resistance. ...
* Author(s) Ronald W. Pies, MD, Cynthia M.A. Geppert, MD, PhD, MA, MPH, MSBE, DPS, MSJ, Mark S. Komrad, MD, DFAPA