Assisted Suicide In Switzerland Research Articles

Long-term experience on assisted suicide in Switzerland: dementia, mental disorders, age-related polymorbidity and the slippery slope argument

ObjectivesAccording to the Swiss medico-ethical guidelines valid between 2004 and 2018, the key criterion for assisted suicide (AS) was that the patients who wished to die suffered with a disease leading to death in the foreseeable future. Critics of AS fears that broadening of the medical indications will lead to an uncontrolled expansion to persons who are not terminally ill (slippery slope argument). We evaluated to what extent this broadening took place in practice over time. Study designRetrospective national cohort study. MethodsBy using data of the Swiss Federal Statistical Office, we analyzed the long-term development of AS in Switzerland over a 20-year period (1999–2018; n = 8738 cases). We classified the cases into one of three categories regarding the aforementioned key criterion for AS. ResultsIn 43.6% of AS cases, the criterion ‘end of life is near’ was met. In 5.3% of cases, this criterion was not met (4.7%: mental disorders; 0.6%: dementia). In 51.1% of cases, the reason underlying AS comprised several, mostly age-related diseases and/or functional impairments; the aforementioned key criterion, however, was probably not met in most of the cases. Over time, the number of cases doubled over each 5-year period; this increase occurred similarly for the three categories. ConclusionThe fact that many AS cases took place outside the valid medico-ethical guidelines might be interpreted as a development in the idea of the slippery slope argument. The fact that the percentage distribution of these cases remained unchanged over time argues against it.

Conventional and assisted suicide in Switzerland: Insights into a divergent development based on cancer-associated self-initiated deaths.

We tested the hypothesis of supporters of assisted dying that assisted suicide (AS) might be able to prevent cases of conventional suicide (CS). By using data from the Federal Statistical Office, we analyzed the long-term development of 30,756 self-initiated deaths in Switzerland over a 20-year period (1999-2018; CS: n = 22,018, AS: n = 8738), focusing on people suffering from cancer who died from AS or CS. While cancer was the most often listed principal disease for AS (n = 3580, 41.0% of AS cases), cancer was listed in only a small minority of CS cases (n = 832, 3.8% of CS cases). There was a significant increase in the absolute number of cancer-associated AS cases: comparing four 5-year periods, there was approximately a doubling of cases every 5 years (1999-2003: n = 228 vs.2004-2008: n = 474, +108% compared with the previous period; 2009-2013: n = 920, +94%; 2014-2018: n = 1958, +113%). The ratio of cancer-associated AS in relationship with all cancer-associated deaths increased over time to 2.3% in the last observation period (2014-2018). In parallel, the numbers of cancer-associated CS showed a downward trend only at the beginning of the observation period (1999-2003, n = 240 vs. 2004-2008, n = 199, -17%). Thereafter, the number of cases remained stable in the subsequent 5-year period (2009-2013, n = 187, -6%), and increased again toward the most recent period (2014-2018, n = 206, +10%). The assumption that, with the increasingly accessible option of AS for patients with cancer, CS suicide will become "superfluous" cannot be confirmed. There are strong reasons indicating that situations and circumstances of cancer-associated CS are different from those for cancer-associated AS.

Long-term development of assisted suicide in Switzerland: analysis of a 20-year experience (1999–2018)

The legalisation of assisted suicide is one of the most debated topics in the field of medical ethics worldwide. In countries in which assisted suicide is not legal, public discussions about its approval also encompass considerations of the long-term consequences that such legalisation would bring, for example, how many people will use this option, from what conditions would they be suffering, would there be differences between male and female assisted suicide and which developments and trends could be expected if there were to be a marked increase of cases of assisted suicide over time? In order to answer these questions, we present the development of assisted suicide in Switzerland over a 20-year period (1999-2018; 8738 cases) using data from the Swiss Federal Statistical Office. During the observation period, the number of assisted suicides rose significantly: when four 5-year periods (1999-2003, 2004-2008, 2009-2013, 2014-2018) were analysed, the number of assisted suicide cases doubled over each period compared with the preceding one (Χ = 206.7, 270.4 and 897.4; p <0.001). The percentage of assisted suicides among all deaths rose from 0.2% (1999-2003; n = 582) to 1.5% (2014-2018: n = 4820). The majority of people who chose assisted suicide were elderly, with increasing age over time (median age in 1999-2003: 74.5 years vs 2014-2018: 80 years), and with a predominance of women (57.2% vs 42.8%). The most common underlying condition for assisted suicide was cancer (n= 3580, 41.0% of all assisted suicides). Over time, assisted suicide increased similarly for all underlying conditions; however, the proportion in each disease group remained unchanged. It is a matter of one's viewpoint whether the rise of assisted suicide cases should be considered alarming or not. These figures reflect an interesting social development but still do not appear to represent a mass phenomenon.

Legal Challenges to Restrictions on Assistance in Suicide in Italy, Germany and Austria: An Ethico-Legal Analysis.

This paper deals with a series of legal cases in Italy, Germany, and Austria, between September 2019 and December 2020, which ruled that laws prohibiting or restricting assistance in suicide were unconstitutional. There are similarities between these three cases, all of which are influenced by the practice of assisted suicide in Switzerland, but also differences, not least because of the antecedent legal contexts. Each case is based on flawed reasoning. They have in common an exaggerated account of autonomy or self-determination, insufficiently qualified by the duty to protect human life or by other ethical constraints. The Italian and Austrian Courts also appeal to the principle of equality and to a supposed analogy with refusal of life-sustaining treatments, both of which raise concerns in relation to further expansion of the provisions. In responding to these flawed judgements, legislators should favour proposals that prevent the normalisation of assisted and non-assisted suicide.

The Ambiguities of Assisted Suicide in Switzerland

This article aims to highlight the particularity of assisted suicide in Switzerland. Compared with other contemporary forms of dying around the world, which are mainly medicalized, the implementation of assisted suicide in Switzerland is carried out by volunteer associations. The political culture pertaining to assisted suicide reflects the reluctance of medicine to recognize the practice. But its legitimacy is not only a question of justice and rights. It is based on a process of social recognition, advanced by a citizen’s movement, and debated in the public sphere. Through the history of one particular francophone association for the right to die with dignity, the article examines the Swiss way of regulating this manner of dying.

Suicide among the elderly in France and Switzerland: What does the societal context tell us about the place of relatives?

Based on a comparison of accounts by relatives of elderly people who died by suicide in France and by assisted suicide in Switzerland, this article analyzes the place of family members and their interpretations of the suicide of their elderly relative. It highlights the way the societal and legal context influences the collection of data, the feelings of relatives and their interpretations. While in France, relatives try to avoid the risk of the family being stigmatized and try to retrospectively reconstruct the reasons for the suicide, the institutionalization of suicide in Switzerland means that the reasons for suicide are formulated in advance.

A qualitative study on continuous deep sedation until death as an alternative to assisted suicide in Switzerland

BackgroundAccording to the European Association for Palliative Care, decisions regarding palliative sedation should not be made in response to requests for assisted dying, such as euthanasia or assisted suicide. However, several studies show that continuous deep sedation until death (CDSUD) – a particular form of sedation – has been considered as an alternative to these practices in some countries. In Switzerland, where assisted suicide is decriminalized and CDSUD is not legally regulated, no studies have comprehensively investigated their relation. Our study aimed to identify and describe the experience among palliative care physicians of CDSUD as a potential alternative to assisted suicide in the French-speaking part of Switzerland.MethodsWe performed an exploratory multicentre qualitative study based on interviews with palliative care physicians in the French-speaking part of Switzerland and conducted linguistic and thematic analysis of all interview transcripts. The study is described in accordance with COREQ guidelines.ResultsWe included 10 interviews conducted in four palliative care units. Our linguistic analysis shows four main types of sedation, which we called ‘rapid CDSUD’, ‘gradual CDSUD’, ‘temporary sedation’ and ‘intermittent sedation’. CDSUD (rapid or gradual) was not considered an alternative to assisted suicide, even if a single situation has been reported. In contrast, ‘temporary’ or ‘intermittent sedation’, although not medically indicated, was sometimes introduced in response to a request for assisted suicide. This was the fact when there were barriers to an assisted suicide at home (e.g., when transfer home was impossible or the patient wished not to burden the family).ConclusionThese preliminary results can guide clinical, ethical, linguistic and legal reflection in this field and be used to explore this question more deeply at the national and international levels in a comparative, interdisciplinary and multiprofessional approach. They can also be useful to update Swiss clinical guidelines on palliative sedation in order to include specific frameworks on various sedation protocols and sedation as an alternative to assisted suicide. Potential negative impacts of considering palliative sedation as an alternative to assisted suicide should be nuanced by open and honest societal debate.

Associations of end-of-life preferences and trust in institutions with public support for assisted suicide: evidence from nationally representative survey data of older adults in Switzerland.

The legality of euthanasia and assisted suicide (AS) and nature of regulations of these practices remain controversial and the subject of lively debate among experts and the general public. Our study investigates attitudes and behaviours towards AS among older adults in Switzerland where the practice of AS has a relatively long history and remains rather unregulated. We aim to explore how individuals’ preferences regarding their end of life, as well as individuals’ trust in institutions involved in the practice or control of AS are associated with attitudes and behaviours towards AS. We analyse nationally representative data of adults aged 55 and over from wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland (n = 2,145). While large majorities supported current legal arrangements around AS in Switzerland (81.7%) and stated that they could consider AS for themselves under certain circumstances (61.0%), only a minority either was a member of a right-to-die organisation already (4.9%) or stated they were likely to become a member of such an organisation (28.2%). Stated preferences for control over the end of life and for maintaining essential capabilities at the end of life showed a positive association with AS-related attitudes and behaviours, whereas preferences for feeling socially and spiritually connected, as well as for not being a burden displayed a negative association with our outcomes. Higher levels of trust in one’s relative were positively associated with both support for the legality of AS and potential use of AS. A positive association was also found between trust in the Swiss legal system and support for the legality of AS. By contrast, trust in religious institutions displayed a negative association with all five AS-related attitudes and behaviours. Similarly, trust in healthcare insurance companies was negatively associated with potential use of AS. Taken together, older adults were generally supportive towards current practices regarding AS. This approval appears to be closely related to individuals’ preferences and, at different extends, to trust in social and public institutions with regard to end-of-life issues, which is relatively high in Switzerland.

Assisted Suicide in Switzerland: An Analysis of Death Records From Swiss Institutes of Forensic Medicine.

The aim of this research project, part of a program initiated by the Swiss Federal Council, was to trace the development of organized assisted suicide in Switzerland, starting from the very first case in 1985. Retrospective data on 3666 death records from Swiss institutes of foren- sic medicine for the years 1985 to 2014 were systematically compiled, read into a database, and for the most part quantitatively evaluated. Alongside a marked increase in the overall number of assisted suicides since the turn of the century, the number of people traveling to Switzerland from other countries-predominantly Germany-for this purpose has risen steadily. The proportion of women was 60%, and the age at death ranged from 18 to 105 years (median 73). The largest diagnostic category was malignancy overall, neurological disease for those from other countries. The next largest category was age-related functional limitation, e.g., sensory impairment (loss of sight and hearing), the conse- quences of which were stated in writing as the reason for the wish to die. Following the Swiss Federal Court's promulgation of binding requirements in 2006, the docu- mentation contained in the death records for the subsequent period up to 2014 is much more detailed, but still not uniform or even necessarily complete. The number of candidates for organized assisted suicide increased steadily during the study period, but no standard procedures were followed. The question therefore arises of whether further regulation or the introduction of a cen- tral registration office to maximize standardization and promote transparency would lead to improved quality assurance.

Increase in assisted suicide in Switzerland: did the socioeconomic predictors change? Results from the Swiss National Cohort

ObjectiveTo determine whether the strong increase in assisted suicides in Switzerland since 2008 is linked to a shift in the socioeconomic factors associated with assisted suicide and its related diagnoses.MethodsIn...

Family Caregivers' Reflections on Experiences of Assisted Suicide in Switzerland: A Qualitative Interview Study

ContextThousands of family members worldwide are annually involved in assisted dying. Family participation in assisted dying has rarely been investigated and families' needs typically are not considered in assisted dying legislation and clinical guidelines. ObjectivesTo explore family caregivers' reflections on experiences of assisted suicide in Switzerland. MethodsA cross-sectional qualitative interview study conducted in the Italian- and French-speaking regions of Switzerland. Interpretation and analysis were performed using qualitative content analysis. ResultsTwenty-eight close relatives and family carers of 18 patients who died by assisted suicide in Switzerland were interviewed. Family members perceived their involvement in assisted suicide as characterized by five phases; 1) contemplation, 2) gaining acceptance, 3) gaining permission, 4) organization, and 5) aftermath. Families can participate in these phases at diverse levels and with varying degrees of involvement. Important triggers for families and patients for transition between phases include patients' experiences of their life-threatening illnesses and related treatments, their increasing awareness of approaching death, and family member recognition of their loved one's unbearable suffering. Participating in assisted suicide created further demanding tasks for families in addition to their role of caregivers. ConclusionFamilies appeared to be involved in the preparation of assisted suicide along with patients, irrespective of their personal values regarding assisted dying. Support for family members is essential if they are involved in tasks preparatory to assisted suicide. Clinical guidelines and policies concerning assisted dying should acknowledge and address family needs.

Assisted Suicide as a Remedy for Suffering? The End-of-Life Preferences of British “Suicide Tourists”

ABSTRACTThe highly charged debate about the moral status of assisted suicide features regularly in the news media in medically advanced countries. In the United Kingdom, the debate has been dominated in recent years by a new mode of death: assisted suicide in Switzerland, so-called suicide tourism. Drawing on in-depth interviews with people who were actively planning on ‘going to Switzerland,’ alongside participant-observation at a do-it-yourself self-deliverance workshop, I discuss how participants arrived at their decision to seek professionalized assistance. In doing so, I explore the constituent elements of people’s suffering, examining how participants justified, rationalized, or sought authentication from a doctor for their decision to die in light of their own belief systems and aesthetic preferences for a good death.

Obstinacy and suicide

This article takes Durkheim’s Le suicide as a conceptual testing ground for an ongoing field inquiry into assisted suicide in Switzerland. It tackles the question of the extent to which a Durkheimian approach to the social facticity of human practices can adequately grasp the ethico-pragmatic variation in which people give form to their lives, especially under heavily constrained circumstances. The article makes two interventions: it first draws out the conceptual significance of the asymmetry in the architecture of Le suicide , namely, of Durkheim’s explicit refusal to elaborate a fourth type of suicide (fatalistic suicide). It then presents the blind spot, and asymmetry, as constitutive of his normative scientific posture: that social science, in its modern modalities, has the means to identify the normative ends toward which social life should aim, to the detriment of a more pluralist ethical and anthropological postulate through which to grasp and understand the multiplicity of moral forms pertaining to suicide, of which assisted suicide in Switzerland provides the test case.

Nonphysician-Assisted Suicide in Switzerland

In general, legal responses to endof-life issues are not very different in Switzerland than in most European countries. For instance, active euthanasia (i.e., killing on request) is illegal, although it is treated as a lesser offense than murder or manslaughter. Article 114 of the Swiss Penal Code reads, ‘‘Every person who, for honourable reasons, especially mercy, kills another person on his or her serious and pressing request shall be punished by imprisonment for a maximal term of three years or with a fine.’’ Also, like in most European countries, the administration of medication (for instance, morphine) to relieve serious pain of a terminal patient, even though it may lead to the unintended consequence of hastening his or her death, is accepted, in both moral and legal terms. Similarly, like in many other countries, the withdrawal or withholding of life-sustaining treatments, even if they are not covered by any specific legal provision, is not treated as a criminal offense provided that certain conditions are fulfilled. The peculiarity of Switzerland regarding end-of-life issues only relates to assisted suicide. This practice, which is permitted, has two significant differences when compared to the situation in the other (few) European countries that allow it: 1) Nonphysician-assisted suicide is permitted. Whereas in the Netherlands and Belgium only physicians are allowed to assist in a suicide, in Switzerland this assistance is providedby(nonphysician)volunteers working for nonprofit organizations. The role of doctors is limited to prescribing the lethal drug and assessing the patient’s decisional capacity; they do not perform the assistance in the suicide themselves. In this regard, the practice of assisted suicide in Switzerland is similar to the one in the U.S. state Oregon. 2) Oneneednothaveaparticularmedical condition (such as a terminal illness or an unbearable suffering) to request assistance with suicide. The only requirement is that the individual must have decisional capacity, because in the absence of it his or her act cannot be considered a ‘‘suicide’’ in legal terms. In fact, at present, according to a recent study, around 25% percent of people who die by assisted suicide in Switzerland do not have any serious or terminal illness but are just old, or are simply ‘‘tired of life.’’

Just When You Thought the Euthanasia Debate Had Died

The death by assisted suicide in Switzerland of Australian Dr. John Elliott, in early 2007 has highlighted the inadequacy of the law pertaining to medical decisions at end-of-life, both from a legal as well as ethical perspective. Despite being illegal in most jurisdictions around the world, physician-assisted death is a reality, in part because of the flexibility, inconsistent application and, at times, invisibility, of laws surrounding it. The appropriate response to this should be greater transparency by a reform of the law.