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ASSISTED SUICIDE

What are Switzerland’s new assisted suicide rules?

Swiss medical authorities have put in place new guidelines for the country's assisted suicide providers. Here's what you need to know.

Australian scientist David Goodall (C) leaves in a wheelchair. He was barred from seeking help to end his life in Australia, so he was forced to travel to Switzerland. (Photo by SEBASTIEN BOZON / AFP)
Australian scientist David Goodall (C) leaves in a wheelchair. He was barred from seeking help to end his life in Australia, so he was forced to travel to Switzerland. (Photo by SEBASTIEN BOZON / AFP)

Switzerland’s assisted suicide scheme allows people to take their own lives with the assistance of medical professionals.

The scheme is relatively unique internationally, with few other countries allowing the practice – particularly when it comes to non-residents.

New guidelines laid out by the Swiss Academy of Medical Sciences however, assisted suicide practices could be tightened in Switzerland.

These guidelines include a more stringent test for whether you should be allowed assisted suicide services, along with a longer waiting period and more meetings with doctors.

Here’s what you need to know.

What are the rules for assisted suicide in Switzerland?

One important distinction to make is between euthanasia and assisted suicide. Assisted suicide still requires the person in question to administer the suicide themselves, while euthanasia is where a doctor takes this final step.

Euthanasia is not permitted in Switzerland, while assisted suicide is allowed for both locals and foreigners.

Switzerland: What is the difference between assisted suicide and euthanasia?

Assisted suicide is legal in Switzerland on compassionate grounds.

While article 115 of the Swiss penal code prohibits assisted suicide for “self-serving reasons” and article 114 prohibits “causing the death” of a person for “commendable motives, and in particular out of compassion for the victim”, assisted suicide for non-selfish reasons is not specifically prohibited as long as certain conditions are met.

What are the rule changes and what does it mean for foreigners?

In May, the Swiss Academy of Medical Sciences updated its guidelines for assisted suicide as part of its deontological code.

The update added in four main points:

  1. Doctors must now have two consultations with patients which must be at least two weeks apart.
  2. The condition must be serious and severe to the point where it is “unbearable”.
  3. A patient’s environment must be taken into account.
  4. There is no ethical or medical justification for providing assisted suicide to healthy people.

Importantly, the rules are not binding law on assisted suicide providers in Switzerland. However, they have since been adopted by the Swiss Medical Association (FMH).

Around 90 percent of Swiss doctors and medical professionals – including those who provide assisted suicide services – are members of the FMH.

FMH members are required to adhere to the FMH code and can be sanctioned if they do not.

What do these changes mean?

A major change under the new guidelines is that people must have some form of illness or condition which is “unbearable”. 

Under the previous rules, old age was a valid reason for accessing assisted suicide services, as illustrated by the high-profile case of Australian scientist David Goodall.

Goodall made headlines when he travelled to Switzerland to take his life, saying that while he didn’t have a terminal illness, his quality of life had deteriorated significantly and he wanted to die.

The two-meeting requirement is also a significant change and one which is particularly difficult for foreigners, as it means they will need to stay for at least two weeks in Switzerland at what could be a considerable expense.

Exit spoke out against the changes, saying that they create unnecessary suffering.

“If someone is suffering and wants to die as soon as possible, and I can tell that the decision was well-considered, then a second conversation only causes unnecessary suffering.”

While Exit vowed not to adopt the new guidelines, Exit does not provide services to foreigners.

Dignitas, the largest provider of assisted suicide services to foreigners, has also spoken out against the changes but has as yet not indicated whether they would be adopted.

Can foreigners access assisted suicide?

The main associations administering assisted suicides are Exit, Dignitas, Ex International, and lifecircle.

Exit and Dignitas are the largest groups in Switzerland.

Exit only provides assistance for citizens or long-term residents of Switzerland while Dignitas is the only organisation to provide assisted suicide services to foreigners.

According to Dignitas, assisted suicide is popular among foreigners, with 90 percent of those who received help dying in 2018 coming from abroad. The majority of those who received assisted suicide were German.

In order to access assisted suicide as a foreigner, you will need to become a Dignitas member. This can be done from abroad, provided you are deemed to be of full mental capacity and are an adult.

More information is available at the following link.

EXPLAINED: How foreigners can access assisted suicide in Switzerland

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ASSISTED SUICIDE

Do Swiss cantons have different rules on assisted suicide?

Under Switzerland’s federalist structure, cantons have a far-reaching autonomy in deciding what happens on their territories. A few have their own rules on assisted suicide.

Do Swiss cantons have different rules on assisted suicide?

Switzerland has had an assisted suicide law on the books since 1942 — a constitutional right of each person to determine the manner of his or her death.

This basic principle is the same throughout the country, and while some people and organisations are opposed to this practice, most are in favour of the legislation.

In a survey carried out by Swiss Medical Weekly publication, for instance, 81.7 percent of respondents supported the legality of assisted suicide, as is currently the case in Switzerland, and 60.9 percent stated that they would potentially consider asking for assisted suicide under certain circumstances. 

What does this law say?

The practice is heavily regulated in Switzerland on federal level.

Foremost among the rules is that people must commit suicide by their own hand, for example, by taking medication themselves. A doctor cannot administer a lethal injection without being liable for criminal prosecution (this would be euthanasia, which remains illegal in Switzerland).

People must also be aware of actions they are undertaking and have given due consideration to their situation. In addition, they be consistently sure they wish to die, and, of course, not be under the influence of another person, or group of persons.

READ ALSO: What you need to know about assisted suicide in Switzerland

Do these rules differ from one canton to another?

The rules described above are the same throughout Switzerland.

And while cantons have a lot of flexibility to modify existing legislation, cantonal laws cannot contravene federal ones.

In other words, cantons cannot repeal national legislation but, rather, build on it by adding their own rules. 

Relating specifically to assisted dying, “there can be differences in the practical process of assisted suicide — for instance, official investigations following an assisted suicide are not regulated in the same way in every canton,” Muriel Düby, spokesperson for Switzerland’s largest assisted suicide organisation, EXIT, told The Local.

She cited the example of canton of Bern, where “forensics and forensic medicine are always called in, whereas this is not the case in other cantons. This is because federal law, determines the substantive content of criminal procedures, while the implementation is left to the cantons.”

By the same token, there are also different regulations when it comes to assisted suicide in healthcare facilities.

As this is not comprised in the federal legislation, “some cantons have introduced special laws requiring all nursing homes to allow assisted suicide as a basic right,” Düby said.

This is the case in Geneva, Vaud, Neuchâtel, and Valais.

This means that anyone who lives in one of these cantons and is a resident in an elderly care facility, has the right to assisted dying, while this is not the case in the other 22 cantons.

The Geneva ‘exception’
 
While this right has not been challenged in Vaud, Neuchâtel, and Valais, it is currently under threat in Geneva.

At the beginning of September, the Geneva parliament voted to repeal the law passed in 2018 which allows the practice.

In response, EXIT has vowed to force a referendum to stop the canton from revoking the legislation. (Note that this move concerns only healthcare facilities, and is not intended to repeal the entire assisted suicide law).
 
READ ALSO: Can foreigners access Switzerland’s assisted suicide clinics?

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