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ASSISTED SUICIDE

What to know about Switzerland’s latest court judgement on assisted suicide

Switzerland's highest court this week ruled that patients with mental illnesses can be eligible for assisted suicide even without a psychiatric report.

Published: 29 June 2023 11:29 CEST
Foreigners can access assisted suicide in Switzerland.
Foreigners can access assisted suicide in Switzerland. Photo by Marcelo Leal on Unsplash

What’s happening?

The landmark decision was handed down on Wednesday by the Swiss Federal Supreme Court, reported Swiss broadcaster SRF.

The ruling involved a Swiss doctor called Erika Preisig, a doctor and assisted dying advocate based in the canton of Basel-Country, who was prosecuted in 2021 for assisting a mentally ill patient to die.

The prosecutor was of the opinion that Preisig had committed homicide because she had not obtained a psychiatric evaluation on the person before assisting the suicide.

Preisig was acquitted of charges of intentional homicide by the Federal Court, which dismissed the appeal by the public prosecutor’s office of Basel-Country canton.

Preisig had previously been acquitted by the cantonal court, but the public prosecutor appealed the ruling and took the case to the Federal Supreme Court to urge for clarification.

What do previous rulings say?

In 2006, the Federal Supreme Court ruled that, in principle, it was permissible to assist a mentally ill person in committing suicide. But only if the wish to die is based on a well-considered decision by a person capable of making a judgement.

According to the highest judges in 2006, the wish to die must also not be an expression of a treatable mental disorder, and this must be clarified by a psychiatric report. Such a report was not available in the Preisig case.

What does it mean?

The Federal Supreme Court has clarified the situation: although Preisig had not obtained a psychiatric report, she had studied the medical records, had intensive discussions with the woman, questioned relatives and obtained a second opinion. The mentally ill woman was understood to have made a well-considered decision and was capable of judgement. 

According to court documents, the woman had been suffering for several years and had undergone countless physical and psychiatric examinations.

The Federal Supreme Court confirmed that Preisig could assume, even without a psychiatric expert opinion, that the woman had a permanent wish to die, as she suffered from an incurable, permanent, severe mental impairment.

Federal judges believed all of this this was enough to justify the decision to help the patient to die. 

With its judgment, federal judges have upheld Switzerland’s liberal law on assisted dying, as well as confirmed that a report from a psychiatrist is not always required to assist mentally ill people to die.

What is assisted suicide in Switzerland?

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

It is a relatively unique scheme, with few other countries allowing the practice.

One important note to keep in mind is the difference 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 allowed in Switzerland, while assisted suicide is allowed for both Swiss people and foreigners. Assisted suicide is legal in Switzerland on compassionate grounds.

Last year, the Swiss Academy of Medical Sciences laid out new guidelines for assisted suicide practices to be tightened in Switzerland.

READ ALSO: What are Switzerland’s new assisted suicide rules?

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.

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

READ ALSO: How foreigners can access assisted suicide in Switzerland

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For members

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.

Published: 27 September 2023 15:54 CEST
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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