Switzerland’s Shocking Assisted-Suicide Laws: A Brief Overview.

By: Amanda Carmichael

The controversy that surrounds physician-assisted suicide has been a hot debate through the decades. Euthanasia and physician assisted suicide have been happening for centuries with “varying degrees and with questionable legality.”[1] Overall there are very few countries that allow the practice.[2] Some of the most famous countries that all this practice are Switzerland, Belgium,[3] and The Netherlands.[4]

To understand the policies and concerns surrounding this topic, it is first crucial to understand some basic terms and differences that exist. It is herein necessary to present an overview of these topics. Physician assisted suicide, physician assisted death or doctor assisted suicide as it has sometimes been called is “[t]he voluntary termination of one’s own life by administration of a lethal substance with the direct or indirect assistance of a physician.”[5] Aside from that, some countries allow euthanasia.[6] The major different between these two is who performs the final act.[7] With physician-assisted suicide, the patient requesting the service will receive the medication from the doctors, but will actually ingest the medication on their own.[8]  On the other hand, euthanasia is when the doctor injects the medication into the patient.[9] The practice of euthanasia will not be covered in this post because it has many different concerns than physician-assisted suicide. One of those concerns is consent to the intervention. This blog post will only focus on physician-assisted suicide and the controversy that surrounds it within the context of Switzerland.

A recent study found that “57% of physicians practicing today have received a request for physician-assisted suicide in some form or another.”[10] This statistic proves that this idea has been considered by many people, and although the regulation of this practice may be difficult, or against religious beliefs or humane concerns, the conversation surrounding this topic must continue.

One country in particular has been a common destination for those wishing to die for quite some time. Switzerland has had laws in place that allow physician-assisted suicide for over 70 years.[11] As early as 1918, the Swiss government stated that “suicide is not a crime” and that assisting suicide is not a crime.[12] The country limited this application by criminalizing the act of assisting suicide when it is motivated by selfish reasons.[13] Switzerland “views suicide as possibly rational” and prosecution of those that assist only happens “if doubts are raised on the patient’s competence to make autonomous choices [, which] is rare.”[14]

There doesn’t appear to be any specific law that permits doctors to assist in suicide but a statement from the Swiss Academy of Medical Sciences statement that this process “is not part of the physician’s activity” has been understood in different ways.[15] Some think this means that a physician should never assist in this process, while other interpret this to mean that assisted suicide is outside of the professional oversight and therefore physicians may assist suicide because they have the same discretion as any other citizen.[16] While some physicians oppose assisted suicide, and many other support it, the practice has been banned from many Swiss hospitals.[17] Although this additional hurdle has been placed on those who are a proponent of the process or those who want to assist in the process, there are other options in Switzerland. Switzerland is uniquely situated within the realm of physician-assisted suicide because the law is very broad.[18] The law in Switzerland does not require the person to be a citizen of Switzerland, it also doesn’t require that only doctors assist in the process, and lastly, the access to these life-ending drugs is not limited to only patients suffering from terminal illnesses.[19] Because the country’s laws are so broad in comparison to others, the idea of traveling to Switzerland has become “a euphemism for assisted suicide.”[20] The phenomenon is actually known as “suicide tourism.”[21] Currently, there are clinics in place that will help in this process for those who come to Switzerland and it costs roughly $10,000 to have this procedure done.[22]

There are many arguments for both sides of physician-assisted suicide. Within the context of this conversation, it is crucial to iterate both. Aside from religious beliefs, many people who oppose physician-assisted suicide have concerns about what message this gives to unhealthy people,[23] how this will affect the relationship between doctors and patients,[24] and the risk that this will become the alternative to the expanding options for medical care.[25] The concern surrounding the message of this practice is that it creates a “duty to die” for older people.[26] Opponents say that elderly people may feel pressure to exercise this option instead of increasing the burden on family members to pay medical bills or take care of them, as people get older.[27] Another major reason for people opposing the practice is that there remains a concern for the relationship between doctors and patients. Many people feel that it is the duty of a doctor to heal patients and to give them hope and compassion. By allowing doctors to perform this procedure, it portrays a different message and people feel this will become a “reasonable substitute for medical treatment.”[28] The last major argument that many who oppose physician-assisted suicide cite to is the ever-expanding option for medical treatment. As there are advances in medical treatment, many feel that patients should explore these other options. Today, more than ever before,  “modern medicine [] has more knowledge and skills to relieve [pain and] suffering.”[29]

Despite the opposition to physician-assisted suicide, there are many others who support the procedure. “The proponents of assisted dying argue that medical ethos is not restricted to healing, but includes accompanying the patient in situations in which healing is impossible and unbearable suffering [is] present, taking the patient’s personal values into account.”[30] For many supporters of physician-assisted suicide, the right to choose when you die should include how a person will die, when one will do so, and under what circumstances one chooses.[31] This entire concept is “founded on autonomy and individuality” because the main reason to allow this is to “enrich individuality [and] . . . facilitate progress of individuals.”[32] In addition to allowing a person to die with dignity, allowing a person who is in pain to choose how that pain will be alleviated, and promoting individuality, there is another major consideration in this analysis – and in fact, a reason why this practice should be allowed, many would argue. What about the families of those who wish to die via physician-assisted suicide? Studies have shown that when compared to families who have lost other family members because of natural causes, those families who have lost someone who chose to die with physician-assisted suicide “had greater acceptance of the death and the grieving process.”[33] These arguments are some of the most common in favor of physician-assisted suicide, but are not exclusive.

Over the last several decades, there have been proposals to change the law in Switzerland, however, these proposals have continually failed.[34] One main reason for that is likely that the proposals are too restrictive. Because Switzerland has allowed the practice for so many years, it is unlikely that a single law will overturn the practice all together. Instead, however, if the country wishes to change its legislation, taking a different approach will be necessary. One proposal for maintaining the accessibility of physician-assisted suicide, but limiting it to a smaller pool of people came about in a conversation with a BSN student at the University of Tennessee.[35] While many proponents of physician-assisted suicide feel that counseling for patients who wish to use the service is a valuable step in the process, BSN student Megan Hodge felt that counseling should also be mandatory for the assisting physician who participate in the process. Prior to any procedure, perhaps the doctor would have to consult with another doctor, or a panel of doctors during which the treating physician would be required to analyze the case and determine whether the patient is able to undergo the assisted suicide.[36] One major concern with this concept is that the physician, who is allowed to essentially choose who dies, may develop a “god complex.”[37] To support the physicians who may be in this position, legislation that initially restricts the process would be crucial.

Another proposal for a law that may be passed in Switzerland or perhaps a model for countries who are contemplating this topic would be to allow physician-assisted suicide, but limit the accessibility to those who have a terminal illness, have undergone some sort of counseling, and those who are able to indicate in some way that they wish for this to happen. The last prong must be broad enough to encompass both those individuals who are able to verbally or through writing express that they wish to die. It is crucial that this part of the law also include those individuals who may not be able to say or write down their wishes. This part of the law would have to be developed over time and should be as least restrictive as possible, while still ensuring consent. 

Overall, it remains to be seen how the Switzerland law will transform in the coming decades. For now, the country continues to be a reprieve for those who are struggling and those who wish to exercise their right to die with dignity.

[1] Ali Venosa, Suicide Tourism: Traveling for the Right to Die, and the Ethical and Legal Dilemmas that Co me With it, Medical Daily (May 25, 2016), http://www.medicaldaily.com/assisted-suicide-tourism-right-die-387577

[2] For a complete table, see Euthanasia & Physician-Assisted Suicide (PAS) Around the World, ProCon.org (July 20, 2016), https://euthanasia.procon.org/view.resource.php?resourceID=000136.

[3] Venosa, supra note 1. Belgium in particular has very liberal suicide laws and also allows euthanasia. Id.

[4] “The Dutch government's own study revealed that in 1990, there were 2,300 cases of voluntary euthanasia (defined as "the deliberate termination of another's life at his request"), 400 cases of assisted suicide, and more than 1,000 cases of euthanasia without an explicit request. In addition to these latter 1,000 cases, the study found an additional 4,941 cases where physicians administered lethal morphine overdoses without the patients' explicit consent. Physician-Assisted Suicide and Euthanasia in the Netherlands: A Report of Chairman Charles T. Canady, at 12-13 (citing Dutch study). This study suggests that, despite the existence of various reporting procedures, euthanasia in the Netherlands has not been limited to competent, terminally ill adults who are enduring physical suffering, and that regulation of the practice may not have prevented abuses in cases involving vulnerable persons, including severely disabled neonates and elderly persons suffering from dementia. Id., at 16-21; see generally C. Gomez, Regulating Death: Euthanasia and the Case of the Netherlands (1991); H. Hendin,  [54]  Seduced By Death: Doctors, Patients, and the Dutch Cure (1997).”
Wash. v. Glucksberg, 521 U.S. 702, 734.

[5] Physician-assisted Suicide, MedicineNet.com, https://www.medicinenet.com/script/main/art.asp?articlekey=32841.

[6]  This list includes The Netherlands, Belgium, Luxemburg, and Colombia. See Euthanasia & Physician-Assisted Suicide, supra note 2.

[7] Anh Huynh, Euthanasia and Physician-Assisted Suicide Law: An Annotated Bibliography, 32 Can. L. Libr. Rev. 22, 22 (2007).

[8] What is Physician-Assisted Suicide?, Module 5: Physician-Assited Suicide Debate, http://endoflife.northwestern.edu/physician_assisted_suicide_debate/what.cfm.

[9] Id.

[10] Id.  

[11] Derek Humphry, World Laws on Assisted Suicide, Euthanasia Research & Guidance Organization, (last updated Aug. 28, 2010), http://www.finalexit.org/assisted_suicide_world_laws_page2.html.

[12] Samia A. Hurst and Alex Mauron, Assisted Suicide and Euthanasia in Switzerland: Allowing a Role for Non-physicians, US National Library of Medicine National Institutes of Health (Feb. 1, 2003), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125125/.

[13] Id.

[14] Id.

[15] Id.

[16] Id.

[17] Id.

[18] Sarah Kliff, Canada Legalizes Physician-Assisted Suicide, Vox, (Feb. 6, 2015 3:40 PM), https://www.com/2015/2/6/7993315/canada-physician-assisted-suicide.

[19] Id.; See also Penny Sarchet and New Scientish, Tourism to Switzerland for Assisted Suicide is Growing, Often for Nonfatal Disease, The Washington Post, (Sept. 22, 2014), https://www.washingtonpost.com/national/health-science/tourism-to-switzerland-for-assisted-suicide-is-growing-often-for-nonfatal-diseases/2014/09/22/3b9de644-2a14-11e4-958c-268a320a60ce_story.html?utm_term=.f376e33bdfac.

[20] Venosa, supra note 1. This euphemism is limited to the UK context. Id.

[21] See generally id.

[22] Derek Humphry, How and How Much for Assisted Suicide in Switzerland, Assisted-Dying Blog,  (Mar. 4, 2016), http://assisted-dying.org/blog/2016/03/04/how-and-how-much-for-assisted-suicide-in-switzerland/.

[23] This concern is in particular focused on the impacts of elderly persons who have increased medical expenses due to failing or worsening health conditions. Reasons to Oppose Physician-Assisted Suicide, Focus on the Family, (2014, 2017), http://www.focusonthefamily.com/socialissues/life-issues/physician-assisted-suicide/reasons-to-oppose-physician-assisted-suicide.

[24] Physician-assisted Suicide, supra note 5.

[25] What is Physician-Assisted Suicide?, supra note 10.

[26] Reasons to Oppose Physician-Assisted Suicide, supra note 23.

[27] Id.

[28] Id.

[29] What is Physician-Assisted Suicide?, supra note 10.

[30] Nicole Steck et. al., Suicide Assisted by Right-to-die Associations: A Population Based Cohort Study, 43 Int’l J. of Epidemiology 614-622, (2014).

[31] Ian Macleod, A Short History of Assisted Suicide, Ottawa Citizen, (Jan. 10, 2016), http://ottawacitizen.com/news/politics/a-short-history-of-assisted-suicide

[32] Raphael Cohen-Almagor, Physician-Assisted Suicide - A Qualified Endorsement, 3 Amsterdam L.F. 115, 116 (2011).

[33] Emily Lea Berry, Physician-Assisted Suicide: Yes or No? The Great Debate, MedScape, (Jan. 7, 2015), https://www.medscape.com/viewarticle/837390#vp_3.

[34] Julie Beck, Going to Switzerland is a Euphemism for Assisted Suicide, The Atlantic, (Aug. 27, 2015), https://www.theatlantic.com/health/archive/2014/08/going-to-switzerland-is-a-euphemism-for-assisted-suicide/379182/.

[35] Telephone interview with Megan Hodge, Student Accelerated BSN Program, The University of Tennessee (Oct. 28, 2017).

[36] Id.

[37] Id.