Unlike any other country in regard to this issue, Switzerland has the longest history of the legal practice of non-physician assisted suicide. Assisted dying is legally allowed, as controversial as it may be. What would otherwise be seen as a crime, assistance to “die by a third party" in the event of suicide has been permitted in Switzerland since 1918.
However, this can lead to open questions of how this can be tolerated consistently with ethics, religious or our own consciousness and values.
One reason why someone might consider assisted dying is that people seek a self-determined life which they will not allow to be taken away from them, even at their end of life in the event of their own death. They wish to be in control and to keep their self-determination and to be able to decide the progression of their life by deciding themselves when the time has come for them to die. When someone’s suffering is too much, they sometimes prefer to die thereby giving an end to their suffering.
It could be said, that because of the right-to-die assisted dying associations, the active suicides in Switzerland might be reduced or most importantly, a higher number of suicide attempts would be prevented.
In Switzerland there is no minimum age requirement (above the legal age), diagnosis, or symptom state. Although the reason always must be clearly “not selfish” which may be understood to be inheritance reasons or not wanting to care for a terminally ill person. The eligible criteria are that the person must be capable of discernment and expressing a persistent and repeated wish to die over a prolonged period of time.
According to the Swiss Medical Weekly (2020) between 2010-2014 94% above the age of 55 and only 0.5% under the age of 35 were assisted suicides. In 2016 assisted suicides represented 1.4% of all deaths in Switzerland.
In order to gain an in-depth view of the very small differences between the terminology, euthanasia versus assisted dying and their legal regulations, I would like to cite the definition given by the Swiss Federal Office of Justice (2022)
“Direct Active Euthanasia:
Targeted killing to lessen the suffering of another human being. The Physician, or a third party, intentionally gives the patient an injection that leads directly to death. This form of euthanasia is punishable under Article 111 (deliberate killing) Article 114 (killing on request) or Article 113 (manslaughter) of the Criminal code.
Indirect Active Euthanasia:
Drugs (for example Morphine) are used to alleviate suffering, which can reduce lifespan as a side effect. Death, which may occur earlier, is accepted. This type of euthanasia is not expressively regulated in the Criminal Code but is generally permitted. The guidelines on euthanasia of the Swiss Academy of Medical Sciences (SAMS) also regard this form of euthanasia as permissible.
Only those who help someone to commit suicide ‘out of selfish motives’ (for example by obtaining a deadly substance) are punished with imprisonment of up to five years or a fine under Article 115 of the Criminal Code.
Assisted Suicide is about conveying the deadly substance to the patient, which the suicidal person takes himself/herself without outside influence. There are organisations in Switzerland, like EXIT, that provide assisted suicide under this law. They are not punishable unless they can be accused of selfish motives.”
Other than in Switzerland, assisted dying is legally allowed also in some forms in the following countries: Netherlands, Spain, Belgium, Luxembourg, Canada, Colombia, Australia, several states in the USA and New Zealand.
In Switzerland there are two main recognized associations that are legally recognized, EXIT and DIGNITAS. The first of them is EXIT. They are based in Zurich since 1982 and for over 35 years they are committed to everyone’s right of self-determination in life and death. EXIT is a non-profit-organisation as well as the first and most experienced euthanasia organisation in Switzerland. They have over 145,000 members, which makes them one of the biggest worldwide (keeping in mind the small size of Switzerland). For them it is crucial that the members decide what is unbearable or unreasonable in alignment with their life values. They are required, however, to be a Swiss citizen or resident in Switzerland and to be a member for a minimum of three years (annual membership fee Sfr 45 (£36). In some circumstances this could be accelerated, however at a significantly increased financial cost.
According to EXIT their participation ensures a gentle, safe, and dignified death with the drug Sodium Pentobarbital (NaP) in the person’s own home, surrounded by their relatives. This is usually given in a glass and must be taken and drunk by the person itself. In some advanced illness circumstances (like bowel cancer), this can be administrated by an infusion with the person opening the drip themselves. Usually, death occurs within minutes from taking the drug. Soon after, the notified police will appear with an official doctor for a legal inspection of the dead person to document that everything has been carried out according to the legal regulations.
The second largest organisation in Switzerland is called Dignitas. Their logo is “Dignitas- To live with dignity- to die with dignity.” They are also based in Zurich and founded in 1998.
There is a one-off joining fee of Sfr200 and an annual membership fee of at least Sfr80. Although there is not a waiting period, in some cases, the process from making the first contact with a doctor at Dignitas to the moment of death can take up to three months before the assisted dying can occur, often longer.
Dignitas has not limited assisted dying only to Swiss residents but accepts members from all over the world. This has led to the controversial “death tourism” political debate. According to Dignitas “a person’s wish to end his or her own life is a human right and no one should be discriminated against in any way, not even on the basis of where they live.” In 2018 there have been registered 256 persons from abroad who have travelled to Switzerland and have sought help successfully to end their life through Dignitas.
In Switzerland, a large majority of people join an assisted dying organization at a certain point in their life, either when they are without any sign of illness or once they have been confronted with a life-threatening illness.
Over the years, I would witness myself that for many people it was the wish and the feeling of self-determination, of being in control over themselves that was the main reason why they would join for example Exit or Dignitas. They thought of having an alternative, but if the suffering is too much it gives most people hope and a way to cope with their destiny.
However, I could notice that of all the members of those associations, only a small number of people eventually die through the lethal medicine. This can also be explained according to the Swiss Federal Office of Justice (2022):
“Palliative medicine and care include medical treatment, physical care, but also psychological, social and pastoral support for the patient and their relatives. They can significantly increase the quality of life of the seriously ill and dying and thus also prevent the wish to die.”
In the end, how we decide to live and to die is everyone’s very personal and most intimate decision. As hard as it is to understand certain feelings that some actions may bring people to take decisions, it is very much their own way. As controversial and irritating as it can be, what for some people is freedom, for others is pain…