Whilst the French government is preparing a bill for the end of life with a possible opening for assisted suicide, the experience in Switzerland, a country which has authorised the practice for many years, is showing worrying signs of abuse.
See our note expert on assisted suicide in Switzerland.
Assisted suicide has been permitted in Switzerland since 1937, with the only limitation established by article 115 of the penal code, that the person providing the assistance for the act must not be motivated by any selfish intent. Switzerland has established criteria set by the Swiss Academy of Medical Sciences (ASSM): Candidates must be adult, have their full powers of judgment, be capable of self-administering the lethal dose, and be suffering from an incurable disease, or be plagued with unbearable suffering, or disabling multiple pathologies associated with old age. Since Switzerland does not consider assisted suicide as a medical act, the logistics and implementation are provided by associations. In practice, these criteria are subject to various interpretations by the associations leading to practices which are questionable.
For Swiss residents, members of associations, the cost of resorting to assisted suicide is included in their subscription fee, except if they have been members for less than a year. In such case, the cost is a few hundred euros. For foreigners, the cost varies between 7,000€ and 11,000€, leading to so-called “Death tourism”.
The Federal Office of Public Health and Swiss Health Observatory regularly publish statistics on suicide in general with specific data on assisted suicide. The number of assisted suicides is increasing year on year (reaching 2% of total deaths in 2021) whilst the number of suicides at the same time remains steady at around 1,000 per year.
Although Switzerland has finally abandoned the idea of legislating at the federal level, certain cantons have introduced measures compelling health establishments (medico-social establishments equivalent to EHPAD in France or hospitals) to accommodate the practice of assisted suicide on their premises (recognised public health establishments in the Vaud canton in 2012, medico-social establishments in the Neuchâtel canton in 2014, medico-social establishments and hospitals in the Geneva canton in 2018 and medico-social establishments in the Valais canton in 2022). Although their staff are not required to take part in suicide assistance since this is undertaken by the associations, the law prohibits, de facto, “institutional” conscientious objection (in other words concerning an entire establishment). However, in September 2023, the Geneva canton lifted this obligation by deleting these measures [1].
Over the years, the ASSM has revised the directives by gradually aligning itself on the practices of the associations. This is how the criteria for resorting to assisted suicide have gradually been broadened: from the need for a close end of life, requests for assisted suicide have evolved to include multiple pathologies associated with old age, fatigue for life, up to opening the possibility for prisoners to have access also. Several situations have been highlighted in the media like for example the case of two American sisters aged 54 and 49 years old [2] who obtained joint assisted suicide through the Pegasos association in February 2022. Claiming to be suffering from “medical frustrations” such as chronic insomnia, vertigo and back ache, they said they were “tired of life” and wished to depart together.
The practices of the associations generate controversy: The Federal Department of Justice and Police and the Director of the Federal Office of Social Insurance are concerned in particular concerning the financial aspect of the associations which are deemed to be non-profit making. The Neue Zürcher Zeitung (NZZ) revealed in 2019 that the balance of the assets of the Exit association amounted to some 29 million Swiss Francs (an amount which has tripled since 2013).
Moreover, the main associations operating in Switzerland, are militating more or less openly for the practice of assisted suicide to be authorised in a maximum number of states. The actions by Dignitas, the most active among them, have led to recognition of the practice of assisted suicide in Germany in 2020 and in Austria in 2021. In May 2023, its members appealed to the European Court of Human Rights against France after several failed appeals to the State Council.
Further reading: Assisted suicide: the State Council rejects a new appeal by the Dignitas association.
[1]EUROPEAN INSTITUTE OF BIOETHICS, Geneva: Health establishments have regained their freedom to refuse assisted suicide, Geneva: Health establishments have regained their freedom to refuse assisted suicide – European Institute of Bioethics (ieb-eib.org). [2]RENAUD MICHIELS, 29/03/2022, Double assisted suicide in Switzerland: They were “Tired of living”, United States, Le Matin, United States – Double assisted suicide in Switzerland: They were “Tired of living” – Le Matin.
