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Monday, May 16, 2011

Switzerland: Assisted Suicide Remains Legal

Story from the BBC

The Suicide
Madalina Iordache-Levay

Voters in Zurich, Switzerland, have rejected proposed bans on assisted suicide and "suicide tourism".

Some 85% of the 278,000 votes cast opposed the ban on assisted suicide and 78% opposed outlawing it for foreigners, Zurich authorities said.

About 200 people commit assisted suicide each year in Zurich, including many foreign visitors.

It has been legal in Switzerland since 1941 if performed by a non-physician with no vested interest in the death.

Assistance can be provided only in a passive way, such as by providing drugs. Active assistance - helping a person to take or administer a product - is prohibited.

'Last resort'

While opinion polls indicated that most Swiss were in favour of assisted suicide, they had also suggested that many were against what has become known as suicide tourism.

Many citizens from Germany, France and other nations come to die in Switzerland because the practice remains illegal abroad.

One local organisation, Dignitas, says it has helped more than 1,000 foreigners to take their own lives.
Another group, Exit, will only help those who are permanently resident in the country - saying the process takes time, and much counselling for both patients and relatives.
Its vice-president, Bernhard Sutter, said the result showed Swiss voters believed in "self-determination at the end of life".

The referendum had offered a proposal to limit suicide tourism, by imposing a residency requirement of at least one year in the Zurich area in order to qualify for the service.

It was backed by two conservative political parties, the Evangelical People's Party and the Federal Democratic Union.

But the major parties of the left and right, including the Swiss People's Party and the Social Democratic Party, had called on their supporters to vote against both motions.

The BBC's Imogen Foulkes, in Geneva, says the size of the vote against a ban on assisted suicide reflects the widely held belief among the Swiss that is their individual right to decide when and how to die.
Their rejection of the proposal to limit assisted suicide to those living in Zurich shows that concerns about suicide tourism carry less weight with voters than their conviction that the right to die is universal, our correspondent says.

But the debate in Switzerland will continue, she adds. Polls show voters do want clearer national legislation setting out conditions under which assisted suicide is permitted.

The Swiss government is planning to revise the country's federal laws on assisted suicide.

It has said it is looking to make sure it was used only as a last resort by the terminally ill, and to limit suicide tourism.


Blogger Note: Many ethical issues are found in this story.


Dr. Stephen A. Ragusea said...

Dealing with terminal illness and dementia is my family has clearly revealed -- at least to me -- our society's naiveté about this issue. The action taken by the Swiss in this matter reflects a level of maturity in political discourse that this nation hasn't witnessed in many years. The sometimes superficial ethical dogma of preserving human life at all costs has a different meaning at a time in history when we can use medicine and forced feeding to keep human beings alive for years/decades to experience often profound suffering and a thirst for death that goes unquenched. The Swiss are embracing a more thoughtful set of ethical principles.

John Gavazzi, PsyD said...

Thanks for the comments!!

The voters of Switzerland indicated that they favor autonomy and quality of life over nonmaleficience and quantity of life.

I agree that terminal illness and other physical disorders are debatable.

My concerns stems from the fact that a physician (and I will interpret psychologist) do not need to be involved in the process of euthanasia. The two groups mentioned in the story advocate for physician involvement. However, what is reported is that no medical or mental health professionals need to be involved in the assessment process.

Also, the concept of "suicide tourism", in which a person or organization can profit from someone's death, seems ghoulish to me. Again, if a person or organization sets up suicide tours to Switzerland, these types of organizations have the potential to take advantage of depressed individuals who have not received any treatment.

Anonymous said...

I saw this article at BBC before I saw it posted here and my initial reaction was that assisting a suicide would surely violate the Hippocratic Oath, hence the stipulation in Switzerland that it is only to be performed by a non-physician. What I found (ah, the benefits of Google) was that while the original Oath stated, "I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect" (The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943), it was later replaced by another used in most medical schools today which actually discusses the taking of a life, "Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God." (Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, 1964).

The issue has sparked debate/disagreement among practitioners:

"The prohibition against killing patients... stands as the first promise of self-restraint sworn to in the Hippocratic Oath, as medicine's primary taboo.... In forswearing the giving of poison when asked for it, the Hippocratic physician rejects the view that the patient's choice for death can make killing him right. For the physician, at least, human life in living bodies commands respect and reverence--by its very nature. As its respectability does not depend upon human agreement or patient consent, revocation of one's consent to live does not deprive one's living body of respectability. The deepest ethical principle restraining the physician's power is not the autonomy or freedom of the patient; neither is it his own compassion or good intention. Rather, it is the dignity and mysterious power of human life itself, and therefore, also what the Oath calls the purity and holiness of life and art to which he has sworn devotion." (Leon Kass, MD, PhD, former Chairman of the President's Council on Bioethics, Neither for Love nor Money, Public Interest Journal, 1989).

"Over time the Hippocratic Oath has been modified on a number of occasions as some of its tenets became less and less acceptable. References to women not studying medicine and doctors not breaking the skin have been deleted. The much-quoted reference to 'do no harm' is also in need of explanation. Does not doing harm mean that we should prolong a life that the patient sees as a painful burden? Surely, the 'harm' in this instance is done when we prolong the life, and 'doing no harm' means that we should help the patient die. Killing the patient--technically, yes. Is it a good thing--sometimes, yes. Is it consistent with good medical end-of-life care: absolutely yes." (Philip Nitschke, MD, Director and Founder of Exit International, interview with Kathryn Jean Lopez titled "Euthanasia Sets Sail", the National Review Online, June 5, 2001).

Personally, I oppose frank euthanasia/assisted suicide whether physician assisted or otherwise, however, I also think that our current medical expertise can overreach the wherewithal to compassionately and appropriately deal with death, and that physicians sometimes scramble to prolong life by any/artificial means, rather than to afford patients the right and dignity to die in peace.


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