“Switzerland offers a unique model of assisted suicide”

In 2020, 1,280 people received assisted suicide in Exit Switzerland, 68 more than the year before. While this medical act may indeed be authorized in Switzerland, it is generally subject to strict conditions. But what are the motivations and situations experienced by people affected by this form of assisted death in the country?

To understand this, four researchers (Marc-Antoine Berthod, Dolores Angela Castelli Dransart, Alexandre Pillonel, Anthony Stavrianakis) investigated for several years after numerous cases. They publish their results in “La mort appreciated”, a book published by Antipodes. Two of them answered questions from our readers.

Read: Assisted suicide, its limits and legal framework

To what extent does assisted suicide provide a more dignified access to death? (Laura)

Marc-Antoine Berthod and Alexandre Pilonel: According to several actors that we found in the course of this research, death by assisted suicide is perceived as a “soft”, “peaceful” and “painless” death.

It has often been described as “serene”, especially by the professionals who oversee this practice. However, it is not up to us researchers to comment on the dignity of this type of death in relation to other ends of life.

Can you describe your investigation for us? (Sacha)

We conducted a three-year ethnographic study of assisted suicide with funding from the Swiss National Research Fund. The aim was to document as accurately and concretely as possible what happens before, during and immediately after an assisted suicide. This type of description has so far been lacking in the social science literature.

Read too: Assisted suicide: how the taboo broke in 20 years

What motivated you to do this work?

There are many documents and articles that deal with assisted suicide in Switzerland from the point of view of bioethics, values, statistics, but very few from the point of view of actors and actresses who concretely experience suicide assistance. There was an originality to be learned here that fueled our curiosity and interest in this subject.

We also wanted to meet as many people as possible involved in this practice: nursing staff, family members, loved ones, people seeking assisted suicide, pharmacists, guides from suicide aid associations, coroners, police officers, prosecutors, funeral directors. These meetings were often very intense and very rich.

Is the motivation of physicians to assist in suicide explained by the fact that they are against therapeutic relentlessness? (MW)

Historically, associations for the right to die with dignity, which emerged in the early 1980s, aimed to promote patients’ autonomy in relation to their end of life and to find an alternative to a certain form of “therapeutic tirelessness”. The practice of assisted suicide as we know it today in Switzerland developed then and gradually established itself in a way that involves a plurality of actors – and not just doctors – in this process. Therefore, it is no longer just a question of offering an alternative to “therapeutic tirelessness”, but of offering support to certain people who have decided to voluntarily end their lives.

Read: Towards the use of “capsules” for assisted suicide?

What are the alternatives to assisted suicide? (Jeans)

In the same period and in parallel with the emergence of associations for the dying, the provision of palliative care developed in Switzerland, particularly under the impetus of public health authorities. During assisted suicide, the associations’ support agents evoke and discuss with people other possible treatments, including follow-up by a palliative care team.

In addition, even if there are cases of assisted suicide carried out in a very short period of time – between one and two weeks – most situations extend over a longer period, allowing people to consider different alternatives for the end. of life. It should also be noted that many of these people resort to assisted suicide after having tried, or even exhausted, other solutions that allow them to preserve a certain quality of life.

Why is Switzerland one of the few countries to offer assisted suicide?

The historical circumstances and the perseverance of some actors in the movements to die with dignity allowed the emergence of a unique model of assisted suicide. As for the first point, during the elaboration of the first Swiss Penal Code, at the turn of the 20th century, suicide was no longer considered a crime; it therefore seemed inappropriate to sanction a practice – assistance – for an act – suicide – which was no longer a crime. Added to this is the fact that, if there is no selfish reason to accompany a person to his death, assistance is tolerated.

As for the second point, it was only at the end of the 20th century that pioneering figures of assisted suicide began to follow people declaring their support for the police and to establish a procedure that has been installed and adapted to the present day. Euthanasia, on the other hand, remains illegal, while the latter has been favored in other countries that have legalized and medicalized voluntary death. In Switzerland, assisted suicide is still classified as a “violent death”, and state control over this practice is done post-mortem, through a medico-legal investigation that takes place shortly after the suicide.

Read too: Erika Preisig, the missionary of free death

Does the patient’s age influence decision making? (Hervé)

Yes! In the interviews carried out with the actors involved in carrying out assisted suicide, this issue of age often appears as a determining factor in the legitimacy of assisted suicide. Without being covered by a formal criterion for access to assisted suicide, companions remain sensitive to this issue, in the same way as other health professionals. It always seems more difficult to organize such assistance for a young person, for example, even if in some cases, the pathology or illness from which he suffers completely justifies access to such an approach.

Is it possible to resort to assisted suicide when suffering from a mental illness? (NM)

There is no specific legal provision on this issue, except that the person requesting assistance for suicide should benefit from his or her capacity for discernment. In case of doubt, a psychiatric expertise may be requested. If the ability to discern is attested, there is no formal obstacle to carrying out assisted suicide.

Conclusion

A big thank you to all the readers for their questions and for their interest in this subject that leaves no one indifferent. Unfortunately, we are unable to answer all your questions and we invite you to explore all facets of this reality of assisted suicide in Switzerland through the two books we publish during this year 2021.

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