The issue of assisted suicide is undoubtedly controversial. Though restricted in many countries, it is not clearly regulated in Switzerland, which leads to a convergence of so-called suicide tourists coming to the country in search of assisted suicide, to “die with dignity.” Now, a new study reveals that within 4 years, the number of these suicide tourists going to Switzerland has doubled.
The study, published in the Journal of Medical Ethics, reveals that Germans and Brits are the main groups going to Switzerland for assisted suicide (AS), and the top reasons include various neurological conditions, such as paralysis, motor neuron disease, Parkinson’s and multiple sclerosis.
Dignitas is the main AS organization operating near Zurich and, between its Swiss and German arms, has over 5,500 members in 60 different countries. “To live with dignity – to die with dignity” is the motto of the organization, which is a member of the World Federation of Right-to-Die Societies.
To investigate whether the availability of suicide tourism in Switzerland had influenced legal changes in AS in other countries, as well as to determine who was going to Switzerland for help with committing suicide, the researchers searched databases of the Institute of Legal Medicine in Zurich for details of investigations and postmortem exams among non-Swiss nationals who had AS between 2008-2012.
In total, there are six right-to-die organizations in Switzerland, and four of them allow individuals from other countries to use their services.
“In the UK, at least, ‘going to Switzerland’ has become a euphemism for (assisted suicide),” the study authors write. “Six right-to-die organizations assist in approximately 600 cases of suicide per year; some 150-200 of which are suicide tourists.”
Germans and Brits highest non-resident customers of Swiss AS
Overall, the researchers identified 611 cases of people who came to Switzerland from other countries to organize their own deaths.
After analyzing the 611 cases, the team found that they came from 31 different countries. All but four of these individuals had gone to Dignitas, and their ages ranged from 23-97 years old, though the average age was 69. Additionally, nearly 60 percent of the individuals seeking AS in Switzerland were women.
Of the countries represented, Germany had the highest number of tourists, at 268, followed by the UK, at 126. France, Italy, the US, Austria, Canada, Spain and Israel were also in the top 10.
Between 2009 and 2012, when the study took place, the researchers found that the number of people coming to Switzerland for AS doubled.
The team notes that nearly all of the deaths were from taking sodium pentobarbital, the medication most commonly used for AS – which can only be prescribed with specific conditions under Swiss law. However, four people inhaled helium, deaths widely publicized as “excruciating,” according to the researchers, who say it could be responsible for the decrease of suicide tourists to Switzerland between 2008 and 2009.
Though 1 in 3 people had more than one condition, neurological conditions made up nearly half of all cases, with cancer and rheumatic diseases following.
Regulating suicide
While the researchers note several key limitations, they say their results “imply that non-fatal diseases or diseases that are not yet end stage […] are more often becoming the reason for seeking AS.”
Assisted suicide laws around the globe are in flux as countries debate the pros and cons of allowing doctors to help terminally ill patients, or patients in a lot of pain, die. Currently, few countries regulate assisted suicide, or euthanasia, and in many it is a punishable crime to help someone end their life, even if they are suffering severe and incurable pain.
In Switzerland, assisted suicide is not clearly regulated by law, said the study authors. Last year, the European Court of Human Rights urged the country to clarify the guidelines after an octogenarian who wanted to end her life failed to convince doctors to assist her because she was not ill enough.
In Germany, there is no formal legal language in the criminal code about assisted suicide, but doctors are not ethically allowed to help someone commit suicide — and can be held criminally responsible for not helping a patient if they witness him or her going unconscious.
In the United Kingdom, Ireland and France, assisted suicide is illegal, though recent cases have been presented to high courts.
An issue of international importance
The issue of euthanasia is a hot topic around the globe. Last month, South Africa’s Nobel Peace laureate, archbishop emeritus Desmond Tutu, drew attention to the issue when he voiced his support for assisted dying for the terminally ill.
An international survey of 12 European countries found the majority of people favor legalizing assisted suicide, according to the study authors. This seems to match opinion in the United States, where four states — Oregon, Washington, Montana and Vermont — allow assisted suicide.
But others have argued that legalizing assisted suicide is not addressing the real issue, which is the need for better palliative care, and that assisted suicide laws would put vulnerable populations at risk.
Alison Twycross of London South Bank University, in an editorial accompanying the new study, writes that advocates for assisted suicide often have a friend or relative who experienced a long, painful death. “So the issue,” she writes,”may be a need to provide good end-of-life care.”
“We need to start asking questions such as: Is it appropriate to give antibiotics to a terminally ill patient who develops a chest infection? It is possible that a tendency to carry on with curative treatment even in those clearly dying explains the general public’s support for (assisted suicide).”
Twycross cites data from Oregon that suggests regulations put in place when assisted suicide was legalized are not always followed.
“Autonomy is important,” she writes. “But it could be that, in matters of life and death, you cannot create freedom for the few without taking away adequate safeguards for the many.”