Assisted Suicide in Switzerland

20/10/2023

I – SUMMARY

  1. Assisted suicide is permitted in Switzerland, but not euthanasia

Since 1937, the Swiss penal code specifies in its article 115 : “Anyone who, for a self-interested motive, incites a person to commit suicide, or who provides assistance for suicide, shall, if the suicide is fulfilled or attempted, be punished by a maximum of five years in prison or a fine[1].” On the other hand, it tolerates assistance to suicide if the self-interested motive of the assistant cannot be established.

Euthanasia, is moreover prohibited by article 114 of the penal code. In the years 2000, several attempts were made to legalise this practice also, but the Federal Council (Government) finally gave up, in June 2011, to make any changes.

  1. The conditions of access are flexible

There is therefore no overall law governing assisted suicide, merely medico-ethical directives, established by the Swiss Academy of Medical Sciences [2], which must be followed. As a result, the principal conditions to be satisfied in order to resort to assisted suicide are currently as follows: candidates must be adult, must have their full powers of discernment, must be able to self-administer the lethal dose, and be suffering either from an incurable disease, or be plagued with unbearable suffering, or multiple disabling pathologies associated with old age. This latter criterion for multiple pathologies is tending to be interpreted ever more broadly by the associations.

  1. The associations manage the practices

Since assisted suicide is not legally considered as a medical act, the act is conducted in Switzerland by associations: Dignitas, Exit, Lifecircle, Pegasos and ExInternational. Apart from Exit which only deals with Swiss residents, the others accept to accommodate foreigners. These associations deal with:

  • Organising the prior appointment to evaluate the acceptability of the request, proceeding with the administrative procedures;
  • Procuring the lethal doses (which requires a prescription delivered by a Swiss doctor);
  • Provision of the logistics for the operation (apartment, various premises, if not in the home or in a hospital. Assisted suicide in a public place is prohibited);
  • Ensuring the “smooth running” of the operation;
  • Management of the aftermath of the death: declaration to the police and health authorities, cremation or burial… These operations are costly (between 7,000€ and 11,000€[3],excluding transportation), and constitute a highly lucrative activity. Doctors are involved in these operations merely to check that the products provided are indeed delivered against a medical prescription.
  1. In certain cantons, the health establishments can no longer refuse assisted suicides on their premises.

In Switzerland, the cantons are responsible for choosing their health policies, which must however comply with the State laws. Up till 2012, the cantons had no legislation on assisted suicide other than that of the Swiss penal code. But under militant pressure from Exit and Dignitas, several cantons have gradually compelled their public health institutions (hospitals, socio-medical establishments, care homes) to accept assisted suicides on their premises. The “Institutional conscientious clauses” (refusal for an institution to have such and such an act practiced on their premises) are in consequence prohibited for such organisations: the refusal of assisted suicides leads to the withdrawal of the State subsidies which are essential for the survival of such establishments.

The cantons of Vaud (in 2012) and Neuchâtel (in 2014) were the first to act in that way. Then, the cantons of Geneva (in 2018) and Valais (in 2022) adopted similar legislation.

As the Swiss legislation is in fact both vague and flexible, the number of assisted suicides is ever increasing, and the abuse is multiplying in several forms.

II – STATISTICAL DATA

The Federal Office of Public Health (OFSP) and the Swiss Health Observatory (Obsan) regularly publish statistical data on suicide in general, with specific data on assisted suicide.

On that basis, the resorting to assisted suicide has been increasing, virtually every year for almost 25 years. In 2021, it reached a level of almost 2% of all deaths “representing an increase of 11 % over the previous year and of 44 % relative to 2015. [4].”  Whilst the number of suicides, remained stable, at around 1000 per year.

suicide assisté en suisse

Two main associations conduct the vast majority of assisted suicides each year:

→ Exit in fact consists of two sister associations founded in 1982, who operate only for Swiss residents : Exit-ADMD-Suisse-romande (French language, based in Geneva, with 33,000 members and 502 “accompaniments” in 2022) and Exit en Suisse alémanique et Suisse italienne (in German language, based in Zurich, with 155,000 members and 1125 “accompaniments” in 2022)

→ Dignitas is based in Zurich, has 34 employees and accounts for some 12,000 members, of which over 90% are foreigners (mainly Germans, and around 10% French). It declared having conducted 206 assisted suicides in 2021 and in total, 453 French nationals between 2001 and 2021 were “suicided”).

III–APPLICABLE LAW

  1. At the federal level

The historical basis of the penal code

As early as 1918, in its draft penal code, the federal council (government) adopted the principle of not punishing incitement or assistance to suicide if the act is “inspired by altruist motives[1] ».

In the version finally adopted in 1937 which came into force in 1942, the penal code therefore limited the possible sanctions to those people whose self-interested motive could be proved. This is the purpose of article 115, whose current wording is as follows:

Any person who, for self-interested purposes, incites a person to suicide, or provides them with assistance for suicide, shall, if the suicide is fulfilled or attempted, be punishable by a maximum of five years imprisonment or a fine [2].”

The other legal texts are not much more explicit on the subject. Article 28 of the civil code mentions the protection of physical integrity: any offence against this is presumed to be illicit, “unless it is justified by the consent of the victim[3].

After numerous debates, rejection of any legislative modification

Between the early 1990s and up to around 2010, national debates took place on several occasions to examine whether or not there was any need to extend the access to assisted suicide and to introduce the possibility of so-called “active” euthanasia (in particular on the basis of the 1994 Ruffy notion [4]).

Under the leadership of the Federal Department of Justice and Police, several reports have been issued. The main ones, conducted in 1999, in 2006 and in 2009 (following several highly mediatized cases), provided a statement on the stakes and the evolution of the practices, and examined several possible orientations.

In June 2011, the federal council finally abandoned any legislative modification, whether for better controlling the practices by the associations or for depenalising euthanasia.

  1. At the canton level

The Swiss federal system assigns authority for health matters to the cantons. Most of them have no legislation on the subject. Certain cantons have established measures to ensure the possibility of resorting to assisted suicide in medico-social establishments and hospitals (Vaud canton – law dated 21/02/2012 Neuchatel canton – law dated 4/11/2014; Geneva canton – law dated 24/05/2018; Valais canton – law dated 27/11/2022). Although the staff are not compelled to take part in the suicide assistance, since it is provided by the associations, these laws consequently prohibit “institutional” conscientious objection (i.e. concerning an entire establishment). However, in September 2023, the Geneva canton repealed these measures[5] by considering that they were superfluous with regard to the federal law. In that canton, will the absence of any explicit obligation open a new space for freedom of choice?

  1. At the medical institution level

End of life supervision is principally managed by the medico-ethical directives issued by the Swiss Academy of Medical Sciences (ASSM) and regularly revised.

These documents have a true influence in the field. The Swiss Academy of Medical Sciences presents itself as a first-rate moral authority, to the extent that the political authorities have a tendency to consider the standards which it issues in the fields of ethics and medical practices as additional laws. However, as the Academy is a private foundation, its directives are not legal standards. They do however have a certain legal authority since the courts refer to them when considering the cases submitted to them. 

Old medico-social directives are little followed

The first directives by the ASSM on the end of life, issued in 1995, recalled the prohibition of active euthanasia, opposed assisted suicide which was considered not to be a medical act, authorised passive euthanasia, and recognised the validity of life wills.

Since 1995, these directives have been updated several times, in particular to gradually extend the possibilities for assisted suicide.

Whereas the initial ASSM directives used an imminent end of life as a criterion, reality has in fact shown that these directives were not being followed. Prior to 2014, the Dignitas and Exit associations assured that they refused to assist candidates for their suicide, whenever the latter were not at their end of life. In truth, some highly questionable assisted suicides sometimes took place, leading to diverse reactions in the media.

For example, in 2002, the Dignitas association accepted to “suicide” a French brother and sister, aged 29 and 32 years old and suffering from schizophrenia[6]. In 2003, a British couple[7] suffering from diabetes and epilepsy, but not at their end of life, who resorted to the “services” of the association. Their families, who were unaware of their intentions, were particularly taken aback by the announcement of their death.

Scandals were also exposed following the resort to assisted suicide of people suffering from depression or who could have been treated. A study published in the Journal of Medical Ethics already revealed that, over the period 2008-2012, 34 % of those who had resorted to assisted suicide, through one of those associations, were not suffering from any fatal disease.

In September 2015, a 75-year old English lady[8], with no serious health problems, resorted to assisted suicide in a Swiss clinic via the Lifecircle association. In November 2016 two brothers appealed to the Geneva civil court[9] to prevent the assisted suicide of their third brother by the Exit association. The latter, who finally went through with the procedure, was suffering from depression, but no serious pathology.

This is why the ASSM finally re-evaluated its directives.

Medico-ethical directives which no longer demand an imminent end of life

In 2018, the Swiss Academy of Medical Sciences (ASSM) revised its directives on the end of life, resulting in a relaxation of the conditions required for access to assisted suicide.

Although the previous versions mentioned the need to be suffering from a pathology resulting in an imminent end of life in order to qualify for assisted suicide, this is no longer the case since a new version published in 2018 and revised in 2021, under the heading “Attitude when facing the end of life and death”: this merely mentions the presence of “functional diseases and/or limitations” causing the patient “suffering considered to be intolerable”. This may consist of, other than physical or mental symptoms, “limitations in everyday life and in social relations, losses as well as feelings of despair and uselessness.” (…) “Moreover, the self-determined desire for suicide of a patient is not motivated by an objective medical condition, but by their suffering subjectively considered as unbearable. Suffering cannot be objective, but can be felt through the intersubjective comprehension of the family doctor.

The discomfort of doctors

This troubling about-turn of the ASSM position appears to result from a certain submission to the practices already adopted by the associations who no longer truly considered the directives provided.

The Swiss Doctors Federation (FMH) had however, prior to this newly declared position by the ASSM, voiced vivid criticism on this change: “Suicide assistance is now possible if the suffering has become unbearable from the point of view of the patient and that another assistance is considered unacceptable by the patient. In consequence, the directive is diverting from its initial aim, in particular to assist patients at their end of life following disease – assisted suicide is now available to patients who are not suffering from any terminal disease but who consider that their suffering is unbearable. […] From the doctor’s point of view, it is extremely difficult and delicate to set a clear limit. This change also introduces a problem regarding suicide prevention, and concerns in particular those patients suffering from mental disorders, who are quite capable of discernment but who have a tendency to develop suicidal thoughts due to their disease[10]»

As a result of this disagreement, a working group within ASSM has sought how to express the role of doctors in a way which is acceptable to the FMH. The 2018 directives were modified in 2021 for that purpose, with details on the prior conditions which doctors must check before agreeing to assisted suicide. These conditions concern the following four domains:

  • Discernment capability
  • Independent will
  • Extreme suffering
  • Examination of other alternatives.

In May 2022, the FMH finally revised its position in line with that of the ASSM. Unbearable suffering must merely be proved by the person concerned and doctors must conduct at least two appointments two weeks apart in order to confirm their conviction. The FMH nevertheless considered it necessary to specify that “assisted suicide of people in good health is not defendable from a medico-ethical point of view[11]“.

Michel Matter, ex vice-president of FMH, explained this change as follows: “In 2018, the medical chamber of the FMH did not vote for or against assisted suicide, but merely expressed itself against the new ASSM directives regarding the matter of unbearable suffering. From a legal standpoint, this notion is meaningless and is very difficult to prove.” Therefore the role of doctors can only be reduced to the following approach: “The symptoms or functional limitations of the patient have reached an extreme level and this feeling must be objectivized by a diagnosis or a prognosis to that effect. These elements cause suffering which the patient considers unbearable (…). Since it is not possible to determine objectively whether or not their suffering is unbearable, it is not reasonable to ask a doctor to issue such a statement. However, the doctor must record the fact that all due diligence has been applied to become familiar with the concrete personal situation of the patient, in order to fully apprehend the unbearable nature of the suffering[12]. »

It also appears important to underline the uncomfortable position of doctors, regarding their involvement in assisted suicide and their difficulty in judging the suffering which is experienced subjectively by the patient.

Reinforcement of the authority of the patient’s advance directives

In 1995, in a general document concerning the medical accompaniment for patients at their end of life, the ASSM mentioned that “When a doctor is confronted with a written declaration prepared beforehand by a patient whilst still fully capable of discernment, it is determining. However, it is not possible to consider any requests involving illegal behaviour on the part of the doctor or which call for an interruption of life support measures whereas, according to general experience, the state of the patient provides hope of a return to social communication and the reappearance of a will to live”.

In 2009, the ASSM issued a document concentrating exclusively on advance directives. It states that “Doctors are expected to comply with advance directives, unless the will of the patient breaches the legal provisions or if there exists any doubt on the fact that the directives have been drawn up freely, or on the fact that they still reflect the presumed will of the patient.” These advance directives may in particular specify various medical end of life situations, explain “the scale of personal values” of the author, including the naming of a “representative” (trusted person), refer to organ donation, request spiritual assistance. The role of the advice by the medical staff is heavily underlined.

In principle, the application of advance directives cannot lead to conducting assisted suicide on a person who is unconscious, since a clear oral expression of consent is demanded at the very moment of the act and since the person is incapable of self-administering the lethal dose.

IV–NOTABLE ABUSES ?

Despite the changes to the ASSM directives, the practices by the associations continue to exceed the limits established by them, as illustrated by the following example:

In February 2022, two American sisters aged 54 and 49 years of age [13] obtained a joint assisted suicide through the Pegasos association. Claiming to suffer from medical “frustrations” such as chronic insomnia, vertigo and back ache, they said they were “tired of living” and wished to depart together.

The change in criteria and the positioning of the ASSM or the FMH were preceded by interpretations specific to the associations. The criteria are extended to align with their practices.

  1. From imminent end of life, to multiple pathologies associated with old age

In 2014, the Exit association decided to relax its regulations, henceforth accepting to operate for any person suffering from health problems, even if not an incurable disease.

Gradually from that date, the various associations ever more often registered the criterion of “multiple invalidating pathologies associated with old age” in order to accept requests for assisted suicide. Symbolic situations are regularly published in the press, such as the following cases for example:

In May 2018, the Eternal Spirit association thus permitted a 104-year old eminent Australian scientist [14], suffering from no terminal phase pathology but who considered that his quality of life was inadequate, to resort to assisted suicide in Switzerland.

In September 2022, film director Jean-Luc Godard[15] did likewise at 91 years of age, the papers when announcing the fact clearly stated that: “He was not ill, he was simply tired out”. The Exit association, which faced a lawsuit over this suicide, tried to justify its definition of multiple pathologies associated with old age: “As is often the case in the field of assisted suicide, there are no precise definitions. But we are concerned with difficulties generated by old age which may accumulateFor example? Chronic pain, breathing difficulties, intense fatigue, hearing or eyesight difficulties, incontinence, partial or total loss of mobility or autonomy. Problems which may be added to mental suffering or depression, a feeling of isolation, loss of dignity, etc[16]. »

In another article published soon afterwards, the ex-Vice President of Exit added:” Since 2015, the penal authorities in our country authorise assisted suicide for people suffering from multiple pathologies associated with old age: loss of balance, eyesight, hearing, all those little things, which in isolation, are not necessarily serious but when combined make old age intolerable for some[17]. »

  1. Towards assisted suicide due to old age and being “tired of life”?

Increasing pressure has been exerted for several years to allow assisted suicide for the single motive of old age. In support of this request, an opinion poll conducted in September 2014 established that 68 % of people questioned supported assisted suicide for the old aged[18].

In June 2017, the Exit association established a commission in order to work on this question and to submit a report indicating the means for “facilitating access to natrium-pentobarbital[19] for the old aged.” The experts must also consider the legal, ethical and political aspects of such a practice.

In November 2021, a 90-year-old French lady described as “in good health” but who had decided to end her life, wanted her assisted suicide to be publicised in the media, with the following message broadcast over the wireless: “In my view, old age is an incurable disease. In Switzerland, they are well aware of this. After 85 years, the Swiss associations no longer demand a medical file mentioning incurable diseases or intolerable suffering for assistance in dying[20].”

However, according to the current medico-ethical directives of the ASSM (cf. § III), the mere motive of being “tired of life” for people in good health, is not sufficient to justify assisted suicide.

  1. Assisted suicide for convicts

The possibility of access to assisted suicide for convicts was opened in 2018, with the case of Peter Vogt. This multiple rapist was sentenced in 1996 to ten years in prison, before being locked up for life (due to his pathological danger and the obvious risk of his re-offending). In 2018, he contacted the Exit association for assistance in suicide, stating: “It is more humane to want to commit suicide than to be buried alive for years to come […] Better dead than vegetating behind walls[21].

In consequence, the Conference of the Canton Heads of Departments for Justice and Police[22] (CCDJP) adopted an agreement in principle in February 2020 for the extension of assisted suicide to convicts. The Conference called upon the Swiss Centre of Competences for the Execution of Sentences (CSCSP) to draw up proposals for the procedures to be adopted for assisted suicide in prisons, based on the positions of the cantons.

In September 2019, that organisation issued a report[23] in favour of the request by P. Vogt in the name of the “right to self-determination” and “human dignity“. Then in September 2020 they published a Guide titled “Assisted suicide in prison”, where the basic principle states that the act must not be performed inside the prison and must not involve prison staff. The first case of assisted suicide for a convict [24], widely mediatised in the press, was conducted in February 2023 by Exit, in the Zurich canton.

Nevertheless, according to Damien le Guay, an ethicist, philosopher and emeritus member of the Scientific Council of the French Society for Accompaniment and Palliative Care (SFAP), these positions are ethically questionable: “All citizens benefit from all their rights until they expose themselves to the rigour of the law – and therefore […] to the privation of rights and freedom, which are just in view of the acts committed against others. […] How can one claim, without considering the situation, that prisoners have a right to self-determine and that they should be able to exercise full and entire freedom of their body and life? As a matter of principle, prisoners have their freedom fettered, and therefore have limited rights. If one considers that prisoners should enjoy full rights (like citizens with full rights like others), then prison itself is an assault on the free expression of their individual rights. Prisons should therefore be deleted. Together with all sentences which restrict freedom which all represent an assault, in principle, on the right to freedom of determination[25]»

V– THE CONTROVERSIAL PRACTICES BY THE ASSOCIATIONS

  1. The dubious logistics of the associations

Daniel Gall, the author of a book published in 2009: “I accompanied my sister”, in which he describes the painful experience with Dignitas for the suicide accompaniment of his sister, vented vivid criticism of the association. “As for dignity, they couldn’t give a damn” In his view, Dignitas fluctuates between “lack of professionalism and series production”. With his sister, they were “Greeted by two messenger boys, in disgusting premises and with no toilets”. He explains that he saw no doctor until his sister had swallowed her cup of barbiturates. “The medical records, they couldn’t care less, and actually, there is no need to be ill at all[26]“.

Daniel Gall is not the first person to complain about the practices by the end of life associations. In 2007, the Dignitas association had to leave their council apartment in Zurich where they had been operating for eight years, following numerous complaints by neighbours for the annoyance caused: corpses in body bags, in the lift; placing corpses in coffins on the pavement in front of the building; coffin traffic within and around the building. In order to conduct their activities, these various associations up till now have made use of various premises, such as hotels, private houses, industrial zone warehouses, caravans on public car parks, etc.

In addition to the usual barbiturates to be swallowed or drip-fed, Dignitas in the past has also used suffocation in a plastic bag filled with helium[27], in order to get round the requirement of a doctor’s prescription for the barbiturates.

The fate of the corpses of the deceased has also been a problem. In May 2010, for example, several tens of funeral urns[28] were discovered at the bottom of a lake in Zurich, despite the prohibition by the Zurich canton government to use the lake as a last resting place. The Dignitas association admitted having deposited an urn in the lake at the request of a patient. The Swiss press echoed the suspicions surrounding the Dignitas management concerning the other urns found. The case was closed in August 2010, whereas the enquiry was inconclusive. A total of 67 funeral urns were discovered in the lake.

Following these criticisms, the associations have sought in recent years to improve their public image, in particular by using more neutral suicide locations and improved procedures.

  1. Questions concerning the non-profit making status of the end of life associations

In 2009, The Federal Department of Justice and Police submitted a report concerned about the evolutions in the practices of the suicide assistance associations and in particular on the prices charged by them. According to the President of the LifeCircle association[29], a suicide with the assistance of its association in 2015 costed 9 045€. For foreigners, the price is therefore between 8,000 and 10,000€. At Exit, “which deals exclusively with Swiss residents and Swiss nationals living abroad, assisted suicide is free of charge for its members (who pay a subscription of 40 Swiss Francs per year). It costs 350 Swiss Francs (358 €) for those who have been members for less than a year[30].”

In February 2012, the Director of the Federal office of Social Insurance in Berne was already concerned about the financial aspect of the suicide assistance associations. “This item has never been subject to any instruction by the penal authorities, but it would appear that this practice exceeds the scope of free of charge acts between close relations” as he explains. “In 2007 one organisation had funds in capital and in real estate amounting to several million Swiss Francs, provisions life members and financial investments of some 4.5 million Swiss Francs. […] Dignitas, which is registered as an “association exercising a commercial trade”demands a minimum down payment of 10,000 Swiss Francs for its services and declared a turnover of 1.4 million Swiss Francs in 2008.”

Even if the organisations stress that they are not performing a lucrative activity, one can but admit that their activity provides an undeniable economic aspect. Thus, during a recent discussion with the federal authorities, the suicide assistance organisations deployed major efforts in communication, for the recruitment of new members, public relations and lobbying, going so far as to broadcast TV and radio advertisements in favour of their activities[31] ».

A testimony by a nurse having taken part in these suicides is edifying concerning the financial interests of these associations. She worked until 2005 for the suicide clinics, in particular with Ludwig Minelli, the founder of Dignitas. She denounces the lack of attention to patients, the poor treatment of close relatives prevented from taking time to consider their decision, a methodology totally contrary and disrespectful of human dignity: “Dignity is the last thing being provided for these poor people[32]“. According to her, it is a genuine machine aimed at economic profit which motivates the association.

In 2018, Ludwig Minelli[33], the founder of Dignitas, was summoned before the Swiss courts, accused of having taken more money than the effective costs of his services, in three cases of assisted suicide. He was eventually acquitted by the court.

In 2019, an article in the Neue Zürcher Zeitung (NZZ) newspaper [34] examined the capital assets of the Exit association. Its total capital assets had tripled in five years, increasing from 9.4 million Swiss Francs in 2013 to 29 million[35].

  1. The activism of the associations to impose assisted suicide abroad

The main associations militate more or less overtly for the practice of assisted suicide to be recognised in a maximum of other states. These actions take multiple forms, in particular :

  • Participation in debates organised by foreign organisations close to their ideas (conferences, training, etc.)
  • Presence in the media (radio, television), in the context of reports, interviews.
  • Legal approaches, in particular with the European Union Court of Justice (EUCJ) or the European Court of Human Rights (ECHR).

The most active association is without doubt Dignitas[36]. It applies a full strategic programme with highly targeted initiatives for the adoption of laws by foreign states. An appeal submitted by that association was the basis for a decision by the German Federal Constitutional Court, in February 2020, demanding a change in the legislation to permit assisted suicide in that state: the German parliament [37] was therefore brought to examine various bills, without as yet being able to adopt any text. Germany now finds itself in a legislative grey area (assisted suicide is neither prohibited nor explicitly authorised) with the only prohibition being that the practice should be paid for. An appeal of the same type was submitted in December 2020 to the Austrian Constitutional Court, with the same legal consequences: the Austrian Parliament[38] was obliged to adopt a law, in December 2021, to establish an assisted suicide procedure.

Dignitas have also been pressurising France since 2021[39]. They have submitted several appeals to the State Council, based on the legislative technique of Priority Preliminary Ruling on Constitutionality (PPRC) aimed at referring to the Constitutional Council. Contesting first of all the prohibition in France from prescribing ” sodium pentothal” (the product frequently used in assisted suicides in Switzerland), it then appealed against the provisions of the 2016 Claeys-Leonetti law. After failing in these two appeals, they applied to the ECHR in May 2023[40] hoping to have France sentenced to be compelled, like Germany and Austria, to legalise assisted suicide. The ECHR has accepted to examine these requests[41], the investigation is following its course with a judgement by the court scheduled for around the end 2025.

  1. The development of “Death Tourism”

The ease of access to assisted suicide, as well as the service offered to Swiss non-residents by certain associations, have enabled the development of a veritable “Death Tourism”. Although the Swiss Government records only the assisted deaths of its nationals, it is estimated, based on the figures provided by the end of life associations that around a hundred French nationals, for example, resort to assisted suicide [42] in Switzerland each year.

Some of them organise major media coverage of their choice in order to pressurise their own government, as was the case recently in Italy or in France: in February 2017, the famous Italian Disc Jockey  Fabio Antoniano[43], at 39 years of age who became tetraplegic and blind following a serious road accident, travelled to Switzerland to resort to assisted suicide, which is prohibited in Italy. He had wisely communicated on the subject on the social networks, and published an open letter to the President of the Republic. In 2011, a French comedian, Maïa Simon[44], aged 67 years old and suffering from widespread cancer, also travelled to Switzerland for assisted suicide. She previously recorded a last message of explanation, which was subsequently broadcast on the radio.

Another case is that of Jacqueline Jencquel[45], the national secretary of the ADMD (Association pour le Droit de Mourir dans la Dignité – Association for the right to die with dignity), who became famous in 2018 by announcing that she wished to resort to assisted suicide in Switzerland, whereas she was not at her end of life. Her allocutions have been widely mediatised (she finally committed suicide in France in 2022). In March 2021, the assisted suicide of Paulette Guinchard[46], an ex-Secretary of State for the elderly, has also been used as a political argument: “To advance the cause, she wished her decision to be made public“, according to her husband after her death.

Consequently, Switzerland remains an attractive nation for the promoters of assisted suicide or euthanasia. The media continue to regularly echo the assisted suicides which Swiss non-residents “stage” in order to pressurise their respective governments, to legalise these practices in their own nations.

An enquiry titled “The tourism of suicide: a pilot study of the Swiss phenomenon[47]“, published in 2014 by the Journal of Medical Ethics, showed that assisted suicide in Switzerland is attracting more and more people. According to the enquiry, based on a study of 611 cases recorded between 2008 and 2012 by the Institute of Legal Medicine for the canton of Zurich, the candidates for assisted suicide in Switzerland came from 31 different nations. The three nations which were most represented at the time were Germany (268 cases, 43.9 %), the United Kingdom (126 cases, 20.6 %) and France (66 cases, 10.8%). Followed by Italy (44), the United States (21), Austria (14), Canada (12), Spain and Israel (8).

This unintended and relatively negative publicity pushed the Federal Council to launch a national debate on the opportunity to change the legislation. The 2009 report by the Federal Department of Justice and Police clearly underlined the abuses in the practices of the associations. But in the end, the matter was “buried” in 2011, due to the lack of consensus on the opportunity of legislation and on the possible content of any such legislation (see §III-A-2 above).

CONCLUSION

Within the Swiss Medical Corps, voices are now being raised to denounce these practices. Doctor Zwahlen, the coordinator of the Swiss National Fund for Scientific Research, warns for example about the abuses and problems of assisted suicide in Switzerland[48]. He denounces laxist control, patients who do not qualify for the required conditions, and the profits made by the end-of-life associations.

More generally, the increase in assisted suicides and the abuses pose major ethical and cultural problems for the accompaniment of the aged. Bertrand Kiefer, Chief Editor of the Swiss Medical Review[49], strongly underlines: “The demands by Exit compel us to consider the question of old age and the cultural space which we grant it. It is associated with a feeling of decline in a world which values youth, performance and beauty; mankind is increasingly considered as a product which must be of good quality.” […] “Although the number of assisted suicides is on the increase, the true danger would be to install a culture going in that direction. We must avoid that those who do not opt for that choice be subjected to pressures by integrating the idea that with increasing age, we become useless.

October 2023

[1] Code pénal suisse, article 115, RS 311.0 – Code pénal suisse du 21 décembre 1937 (admin.ch).

[2] Académie suisse des sciences médicales, Directives « attitude face à la fin de vie et à la mort »Fin de vie et mort (samw.ch)

[3]Clara Pouvil, Nadège Delépine, 14/09/2022, Suicide assisté en Suisse : le coût exorbitant de cet acte médical, News actu, Femme Actuelle, Suicide assisté en Suisse : le coût exorbitant de cet acte médical : Femme Actuelle Le MAG.

[4]Carine Janin, 20/05/2023, En Suisse, le suicide assisté est autorisé depuis 1942, Ouest-France, Société – Fin de vie, En Suisse, le suicide assisté est autorisé depuis 1942 (ouest-france.fr).

[1]Commission nationale d’éthique pour la médecine humaine NEK-CNE, L’assistance au suicide,  « L’incitation et l’assistance au suicide, elles-mêmes, peuvent être inspirées par des mobiles altruistes », 1918, p.33.

[2]Commission nationale d’éthique pour la médecine humaine NEK-CNE, L’assistance au suicide, op.cit.

[3] Code civil, article 28.

[4]Conseil fédéral, Une réglementation explicite de l’euthanasie passive et de l’euthanasie active indirecte est envisagée, Une réglementation explicite de l’euthanasie passive et de l’euthanasie active indirecte est envisagée (admin.ch).

[5]Institut Européen de Bioéthique, Genève : Les établissements de santé retrouvent leur liberté de refuser le suicide assisté, Genève : Les établissements de santé retrouvent leur liberté de refuser le suicide assisté – Institut Européen de Bioéthique (ieb-eib.org).

[6]Afsané Bassir, 07/02/2003, Polémique en Suisse autour d’une association qui offre la mort aux candidats au suicide, Société, Le Monde, Polémique en Suisse autour d’une association qui offre la mort aux candidats au suicide (lemonde.fr).

[7]Jean Robin, 16/04/2003, Un double suicide choque l’Angleterre, Société, Le Parisien, Un double suicide choque l’Angleterre – Le Parisien.

[8]03/08/2015, Une septuagénaire en bonne santé euthanasiée, car « la vieillesse n’est pas drôle », Santé, Le Point, Une septuagénaire en bonne santé euthanasiée, car « la vieillesse n’est pas drôle » (lepoint.fr).

[9]Julien Culte, 24/10/2016, Ils ne veulent pas que leur frangin se suicide avec Exit, 20 minutes, Genève : Ils ne veulent pas que leur frangin se suicide avec Exit – 20 minutes.

[10]Fédération des médecins suisses, 15/02/2018, Directives « Attitude face à la fin de vie et à la mort » , p.3, Prise_de_position_de_la_fmh_Directives_Attitude_face_a_la_fin_de_vie_et_a_la_mort.pdf.

[11]19/05/2022, Aide au suicide : la Fédération des médecins suisses revoit ses directives, Arc Info, Aide au suicide : la Fédération des médecins suisses revoit ses directives (arcinfo.ch).

[12] Esther Rich, 26/09/2022, Suicide assisté : aussi pour les personnes qui ne sont pas en fin de vie, Planète santé, Ethique, politique et droit, Suicide assisté : aussi pour les personnes qui ne sont pas en fin de vie – Planete sante.

[13]Renaud Michiels, 29/03/2022, Double suicide assisté en Suisse : elles étaient « fatiguées de la vie », Etats-Unis, Le Matin, États-Unis – Double suicide assisté en Suisse : elles étaient « fatiguées de la vie » – Le Matin.

[14]Loup Besmond de Senneville, 11/05/2018, En Suisse, le suicide assisté se développe, Actualité, La Croix, En Suisse, le suicide assisté se développe (la-croix.com).

[15]13/09/2022, Sa décision Jean-Luc Godard a eu recours au suicide assisté : « Il n’était pas malade, il était simplement épuisé », Culture, Cinéma, Libération, Jean-Luc Godard a eu recours au suicide assisté : « Il n’était pas malade, il était simplement épuisé » – Libération (liberation.fr).

[16]Vincent Coquaz, 22/09/2022, Mort de Jean-Luc Godard : peut-on avoir recours au suicide assisté en Suisse sans être « malade » ? CheckNews, Libération, Mort de Jean-Luc Godard : peut-on avoir recours au suicide assisté en Suisse sans être « malade » ? – Libération (liberation.fr).

[17]Ariane Chemin, 02/12/2022, Les derniers jours de Jean-Luc Godard, Cinéma, Le Monde, Les derniers jours de Jean-Luc Godard (lemonde.fr).

[18]25/09/2014, La raison de l’âge invoquée pour l’aide au suicide, Culture, Société, Sondage, Tribune de Genève, Sondage – La raison de l'âge invoquée pour l'aide au suicide | Tribune de Genève (tdg.ch).

[19] 18/06/2017, Exit envisage une aide au suicide élargie, Front, Suisse, Zurich, 20 minutes, Zurich : Exit envisage une aide au suicide élargie – 20 minutes.

[20]Sébastien Germain, 11/11/2021, TÉMOIGNAGE – Une Azuréenne de 90 ans en pleine forme décide de partir en Suisse pour se suicider, Société, France Bleu, TÉMOIGNAGE – Une Azuréenne de 90 ans en pleine forme décide de partir en Suisse pour se suicider – France Bleu.

[21]Audrey Freynet, 07/01/2020, L’aide au suicide pour les prisonniers envisagée par la Suisse, Société, Le Point, L’aide au suicide pour les prisonniers envisagée par la Suisse (lepoint.fr).

[22]19/02/2020, Vers le suicide assisté dans les prisons suisses : autodétermination ou désespoir ?, Fin de vie, Euthanasie et suicide assisté, Institut Européen de Bioéthique, Vers le suicide assisté dans les prisons suisses : autodétermination ou désespoir ? – Institut Européen de Bioéthique (ieb-eib.org).

[23]Le suicide assisté en exécution des peines et mesures, Document-cadre du Centre suisse de compétences en matière d’exécution des sanctions pénales (CSCSP), Le suicide assisté en exécution des peines et mesures – KKJPD – CCDJP – CDDGP – FR.

[24]08/03/2023, Suisse : un prisonnier recourt au suicide assisté, une première, International, Le Parisien, Suisse : un prisonnier recourt au suicide assisté, une première – Le Parisien.

[25]Marguerite Richelme, 09/01/2020, Suisse : « L’aide au suicide pour les prisonniers est une dérive individualiste de l’éthique », Vox Société, Figaro Vox, Suisse : « L’aide au suicide pour les prisonniers est une dérive individualiste de l’éthique » (lefigaro.fr).

[26]Julien Ménielle, 27/01/2009, Dignitas : l’usine à suicide, entre « artisanat et travail à la chaîne », 20 minutes, Dignitas : l’usine à suicide, entre « artisanat et travail à la chaîne » (20minutes.fr).

[27]04/11/2008, Des suicides à l’hélium proposés par Dignitas, Suisse, RTS, Des suicides à l’hélium proposés par Dignitas – rts.ch – Suisse.

[28]Ariane Gigon, 22/05/2010, Des urnes funéraires au fond du lac de Zurich, Swissinfo, Des urnes funéraires au fond du lac de Zurich – SWI swissinfo.ch.

[29]Interview d’Erika Preisig, « J’ai aidé 500 personnes à mourir », Société, Le Parisien, Erika Preisig : « J’ai aidé 500 personnes à mourir » – Le Parisien.

[30]Carine Janin, 25/05/2023, En Suisse, le suicide assisté est autorisé depuis 1942, Société, Fin de vie, Ouest France, En Suisse, le suicide assisté est autorisé depuis 1942 (ouest-france.fr).

[31]ROSSIER Yves, « Le débat suisse sur les organisations d’aide au suicide », Études, 2012/2 (Tome 416), p. 187-198. DOI : 10.3917/etu.4162.0187. URL : https://www.cairn.info/revue-etudes-2012-2-page-187.htm.

[32]Steven Ertelt, 27/01/09, Dignitas en Suisse : témoignage, Synthèse de presse, Fin de vie, Gènéthique, Dignitas en Suisse : témoignage – Genethique.

[33]18/05/2018, Dignitas comparaît pour avoir encaissé trop, Le Matin, Suisse : Dignitas comparaît pour avoir encaissé trop – Le Matin.

[34]Erich Aschwanden,07/05/2019, Exit hat ein Millionenvermögen angehäuftExitReichtumNZZ052019.pdf (docfind.ch).

[35] 07/05/2019, La bonne fortune d’Exit dans le suicide assisté crée la polémique, Heidi News, La bonne fortune d’Exit dans le suicide assisté crée la polémique – Heidi.news.

[36]Sibilla Bondolfi, 14/11/2018, Comment Dignitas prône l’assistance au suicide à l’étranger, Swissinfo, Comment Dignitas prône l’assistance au suicide à l’étranger – SWI swissinfo.ch.

[37]Gaspar Bazinet, 06/07/2023, Les législateurs allemands ne parviennent pas à s’entendre sur la réglementation du suicide assisté, Dernières nouvelles, News 24, Les législateurs allemands ne parviennent pas à s’entendre sur la réglementation du suicide assisté – News 24 (news-24.fr).

[38]16/12/2021, L’Autriche légalise le suicide assisté, Actualité, Flash Actu, Le Figaro, L’Autriche légalise le suicide assisté (lefigaro.fr).

[39]Jean-Baptiste Jacquin, 22/09/2021, La Constitution invoquée au secours du droit à mourir dans la dignité, Société, Fin de vie, Le Monde, La Constitution invoquée au secours du droit à mourir dans la dignité (lemonde.fr).

[40]Abel Mestre, Béatrice Jérôme, 19/05/2023, L’association suisse Dignitas veut faire reconnaître un droit à mourir dans la dignité et attaque la France devant la CEDH, Société, Fin de vie, Le Monde, L’association suisse Dignitas veut faire reconnaître un droit à mourir dans la dignité et attaque la France devant la CEDH (lemonde.fr).

[41]Béatrice Jérôme, 26/09/2023, Fin de vie : la Cour européenne des droits de l’homme va statuer sur le recours de l’association Dignitas, Société, Fin de vie, Le Monde, Fin de vie : la Cour européenne des droits de l’homme va statuer sur le recours de l’association Dignitas (lemonde.fr).

[42]M.P., 30/01/2015, Suicide assisté : ce qui se passe vraiment, Archives, Le Parisien, Suicide assisté : ce qui se passe vraiment – Le Parisien.

[43]Annabel Benhaiem, 27/02/2017, DJ Fabo, l’Italien qui a rouvert le débat sur l’euthanasie dans son pays, est allé mourir en Suisse, Life, Huffington post, DJ Fabo, l’Italien qui a rouvert le débat sur l’euthanasie dans son pays, est allé mourir en Suisse (huffingtonpost.fr).

[44]14/10/2007, Suicide médicalement assisté pour l’actrice Maïa Simon, Actualité, Le Figaro, Suicide médicalement assisté pour l’actrice Maïa Simon (lefigaro.fr).

[45]24/08/2018, Jacqueline Jencquel veut décider de la date de sa mort, vidéo Brut, Jacqueline Jencquel veut décider de la date de sa mort – YouTube.

[46]Catherine CHAILLET, 08/03/2021, Suicide assisté : l’ex-secrétaire d’État Paulette Guinchard « voulait que sa décision soit publique », le témoignage bouleversant de son mari, Société, Doubs, L’Est Républicain, Doubs. Suicide assisté : l’ex-secrétaire d’État Paulette Guinchard “voulait que sa décision soit publique”, le témoignage bouleversant de son mari (estrepublicain.fr).

[47]Saskia Gauthier, Julian Mausbach, Thomas Reisch, Christine Bartsch, 2014, Suicide tourism: a pilot study on the Swiss phenomenon, Journal of Medical Ethics; 41:611-617.

[48]M.P., 30/01/2015, Suicide assisté : ce qui se passe vraimentop.cit.

[49]Exit, révélateur d’un malaise de société, Suisse, Le Courrier, Exit, révélateur d’un malaise de société – Le Courrier.

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