European Network of Health Care Chaplaincy
Protestant Association of Hospital Chaplaincy
End of life issues in Switzerland
1. The legal regulations on end of life choices in Switzerland
Public policy debate today surrounds end of life issues, esp. assisted suicide. The government, among them the chief executives, are about to change the federal crime laws concerning assisted suicide. The debate is open for the public till March 1st 2010, and implementation will follow based on the outcome of this debate.
There are mainly three positions:
- to ban end of life organizations, who have up to now performed assisted suicide legally
- to define standards regarding end of life issues and to make assisted suicide itself less easily accessible
- to maintain the status quo: mainly personal freedom of assisted suicide without any restrictions
Article 115 of the Swiss penal code: Inciting and assisting someone to commit suicide
“A person who, for selfish reasons, incites someone to commit suicide or who assists that person in doing so will, if the suicide was carried out or attempted, be sentenced to a term of imprisonment of up to 5 years or a fine.“
When the article 115 of the Swiss penal code was established in 1937, there were no organizations for assisted suicide. What the lawgiver had in mind was assisted suicide in the context of a personal relationship. “Exit”, the oldest organization for assisted suicide, was founded in 1982. Today there is a debate on the question: Is article 115 really a legal basis for such organizations as “Exit”?
Restrictions by law
The more restricted position is new. Three years ago the government rejected a more restricted law for end of life organizations. As it is now, helping someone to kill himself is not forbidden if the motive is not selfish. Yet now, the government is ready to adopt a more restricted law.
The law in detail
People who are willing to commit suicide should reflect on the issue for a long time before actually getting in touch with at least two independent medical doctors who work with end of life organizations. Doctors have to make sure and hand out some kind of proof that the person is incurably ill.
There is debate about what is actually meant by “incurably ill”. Walther Fesenbeckh, board member of the end of life organization “Exit” (he is a retired pastor of the Reformed Church), considers the suggested law as very restrictive or even an abolition of self-determination. He argues that people with chronic diseases would be forced to go on suffering under such a new law.
2. The view of the Protestant Church Council SEK
Members of the Protestant Church Council SEK (Schweizerisch Evangelischer Kirchenbund) are in favour of the restrictions. They vote for a more accessible and elaborated control of end of life organizations. According to the evangelical view of life, to protect life is of highest importance, although the person’s autonomy should be considered as well. For the SEK, it is important that the standards for the implementation of end of life organisations should not be loosened. Their work should be under better control, and it should become less easy for suicidal people to find help to commit suicide.
Adrian Kerkhoven, December 2009
Association of the Swiss Catholic German-speaking Hospital Chaplains
Switzerland
1. The legal regulations on end of life choices in Switzerland
In Switzerland it is allowed to withhold or withdraw curative or life-sustaining treatment. All treatments, esp. pain or symptom control and palliative care or sedation, aim at maximizing, in an active way, the incurably ill patient’s quality of life and comfort.
However, euthanasia by consent, to kill on demand, is prohibited and assisted suicide is penalized if and only if the motive is selfish. The federal crime laws thereto:
Article 114 of the Swiss penal code (established in the year 1937):
To kill on demand
“A person who, from respectable esp. merciful motives, kills someone who seriously and urgently demands to be killed, will be sentenced to a term of imprisonment of up to 3 years or a fine.”
Article 115 of the Swiss penal code (established in the year 1937):
Inciting and assisting someone to commit suicide
“A person who, from selfish motives, incites someone to commit suicide or who assists that person in doing so will, if the suicide was carried out or attempted, be sentenced to a term of imprisonment of up to 5 years or a fine.“
Since the 1980s article 115 has been interpreted as legal permission to set up organizations administering lethal medication. In Switzerland there are two such organizations that offer assisted suicide: Exit and Dignitas.
Today public policy debate centers on organized assisted suicide. The government wants to change the federal crime laws concerning organized assisted suicide. The question is: Can article 115 be interpreted as a legal basis for such organizations? The debate is open for the public till March 1st 2010.
There are mainly three positions:
2. The view of the Roman Catholic Church (Swiss bishop conference)
The bishops are strictly against euthanasia by consent and any form of assisted suicide. They support the efforts to establish palliative care, as well as the idea of health care directives (the patient’s living will).
3. The main tensions in the chaplains’ general practice concerning quality of end of life
The tensions in the chaplains’ general practice concerning quality of end of life depend on the institution (hospital, psychiatric hospital or nursing home) and on the legal regulations of the canton where the chaplain works. The main tensions are caused by the existing organizations Exit and Dignitas that offer assisted suicide. For example the canton of Zurich: Organized assisted suicide is not allowed in the hospitals, yet it is allowed in the nursing homes.
Audrey Kaelin, January 2010