Healthy people are not allowed to assist suicide
How did this change occur? In May, the Swiss Medical Association (FMH) agreed with the revised "end-of-life management" guidelines proposed by the Swiss Academy of Medical Sciences (SAMS). The guidance will become part of the code of obligations that doctors must abide by in the future, as follows:
- Doctors must have at least two detailed discussions with the patient, separated by at least two weeks, except in justified exceptional circumstances.
- The symptoms of the disease and/or dysfunction must be intolerable and their severity justified by a reasonable diagnosis and prognosis.
- Providing assisted suicide to healthy people is not medically or ethically justifiable.
The needs of relatives and the interprofessional care and support team must also be considered before, during and after assisted suicide. The required support should be provided and must be documented.
SAMS's guidelinesExternal link are not legally binding. But the fact that the Swiss Medical Association (FMH) has adopted them and incorporated them into deontological norms makes it possible to sanction violations. The FMH is the umbrella organization for all medical associations in Switzerland and represents the interests of Swiss doctors, more than 90% of whom are members of the FMH and must abide by deontological principles .
“It’s not about tightening, it’s about being refined.”
In 2018, the private research funding agency SAMS issued new medical ethics guidelines for "end-of-life management". It sets out exactly what doctors should follow when performing assisted suicide. However, the FMH disagreed with the 2018 guidance and rejected it as being too vague.
SAMS Secretary General Valérie Clerc said: "The revised guidelines are not tightening, but refining."
Assisted suicide groups firmly reject the new guidelines. Erika Preisig, a physician and president of Lifecircle, is particularly troubled by the two-week rule, which she says is particularly difficult for foreigners.
Although Lifecircle is offering its first online meetings, Preisig thinks this will still be an issue for some. "Most of our patients are elderly and they may not know how to conduct online meetings. Some don't even have smartphones," she noted. This means they must travel to Switzerland two weeks before their scheduled assisted suicide. This is particularly expensive for people with disabilities, who have to pay for specialized care in the two weeks between consultations.
"The guidelines allow for exceptions, but not if people cannot afford to stay in Switzerland for two weeks," Claire told SWI swissinfo.ch. "If a person is close to death or their pain is so unbearable that they are waiting for assisted suicide When long hours seem unbearable, exceptions will be made.”
Switzerland has long been criticized for its stance on assisted suicide. Critics say Switzerland's approach promotes "suicide tourism".
Is the "two-week rule" introduced to reduce the number of "suicidal tourists"? SAMS simply points out that the guidance does not distinguish between Swiss nationals and foreigners at any time.
"Doctors become gods"
Travel expenses aren't the only problem. Thirty-year-old Aina from Japan suffers from a rare neurological disease. Her assisted suicide was also approved. But she worries about the rule that "the severity of suffering should be demonstrated by a reasonable diagnosis and prognosis."
People seeking assisted suicide in Switzerland must explain in their own words the severity of their suffering and why they want to die. This letter must be submitted in addition to the medical records.
Aina's condition is so severe that she cannot stand or walk and relies entirely on her mother to get through her days. Her condition was different from terminal cancer. She would not die immediately and would likely suffer for a long time.
"If the doctor is using his or her own judgment to decide whether my condition meets the guidelines for assisted suicide, what about my own decision-making authority?" she wondered. "No one but me can judge the severity of my pain and how much I want to die from it. These new guidelines almost turn doctors into gods."
Assisted suicide group Dignitas takes a similar stance. In its newsletter External link it states, "The new guidance moves away from valuing the patient's personal perspective as a physician's rationale for supporting a request for assisted suicide, towards a more medically diagnostic classification of suffering."
It also said that "medical reports and internal documents requested by Swiss doctors must be more detailed than before."
EXIT, Switzerland's largest assisted suicide organization, told SWI swissinfo.ch: "The guidelines do not recognize that psychosocial problems can also be legitimate factors in wanting to end one's life."
Assisted suicide organizations believe that the ban on helping healthy people end their lives does not take into account that "the Swiss Federal Supreme Court and the European Court of Human Rights have declared that everyone has the freedom to decide when and how to end his life." To have one's own life as a human right. "
Procedural opacity
Assisted suicide groups have criticized the "lack of transparency" of SAMS and FMH. EXIT spokesman Muriel Düby said the Swiss medical community, patients and assisted suicide organizations had not had a chance to react to the new guidelines. "Even if the draft is approved by the highest authority of the State Administration for Market Regulation, it is still classified as confidential."
EXIT provides services to Swiss nationals living in Switzerland and abroad. At a meeting in June, board members decided to continue business as usual despite the new guidelines.
Presig and other representatives of assisted suicide groups worry that more doctors will be hesitant to perform assisted suicide in the future.
Pandolfo said that if he had not been licensed for assisted suicide a few years ago, he would have taken his own life out of fear for the future. "The idea of assisted suicide improves my quality of life because I know I can end my life at any time." Ultimately, it prevents suicide. "I think Switzerland made a big mistake [by introducing these new guidelines]."
