Case puts assisted suicide at a crossroads

The drug Pentobarbital is taken by patients of the right-to-die organisation, Exit Keystone

The acquittal of a doctor accused of euthanasia has rekindled the debate on assisted suicide in Switzerland, ahead of votes at the cantonal level on the issue.

A regional criminal court in Boudry, canton Neuchâtel, ruled in December that the doctor had no choice when she took the final step to end the life of a terminally ill patient. The acquittal was made definitive in a ruling issued on Tuesday.

Direct active euthanasia is illegal in Switzerland but assisted suicide and passive euthanasia (mercy killing) are not.

In the Neuchâtel case, the medic had started a lethal drip for a patient who was suffering from an incurable degenerative condition. As the patient – who had expressed a wish to die – was not able to perform the act herself, the doctor relied on a movement of the patient’s foot as a signal.

The court ruled that as there was no doubt about the patient’s wishes, the doctor in this case had a medical and moral duty to break the law out of compassion.

The verdict provoked many, mostly positive reactions, with the response from the Swiss Bishops Conference being one exception.

“[We are] convinced there are no life situations which, by definition, would be unworthy of being lived,” the Conference said, strongly rejecting the idea of the necessity to aid in a person’s death.

Political consequences

The verdict has had political consequences. Two senators have submitted postulates to the federal government.

One politician, Didier Berberat, a centre-left Social Democrat who represents canton Neuchâtel, had called on the cabinet to propose solutions to problems posed by the penal code that punishes those who assist in another’s suicide with a maximum of three years in jail or a fine.

“My goal is not to have direct, active euthanasia allowed,” Berberat said. “This is also a relatively rare scenario.”

Berberat added that he does not want to see doctors being allowed to perform assisted suicide in any case, for example when someone suffers from a “broken heart”.

In his request to the cabinet, he has listed the possible restrictions, which are already mentioned in the guidelines of ethics committees: the person willing to die must have an incurable disease, the disease must be in a terminal phase, and the patient is suffering excruciating pain but is still capable of making judgements.

According to surveys of the population, these conditions are still considered acceptable reasons to resort to assisted suicide.

“Over the years, the proportion has barely changed at three-to-one in favour,” says former doctor Jean Martin, member of the National Advisory Commission on Biomedical Ethics.

More restrictive?

Former Justice Minister Eveline Widmer-Schlumpf had wanted to make the law more restrictive by either banning right-to-die organisations or at least control them more closely. However, Widmer-Schlumpf – of the centre-right Conservative Democratic Party – moved to the finance ministry in November, handing over the justice portfolio to Simonetta Sommaruga of the Social Democrats.

But it is not yet known what approach to assisted suicide Sommaruga will take. “The work is ongoing,” was all Folco Galli, spokesman for the Justice Office, would say.

In his postulate, senator and Green party member from canton Vaud, Luc Recordon, asks that any changes to the law ensure that assisted suicide can never become a commercial activity.

But Recordon also wants to see that foreigners are able to come to Switzerland for assisted suicide. This service offered to people from abroad by the Zurich-based Dignitas organisation has been the target of widespread disapproval.

Loopholes

“When abortion was prohibited in Switzerland, we were quite happy to go abroad,” Recordon said.

Even if he believes the current law adequately addresses assisted suicide, the Green senator would like to close loopholes in article 115 which foresees jail terms up to five years for anyone acting out of their own interest to incite a person to commit suicide or to assist in that suicide. At the moment, many prosecutors believe the article is not worded strongly enough to prevent abuse.

Pressure on the government to act is also coming from the cantons. The authorities in Basel Country have filed a cantonal initiative calling for improved monitoring of right-to-die organisations. And in May, voters in Zurich will decide on proposals to further tighten or introduce an outright ban on assisted suicide at the cantonal level.

Martin, who has published an article in a collection of French essays titled, “Il n’y a pas de mort naturelle” (There is no natural death), says he is not opposed to better controls on assisted suicide organisations.

“For example, donations from individuals using their services should be prohibited,” he said.

But he added that this should not lead to a multiplication of bureaucratic hurdles that may prevent people from exercising their right to determine their own death.

Assisted suicide

Swiss law tolerates assisted suicide when patients commit the act themselves and helpers have no vested interest in their death. Assisted suicide has been allowed in the country since the 1940s.

In a statement in October 2009, the Justice Office said the government wanted to tighten the law to prevent assisted suicide becoming a “profit-driven business”. New Justice Minister Simonetta Sommaruga has yet to outline her position on the subject.

The way of committing suicide is usually with a lethal dose of barbiturates that has been prescribed by a doctor. The Swiss practice allows the use of intravenous drips or stomach tubes.

The legally critical act is the last step of the procedure, opening the tap of the drip or tube. 
The last step must always be carried out by the individual wanting to die and this must be attested to by a witness.

(Adapted from French by Dale Bechtel)