Assisted suicide and euthanasia in Switzerland: allowing a role for non-physicians

doi:10.1136/bmj.326.7383.271

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Samia A Hurst (shurst@cc.nih.gov), postdoctoral fellowa,
Alex Mauron, professorb

^a Department of Clinical Bioethics, National Institutes of Health, Bethesda, MD 20892-1156, USA
^b Unité de Recherche et d'Enseignement en Bioéthique, Faculty of Medicine, University of Geneva, Switzerland

Correspondence to: S A Hurst

Accepted 17 January 2003

Switzerland has an unusual position on assisted suicide: it is legally condoned and can be performed by non-physicians. Euthanasia is illegal, but there is a debate about decriminalisation that also discusses participation by non-physicians

The involvement of a physician is usually considered a necessary safeguard in assisted suicide and euthanasia. Legislation in Holland, Belgium, and the US state of Oregon all require it, as did the legalisation of euthanasia in Australia's Northern Territories.1^–4 Physicians are trusted not to misuse these practices; along with pharmacists they are in control of prescription drugs. Physicians are believed to know how to ensure a painless death, and they are in a position to offer palliative care knowledgeably.

Switzerland seems to be the only country in which the law limits the circumstances in which assisted suicide is a crime, thereby decriminalising it in other cases, without requiring the involvement of a physician. Consequently, non-physicians have participated in assisted suicide. The law has explicitly separated the issue of whether or not assisting death should be allowed in some circumstances, from that of whether physicians should do it. This separation has not resulted in moral desensitisation of assisted suicide and euthanasia.

Summary points

Most legislation condoning assisted suicide or euthanasia stipulates that a physician must be involved

The acceptability of voluntary death is not entirely contained within the framework of medicine

Assisted suicide is not a criminal act under Swiss law if it is motivated by altruistic considerations

Sharp controversy surrounds assisted suicide in Switzerland, but the few data that exist suggest that the public supports it

Methods

We describe the history of the Swiss law for assisted suicide, the current debate, and the existing data on euthanasia and assisted suicide in Switzerland. This review is based on the relevant literature and on the experience of participants …