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Education And Debate

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

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7383.271 (Published 01 February 2003) Cite this as: BMJ 2003;326:271

Rapid Response:

Assisted Suicide and Euthanasia in Switzerland: Response to Comments

We are grateful for the responses to our article.
Whether assisted suicide should be allowed is one point, and whether
physicians should participate in it is a distinct point, even if they are
often mistakenly conflated. Debates about these two points cannot, and
probably should not, be held in complete isolation from one another, but
mixing the two issues is unenlightening. That there is no intrinsic need
to involve doctors in assisted suicide, even if the practice itself is
accepted, is a point that the Swiss situation illustrates.

Regarding the link between the practice of euthanasia and its legal
status, it is clear that assisted suicide and euthanasia can exist even
where they are not legal. In the absence of specific research, it is
difficult to know the effect of a given legal framework on their
frequency. We would like to point out Vincent's survey of critical care
doctors in 12 European countries. Regarding Switzerland, this study is
very limited by the small number of Swiss responses (26), which is why we
did not include it in our article. Despite the fact that Holland was, at
the time, the only country surveyed where euthanasia was decriminalized, a
higher proportion of ICU doctors responded that they "sometimes practice
deliberate administration of medication to speed death in patients with no
chance of recovering a meaningful life" in France and in Belgium, than in
the Netherlands. [1] This suggests that the practice of assisted death
could be more complex than examination of the legal situation in the
abstract would show.

It is mistaken to view the ethics of assisted suicide as part of a
project that "creates hierarchies of human worth". Proponents of assisted
suicide argue that respecting each of us as a legitimate chooser of our
own moral values (as long as we do not harm others) requires that a
patient be allowed to end her own life if she herself feels that it is not
worth living. It is, of course, possible to disagree with this conclusion,
but this position does view all human beings as having equal worth.

There is some concern that having the legal option of assisted
suicide or even euthanasia encourages lowering the threshold for giving up
on palliative care. One study has shown oncologists in the US to be less
likely to have performed euthanasia if they reported better training in
palliative care, or better access to end-of-life care for their patients.
[2] This is good reason to increase training in palliative care. However,
the questions of assisted suicide and euthanasia will remain, as they have
philosophical dimensions that are beyond the reach of medicine.
Furthermore, in shaping attitudes towards assisted death, culture does
count: generalization of results across borders should be made cautiously.
Further data on practices at the end of life in Switzerland would be
important in understanding the implications of its unique legal situation.

We also wish to stress that the importance of palliative care is the
one point that does seem to be recognized by all stakeholders in the Swiss
debate. Relieving a patient's suffering is very much the main issue. What
opponents in the debate disagree on is whether assisted suicide can be an
acceptable response when palliative care fails to relieve suffering
sufficiently to make life bearable in the patient?s eyes, and whether
physicians should have a part in it.

(The views expressed here are the authors' own and do not reflect the
position of the National Institutes of Health, or of the Department of
Health and Human Services.)

1. Vincent JL. Forgoing life support in western European intensive
care units: the results of an ethical questionnaire. Crit Care Med
1999;27(8):1626-33.

2. Emanuel EJ, Fairclough D, Clarridge BC, Blum D, Bruera E, Penley
WC, et al. Attitudes and practices of U.S. oncologists regarding
euthanasia and physician-assisted suicide. Ann Intern Med 2000;133(7):527-
32.

Competing interests:  
None declared

Competing interests: No competing interests

01 March 2003
Samia A. Hurst
post-doctoral fellow
Alex Mauron, Unité de Recherche et d'Enseignement en Bioéthique, Faculty of Medicine, University of Geneva, Switzerland
Department of Clinical Bioethics, National Institutes of Health, Bethesda, MD 20892, USA