What is the difference between end-of-life care and euthanasia?

What is end-of-life care?

End-of-life care is a form of special care for people who are nearing the end of their lives. Specially trained professionals in hospitals, retirement homes, hospices, etc. can work together with doctors, nursing staff, pastoral care workers and therapists to help those affected and their relatives. This help includes supporting those affected in coming to terms with their situation and finding an approach to the subject of death. In clear and deliberate contrast to euthanasia, end-of-life care sees itself as an aid to coping and thus to life. As such, it does not necessarily contradict the offer of euthanasia, but should help those affected to create a better basis for decision-making and to understand the full implications of using such services for themselves and their environment.

End-of-life caregivers must therefore be able to put themselves in the shoes of their loved ones and understand their needs. They must also be aware of the difficulty of the situation. They take on a mediating role between the parties involved in the end of a person’s life and must communicate empathetically. There are few rigid rules. In addition to the basic knowledge that the end-of-life caregivers have learned in training, they also need years of experience in dealing with such exceptional situations. The training can be of a different nature: it can focus on medical, psychological, socio-pedagogical and pastoral aspects, whereby these necessarily complement each other.

Emotional support for relatives

Part of end-of-life care can also be grief counseling, which prepares close relatives for the death of a loved one, but also helps them to cope with the bereavement.

What is passive euthanasia?

So-called “passive euthanasia” is the deliberate and intentional omission of potentially life-prolonging medical measures. The administration of pain-relieving medication at the cost of shortening the remaining life span also falls under this term. Such a decision may conflict with the right to life and physical integrity, which are guidelines for medical action and interventions. However, patients also have the right, after careful consideration, to refrain from further interventions and instead opt for purely palliative medical care. A form of passive euthanasia is also euthanasia fasting, which involves abstaining from eating and thus accelerating the natural dying process.

Take measures at an early stage

Normally, after consulting with specialists and relatives, the person concerned can assess the consequences themselves and make the right decision for them. However, depending on their illness or mental state, this is not always the case. For example, if someone is permanently in a comatose state or suffers from advanced Alzheimer’s disease.

For this reason, it is advisable to make provisions for the loss of your capacity of judgment. You can do this with a living will or an advance care directive. In the living will, you can specify which medical measures you refuse and which you agree to. You can specify who may make decisions on medical matters in your place in case of doubt. With the advance care directive, you authorize certain persons to represent you in the event of your incapacity to judge in various matters to be defined individually (e.g. asset management or legal transactions). The two documents complement each other, with the living will taking precedence over the advance care directive in medical matters. If you have not made an advance directive, the child and adult protection law in Art. 378 of the Swiss Civil Code makes assumptions about the power of representation of close persons (so-called “decision cascade”: living will/advance directive). Advance care directive > Assistance > Spouse/registered partner > Cohabiting partner > Descendants > Parents > siblings).

Assisted suicide or assisted suicide

Liberal legal framework in Switzerland

In Switzerland, “incitement and assistance to suicide”, as described in Art. 115 SCC, is only punishable if it is committed for selfish motives:

Any person who, for selfish motives, induces or assists someone to commit suicide shall, if the suicide has been carried out or attempted, be liable to a custodial sentence not exceeding five years or to a monetary penalty.

Art. 115 SCC Incitement and aiding and abetting suicide

This abstract formulation has far-reaching practical consequences for assisted suicide in Switzerland, as it allows assisted suicide to be carried out without penalty if the person or organization providing assistance is not driven by selfish motives (especially the intention to enrich themselves). This provision makes Switzerland’s assisted suicide legislation one of the most liberal in Europe and strikes a compromise between the right to life and the right to a self-determined, pain-free death.

Assisted suicide by non-profit organizations

Swiss associations dedicated to assisted suicide and its preparation, as well as educational work, include EXIT, DIGNITAS and lifecircle. They work on a non-profit basis and are represented throughout Switzerland. As such organizations are subject to very strict ethical requirements, they are generally only prepared to provide assisted suicide if there is a justified request from association members. Membership fees are only intended to cover expenses and administrative costs, as the organizations are not allowed to operate for profit. In particular, a hopeless and unquestionable prognosis of illness, unbearable discomfort or unreasonable restrictions on a self-determined life are recognized as reasons.

The person wishing to die must meet these requirements

In order to be allowed to support persons who wish to die, the organizations must in practice at least thoroughly check the following requirements:

• The person must undoubtedly be capable of judgment, i.e. clearly conscious, when they make the decision to commit suicide. They can only make the decision themselves and, unlike in the case of passive euthanasia, cannot delegate it to another person.
• The person concerned must have thoroughly considered all alternatives to assisted suicide and still insist on his or her wish in the long term.
• They must make their decision independently and must not have been influenced by third parties (advice from specialists is by no means detrimental, however, and is in fact an essential part of the preparation).
• The euthanasia drug (a barbiturate, e.g. sodium pentobarbital) is a prescription-only substance and therefore requires a prescription from a doctor. During the examination, the doctor will also assess the patient’s capacity and make a written diagnosis.
• The person willing to die must carry out the act of suicide, i.e. the administration of the means of death, with their own hands.

Active euthanasia is a crime

Unlike the above-mentioned measures, active euthanasia can have criminal consequences for those assisting the dying. The decisive difference between (unpunishable) assisted suicide and active euthanasia (punishable under Art. 114 SCC) is what is known as ” authorship”. This concerns the question of who carries out the act leading to death: If this is the person willing to die themselves, someone who merely assists them (e.g. by providing the means of death) and has no vested interest in their death is not liable to prosecution. However, if another person administers the substance, they may be guilty of an offense, even if they do so at the explicit request of the person and for a worthy motive:

Any person who, out of respectable motives, namely out of compassion, kills a person at that person’s earnest and insistent request shall be liable to a custodial sentence not exceeding three years or to a monetary penalty.

Art. 114 SCC Homicide on demand

It is therefore essential for legal assisted suicide that the person who wishes to die is not only of sound mind but also physically capable of taking the appropriate action independently.

Why should I concern myself with this topic?

In the event of serious illness or severe suffering, people may want to end their lives of their own free will or accept an earlier death. They do this in order to improve their quality of life. In Switzerland, it is recognized that this free decision is part of human dignity and the right to self-determination. However, there is still a lively and vehement debate surrounding the topic of “assisted dying”.

It is important that actions in connection with assisted dying are taken in a well-considered manner and after comprehensive consultation. Furthermore, not all offers of help are the same.

It’s worth giving this some thought

• Think about whether you would like to draw up a living will or an advance care directive. This will allow you to decide now which (medical) measures you agree to and which you do not.
• Talk to your relatives about medical measures in different situations so that they know your opinion on this subject.

Related Articles

• Under what conditions is euthanasia permitted?
• “When is which type of euthanasia appropriate?”
• The advance care directive
• What does assisted suicide cost and who pays for it?
• Euthanasia in Switzerland, Germany and Austria

External links in this context

• EXIT – Association for humane dying
• DIGNITAS – Living with dignity – Dying with dignity
• Association lifecircle