Suicide What does this mean and what are the various options?
Self-determination is a need of our society. In the event of serious illness, at the end of life, we want to decide and have a say in our medical treatment and care.
Better to die than... It is human to think of death when one is afraid of pain when dying, has had enough of life, is sick, fragile, sad and desperate. Each one of us has the right to self-determination in the last phase of life. We'll show you where to find assistance and who has helpful information for you.
Ways of self-determination
Before taking a definite decision upon the wish to depart life, talk about it with someone, e.g. with specialists at the emergency telephone service “Die Dargebotene Hand”. They offer anonymous and skilled advice.
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Determine and arrange the last phase of your life
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Your last will will be taken into account in medical measures
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Quick and easy online
Legal
Euthanasia and assisted suicide
- The renunciation or discontinuation of life-prolonging measures (Example: a life-support machine is switched off, discontinuation of chemotherapy). There are no specific legal provisions governing this form of euthanasia. It is considered permitted and generally accepted in Switzerland.
- Assisted suicide: The person wishing to commit suicide is given the lethal substance, which he or she then takes him- or herself without any external assistance. Organisations such as EXIT offer assisted suicide within the framework of the Swiss Penal Code. Punishable is only who can be accused of having self-serving motives (e.g. for the provision of a lethal substance).
- Physical and psychosocial assistance: Palliative medicine and care is not only medical treatment and physical care but also psychological, social and pastoral support to the patient and his or her family and it can significantly increase the patient's quality of life.
Active euthanasia can be direct or indirect.
- Direct, active euthanasia: Deliberate killing in order to shorten the suffering of another person. The doctor or a third party administers an injection to the patient which results directly in his or her death. If this is upon the wish of the seriously and terminally ill, it is homicide at the request of the victim. Direct, active euthanasia is currently punishable under the Swiss Penal Code.
- Indirect, active euthanasia: In order to relieve suffering, means are used which may have the secondary effect of shortening life (e.g. morphine). It is taken into account that death might occur earlier than it otherwise would had. There are no specific legal provisions governing this form of euthanasia and it is generally regarded as permissible.
Legality
Legally admissible
- Suicide: A person intentionally causes his or her own death. Some see this as an expression of personal freedom. A suicide attempt often happens in an unstable psychological condition and in a limited capacity of judgement. This is why suicide prevention is so crucial.
- Assisted suicide: Legally permissible as long as the person assisting is not motivated by self-serving ends.
Legally punishable
- Direct, active euthanasia: Directly and actively taking someone's life is forbidden in Switzerland and thus the direct, active euthanasia. This includes the deliberate killing of another person at his or her request with the motive to end his or her life and not to heal or relieve the suffering of the seriously and terminally ill.
- The deliberate and direct killing of the dying person can fulfil the legal provision of intentional homicide, manslaughter (includes cases where the offender acts in a state of extreme emotion that is excusable in the circumstances, or in a state of profound psychological stress), or homicide at the request of the victim (includes cases where the offender for commendable motives, and in particular out of compassion for the victim, causes the death of a person at that person’s own genuine and insistent request).
Palliative Care
Palliative care means comprehensive treatment and care for people with incurable, life-threatening or chronically progressive diseases. Its goal is to give patients the best possible quality of life. This includes accompanying the patient's relatives. Palliative Care wants to optimally relieve the suffering of the sick and, according to the wishes of the patient, also take into account social, psychological, spiritual and religious aspects. Providing good palliative care requires professional knowledge and approach. If possible, it takes place at a chosen by the patient location. Palliative care comes to use mainly in the time in which death is foreseeable, but it is often sensible to adopt palliative care measures in advance and at an early stage, possibly in parallel to curative measures.
Palliative Care at home?
What are the conditions so that the patient does not have to spend his or her last days in hospital? With an emergency and action plan, it is easier to plan in advance and to respect people's wish to spend the time they have left at home. In the emergency and action plan it is recorded how to proceed according to the patient's symptoms. Instructions regarding nursing care are indicated by a Spitex employee who is often specialised in a particular nursing area. In addition, the wishes of relatives and close ones, as well as all relevant telephone numbers, are recorded. Palliative care embodies a wide network of people who are able and willing to provide care and assistance. This includes the general practitioner/medical consultant, Spitex and specialised services. If the patient wishes to not go to hospital, the emergency number 144 (Emergency rescue) should not be on the list of telephone numbers.
Legal & Financing
Irrespective of age, illness, origin or financial possibilities, seriously ill and dying people in Switzerland receive palliative care adapted to their situation. Palliative care is financed according to the general principles of the Gemeinsame Einrichtung KVG. Today, patients who have the capacity of judgement regarding their medical treatment and nursing care, also have the right to decide over such matters. The Federal Constitution grants people the fundamental right to physical and mental integrity. Since a medical intervention constitutes assault occasioning actual bodily harm, the patient must give his or her consent and may also refuse a planned intervention (Naef, Hölzle-Baumann & Ritzenthaler-Spielmann, 2012).
Dying and death – The ethics
Palliative care is intended to reduce physical pain, but also to address psychological, social and spiritual challenges. The main aim is to improve the quality of life for the patient and his or her relatives. If necessary, relatives also receive assistance beyond the death of the patient.
Further information on the topic of palliative care can be found at:
Suicide
Non-assisted suicide is when a person intentionally causes his or her own death. Common methods of suicide include hanging, pesticide poisoning, and firearms. Often suicides are due to mental disorders, e.g. depression, anxiety disorders, and substance abuse. Some suicides are impulsive acts due to stress, such as financial difficulties or relationship problems.
Methods of suicide such as hanging, jumping in front of a train or the usage of firearms cause great damage to the ones who involuntarily become witnesses – such as the train driver, the people from the Care Team, family members or the people who happen to find you. There are other ways to leave peacefully.
If you have suicidal thoughts, talk to someone - contact a suicide and crisis hotline, talk to your family and friends or contact a specialist.
Further information and assistance:
Organised assisted suicide
Switzerland has one of the most liberal legislations in Europe with regard to euthanasia. The most common reasons why people seek organised assisted euthanasia (which is legal in Switzerland) are cancer, neurodegenerative diseases or cardiovascular diseases. Therefore, it is a very delicate situation when the patient has dementia as with advanced dementia he or she is not capable of judgement and the capacity of judgement is required for assisted suicide. Persons with dementia are eligible for physician-assisted suicides only during the early stages of the disease. Unlike non-assisted suicide, the organisations mentioned here talk and consult the patient and take a close look at his or her situation.
EXIT
The conditions for assisted suicide – which are not legally required, but EXIT has set in its by-laws and internal guidelines – are the following: "EXIT will provide end-of-life care only to persons with hopeless prognoses, or with unbearable symptoms, or with unacceptable disabilities". For EXIT, it is crucial that the person concerned decides for him- or herself what is unbearable or unreasonable for him or her. It is important and required by law that the person wishing to die knows what he or she is doing (faculty of judgement). Therefore, EXIT requires that a physician confirms the person's faculty of judgement in writing. The wish to die must also have come about autonomously, i.e. without the influence of any third party. Furthermore, it will be made sure that the patient is not acting on impulse (due consideration) and has a persistent wish to die (constancy). Assisted suicide comprises the autonomous decision on when and how to die.
Further information:
- www.exit.ch
- Freitodbegleitung: «EXIT leistet auch Suizidprävention»
- «Für s Mami war der Tod eine Erlösung»
- Lieber sterben als dement: Umstrittener Freitod mit Exit
Dignitas
To live with dignity – to die with dignity, this is Dignitas' motto. Dignitas has the objective of ensuring a life and a death with dignity for its members and of allowing other people to benefit from these values. The activities of Dignitas comprise, amongst others: Counselling in regard to all end-of-life issues; cooperation with physicians, clinics and other associations; carrying out patient’s instructions and patient’s rights with regard to doctors and clinics; suicide- and suicide-attempt prevention; support in conflicts with authorities, nursing homes and with doctors; further legal developments in regard to questions about “the last issues”; accompaniment of dying patients and assistance with a self-determined end of life. Dignitas' conditions for the provision of assisted suicide are the following: the person is suffering from an illness which will inevitably lead to death, and/or has an unendurable disability, and/or severe pain. Dignitas is based in Zurich and has an association in Germany for people with residence there.
Further information:
Doctor
The law allows doctors to assist a patient capable of judgement. In principle, he or she may write a prescription for sodium pentobarbital. Doctors, however, have the duty to save lives and/or provide long-term life-supporting treatment. Hence, the doctor will be wary of prescribing such a drug without conducting a similar assessment as the one conducted by organised assisted suicide organisations.
Further information:
Dying by fasting
Food is deliberately avoided during this type of fasting. It is a process that the person can stop after 3 to 7 days without suffering any damage. It necessarily requires well-discussed and sometimes intensive care. Family and friends are intensely confronted with the process of dying for approximately 8 to 14 days. Medical care is necessary depending on the state of the person, whereas palliative care is essential. Maybe the patient has a patient decree in which he or she prohibits force-feeding or infusions. Distinguishing between fasting in terminal illness and a non-dying person fasting is very important. With terminal illnesses, including severe end-stage dementia, denying food and fluids or the lack of hunger and thirst is physiological as it ultimately belongs to the dying process. It is different with non-dying people and especially with young people, as they have the feeling of thirst and hunger and it, therefore, takes a lot of determination to resist these. This means a great deal of suffering for the person fasting. In addition, it also puts a strain on the relatives and the carers. The feeling of hunger is less challenging, as it has shown that not eating is easier than not drinking any liquids. People who choose this path must be aware that fasting to death is a process that does not just take 3 to 4 days. It is a very arduous death, especially for younger people. If a person opts for fasting, it should be taken into account that it is not foreseeable how the death process will go. In any case, it is crucial to consider suitable options and to discuss them with the involved people, such as the general practitioner/medical consultant.
Legal
The conscious and voluntary denial of food and fluids is legally unproblematic. It is allowed to shorten the personal death process in this way. Depending on the specific circumstances, the police or the public prosecutor will initially assume an “exceptional death” and conduct an investigation, as it is conceivable that the deceased person did not voluntarily not take in food and liquids, but was urged to do so by relatives (so-called inciting and assisting suicide); and that, due to the circumstances, the relatives would have been obliged to seek help. Namely, when the person had no will to die, but could not take in food and fluids due to illness. Of course, such cases are rare, but because they do exist, the police may need to clarify the cause of death.
Ethics
Actually, the decision as to whether I find my life worth living or not, cannot be delegated to others. As long as someone has the capacity of judgement, the person always decides for him- or herself. Nevertheless, in certain medical situations, a decision has to be taken in the name of the patient as to whether life support measures should be taken or discontinued. These decisions are made on the basis of Adult Protection Law, Law of Persons and Law of Children.
Further information on the topic of fasting can be found at: