info suisse Winter 2017 / March 2017
Medical Assistance in dying in Canada and in Switzerland
Many people plagued by old age afflictions are afraid of becoming victim of pointless operations or ineffective pharmaceutical therapies. Others fear to find themselves connected to machines and being kept alive for a long period of time. In this situation, they wish to choose a self-determined end of life in the form of an assisted suicide.
While assisted suicide is restricted in many countries, Switzerland has a liberal legislation and, as a consequence, the bad reputation to attract “suicide tourists”. In Canada, on the other hand, there was a federal ban on assisted dying until June 2016 when the government of Canada introduced Bill C-14 on Medical Assistance in Dying.
On Feb. 6, 2015, the Supreme Court of Canada decided to revoke the ban on physician-assisted dying, arguing the old law violates the Canadian Charter of Rights and Freedoms. Until then, each year, a handful of severely ill Canadians traveled to Switzerland for a medically assisted death. But the costs — several $10,000 for flights and accommodation including accompanying persons — put this option out of reach for most Canadians.
On June 17, 2016, the Parliament adopted the Bill C-14 that decriminalizes medical assistance in dying. However, some restrictive criteria were added that limit the access to medical assistance in dying. In particular, the bill specifies that the natural death of eligible patients must be foreseeable. Moreover, the Bill does not cover mental illness such as dementia or Alzheimer’s, nor will patients be able to provide advanced consent by leaving legal instructions for their assisted death in the event that they become incompetent. Finally, the Bill limits the availability of medical assistance in dying to persons who are eligible for government-funded health services in Canada. This means that eligible persons must be citizens or permanent residents of Canada. This requirement was obviously added to prevent that Canada becomes a destination for assisted suicide travel.
Not unexpected, the long-awaited legislation has drawn some widespread criticism for implementing eligibility criteria that are inconsistent with the Supreme Court of Canada’s ruling of 1015. Bill C-14 is even considered unconstitutional, because the proposed law limits access only to patients whose natural death is “reasonably foreseeable.” Therefore, assistance in dying will be unavailable to anyone who is not expected to die in the near future, no matter how severe his illness is. As a consequence, non-terminally ill Canadians have again to take the long and expensive way through the courts to obtain the right to die with dignity.
“Switzerland’s suicide tourism industry is booming” is only one of many headlines in the foreign press commenting the fact that Switzerland permits non-residents to end their life lawfully with medical assistance. The Swiss canton of Zurich remains the most common destination for travel for assisted suicide.
There are six organizations providing assistance for suicide in Switzerland with Exit being the largest with around 100,000 members. Exit was involved in the majority of the assisted suicide deaths in Switzerland in 2015, comprising 782 cases.
However, Exit does not offer its services to foreign nationals. A further 222 deaths occurred in clinics run by Dignitas, which does offer its services to foreigners. In a BBC interview of July 2010, Ludwig Minelli, founder of Dignitas, says his death clinic services are available to anyone. Asked if he would assist in the suicides of people who are neither physically nor mentally ill, but only tired of life, he said, “Of course, why should we say no?”
Swiss law tolerates assisted suicide when patients commit the act themselves and assisting persons have no benefit from their death (Article 115 of the Swiss Criminal Code). Some Swiss cantons have additional regulations by permitting or prohibiting assisted suicide in care homes or hospitals. In September 2012, Switzerland’s parliament voted against a proposal to strengthen controls on assisted suicide, rejecting concerns about foreigners traveling to the country to die. Foreign journalists often make the mistake of asserting that direct euthanasia is allowed in Switzerland, which is not true.
The costs for an assisted suicide can amount up to CHF 4000 for Swiss residents and up to CHF 10,000 for foreigners, considering that a team of two doctors and two assisting persons is involved and a clinic room is required. Included are also the costs for the preliminary contact with the patient and his family doctor and for the assessment of the patient’s medical history. A person from abroad must expect to stay in Switzerland for a week or more, before an assisted suicide can happen. The organisation offering suicide assistance provides the necessary medication, a fast acting barbiturate (usually sodium pentobarbital). The patient can either drink it or have it administered by an intravenous drip (if the injection is activated by the patient himself). Falling asleep occurs within a few minutes, death usually follows within half an hour. Once death has occurred, the Swiss police has to be notified, which is required by Swiss law.