1. The number of foreign patients seeking assisted suicide in Switzerland has increased dramatically over the past 5 years.
2. Neurological and rheumatic diseases, potentially non-terminal, have increasingly been cited as reasons for seeking assisted suicide.
Evidence Rating Level: 2 (Good)
Study Rundown: Switzerland’s assisted suicide (AS) laws have remained vague since at least the 1940’s, leading many chronically-ill foreigners to travel to Switzerland seeking AS. This migration of foreign patients from countries with more restrictive AS laws has been termed “Suicide Tourism.” While federal regulation attempts have been made, the failure of consensus has led to cantonal AS regulation. In addition, six major right-to-die organizations exist in Switzerland to help local and foreign patients willingly end their life. This study gathered and analyzed patient data from the Canton of Zurich over a five year period to provide a demographic perspective of Switzerland’s suicide tourism. This study found that about 6 of 10 foreigners seeking AS are female, with a median age of 69. Neurological disorders were cited by nearly half of patients, cancer in about a third, and rheumatic and cardiovascular disorders in many as well, though significant co-morbidity existed. This study found that the number of foreigners seeking AS had doubled between 2009 and 2012. Further, 75% of foreigners seeking AS come from Germany, the United Kingdom (UK), or France, where AS laws are highly restrictive.
This pilot study gives a perspective into a phenomenon with increasingly important medical-legal implications, and though short in study length, describes important AS trends. Though the researchers are investigating further, a major weakness of the study was its lack of data defining which patients were terminally ill..
Relevant Reading: Suicide assisted by right-to-die associations
In-Depth [retrospective cohort]: Between 2008 and 2012, 611 foreigners were identified as seeking AS in Switzerland from databases documenting investigations and postmortem examinations from the Institute of Legal Medicine in Zurich. Review of existing legislation in the countries with the most patients seeking AS was done using articles searchable on Pubmed and Medline. This study found that 58.4% of foreigners seeking AS were women, with ages from 23 to 97 (median 69). Dignitas was the main organization that facilitated AS in Zurich, with Exit supporting only four patients. No AS reports were documented from other organizations or independent of any organization. The main diseases causing patients to seek AS were neurological, oncological, rheumatic, and cardiovascular, though co-morbidity was very common. Foreigners came from 31 different countries, but a combined 75% came from Germany, the UK, and France (in order of most to least). Italian foreigners seeking AS increased 10-fold over the 5 year study period. Germany’s Federal Medical Association forbids AS under its professional code of conduct, though no law has taken a clear stance on AS. Both the UK and France penalize those performing AS with jail sentences. Germany and France also switch the authority of an unconscious suicide patient, suggesting that physicians who witness a suicide but do not intervene may be liable. This study represents part of an ongoing project to characterize AS over the past 30 years.
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