German court scraps ban on assisted suicide

Germany's highest court on Wednesday ruled that a 2015 law banning professional assisted suicide was unconstitutional, as it robbed terminally ill patients of "the right to a self-determined death".

German court scraps ban on assisted suicide

Judge Andreas Vosskuhle said the right included “the freedom to take one's life and seek help doing so”.

The ruling is a major victory for the terminally ill patients, doctors and assisted suicide organisations who brought the case, complaining that the existing law went too far.

Known as Paragraph 217, the 2015 legislation penalised anyone offering assisted suicide as a professional service, whether they accepted payment or not.

READ ALSO: German court discusses legality of assisted suicide

It was mainly aimed at barring associations dedicated to supporting patients wanting to end their lives, but also meant medical personnel faced prosecution for prescribing life-terminating drugs.

The legal uncertainty worsened when a 2017 lower court ruled that officials could not refuse lethal medication in extreme cases, creating confusion among doctors.

The verdict on Wednesday from the Karlsruhe-based court was closely watched in a fast-ageing country where Catholic and Protestant Churches still exerts strong influence, but polls show growing public support for physician-assisted suicide.

It is also a particularly sensitive subject in Germany as the Nazis used what they euphemistically called “euthanasia” to exterminate around 200,000 disabled people.

“The right to live does not constitute an obligation to live,” Wolfgang Putz, one of those who brought the case, told judges as they began the hearing last year.

READ ALSO: German court strengthens patients' rights in assisted suicide ruling 

Patients' perspective

For Horst L., paragraph 217 closed a door. The media frenzy about the issue was too much for the cancer patient who wished to remain anonymous.

But in 2019 he read a personal statement before the Constitutional Court. L is suing because he is a member of the German Assisted Suicide Association, which gave him the green light in 2015 – all he had to do was give the signal.

But when the ban came into force, this became illegal. He therefore lost the peace of mind of knowing that if things got too tough, he could pull the plug.

He told the Süddeutsche Zeitung in 2018: “I find it outrageous when others tell me: you have to live, endure and accept.”

Other patients, unable to receive assistance in Germany, traveled to neighbouring Switzerland, where assisted suicide is legal under certain conditions.

The following graph shows how many people traveled to Switzerland between 1998 and 2019 to receive suicide assistance from the non-profit Dignitas. Graph prepared for The Local by Statista.

Helmut Feldmann witnessed both his father and sister suffer painful deaths from lung disease COPD. Now he is ill himself and had made provisions for his death.

But since 2015, his membership to the Assisted Suicide Association has become worthless. “I do not accept that a few hundred parliamentarians are able to decide how I will die”, he told Der Spiegel before the verdict. “I will fight to the end”.

For other claimants the judgement has come too late. They have already lost their race against death during the lengthy procedural process.

Right to dignity

At the heart of the debate was the plaintiffs' argument that Germany's constitution guarantees personal freedom and dignity, which they said includes the right to a self-determined death.

For seriously ill patients who have chosen to end their life, the existing legislation made it “almost impossible to carry out that decision in a dignified manner”, said Christoph Knauer, who represented two of the plaintiffs.

Under Paragraph 217, professionals falling foul of the law risked a fine and up to three years in prison.

This left German patients turning to family members or loved ones for help, some getting life-terminating medicine from abroad.

Judge Vosskuhle said Paragraph 217 “also violates the basic rights of persons and associations who wish to provide suicide assistance”.

On the other side of the debate, the Catholic Church had objected to changing Paragraph 217.

Berlin's Archbishop Heiner Koch urged the court to “send a strong signal for the protection of lives”.

The German Medical Association had likewise spoken out against legalising physician-assisted suicide.

Its former president Frank Ulrich Montgomery warned last year that if doctors were allowed to prescribe a cocktail of life-ending drugs, it could lead to legalising euthanasia — where doctors take an active role in ending a patient's life, for instance through lethal injection.

Judge Vosskuhle acknowledged that the ruling would be a blow to supporters of Paragraph 217 but said the wishes of those wishing to end their lives had to be respected.

“We may regret their decision and try everything we can do change their minds but ultimately we must accept their freedom to choose,” he said.

Euthanasia is officially legal in only three Europe Union countries — the Netherlands, Belgium and Luxembourg — but others allow or tolerate a form of assisted suicide.

In non-EU Switzerland, as well as in the US states of Vermont, Oregon and Washington, assisted suicide is legal.

A survey for broadcaster ARD on Tuesday found that 81 percent of Germans believed doctors should be allowed to help severely ill patients with their wish to die, up from 76 percent in 2012.

Sixty-seven percent of respondents said Germany's Paragraph 217 should be amended.


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Switzerland: What is the difference between assisted suicide and euthanasia?

While the terms often are used interchangeably, assisted suicide and euthanasia - and the laws that govern them - are quite different. Here’s what you need to know.

A person in a medical coat holds hands with another
Euthanasia and assisted suicide might be spoken of in the same breath, but they are quite different. Here's what you need to know. Photo by Matheus Ferrero on Unsplash

The terms assisted suicide, assisted dying and euthanasia are often used interchangeably – even by media and politicians covering the matter. 

There are however some key differences, both in terms of the legal situation and the practice itself. 

Assisted suicide is where a medical professional, usually a doctor but sometimes a pharmacist or other specialist, provides some form of medication to assist a patient as they commit suicide. 

EXPLAINED: How foreigners can access assisted suicide in Switzerland

Crucially, it is the patient who takes the final step, i.e. by taking a medication or by pressing a switch through which the medication is administered. 

Euthanasia on the other hand is where the medication which ends someone’s life is administered by a doctor or medical professional. 

Euthanasia is sometimes known as voluntary euthanasia, which references the fact that the patient volunteers for the process by providing consent. 

Other forms of medical intervention which lead to death – for instance turning off life support for someone who has been in a long-term coma – do not fit within the definition of voluntary euthanasia. 

The term ‘assisted dying’ is used as a grouping term to refer to both assisted suicide and euthanasia, although media sources – particularly in the United Kingdom – often use assisted dying when referring primarily to assisted suicide. 

What are the rules for assisted suicide and euthanasia in Switzerland? 

The law in Switzerland recognises the distinction between assisted suicide and euthanasia. 

Euthanasia is not permitted under law in Switzerland, while assisted suicide is allowed for both locals and foreigners. 

While article 115 of the Swiss penal code prohibits assisted suicide for “self-serving reasons” and article 114 prohibits “causing the death” of a person for “commendable motives, and in particular out of compassion for the victim”, assisted suicide for non-selfish reasons is not specifically prohibited as long as certain conditions are met. 

The Swiss supreme court has ruled the following: people must commit suicide by their own hand, for example, by taking medication themselves. A doctor cannot administer a lethal injection without being liable for criminal prosecution.

People must also be aware of actions they are undertaking and have given due consideration to their situation. In addition, they be consistently sure they wish to die, and, of course, not be under the influence of another person, or group of persons.

READ MORE: What you need to know about assisted suicide in Switzerland

Several other jurisdictions across Europe and the globe also make a legal distinction between the two, although euthanasia is legal in some countries including the Netherlands, Belgium, Luxembourg and Columbia. 

What is the medical procedure involved?

Most Swiss associations request that patients drink sodium pentobarbital, a sedative that in strong enough doses causes the heart muscle to stop beating.

Since the substance is alkaline, it burns a bit when swallowed.

A professional prepares the needle, but it is up to the patient to open the valve that allows the short-acting barbiturate to mix with a saline solution and begin flowing into their vein.

A video is shot of the patient stating their name, date of birth and that they understand what they are about to do. The camera keeps rolling as they open the valve and the footage is used as evidence that they willingly took their own life.

It usually takes about 20 to 30 seconds for the patient to fall asleep.