Switzerland gets tough on suicide clinics

The Swiss
government (the Federal Council)
has recently announced its intention to crack
down on “suicide tourism”
 and to severely restrict the activities of suicide clinics like Dignitas and
Exit, which have regularly made the headlines outside Switzerland in the last
few years (particularly Dignitas), as foreigners make up a large proportion of
the hundreds of people they help to die every year. The government is proposing two draft Bills for public deliberation until March. The first option is an outright ban on suicide clinics; were it to become law, clinics like Dignitas and Exit would simply have to close down. Such an extreme measure, however, doesn’t have the favors of most members of the Federal Council, and probably won’t have those of the Parliament either. The second option is more likely to prove popular, and I will thus focus on it: it would involve much stricter regulations – rather than a ban – being imposed on the activities of these clinics. Violations of those regulations would involve
sanctions of up to five years in prison.

Dignitas,
in particular, has been criticized for proceeding too quickly with some
requests for assisted suicide and for helping people to die who were simply
temporarily depressed
.
The idea behind the proposed regulations is thus to slow down this decision
process and make it a more considered, and carefully policed, decision. It also
reflects the will to prevent assisted suicide from becoming a lucrative
business.

 

To the
extent that it is motivated by such ideas, the Federal Council’s plan to
regulate the activities of Swiss suicide clinics is to be welcomed (leaving
aside the fact that it might also have a morally less respectable motive,
namely the fear that the “Heidi-and-cowbells” image of Switzerland is being
damaged by suicide tourism). Clearly any government should take seriously the
fact that some of its citizens are asking to be helped to take their own lives,
and should legislate on this phenomenon when it arises. An ideal law on
assisted suicide would only allow it to happen when it has been ascertained
that the would-be suicide’s request:

1)    has not been prompted by outside
(e.g. family) pressures

2)    is the product of a careful
reflection, and

3)    persists even after a significant
period of time – what exactly this means is one of the things legislators
should determine – during which the person will have had the opportunity to
receive some counseling, and been made clearly aware of the alternatives
available to her.

 

Unfortunately,
despite the good intentions behind it, the Federal Council’s proposed
regulation is far from ideal. If the Bill became law (which would probably
require a popular vote even if the Parliament were to endorse it, given the
threat of a referendum raised by Exit and Dignitas), it would constitute a step
in the wrong direction, for it would unduly restrict people’s autonomy. The
stricter rules would require patients to present two medical opinions, one
declaring that they suffer from an incurable disease which will “shortly” lead
to death, the other one stating that they have made their decision of sound
mind and fully aware of their options. The latter condition is in principle
beyond reproach, though in practice it raises the concern that some
psychiatrists tend to treat any expressed desire to die as a symptom of
clinical depression, which then makes the relevant condition impossible to meet
by definition. Let’s assume this problem (which admittedly any reasonable
legislation on assisted suicide will have to deal with) can be solved. The
former condition is, by contrast, ethically questionable. To take a few
well-known examples from the UK, it would make it legally impossible for
severely disabled people like Daniel James or Noel Martin to ask for assisted
suicide. The same would apply to those suffering of progressive forms of a
neurodegenerative disease like multiple sclerosis, such as Debbie Purdy, as
long as it was judged that their illness, though incurable, would not lead to
death within a “short” amount of time from the moment they made their request.

 

The Swiss
justice minister, who has defended the government’s proposal in front of the
media, argues that palliative care must allow these people to go on living with
dignity (http://www.20min.ch/ro/news/suisse/story/15516468, in French).
This would sound fine were it meant to refer to an option
that society must offer to people
in such difficult situations. But given the content of the proposal, this must
in fact be read as stating an obligation
: these people must go on living no matter how they feel
about it. Now even though we can agree that a civilized society should generally have a “pro-life” attitude and must not make it easy for its members to take their own
lives, there is a significant difference between this and forcing certain
people to either keep on living a life of misery, against their own considered
wishes, or make those who agree to help them to die risk serious legal sanctions. This, I take it, is unworthy of a civilized society, yet this is
just what the Federal Council’s regulation would lead to if accepted.


A
better balance needs to be struck between the conflicting demands of compassion
and respect for individual autonomy on the one hand, and respect for life on
the other. Hopefully none of the two draft Bills (especially the more radical
one) will be passed in its current form, even though Switzerland does urgently
need an adequate legislation on this issue – as do its neighbors. One benefit
of better laws on assisted suicide throughout Europe is that they would
precisely reduce the “suicide tourism” to Switzerland that prompted these
restrictive proposals.

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