Vaud is set to become the first Swiss canton to introduce a law explicitly regulating assisted suicide. On Sunday, 62 per cent of people in the French-speaking canton voted in favour of a proposal obliging nursing homes and hospitals to accept the practice.
The plan was put forward by the cantonal parliament and when the new law comes into force, doctors in nursing homes and hospitals must respect the wishes of a person requesting assistance to die.
However, certain conditions must be met before the wish is granted: the person in question is suffering from an incurable illness or injury and is of sound mind. The decision whether both criteria are met is taken by the head of the nursing home or, in the case of a hospital, by the chief physician.
This proposal was supported by the associations of Vaud nursing homes and doctors and put forward to counter an initiative by assisted suicide organisation Exit, which would have gone further by guaranteeing people in care facilities the unconditional right to die. Voters rejected Exit’s initiative.
Ahead of Sunday’s vote, Exit argued against leaving the final decision to a doctor. “If the law imposes an evaluation of the suicide request by a medical team from the establishment, it is an inacceptable breach of individual liberty and a form of institutional paternalism.”
Exit added that that institutions would do everything in their power to discourage patients from having their last wish carried out.
The assisted suicide organisation said experience had shown that evaluating patient cases was a lengthy process. It said the procedure is already established at the canton’s university hospital in Lausanne and in six years only one request for assisted suicide was granted.
Therefore, Exit argued it would be better for people calling for assistance to return home to die. However, this was not possible for the majority since nursing homes had become their sole place of residence.
Exit estimates that 50 per cent of the 1,600 old people’s and nursing homes in the German-speaking part of the country allow assisted suicide under their roofs. “Five years ago it was 20 per cent,” Bernhard Sutter or the organisation said.
Karim Boubaker, head of canton Vaud’s public health services, was opposed to Exit’s demand to see the remit of nursing homes broadened. “The law clearly explains that these are health establishments which have beds intended for people needing care. They are not private residences with their own rules.”
“The community versus private dimension of these establishments is a real dilemma. Significant collateral damage created by assisted suicide within such residences is a real problem,” said Nicolas Crognaletti, representing a group of homes which campaigned against the Exit initiative.
Both the Protestant and Catholic churches in Vaud were also opposed, on the grounds that “a place of institutional living like a medical-social establishment is not a simple reproduction of the individual’s private living space as they knew beforehand. This place also affects the lives of others who live and work there.”
Before the Vaud vote, only residents in Zurich had cast ballots on assisted suicide. In May 2011, voters in the canton turned down initiatives by a rightwing group which sought to ban the practice.
The authorities in canton Zurich now want to have their own law. Speaking to the NZZ am Sonntag newspaper Zurich’s justice director, Martin Graf, said an article in the Swiss penal code is insufficient to regulate the practice and ensure assisted suicides follow the “correct ethical path”.
Exit and Switzerland’s other assisted suicide organisation, Dignitas, are both based in Zurich. In 2011, they helped around 500 people die.
Direct active euthanasia is taking specific steps to cause the patient's death, such as injecting the patient with drugs. This is usually an overdose of painkillers or sleeping pills.
Indirect active euthanasia is giving the patient a palliative drug that could lead to death.
Passive euthanasia is usually defined as withdrawing medical treatment with the deliberate intention of causing the patient's death.
Assisted suicide is when a doctor provides a patient with the means to end his own life; however, a doctor does not administer it.
Swiss law tolerates assisted suicide when patients commit the act themselves and helpers have no vested interest in their death. Assisted suicide has been allowed in the country since the 1940s.
Death is usually induced through a lethal dose of barbiturates that has been prescribed by a doctor. Ingestion of the poison, whether by drinking it or through the use of intravenous drips or stomach tubes, must be carried out by the person wanting to die.
A 2006 decision by the Swiss Federal Court ruled that all people of sound judgment, irrespective of whether they suffer from a mental illness, have the right to decide the manner of their death.
In June 2011, the government examined various options to regulate assisted suicide practises and decided not to seek legal changes but to boost suicide prevention and palliative care.
Switzerland has two main groups which cater to people who seek an assisted suicide, Exit and Dignitas.
(with input from Clare O'Dea), swissinfo.ch and agencies