Self-determination over religious freedom: Zurich sends strong signal on assisted dying

Journey of no return: the barbiturate sodium pentobarbital is the drug of choice for assisted suicide in Switzerland. KEYSTONE/Alessandro Della Bella

Voters in canton Zurich have made it obligatory for care homes and hospitals to offer assisted suicide. This presents faith-based institutions with a dilemma and sends a signal far beyond the boundaries of the canton.

In Switzerland, voters do not vote against the right to assisted suicide and the trend continues. In the canton of Zurich, a two-thirds majority approved a legislative amendment this Sunday that obliges care homes and hospitals to provide right-to-die organisations with access to their residents and patients – even if this violates the core values of these institutions.

The proposal affects nearly 30 private Christian care homes in the canton that reject this practice. They must now open their doors to Exit, Dignitas, and other assisted suicide organisations, or relocate their operations to another canton that does not yet have such regulations.

The law also brings changes for doctors, as hospitals in the canton of Zurich are now required to allow assisted-dying representatives as well. Critics had warned in vain of a conflict between palliative care and assisted suicide in hospital settings. Among them was the Zurich cantonal government, which had opposed the proposal for that reason.

What lies ahead for Christian care homes

What does this legislative change mean for the affected facilities? Markus Schaaf, director of the Christian care center Zentrum Rämismühle in Zell and a leading voice among the proposal’s opponents, does not consider relocation a realistic immediate scenario.

He assumes that most affected institutions will attempt to adapt to the new legal reality and continue to uphold their own principles and values as far as possible.

One point is particularly important to him: “The law obliges an institution to tolerate assisted suicide carried out by third parties. It does not oblige us to offer suicide assistance ourselves or to involve staff members in it.” Proponents of the law had also consistently highlighted this distinction, which applies equally to hospitals.

Schaaf states that his institution will continue to do everything possible to ensure that people in difficult life situations receive comprehensive care, human compassion, palliative support, and—if desired—pastoral care. Only the legal situation has changed, he says: “Not, however, our fundamental stance on life, dying, and accompanying people at the end of life.”

What Zurich hospitals now face

Zurich hospitals must also establish operational rules for handling assisted suicide, something only a few facilities have done so far. This involves questions such as how attention is drawn to the option of assisted suicide within the hospital or how external assisted suicide organisations can be integrated into hospital routines.

Health Director Natalie Rickli told the media on Sunday afternoon that she does not expect a high volume of cases. Assisted suicide had only been used rarely, even in hospitals where it was already permitted. Furthermore, she expressed trust in the common sense of patients and their relatives to exercise their right prudently.

Natalie Rickli, Zurich’s Director of Health. Keystone / Andreas Becker

For care homes, too, not much will change. The majority of the slightly more than 200 care homes in Zurich had already granted entry to right-to-die organisations. In the remaining, mostly Christian facilities, Rickli noted that most residents would likely choose not to make use of this option in the future either.

Provided no appeal is lodged, she anticipated the law coming into force next spring.

The deeper significance of the vote result

With this vote, the population of Zurich has prioritised the fundamental right to a self-determined death over the free exercise of religion and the economic freedom of care homes.

Opponents had aligned along these two value systems, including the Federal Democratic Union and Evangelical Party whose voters is largely drawn from free church circles and who view assisted suicide critically—as well as the right-wing Swiss People’s Party, which advocates for minimal state regulation.

The economically and socially liberal Radical Liberal Party allowed a conscience vote on this matter, where individual and institutional freedoms clashed. All other parties, from the left-green spectrum to the centre, voted in favour of the law—including the Centre Party, which emerged from the Christian Democratic Party. This serves as a sign of how open even the base of the Swiss national churches is toward assisted suicide.

Legally, the precedence of self-determination is already protected. The Federal Supreme Court ruled on this 10 years ago following an appeal against a legislative revision in the canton of Neuchâtel. It concluded at the time that requiring care homes to tolerate assisted suicide did infringe upon their freedom of thought and conscience, but that this infringement was not severe and was outweighed by the right to self-determination.

With Zurich’s decision, the path is clear for right-to-die organisations to demand the same rules in additional cantons or nationwide. Exit and Dignitas, the two major right-to-die organisations, had initiated the legislative revision in Zurich through a popular initiative.

Room for discussion in the pioneer country of assisted suicide

Switzerland, internationally known as a pioneer in assisted dying, is moving closer toward advanced countries that have partially overtaken it in handling end-of-life care.

One such example is Canada, where assisted dying in hospitals has been taking place for a decade. There, however—unlike the future model in Zurich—it is fully integrated into hospital operations and carried out by medical staff, a practice that continues to face criticism in Canada.

For Switzerland, Zurich’s decision marks the first new development in a long time. The rules governing assisted suicide, which have remained unchanged since the enactment of the first Swiss Criminal Code in 1942, remain progressive in many respects. For instance, they permit assisted suicide for individuals without a terminal illness, provided the desire to die and decision-making capacity are present, and the individual acts independently. However, every effort to update these rules through specific legislation has so far failed.

A discussion facing Switzerland in the future concerns assisted dying in cases of dementia. Countries like the Netherlands allow dementia patients to document their wish to die in advance, with the lethal injection subsequently administered by medical personnel.

In Switzerland, by contrast, active direct euthanasia remains a punishable offence. The act of suicide must be carried out by the individual, and assisted dying requires the person seeking death to possess decision-making capacity.

This puts pressure on patients diagnosed with dementia who wish to end their lives on their own terms to act quickly. They have to confront the difficult question of how long they can afford to wait. Now Switzerland as a whole faces the same question regarding regulation.

Edited by Christian Raaflaub. Adapted from German, sub-edited by Anand Chandrasekhar