Nonphysician-assisted suicide in Switzerland.

In general, legal responses to end-of-life issues are not very different in Switzerland than in most European countries. For instance, active euthanasia (i.e. killing on request) is illegal, although it is treated as a lesser offense than murder or manslaughter. Article 114 of the Swiss Penal Code reads, “Every person who, for honorable reasons, especially mercy, kills another person on his or her serious and pressing request shall be punished by imprisonment for a maximal term of three years or with a fine.” Also, like in most European countries, the administration of medication (for instance, morphine) to relieve serious pain of a terminal patient, even though it may lead to the unintended consequence of hastening his or her death, is accepted, in both moral and legal terms. Similarly, like in many other countries, the withdrawal or withholding of life-sustaining treatments, even if not covered by any specific legal provision, is not treated as a criminal offense provided that certain conditions are fulfilled.1 The peculiarity of Switzerland regarding end-of-life issues only relates to assisted suicide. This practice, which is permitted, has two significant differences if compared to the situation in the other (few) European countries that allow it: 1) Nonphysician assisted suicide is permitted. Whereas in the Netherlands and Belgium only physicians are allowed to assist in a suicide, in Switzerland this assistance is provided by (nonphysicians) volunteers working for nonprofit organizations. The role of doctors is limited to prescribing the lethal drug and assessing the patient’s decisional capacity; they do not perform the assistance in the suicide themselves.2 In this regard, the practice of assisted suicide in Switzerland is similar to the one in the US state Oregon.3 2) One need not have a particular medical condition (such as a terminal illness or an unbearable suffering) to request assistance with suicide. The only requirement is that the individual must have decisional capacity, because in the absence of it his or her act cannot be considered a “suicide” in legal terms. In fact, at present, according to a recent study, around 25% of people who die by assisted suicide in Switzerland do not have any serious or terminal illness, but are just old, or are simply “tired of life”.4