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748 cases of suicide assisted by Swiss right-to-die organisation

Since the 1990s Exit Deutsche Schweiz has offered instruction and personal guidance through suicide to members who suffer from diseases with “poor prognosis, unbearable suffering or unreasonable disability” and wish to die. It currently has more than 50,000 members, almost 1% of Switzerland’s population.

Using Exit Deutsche Schweiz’s case files, the study found that between 1990 and 2000 Exit assisted in 748 suicides among Swiss residents (0.1% of total deaths, 4.8% of total suicides). 54.4% of the deceased were women. Assisted suicide was over-proportionately represented in the German-speaking, more urbanised, predominantly Protestant cantons. Cancer patients formed the largest diagnostic group, but the percentage (47%) was low compared with 77% of assisted suicides in Oregon and up to 80% of physician-assisted deaths in the Netherlands. The proportion of the total number of Swiss patients suffering multiple sclerosis, amyotrophic lateral sclerosis or HIV/AIDS who chose to end their lives with assistance from Exit (4.5%, 3.4%, and 1.7% respectively) was markedly higher than in cancer patients (0.5%).

Over the 11-year study period, the number of Exit deaths tripled. However, sociodemographic factors and diagnoses relating to the deceased remained “relatively unchanged.” The study attributed the increase to “a growing number of requests [rather than] relaxation of the indications for assisted suicide or […] progressive laxity in decision-making.” The study also noted that the introduction, in 1997, of infusions and gastric tubes for drug administration has enabled those people who experience difficulty in swallowing to have an assisted suicide in Switzerland. (These techniques would probably be classed as voluntary active euthanasia in the Netherlands).

The case files indicated that about one-third of requests to Exit lead to assistance in suicide. All assisted suicides in the city of Zurich were duly notified to the authorities (verification of available files was only possible in the city of Zurich). Exit’s diagnoses were verified by other medical records.

‘748 cases of suicide assisted by Swiss right-to-die organisation’ was conducted by Georg Bosshad, Esther Ulrich and Walter Bär of the University of Zurich’s Institute of Legal Medicine. It was published in the Swiss Medical Weekly 2003; 133: 310-317.