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Austrian government made assisted suicide bill

On Saturday October 23, Austrian government presented a set of rules intended to steer assisted suicide in an orderly manner. Seriously ill adult people should be allowed to obtain a lethal preparation from the pharmacy. Before that, an elaborate procedure with medical information is mandatory.

The bill is expected to be adopted in December and to enter into force on 1 January 2022. If so, with whatever changes to the current draft, assisted suicide will be legal in Austria as of 1 January 2022. 

Bill as the result of a lawsuit

Constitutional Minister Karoline Edtstadler of the ÖVP makes no secret of her initial unwillingness. People should not die by the hand of a human being, but at the hand of a human being, she quotes Cardinal Franz König, who is still popular many years after his death. Because the ÖVP has always defended this maxim, it would have preferred not to make such a law at all, Edtstadler said. This position of her was probably not much different from that of her coalition partner: Justice Minister Alma Zadić of the Greens.

But the government has had no other choice since the Constitutional Court (VfGH) made a groundbreaking decision almost a year ago. The highest judges overturned a crucial part of Section 78 of the Criminal Code: the inducement to suicide remains prohibited, but aiding and abetting is not(see knowledge below). It contradicts the right to self-determination to “prohibit any kind of help for suicide without exception”.

In order to prevent abuse, however, the Constitutional Court gave politicians a mandate on the way: The legislator had to “provide for measures” so that those affected by pressure can decide uninfluenced. The coalition had a good year to do so, because repeal will only take effect at the beginning of the new year. If no law is passed by then, there would be no rules for either the conditions or the implementation of the aid. Then a kind of wild growth would threaten.

Acces to the bill

Anyone who wants to leave life with help can – similar to a living will – in future draw up a death will. This is considered proof of one’s own, permanent decision to use assisted suicide. However, this path is only open to people who suffer from an incurable, fatal or serious illness, the consequences of which – as the law states – “permanently impair the way of life”.

This option should also be open to mentally ill people – provided that a prerequisite is met: A death order is in any case only an option if the person concerned is fully capable of making decisions. Excluded are minors and people who are not seriously ill. In these cases, the helpers remain punishable. The same applies in the event that they have reprehensible motives such as greed.

Mandatory medical education

Assisted suicide remains punishable even if the first step of the planned procedure is not adhered to: At the beginning, education by at least two doctors is mandatory. One of them could be the family doctor or attending physician, explains the government. The second must have a qualification in the field of palliative care.

A doctor confirms the presence of the disease, both must determine the patient’s ability to make decisions. If only one of them has doubts about this, an assessment by psychiatrists or psychologists is provided. After clarification, it is important to wait three months before the death order can be drawn up – this is to ensure that the person concerned is not merely in a temporary crisis phase. For people who are likely to have only a very short life, there is one exception: then the deadline is shortened to two weeks.

Deadly preparation from the pharmacy

The death order – it can be drawn up for cost reasons not only at the notary, but also by the patient advocates – entitles the dying person to pick up a lethal preparation in the pharmacy. If necessary, this can also be done by an authorized person, delivery by the pharmacy is also possible. The law provides for sodium pentobarbital, the remedy that is also used in Switzerland. However, the Minister of Health can release other medications by decree.

The person concerned must ultimately take the preparation himself – because only assisted suicide is unpunished, but not killing on demand. If this is no longer possible due to health problems, this can also take place via a probe. However, the last trigger must also be activated here by the person willing to die.

The central principle: No one – neither a doctor nor a pharmacist – is obliged to participate in assisted suicide. Conversely, the government stresses, however, no one should be threatened with a disadvantage who does so in the legal channels.

What is still important to the ÖVP and the Greens: Economic benefits from assisted suicide are prohibited as well as advertising. Nobody wants relevant flyers to be available in retirement homes. Non-profit associations that handle the procedure as in Switzerland are not excluded per se. However, the ÖVP assumes that the incentive is limited because of the provisions.

Palliative care

Assisted suicide, however, is only one way to enable a dignified farewell, the government stresses. At the same time, hospice and palliative care will be massively expanded in order to create – as Minister Mückstein says – “a comprehensive, residential offer”. The federal government therefore wants to multiply the current funding of six million: to 21 million in 2022, to 36 million in 2023 and finally to 51 million in 2024.

Reaction of lawyer Proksch: positively surprised

The lawyer behind the successful application to the Constitutional Court, Wolfram Proksch, is “relatively positively surprised”. Proksch had feared more restrictive – and thus vexatious – regulations.

Some pitfalls are in the detail, says Proksch. The advertising ban should not lead to euthanasia associations not even being able to operate a homepage, he warns, and some hurdles are too high: For a suffering terminally ill person, even the period shortened to two weeks until the permitted death order can be unbearably long. In addition, it is difficult to draw a line between severe and not so serious illness. It is not clear why the legislator takes the autonomy of people who suffer for other reasons and therefore want to end their lives less seriously. But proksch sees a very pleasing approach in the whole, whereby he also emphasizes the expansion of palliative care: If suicide prevention is better effected through all this, a lot has already been achieved.