Assisted dying hasn’t resolved Swiss end of life debates

Despite attempts to normalise it, new challenges still arise.

Markus Zimmerman

Markus is Professor of Moral Theology and Ethics at the University of Fribourg, Switzerland.

A single bed, wiith an unmade colourful duvet stands in the corner of a room. A hoist reaches over it from the corner.

The dying room, Dignitas Clinic, Zurich.

Dignitas.

While countries such as Germany, France or the UK are currently struggling to find a suitable regulation for assisted suicide, their peers in the Netherlands, Canada and Switzerland have years of experience with the controversial medical practice. Even if each state must explore its own ways of dealing with these ethically controversial issues, it is obvious that international experience should not be ignored as they try to find a way forward.

In Switzerland the discussions and challenges surrounding assisted suicide are increasing rather than decreasing. Contrary to the idea that a liberalisation of assisted suicide would lead to fewer debate, tensions and difficulties are increasing. My observation, and thesis, indicates that practices such as assisted suicide cannot be “normalised”, even in the medium and long term.

Developments

In recent years, one to two per cent of all deaths in Switzerland were due to assisted suicide. From an overall perspective, this practice is therefore still a marginal phenomenon. However, a look at the total number of assisted suicides per year gives a different impression, as this has increased more than fivefold in the years between 2008 and 2020, from an initial 253 to 1,251 deaths per year, a rising trend. The cause of death statistics for Switzerland only include those cases of assisted suicide in which persons resident in Switzerland were involved and the death was reported to the authorities. According to the Swiss Federal Statistical Office, in 2020, it was mainly people over the age of 64 who made use of assisted suicide. Detailed information on the underlying illnesses of the people affected in 2018 shows that about 40 per cent were affected by cancer, just under 12 per cent by diseases of the nervous system, a further 12 per cent by cardiovascular diseases and just over a third by other illnesses, including dementia and depression. There are currently seven right-to-die organisations in Switzerland which play a leading role in a typical assisted suicide procedure. They work closely with doctors who are prepared to prescribe a lethal drug, generally Pentobarbital. The data reflects an ambivalent picture: on the one hand, the proportion of assisted suicide cases is relatively low in relation to all deaths and, for example, in comparison to the large number of people who die in Switzerland in a state of deep sedation until death; on the other hand, the number of assisted suicides in Switzerland has risen sharply in recent years.

Perceptions and assessments

Since the 1990s, the public perception and assessment of assisted suicide in Swiss society has changed from an initially cautious and sceptical attitude towards broad acceptance. While the debates in other countries are characterised by relatively sharp controversies between those in favour and those against, public discourse in Switzerland has been less polarised. There are indications of a certain normalisation of the situation, the strongest sign is that Switzerland has so far refrained from regulating assisted suicide in a separate law. The results of a recently-published study on the opinions of Swiss people over the age of 55 regarding assisted suicide confirm these impressions.: The survey showed that over four-fifths of respondents support legal assisted suicide, almost two-thirds can imagine asking for assisted suicide themselves at some point, and that almost one-third are considering becoming members of an right-to-die organisation in the near future, with one-twentieth of respondents already being members at the time of the survey in 2015. Among people with a higher level of education and older people aged between 65 and 74, approval of assisted suicide and corresponding practices was higher than among less educated, younger and very old people; approval was also significantly lower among religious practitioners.

Sensitive topics

The fact that assisted suicide enjoys broad support in Swiss society as a whole does not mean that there are not difficult and controversial aspects relating to its practice. Relevant topics include, in particular, places of death, authorisation criteria and procedures.

Places of death: Assisted suicide is permitted also for mentally ill persons in psychiatric clinics, but the federal court recommends great caution here and requires two psychiatric expert opinions to ensure that the person willing to die is capable of judgement with regard to the desire to commit suicide. Although assisted suicide for children and adolescents has hardly been an issue in Switzerland to date, the corresponding debates are currently being held in Canada and elsewhere. The question of whether people in prison also have a right to make use of assisted suicide, has been the subject of intense debate in Switzerland for years, with a generally positive response. The question of whether right-to-die organisations should be given access to acute hospitals and nursing homes is still the subject of controversial debate, with regulations varying from hospital to hospital, nursing home to nursing home

Authorisation criteria: With regard to the admission criteria for persons willing to die, the capacity for judgement is at the centre of attention: while the importance of the criterion is undisputed in itself, there is a struggle for reliable standards and procedures to reliably test this criterion. Since the publication of the SAMS ethical guidelines Management of Dying and Death in 2018, the criterion for end of life and, depending on this, that of unbearable suffering have received new attention due to an objection by the Swiss Medical AssociationFMH. While the guidelines are based on the criterion of unbearable suffering, the FMH wants to stick to the near end of life. It is certainly difficult to diagnose the existence of unbearable suffering, as the international debate on the significance and assessment of existential (neither physical nor psychological) suffering shows. This difficulty is illustrated by the debate that has been going on for several years in Switzerland about so-called old-age suicide and the inherent criterion of tiredness of life. At the centre of the dispute is the legally difficult question of whether a doctor is also allowed to prescribe a lethal drug to a healthy person.

Procedures: Here the role of the medical profession and right to die organisations is by far the most important issue. In contrast to the physician-centred models in Belgium, Canada and the Netherlands, the Swiss model of assisted suicide is based on the idea that every person has the right to end their life and may call on the help of any other person to do so. Although the medical profession is usually involved in the process, the management of the procedure is normally the responsibility of a right-to-die organisation. This division of responsibilities is always up for debate when legal regulations are being considered, in which doctors should tend to take the lead in the process due to their professional background. There is also a debate about how and by whom compliance with the authorisation criteria should or could be monitored, whereby it remains to be decided whether this should be carried out before or after the death. At present, a certain amount of monitoring takes place following a suicide, insofar as the authorities investigate the cases afterwards. There is also debate as to whether Pentobarbital is a suitable means of suicide, especially if this barbiturate is not administered intravenously but taken orally; there is no knowledge of how many cases are currently administered intravenously and by whom an infusion is then set up. Last but not least, consideration has already been given to the use of lethal drugs, such as helium gas, which can be obtained over the counter.

Attempts at regulation

Political efforts to regulate assisted suicide in Switzerland in a more nuanced way than today have been made since the 1990s but have remain largely without consequences to date. In relevant judgements by the Federal Supreme Court or in statements by the Federal Department of Justice and Police, reference is regularly made to the ethical guidelines of the SAMS. These are classified as soft law and are therefore not legally binding, even though their content has become the subject of dispute. The National Advisory Commission on Biomedical Ethics (NCE) had already recommended more far-reaching legal regulation in 2005 as part of a detailed opinion on the subject; in the opinion of the NCE at the time, the review of authorisation criteria, a justifiable regulation of assisted suicide for the mentally ill, children and adolescents and state supervision of right-to-die organisations, should be ensured by law. The question is what form a legal regulation can take that grants the medical profession far-reaching powers but at the same time prevents medical paternalism (in favour of or against assisted suicide). From the perspective of Swiss experience, this is “a square circle”: either the doctors retain the final decision on who receives the barbiturate, or official access rules are established, the review of which does not generally require medical expertise.

The outlook

In the short and medium term, it can be assumed that the number of assisted suicides in Switzerland will continue to rise. The coronavirus pandemic and the particular difficulties faced by nursing homes during this time are likely to exacerbate this increase. In view of these expectations and the legislative processes in other European countries, pressure is likely to increase in Switzerland to create a legal regulation. Overall, I think politically it will be important to create a legal regulation, in order to ensure legal equality and legal certainty on the one hand and prevention of abuse and expansion on the other. At the centre of social-ethical reflection is the challenge of learning to deal with the pluralism of different ideas of a good death and to develop and establish alternative models to medically assisted dying. The thesis I mentioned at the beginning is confirmed today: assisted suicide in Switzerland can hardly be normalised; new problems, challenges and demands are constantly arising. Suicide, whether with or without the help of another person, always means an existential transgression that defies normalisation.

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17 September 2025

5 min read

I protested against the Unite The Kingdom protest

The need to see one another

Thomas Sharpe

Thomas is a writer exploring the intersection of faith, politics, and social justice.

CCTV footage show two rival protests divided by a line of riot police.

CCTV image of the rival protests on Whitehall.

Met Police.

I don’t know why I was so concerned about the horses. I kept noticing them swaying through the sea of shivering bodies. I was so drawn to them that I tried to take a photo, a rare occurrence for me, but I was too far away. The horses riders, dressed in full riot gear, were being pelted with beer bottles. Maybe the horses were getting hit too, but it felt like they were recoiling on behalf of their riders.

In front of the horses, engulfing Trafalgar Square, were tens of thousands of “Unite the Kingdom” protestors. From what I could see, they were predominantly white men. Many of them were dancing and waving flags, but a sizeable contingent was furious, drunk, and insisted on attacking any unfortunate police officer in their way.

Behind the horses, lining the streets of Whitehall, were five thousand counter-protestors, including me. Unlike our opposite numbers in Trafalgar Square, we were trapped, surrounded on every side by St George’s flags, Union Jacks, and, oddly, some Georgian flags too. Maybe the shop had sold out. To my right, I could see the counter-protestors defiantly dancing. To me left, I could see a group chanting “Nazi scum, off our streets” whilst swearing towards the St George’s flags.

There in the middle, I found myself feeling a curious mixture of discomfort, sadness, and anger. Uncomfortable because I’d been trapped for four hours, stuck on a continuous cycle of rinse and drain. Sad, because I knew that much of the “Unite the Kingdom” violence was built on misinformation and the scapegoating of refugees, a group I know well, and because this fog of violence blew over the counter-protestors as they hurled insults towards the St George’s flags. And angry, because figures like Elon Musk were using their extraordinary wealth and influence to spread fear and lies: “Whether you choose violence or not, violence is coming to you. You either fight back or you die. You either fight back or you die. And that’s the truth. It’s only a matter of time till that happens to towns and villages. It will spread. And no one will have any peace.” Over the years, I have spent many hundreds, if not thousands, of hours with refugees and asylum seekers, both in my home and at my church. I had experienced no violence. In that moment, I was surrounded by “leftists”, socialists, and trade unionists, and the only violence I was experiencing was from the glint of beer bottles raining down on the police two hundred meters away.

I was grateful for the interruption of an elderly lady asking if she could get past. I’d been asked a number of questions throughout the day, primarily because I was one of a group of four Christians holding signs like “Jesus was a refugee”, “love thy neighbour”, and “I was a stranger and you welcomed me”. At the start of the protest, an older lady and a young man joined our circle. The young man asked “I’m glad to see there are some Christians here. What do you think of Christian nationalism? Your religion doesn’t feel much like Jesus?” He was a brave Saudi Arabian refugee with a bright smile, earnestly questioning the fractures in my community of faith. Taken aback by the poignancy of the question, I fumbled a response before being rescued by one of my friends.

Protest signs written on cardboard. — *Tommy's protest signs before the rain.*

After a while, the older lady started speaking. “Sorry for interrupting. I used to be a Roman Catholic, but I’ve lost my faith. On days like this though, I always want to pray. I don’t feel much hope for the church. A while ago, I went into a catholic church. I asked if the church could do anything about the divisions in our community and the anger at refugees. The priest shrugged and said no. I’m glad you’re here.” Her short, staccato sentences mirrored the tension of the day. I told her about how our church serves refugees, how I struggle with the anger of days like today, and how some of us have forgotten that the bible tells us to welcome the stranger dozens of times. As they walked away, I felt touched by the honesty both the young and old had gifted to four strangers, and I was glad to be carrying our smalls signs of hope.

The megaphone brought the present back into view with another question. “Could everyone please get ready to leave up the left of Trafalgar Square?” it said. The police had cleared a path for us to leave, the sea of flags artificially parted by riot gear. We were escorted to Green Park tube station, at which point we turned off towards Oxford Street. My wife remarked at how quickly normality returned. I was devastated by the day, but felt too tired to weep. I wasn’t quite the same Tommy that I’d been that morning. The man who shares my name, and the chaos he wrought on my city, had turned a dial in me a little further than it had been turned before.

I knew that I would have more days like this. In the midst of my discomfort, sadness, hope, and fear, I knew that I was supposed to be there, holding my soggy “Jesus was a refugee” sign, shivering in my damp clothes, and praying under my breath. I knew that I needed to gather other reluctant protestors alongside me, holding their own soggy signs and praying their own prayers.

And I also knew that there was a better way to carry this fragile message of unity in our increasingly fragile land and increasingly fragile time. As a half-British, half-South African man, I’ve had the privilege of growing up with the stories of the anti-apartheid movement, stories which steward the hard-earned truth that defiant, tenacious, persistent love is the only antidote to hatred, misinformation and fear. As Desmond Tutu once said, “when we can accept both our humanity and the perpetrator’s we can write a new story”. Saturday left me feeling that we desperately need a new story, and that requires us to look beyond the swaying horses and see one another clearly.

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