Switzerland, an Alpine island in the middle of the European continent, is a peculiar place. Not only do people find it normal to have four national languages, but it is also one of the few countries whose open-mindedness extends to allowing the practice of assisted suicide. Swiss citizens appear to be unique in that they can say what they want directly to their government, create organizations and associations, and even choose when and how to die.

Not that the law does not explicitly allow assisted suicide, but Article 115 of the Swiss Penal Code states that assisted suicide without self-interested motivation is not a crime. This means that if the person assisting the suicide is not doing it for her or his benefit, then she or he is not committing a crime.

I will explore the case of A-L to elucidate the Swiss position on assisted suicide. She was a real-life example of someone who wants to end her life surrounded by her loved ones. 

A-L was 83 years old. She was the mother of two and the grandmother of three—my own two children and their older step-sister. A-L had been a physician since the late 1950s, specializing in children’s psychiatry and psychoanalysis. Until well into her 70s, she was an active member of the local psychoanalytical society, where she tutored numerous new psychoanalysts. Many of them remember her as a great teacher. 

By 83, A-L was suffering from bone cancer. She had suffered breast cancer in her 40s. Perhaps the cancer returned after a few decades. A-L feared the onset of dementia, which afflicted her father and one of her brothers. She regularly spent weeks or months in hospitals. Her bones had turned brittle and broke easily. She should have been walking with a cane but complained  “it got in the way.”

A-L wrote to an organization in her home canton of Geneva in Switzerland named Exit, asking for help. She hoped to end her life with dignity.

Death with dignity is a privilege, not a flawed liberal law. 

In Switzerland, both the law and the relationship citizens have with institutions are very close and open. Many decisions and even paradigmatic changes are bottom-up rather than top-down, following well-established social and cultural practices. In theory at least, nothing is sacred. Everything can be openly criticized through referenda or popular initiatives. The downside is that any change takes a very long time to take place. Remember that Swiss women earned the right to vote only in 1971. Some characterize our political landscape as boring. We do not dramatize politicians’ deeds and tribulations as much as other countries. Some of our federal counselors go to work on a bicycle or using public transport.  

Still, aging and illness are present in every society. Every year, more than 1,000 people request the help of a few organizations to end their lives. The Federal Council and the parliament avoided clearly defining a law on assisted suicide in 2011 and 2012. They support mental health care, palliative end-of-life care and suicide prevention but consider that Swiss law and customs already provide enough elements to avoid abuses. The Federal Tribunal’s judges stand their ground despite the European Court of Human Rights in Strasbourg suggesting that the Swiss make the laws more explicit. 

In many ways, assisted suicide is an astonishing practice, counterintuitive for some and appalling for others. Swiss citizens mostly see it as humanistic, even humane, meaning it respects the human person. In this country, being “liberal” doesn’t necessarily mean seeing every individual as an island. Community ties are strong and cross many different domains, including one’s church or a section of the Alpine Club. Grassroot organizations are an integral part of the political and social landscape. 

Recently, Swiss-French Film director Jean-Luc Godard chose death with dignity, and it made the headlines in France and elsewhere. This led French President Emmanuel Macron to relaunch the debate on a new law for France in September 2022. This law would make assisted suicide a possibility. Many other cases of citizens asking for an amendment to the interdiction against assisted suicide have made the headlines in the past two decades. Some, from as far away as Australia — such as David Godall, a 104 year-old scientist — have traveled to Switzerland to access the privilege of a death in dignity.

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A-L’s daughter initially did not like the idea of her mother choosing assisted suicide. Still, after about a year and some conversations with her mother and her partner who was a retired physician, the daughter accepted the idea. A-L’s son, my partner, agreed with his mother’s decision from the beginning. She had gotten into the habit of spending time alone and sometimes with her companion whom she met after her husband passed away. On several occasions, we had to call the police to break in and see how she was doing in her apartment, as she could not reach the door or answer her phone. 

We were not surprised when A-L announced her will to die in dignity. In the months following her demand, her health kept degrading. In the end, we took her into our home and made arrangements for nurses to see her in the mornings and evenings. We didn’t know for how long and what kind of engagement her stay would become. During the spring of 2020, her health deteriorated again after a fall and a long stay in the hospital. When she returned home, A-L rested for a couple of weeks and decided to go forward with her plan to end her life. 

She called the association’s volunteer and said she was ready. 

An indefensible practice or the privilege of the ultimate choice?

Some detractors or adversaries find assisted suicide indefensible. They accuse Switzerland and other “liberal” countries of negligence. The long history and the genesis of the Swiss Penal Code gives us clues as to the country’s cultural mindset. Alex Mauron, a professor of ethics at the University of Geneva, did a brilliant summary of the genesis of article 115 of the penal code, which was drafted during the second half of the 19th century but only enforced in 1937. The drafting was a painstaking deliberative exercise that was interrupted by World War I. Eventually, the consensual Swiss society came to accept the penal code  and even embraced death with dignity. 

In Christian Europe, suicide of any form was abhorred. Life is considered sacred. It is for this reason the Catholic Church still opposes abortion and even contraception. For centuries, anyone who committed suicide was denied burial in a church graveyard. Both l’ancien regime and the legendary French revolutionaries of 1789, prohibited suicide. It was considered a crime.

The Enlightenment questioned established values. The injunction against suicide gradually weakened. In the 19th century, suicide was decriminalized. Swiss legislators asked: if suicide was not a criminal act then could assisted suicide be acceptable as well? 

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Eventually, legislators came to the view that if the person assisting suicide had nothing to gain from the dying person’s death, then she or he was not committing a crime. Over time, assisted suicide has become an accepted practice in Switzerland. This is not to say everyone agrees with this practice. Healthcare professionals continue to question it.

The Académie Suisse des Sciences Médicales applies stricter criteria than those of civil society organizations that practice assisted suicide. Note that euthanasia is forbidden in the Swiss Penal Code. Article 114 clearly states: “Any person who for commendable motives, and in particular out of compassion for the victim, causes the death of a person at that person’s own genuine and insistent request shall be liable to a custodial sentence not exceeding three years or to a monetary penalty.” 

As stated earlier, A-L had stage IV terminal bone cancer and various other ailments due to her age. When she decided upon assisted suicide, she wrote to Exit and became a member of the association. The organization asked A-L for her entire medical history. They examined all relevant documents and conducted a medical examination. A-L also had to write a letter by hand explicitly explaining her motivations.

A couple of weeks later, Exit sent a trained volunteer to speak with A-L and interview close family members to assess the situation. Once her demand had been approved, A-L could wait until she felt ready. This eased her anxiety to some degree. Her late husband MR had already chosen death with dignity five years earlier. He handled things independently, didn’t ask anyone, and only informed everyone in his usual matter-of-fact manner when everything was already decided. He was also a physician and a psychoanalyst. 

Jean-Jacques Bise, the co-president of the Association for Death with Dignity known as Exit, states that people who apply for assisted suicide and are accepted often “calm down” and don’t get back to Exit for quite some time. He reckons that the possibility of choosing one’s death to be a peaceful one surrounded by those one feels safe with can make the end of life more serene.

The picture that Bise paints is best captured in the documentaryLe Choix de Jean (2005). We see a middle-aged Swiss man from the canton of Fribourg who has chosen assisted suicide after a long and sadly fruitless battle with brain cancer. This long-suffering man says that he fears collapsing on the street among strangers. Instead, he would much rather die in his bed in the presence of his wife before life becomes too hard for both of them. His wife says that she would support whatever he chooses. Choice in Switzerland in life and to end life is accepted both socially and legally.

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.