Assistance to suicide - The legal and ethica situation in Switzeland

Assistance to suicide is accepted today in some US States, in Switzerland, and in the Netherlands, Belgium and Luxembourg - in the latter countries, euthanasia is also possible; this article does not discuss that topic and deals with situations where the patient makes the determining fatal act. The issue of assisted suicide was part of the author's official duties (adviser to the Minister) during twenty years, and has been substantially discussed within the Swiss National Advisory Commission on Biomedical Ethics of which he is a member. After a socio-historical introduction, human dignity is debated: some affirm that it is ontological in nature, regardless of the person's evaluation of his suffering and dependence; others think on the contrary that the patient is the master in this regard and best placed to judge what dignity means for himself. It is relevant to note that the wish to die in old persons is not necessarily linked to depression and that good palliative care does not suppress all related demands. There are questions and challenges in respect to the appropriate role of public authority. It doubtless has a general mission of suicide prevention but, obviously, all suicidal intentions cannot be seen as a single entity. Each demand should be carefully evaluated in its specificity; the will and reasons to end one's life cannot be judged by checking items on a questionnaire. As much as possible, the demand for help and the answer one might give (conscience clause being reserved) should remain private, based on an interpersonal relation. For such intimate decisions the State or his agents have no legitimacy to pretend knowing better than the person concerned what is good for her. Prat Organ Soins 2011;42(4):277-81