Expert Views on Medical Involvement in the Swiss Assisted Dying Practice: “We Want to Have Our Cake and Eat It Too”?

Abstract

Background

Most jurisdictions that allow euthanasia and assisted suicide (AS) regulate it through the medical profession. However, the extent and nature of how medicine should be involved are debated. Swiss AS practice is unusual in that it is managed by lay AS organizations that rely on a law that permits AS when done for nonselfish reasons. Physicians are not mentioned in the law but are usually called upon to prescribe the lethal medications and perform capacity evaluations.

Methods

We analyzed in-depth interviews of 23 Swiss AS experts including ethicists, lawyers, medical practitioners, and senior officials of AS organizations for their views on AS.

Results

Although there was agreement on some issues (e.g., need for better end-of-life care), the interviewees’ preferred model for AS, and the nature of preferred medical involvement, varied, which we categorized into five types: preference for AS practice as it occurred prior to lay AS organizations; preference for the current lay model; preference for a modified lay model to increase autonomy protections while limiting medical AS normalization; preference for various types of more medicalized models of AS; and, ambivalence about any specific model of medical involvement. The rationales given for each type of model reflected varying opinions on how medicine’s role would likely impact AS practice and demonstrated the experts’ attitudes toward those impacts.

Conclusion

The dynamics within the Swiss AS regime, as reflected in the varying views of Swiss AS experts, shed light on the dilemmas inherent to medical scope and involvement in AS, which may have implications for debates in other jurisdictions.

Keywords:

• Assisted suicide
• autonomy
• dying
• end-of-life
• regulation
• Switzerland

Acknowledgments

The research was approved by the University of Hull Faculty of Business, Law and Politics Ethics Committee and the NIH Intramural IRB. Signed interview consent forms are stored on secure servers and are backed up at an offsite location. The ideas and opinions expressed are the authors’ own; they do not represent any position or policy of University of Hull, the National Institutes of Health, the Department of Health and Human Services, or the U.S. government. The authors have no competing interests.

The interviews were conducted by RCA. All authors contributed to the initial conceptualization of the article, CN wrote the first draft, all authors edited the draft for intellectual content, and all read and approved the final version. This article addresses important points in the current assisted death discussion, which is an ever-evolving issue as jurisdictions continue to debate and modify their laws.

Additional information

Funding

This study was funded in part by the Intramural Research Program of the NIH (SK). Research support was also provided by the NIH Medical Research Scholars Program, a public–private partnership supported jointly by the NIH and contributions to the Foundation for the NIH from the American Association for Dental Research and the Colgate-Palmolive Company (CN). The funding to enable fieldwork in Switzerland was provided by the Swiss National Science Foundation (SNSF).