Long-term experience on assisted suicide in Switzerland: dementia, mental disorders, age-related polymorbidity and the slippery slope argument

Güth, U.; Junker, C.; McMillan, S.; Elfgen, C.; Schneeberger, A.R.

doi:10.1016/j.puhe.2023.08.001

Cited by 5 publications

(2 citation statements)

References 25 publications

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“…The challenge is to find the 'least worse' option. A lack of readily available high-quality palliative care will always be coercive, there will always be abuse, the boundaries of the law will always be stretched, and a wrong diagnosis will mean that some people will die unnecessarily [12,24].…”

Section: Discussionmentioning

confidence: 99%

“…The former requirement that 'the patient's illness justifies the assumption that the end of life is near or can be expected to be near' has been replaced by 'the symptoms of disease and/or functional impairments are a source of intolerable suffering for the patient' [11]. One reason for this change may be the fact that a review of practice from 1999 to 2018 indicated that over 50% of cases probably had not met the key criterion of a short life expectancy [12]. In this same period, the number of deaths by PAS rose steadily from 0.2 to 1.8% of all deaths [13].…”

Section: Switzerlandmentioning

confidence: 99%

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Assisted dying: principles, possibilities, and practicalities. An English physician’s perspective

Twycross

2024

BMC Palliat Care

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It seems probable that some form of medically-assisted dying will become legal in England and Wales in the foreseeable future. Assisted dying Bills are at various stages of preparation in surrounding jurisdictions (Scotland, Republic of Ireland, Isle of Man, Jersey), and activists campaign unceasingly for a change in the law in England and Wales. There is generally uncritical supportive media coverage, and individual autonomy is seen as the unassailable trump card: ‘my life, my death’.However, devising a law which is ‘fit for purpose’ is not an easy matter. The challenge is to achieve an appropriate balance between compassion and patient autonomy on the one hand, and respect for human life generally and medical autonomy on the other. More people should benefit from a change in the law than be harmed. In relation to medically-assisted dying, this may not be possible. Protecting the vulnerable is a key issue. Likewise, not impacting negatively on societal attitudes towards the disabled and frail elderly, particularly those with dementia.This paper compares three existing models of physician-assisted suicide: Switzerland, Oregon (USA), and Victoria (Australia). Vulnerability and autonomy are discussed, and concern expressed about the biased nature of much of the advocacy for assisted dying, tantamount to disinformation. A ‘hidden’ danger of assisted dying is noted, namely, increased suffering as more patients decline referral to palliative-hospice care because they fear they will be ‘drugged to death’.Finally, suggestions are made for a possible ‘least worse’ way forward. One solution would seem to be for physician-assisted suicide to be the responsibility of a stand-alone Department for Assisted Dying overseen by lawyers or judges and operated by technicians. Doctors would be required only to confirm a patient’s medical eligibility. Palliative-hospice care should definitely not be involved, and healthcare professionals must have an inviolable right to opt out of involvement. There is also an urgent need to improve the provision of care for all terminally ill patients.

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Section: Discussionmentioning

confidence: 99%

Section: Switzerlandmentioning

confidence: 99%