On November 27, 2022, Swiss voters in the Canton of Vaud approved by a vote of a 76.55% to 23.45% the Act on Palliative Care and Framework for Assisted Suicide in Institutions and Facilities (Gesetz über die Palliative Care und die Rahmenbedingungen für Beihilfe zum Suizid in Institutionen und Einrichtungen, GPCBSIE). The GPCBSIE promotes supporting and developing the right to palliative care and defines the requirements for receiving assisted suicide in health and social facilities performing a public task. Voter turnout was 38.84%.
In September 2022, the Swiss Federal Statistical Office (FSO) reported that there were 1,251 cases of assisted suicide in 2020, an increase of 4.6% (55 cases) compared to the previous year. Cases of assisted suicide were significantly higher among people 65 years and older (88% of cases) than among younger people.
Content of the Act
The act is divided into two parts: one on palliative care and one on assisted suicide. As a general introduction, it provides that human dignity and personal freedom with regard to end-of-life decisions mean that all persons have a right to receive palliative care, which allows them to maintain their quality of life, and that all adults with legal capacity have the right to avail themselves of their personal freedom to end their life. (GPCBSIE art. 1.)
Palliative Care
Palliative care is defined as “an approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illness by preventing and relieving suffering through the identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.” (Art. 3.) The act reiterates that patients in the last stage of their lives have a right to receive palliative care. (Health Act of the Canton of Vaud art. 23.) The state provides funding to the cantons to implement a palliative care concept, training to boost awareness among workers in health and social institutions, and information to the general public. (GPCBSIE art. 4.) Health and social institutions must develop and implement a palliative care concept, taking into account general guidelines from the cantonal health department. (Art. 5.)
Assisted Suicide
With regard to assisted suicide, the act states as a general rule that health and social institutions that perform a public task must respect the choice of a resident or patient to use external help for assisted suicide. (Art. 6.) Assisted suicide in an institution or facility must fulfill the following requirements:
- The person has legal capacity and does not change his or her mind.
- The person suffers from a serious and incurable illness or from serious and incurable consequences of an accident.
- Every suitable therapy, in particular with regard to palliative care, has been suggested and the person has explicitly stated a position.
- The person has no other home outside of the institution or a return home is not reasonable. (Art. 7, para. 1.)
The staff at the institution or facility and the medical examiner or treating physician are not allowed to be professionally involved in assisted suicide. In addition, in social facilities that treat patients with severe psychic illnesses or disabilities, assisted suicide may be provided in a different place than the living space if it would otherwise disturb the other residents. The facility must provide a suitable place. (Art. 7, paras. 2, 3.)
Whether the legal requirements are fulfilled must be reviewed by the patient’s attending physician. The physician must also inform the institution or facility of the patient’s wish. An attending physician who is unable or unwilling to do so must decline the request within a week. The patient may then designate a different doctor. The doctor reviewing the legal requirements may consult another physician licensed in the canton of Vaud. If the doctor suspects that the patient’s wish is influenced by a mental disorder or outside pressure, they may consult a psychiatrist. The result of the review must be submitted to the patient in writing within three weeks. The institutions and facilities must keep anonymized statistics on assisted suicide on their premises on behalf of the respective cantonal authorities. (Art. 8.)
Lastly, the act places certain limits on assisted suicide. Health and social institutions and facilities that do not perform a public task must clearly inform their patients or residents of their policies regarding assisted suicide when they are admitted. Assisted suicide to make a profit and placing advertisements for assisted suicide on public land or on private land that is clearly visible from public land is prohibited. (Art. 9.)
Background on Assisted Suicide in Switzerland
There is no specific federal law that allows assisted suicide; the general legal framework is determined by the rights codified in the Swiss Constitution, in particular article 10, paragraph 2, and the limits set by the Swiss Criminal Code. Assisted suicide is legal unless it is done out of selfish motives. (Swiss Criminal Code art. 115.) In general, assisted suicide is accomplished with the help of associations that provide assisted or accompanied suicide to their members. So far, no court has held that assisted-suicide associations act out of selfish motives. (EJPD at 38.)
In 2009 and 2011, respectively, the Swiss Federal Council (government) published reports on the need and options to regulate assisted-suicide associations on a federal level, but decided that no action was necessary. However, several cantons have enacted or have considered enacting legislation on assisted suicide, in particular to compel hospitals, nursing homes, and similar facilities to grant assisted-suicide associations a right of entry. The Canton of Vaud is the fourth canton to adopt such a law; however, it is more detailed than any of the other provisions.
Jenny Gesley, Law Library of Congress
January 4, 2023
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