euthanasia

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Under euthanasia , both the dying ( help dying or help dying , such as pain relief and avoiding a "agony") understood as also killing (active shortening of life, active euthanasia, "Gnadentod") or letting die (by therapy waiver or discontinuation of therapy, passive Euthanasia) of a seriously ill or dying person because of their own expressed or presumed need ( help to die ). A distinction is made between four forms: passive euthanasia by dispensing with life-prolonging measures while maintaining basic care and pain-relieving treatment, indirect euthanasiathrough pain-relieving treatment while accepting an unintentional shortening of life (for example through opiate-related respiratory depression), assisted suicide as an aid to suicide, for example by procuring and providing the lethal agent, as well as active euthanasia in the form of intentional and active acceleration or induction of death.

The words euthanasia and euthanasia (in this case, “when a doctor administers a lethal substance or carries out an intervention to cause the death of a patient capable of making decisions”) are used interchangeably in other countries or languages. In Germany, the term euthanasia is largely avoided for people today because of the euphemistic use of this word as a disguise for the murders of the sick during the time of National Socialism , but is sometimes found in veterinary medicine .

Types of euthanasia

A distinction is usually made between the three forms of active, indirect (active) and passive euthanasia .

Active euthanasia

Active euthanasia is the targeted bringing about death by acting on the basis of an actual or presumed wish of a person (Austria: spurious direct euthanasia ; Switzerland: direct active euthanasia ; Netherlands: euthanasia ; Belgium: euthanasie active ). Active euthanasia occurs, for example, by administering an overdose of a pain reliever or sedative, anesthetic , muscle relaxant , insulin , potassium injection, or a combination thereof. Active euthanasia is prohibited:

Active euthanasia is punishable in the Netherlands (Art. 293 of the Criminal Code) if it is done intentionally and not by a doctor in compliance with the legal due diligence criteria (Art. 2 of the Euthanasia Act), including the necessary notification to the community coroner with a report on compliance the due diligence criteria (Art. 7 Para. 2 of the Wet op de lijkbezorging ) has been met.

killing on demand

If the killing is carried out at the request of the person willing to die, it is a killing on request. By the end of 2020, this was exempt from punishment in a few countries such as the Netherlands, Belgium, Luxembourg and Canada. On March 18, 2021, Spain became the fourth European country to approve the legalization of active euthanasia with a clear majority in parliament.

In January 2021, the Portuguese parliament voted in favor of the introduction of active euthanasia. However, on March 15, 2021, the Constitutional Court rejected the law in its current version and demanded a more precise definition of the conditions under which active euthanasia was possible.

Known cases of homicide on demand
  • Bob Dent : The 66-year-old Australian was the first in the world to end his life through legal active euthanasia. The carpenter, who had prostate cancer and described his own illness as a “roller coaster of pain”, read an open letter after taking a fatal drug with the words: “If you do not consent to voluntary euthanasia, then do not use it, but Do not deny my right to use them. ”After suffering from cancer for five years, Dent ended his life on September 22, 1996 under the Rights of the Terminally Ill Act, which now only applies in the Northern Territory .
  • Emily Gilbert: The 73-year-old American from Fort Lauderdale, Florida asked her husband Roswell Gilbert for active euthanasia in March 1985 because of an incurable bone condition. Her husband first gave her pain pills and then shot her with a gun. Roswell Gilbert, 76, was sentenced to 25 years in prison by a court. The sentence was reduced in August 1990 by then Governor Bob Martinez and Gilbert was released. He died in September 1994.
  • Vincent Humbert : The Frenchman, who had been paralyzed and blind after a serious car accident since September 2000, asked for active euthanasia in December 2002. This was officially denied to him by the French. His mother then injected him with sodium pentobarbital in September 2003 , which made him unconscious and could no longer be awakened. Two days later, the doctors turned off the life support machines. His case led to a change in the law in France.
  • Piergiorgio Welby (born December 26, 1945 in Rome; † December 20, 2006 ibid) was an Italian who had suffered from muscular dystrophy since he was 18 . He asked for active euthanasia in 2006. This was performed by anesthetist Mario Riccio on December 20, 2006 after a court refused to deal with the case. The later murder charge against Mario Riccio was dismissed by a court in Rome.
  • In October 2011, the weekly newspaper Die Zeit published a previously neglected case: doctors killed a patient in Belgium at her request, and immediately afterwards other doctors removed her organs. Belgian daily newspapers had spoken of a "world premiere".

Killing without an expression of the will of the person concerned

If the actual will of the person cannot be determined, an advance directive or the will expressed earlier can provide clues. A killing without an expression of the will of the person concerned is generally not regarded as active euthanasia, but as manslaughter or murder .

Indirect euthanasia - improving the quality of life while accepting the shortening of life

Austria: spurious indirect euthanasia ; Switzerland: indirect active euthanasia ; Belgium: indirect euthanasia ; Netherlands: double effect

So-called indirect euthanasia is a special case that is particularly interesting as a theoretical, ethical borderline case, but in practice it plays a minor role, especially in relation to the symptom-relieving administration of opium since the 17th century. This includes the administration of drugs to alleviate suffering, e.g. B. pain or fear, understood by accepting premature death.

Seriously ill patients who suffer from excruciating symptoms such as shortness of breath, fears or pain in the end-stage of their illness can be helped with specific narcotics and sedatives. The patient's consciousness may be clouded as a result of the symptom-relieving medication . This sedation can persist until death occurs if the drug administration is continued in the same or higher dosage. If this measure was requested by the patient, it is referred to as palliative or terminal sedation .

Accidental overdosing can result in death earlier. This rare case of "indirect euthanasia" has been discussed in criminal law in Germany. As a result, a majority is of the opinion that the doctor must remain unpunished here. An inferior opinion wants to deny the killing relevance of a behavior aimed at alleviating pain as a matter of fact. The overwhelming opinion sees the doctor justified by a mixture of emergency and justifying conflict of duties. This prevents the doctor from acting outside of the necessary care and thus the permitted risk. In the opinion of the Federal Court of Justice , even failure to administer necessary painkillers on the grounds of not wanting to cause premature death can be punished as bodily harm ( Section 223 to Section 233 of the Criminal Code) or failure to provide assistance ( Section 323c of the Criminal Code) (see palliative medicine ).

Passive euthanasia

As a passive euthanasia (Belgium: euthanasie passive ) is called allowing a started dying process by dispensing, cancel or reduction of life-prolonging treatment measures. It should be noted that this is not a medical termination of treatment, but only the goal of the treatment is changed. Efforts aimed at lengthening life are no longer undertaken, but such measures are undertaken to improve the quality of life in the remaining time. The goal of the measures is no longer curative (goal: healing), but palliative (goal: improving quality of life). Palliative medicine specializes in patients with a limited life expectancy . Part of palliative medicine is always a detailed discussion with the patient and his relatives that takes place without time pressure. Decisions for special therapies or for the possible omission of certain treatment options should be made by mutual agreement. This means that everyone involved is on the same level of information and the treating team gains greater confidence in action. This includes, for example, switching off life-support ventilators and refraining from attempting resuscitation .

Although the concept of passive euthanasia is an internationally established term, many consider it to be ambiguous and unfortunate and believe that it should be more clearly spoken of "letting die", because passive euthanasia is always about a situation in which a person is so seriously ill that he only has a short life expectancy.

In a representative survey in Germany in 2008, 72% of those questioned said they were in favor of granting passive euthanasia.

Known cases of passive euthanasia
  • Terri Schiavo : An American woman from Saint Petersburg (Florida) who suffered severe brain damage caused by a lack of oxygen in a collapse and who was subsequently in a vegetative state for 15 years from 1990 until her death . Since 1998, Terri's husband has been suing several courts for the suspension of artificial nutrition. This was finally granted in February 2005.
  • Eluana Englaro (born November 25, 1970 in Lecco; † February 9, 2009 in Udine) was an Italian who was in a vegetative state after a car accident on January 18, 1992. Although her brain was irretrievably destroyed, she was able to breathe and her heart worked on its own. For almost ten years her father had fought in Italian courts to let Eluana die. In November 2008, the Italian Supreme Court of Appeal decided in the last instance that artificial nutrition could be discontinued. However, because of the ban on active and passive euthanasia in Italy, the verdict was initially not implemented by the regional president of Lombardy and politically blocked by the Italian Ministry of Health. At the beginning of February 2009 she was transferred from a clinic in Lecco, Lombardy, to an old people's home in Udine, Friuli, to die there. After cessation of artificial nutrition and hydration on February 7, 2009, Eluana Englaro died two days later.

Terminal care

Dying care does not intervene in the process of dying, but offers the terminally ill person support in the last phase of life, for example through regular visits, open conversations, activities and small handouts. These and additional nursing, medical, psychological and pastoral offers to help in dying are summarized under the term palliative care .

Assisted suicide

Germany

“Aid” to suicide means the assistance in carrying out a suicidal act by a person who provides a means (usually a drug) to commit suicide. This is allowed in Germany. The earlier prohibition of "business-like assistance" (doctor, euthanasia association) was lifted: On February 26, 2020, the Federal Constitutional Court declared Section 217 of the Criminal Code, introduced in 2015, to be unconstitutional and therefore null and void.

story

From December 10, 2015 to February 26, 2020, business-like encouragement of suicide, which was repeated regardless of the intention to make a profit, was a criminal offense. This act, abstractly endangering life, was prohibited by the newly drafted Section 217 of the Criminal Code . Relatives or other persons close to the suicidal person who only took part in the act as non-business-like participants were already exempt from the threat of punishment at that time.

A suicide only occurs if the suicide is still in control of the last step, i.e. has so-called perpetration control over the event. In Germany, active euthanasia as killing on request is punishable under Section 216 of the Criminal Code and carries a prison sentence of six months to five years. If the other person carries out the last fatal act, there is no longer a suicide, but a homicidal offense . The aid for suicide , such as the Get or providing lethal acting medications is in Germany for lack of existence of an alien unlawful predicate offense is not illegal and not a criminal offense (principle of limited accessoriness ). The suicide is not directed against “another” person and is therefore not a homicide offense within the meaning of Sections 211 et seq. StGB, so that help in this regard does not constitute a criminal offense. However, this relates to aiding and abetting in the legal sense and must be distinguished from active assistance in suicide, which can be punishable as involvement according to the principles of perpetration .

However, case law has made controversial exceptions to this basic impunity. In a ruling the Federal Court of Justice took the view that a “change of authority” would lead to the suicide helper being punishable by failure to act , provided that the suicide helper has a duty to guarantee the legal interests of the suicide.

A criminal liability of a non-guarantor for failure to provide assistance is also possible, because the case law generally interprets the suicide attempt as an "accident" within the meaning of § 323c . The ethical and moral assessment of the behavior must be clearly separated from the criminal law perspective. In the case of procuring or providing fatal drugs, there may also be an administrative offense due to a violation of the Medicines Act or a criminal offense under the Narcotics Act . According to various decisions by the Federal Court of Justice on the position of guarantor, as well as the Federal Constitutional Court on the criminality of a narcotics ordinance in the context of assisted suicide, these legal risks should no longer exist today.

According to a ruling by the Federal Administrative Court on March 2, 2017, permission to acquire a lethal dose of sodium pentobarbital for suicide (autothanasia) is granted under three specific conditions . This drug is the most reliable way to bring about a painless and complication-free death. In its judgment, the court bases its judgment on the free development of personality and the protection of human dignity : “This includes being able to dispose of themselves and shape their own fate. The constitutionally required respect for the individual's way of dealing with illness and their own death also includes the freely responsible decision of seriously ill people to end their life before the phase of death or detached from a fatal course of the disease ”. The court argues that by prohibiting the acquisition of this drug, the state is undertaking a perhaps non-classical, but nonetheless inadmissible “interference” with the freedom to die independently. The court does not consider the provision of the Narcotics Act , according to which drugs such as sodium pentobarbital may be dispensed for therapeutic purposes, to be violated in cases of legally accepted autothanasia, since the use of the drug in such an extreme emergency serves therapeutic purposes. Wolfgang Janisch commented on this in the title of an article in the Süddeutsche Zeitung on May 17, 2017: "Death as the last therapy."

About the receipt of the fatal dose after this judgment, neither decide GPs still a Konsilium the Medical Council , but requested by the Court "particularly careful review" is now in the hands of heranzuziehenden experts the Federal Administrative Court in the Federal Institute for Drugs and Medical Devices ( BfArM settles) . So far, however, the Federal Institute has only monitored the testing and approval of drugs. In order to check the first condition (an extreme emergency caused by an incurable disease with severe pain), doctors at the BfArM will have to make diagnoses in the future , which will have to assess the disease and the mental state of the patient concerned. As a second condition, it must be clarified whether the person who wants to die can decide autonomously, i.e. whether he is able to make a free and serious decision. The third condition says that there is no reasonable alternative to realizing the wish to die, such as discontinuing treatment .

After the judgment of the BVerwG of March 2, 2017, the then Federal Minister of Health Hermann Gröhe (CDU) stated that a state authority "should never become an accomplice in suicide".

At the end of June 2018, Jens Spahn , Federal Minister of Health in the Merkel IV cabinet , instructed the BfArM to ignore the BVerwG's ruling and to generally reject applications by seriously ill people for the receipt of fatal drugs.

Of the 127 applications received by the BfArM by mid-2019, the BfArM did not accept a single one. In its answer to the minor question from MPs Katrin Helling-Plahr, Stephan Thomae, Jens Beeck, other MPs and the FDP parliamentary group, the federal government states the number of applications from the beginning of March 2017 to the end of August 2020. During this period, 190 applications were received . None of the applications were approved.

In June 2020, various media reported that the “Society for Euthanasia” founded by the former Hamburg Justice Senator Roger Kusch helped a resident of a nursing home in northern Germany to commit suicide for the first time.

Also in June 2020, the German Society for Psychoanalysis, Psychotherapy, Psychosomatics and Depth Psychology (DGPT) submitted a statement by its executive board under the title ideas and suggestions on key points of a possible new regulation of suicide assistance .

In April 2021, the Bundestag held an orientation debate to discuss the legislative options for implementing the requirements of the Federal Constitutional Court in connection with the dissolution of Section 217 of the Criminal Code. In the summer of 2021, the German Medical Association published information on how doctors deal with suicidality and death wishes, as well as a guide on how to deal with sustainable suicide wishes in the event of serious illness.

The German Society for Palliative Medicine (DGP) issued “Recommendations (...) on dealing with the desire for suicide assistance in hospice work and palliative care” in September 2021. The State Medical Association of Hesse adapted its regulations in the medical professional code by removing the statement "Doctors are not allowed to assist in suicide". The chamber also emphasized the prohibition on killing on request.

Switzerland

In Switzerland, assisting suicide is not a criminal offense, unless there is a selfish motive (Art. 115 StGB ). The Swiss Academy of Medical Sciences emphasizes in its guidelines, however, that assisted suicide is not “part of the medical profession”. There is also no legal entitlement to assisted suicide.

Known in Switzerland are the two associations EXIT (Romandie) and EXIT (German Switzerland) , which together already have around 90,000 members , which provide their members with help and doctors to assist with suicide on the basis of clear guidelines , as well as the association with around 5500 members Dignitas . These associations are members of the "World Federation of Right-to-Die-Societies". Other organizations are Ex International , which focuses on those from abroad who are willing to die, and Life Circle. In principle, however, every responsible person can ask every doctor about the prescription and procurement of the necessary medication, although by no means every doctor or pharmacy is ready to provide such assistance. However, members of euthanasia organizations benefit from the fact that they offer structures and procedures, such as medical / psychological discussions in which the wish to die is discussed and documented.

The first laws on euthanasia have been in place in some cantons since June 2012. In the canton of Vaud, for example, regulates the conditions under which an euthanasia organization must be granted access in a public hospital or a nursing home and assisted suicide can take place: “A serious and incurable illness must be present and, on the other hand, the person willing to die must be able to judge. A chief physician or clinic director, together with the nursing team and the treating physician, decides whether the two criteria are met. "

The use of assisted suicide is increasing in Switzerland. In 2014 there were 742 people (320 men and 422 women) and in 2017 it was 1009 people (413 men and 596 women).

Austria

In Austria, “participation in suicide” was generally prohibited until 2021 and was punished with imprisonment from six months to five years ( Section 78 of the Criminal Code ). The ban originated from the time of Austrofascism or the authoritarian corporate state , which also explains the religious concept of “ suicide ” instead of “suicide” (1934 to 1974 Section 139b of the Criminal Code). Section 78 of the Criminal Code is very broadly worded and covers even minor acts of support such as buying a train ticket to a death club in Switzerland - even if the support is provided by close relatives, (spouses) partners or other close people. The bioethics commission at the Federal Chancellery therefore called for a reform of the criminal offense, "which takes into account both the principle of maintaining the social norm of suicide prevention and protection from outside regulation of vulnerable people, but also allows individual help in exceptional cases."

In its decision, announced on December 11, 2020, on several complaints from applicants who are willing to die, relatives and a doctor, the Austrian Constitutional Court ruled that the absolute prohibition of any aiding and abetting suicide was unconstitutional. The ban on assistance in Section 78 of the Criminal Code was therefore lifted on December 31, 2021, but not the ban on killing on request , i.e. active euthanasia. The Austrian National Council then voted on December 16, 2021 for a new regulation of assisted suicide for permanently seriously ill or terminally ill adults. The Death Disposal Act and the new version of Section 78 StGB came into force on January 1, 2022.

Netherlands

In the Netherlands, willful assisting in suicide is prohibited (Art. 294 of the Criminal Code), but not punishable if it was committed by a doctor with due diligence and was reported to the coroner. The legalization of the dispensing of lethal drugs by doctors so that those willing to die can end their lives without direct medical help is also being discussed.

United States of America

In the US states of Oregon and Washington , medical-assisted suicide is exempt from punishment and is regulated in the Oregon Death with Dignity Act and the Washington Death with Dignity Act, respectively .

Known cases of assisted suicide
  • Ramón Sampedro : The Spaniard was paralyzed for 30 years with a high cross-section from the neck down. His story was filmed in the film The Sea Inside Me . At the request of a friend, the Spaniard was given a glass of water with potassium cyanide so close to his mouth that he could drink from it himself with a straw and then died (1998). Several of his friends reported themselves to the aiding and abetting, whereupon the case was dropped.

Fasting to death

The death fast without food and fluids is a controversial form of suicide and is viewed by its proponents as a possible alternative to assisted suicide.

Legal regulations

Euthanasia ( euthanasia ) in Europe:
  • Active euthanasia allowed
  • Passive or indirect euthanasia allowed
  • No form of euthanasia legal
  • No data
  • Assisted suicide in Europe:
  • Assisted suicide allowed by law
  • Assisted suicide allowed by court ruling
  • Assisted suicide prohibited by law
  • Germany

    In Germany , active euthanasia as killing on request is punishable under Section 216 of the Criminal Code and carries a prison sentence of six months to five years.

    On December 10, 2015, a law came into force that made business -like encouragement of suicide, which is repeated regardless of profit-making, a criminal offense. This act, abstractly endangering life, was prohibited by the newly drafted Section 217 of the Criminal Code . Relatives or other persons close to the suicidal person who only take part in the act as non-business-like participants are exempt from the threat of punishment.

    On February 26, 2020, the Federal Constitutional Court declared Section 217 StGB (commercial promotion of suicide) introduced in 2015 to be unconstitutional and therefore null and void.

    Legal and social developments before 2020

    The German Society for Surgery was published in early 1979 by an interdisciplinary committee notes for physicians whose preamble states that "[...] prolonging life at all costs not be objective medical action" can.

    In 1986 an interdisciplinary working group presented an “Alternative Draft Law on Euthanasia”. Until about 2006, the discussion was almost exclusively on a theoretical level in the legal field, where a proposal for a comprehensive euthanasia law was published in 2008, which puts the protection of life in the foreground and also takes into account details of a possible legal regulation, but critics accused this draft of regulations that were too meticulous before.

    On September 20, 2006, the 66th German Lawyers' Conference voted with a large majority in favor of statutory regulation of euthanasia and the binding force of living wills. This means that discontinuation of treatment and the failure to take life-sustaining measures should be legally permitted even before the phase of death. In the Criminal Code it should be expressly made clear that doctors do not commit a criminal offense in such cases. This sparked a controversial public debate. Finally, in the spring of 2007, two cross-party group motions were also submitted to the Bundestag. They differ mainly in one point: The proposal by Bosbach , Röspel , Winkler, Fricke et al. In contrast to the other application, the advance directive does not provide for binding in the event that compliance with the advance directive would lead to death, although the disease has not yet taken an irreversible fatal course.

    An omission of medical interventions on the basis of a written by the victim living will or other notable expression of will is not active, but passive euthanasia. A treatment against the patient's will, that is disregarding the patient's will or a living will, met in Germany the offense of assault .

    Based on the euthanasia discussion, the topic was mostly discussed in public under the term “living will”, i.e. from the perspective of those affected. Many people feared that their previously clearly expressed will could be ignored and that they could be expected to die a long time because doctors - out of conviction or fear of legal consequences - act against this will. With the judgment of the Federal Court of Justice of June 25, 2010, these fears are likely to be irrelevant.

    After many deliberations and changes to various drafts, the German Bundestag finally voted on June 18, 2009 with 317 votes in favor, 233 against and 5 abstentions to the “draft of a third law amending the right to care” by MPs Stünker , Kauch , Jochimsen and others MP to.

    The Federal Court of Justice (BGH) strengthened the patient's right to self-determination in a landmark judgment of June 25, 2010 on the discontinuation of treatment ("Putz case") by ruling that (in the criminal sense) the patient's consent justifies the omission of further life-sustaining measures as well as the active termination or prevention of a treatment not or no longer wanted by the patient. The consent leading to impunity could also have been given beforehand in an advance directive or even in an oral statement in the case of a patient unable to consent . Such statements are binding for legal supervisors and authorized representatives ( Section 1901a BGB ), they are also binding on the supervision court ( Section 1904 (3) BGB) and, since February 26, 2013, also directly on the doctor ( Section 630d BGB).

    The professional law of medical professionals was the new legal situation and in particular as a reaction to the above. Judgment of the Federal Court of Justice of June 25, 2010 amended by the new “Principles of the German Medical Association for Medical End-of-Life Care” of January 21, 2011. The discussions at the 114th German Medical Association in early June 2011 show, however, that the topic for the medical profession is far from over.

    The German Foundation for Patient Protection presented an extra-parliamentary draft of such a law to the public on May 8, 2014 . She called for a new Section 217 of the Criminal Code to ban the organized practice of assisted suicide by individuals or groups. According to the will of the authors of the draft law, Steffen Augsberg and Eugen Brysch, anyone who is merely a “participant” in a suicide should remain exempt from punishment - but only if the suicide “is his relative or another person close to him”. However, doctors or nurses are "generally not" included in this.

    In 2014, Federal Health Minister Hermann Gröhe , CDU, initiated this legal regulation of assisted suicide. The grand coalition of CDU / CSU and SPD then agreed on a timetable for a law on euthanasia: On July 2, 2015, the first reading of the four group proposals that had been submitted to the Bundestag took place. On September 23, 2015, the Legal Affairs Committee held a public hearing. The German Ethics Council had formulated its original distance from the new criminal law provisions on suicide in a more differentiated manner. In order to legally strengthen suicide prevention, in the ad hoc recommendation of December 18, 2014, he called for the currently applicable criminal law not to be fundamentally changed. He rejected a separate statutory regulation, such as medical assisted suicide, by the majority, as well as any regulation of assisted suicide for another professional group, also because this would define “permitted normal cases” of assisted suicide. In the opinion of the majority of the German Ethics Council , aiding and abetting suicide and its legal offering should be prohibited if they are intended to be repeated, take place publicly and thus create the appearance of social normality. The German Ethics Council rejected assisted suicide that would not be individual help in tragic exceptional situations, but a kind of normal case, for example in the sense of a selectable standard offer from doctors or in the sense of the service of an association .

    The following five bills were voted on in the first reading in 2015 (only the group proposal for member of the Bundestag Katja Keul ) and in the second and third reading (all other group proposals) in the Bundestag:

    1. The group application for members of the Bundestag Brand , CDU, and Griese , SPD: Anyone who only participates in a suicide without acting in a business-like manner should remain exempt from punishment for this application as long as the suicide is a relative or a close person. This group proposal was referred to by the supporters as the “Middle Path”. This draft law, entitled Draft Law on the Criminal Prosecution of Promoting Suicide in Business Practices , was adopted by the Bundestag with a majority of 360 of 602 votes cast.
    2. The group application for the members of the Bundestag Sensburg , CDU, and Dörflinger , CDU: The application wanted to design any aiding and abetting suicide in Germany.
    3. The group application for members of the Bundestag Hintze , CDU, and Lauterbach , SPD: By means of an amendment to the BGB , doctors should be given protection from those medical associations and thus legal security that prohibits them from assisting in suicide. In the case of suicide, however, doctors should only be allowed to assist those patients who are terminally ill.
    4. The group application for members of the Bundestag Künast , Die Grünen, and Sitte , Die Linke: The application tried to maintain suicide aid unpunished, but wanted to introduce an initial consultation monopoly for doctors and defend its disregard with considerable punishment.
    5. The group application for the member of the Bundestag Keul , Die Grünen: This application pleaded for the retention of the current legal situation.

    Serious legal and criminal objections had been raised against the first four group motions mentioned here. For example, on August 5, 2015, the Scientific Services of the Bundestag took a critical position on the proposals; In the hearing in the Legal Committee, law professors Matthias Herdegen , Eric Hilgendorf and Reinhard Merkel pointed out these concerns. Even before the group proposals were published, more than 140 criminal law professors warned against changing criminal law in this regard.

    The medical ethicist Axel W. Bauer , among others, expressed criticism of such a change in the penal provision from a conservative perspective in 2013 and Gunnar Duttge, a criminal and medical lawyer, in 2016 . Also Claus Roxin opposed the provision and presented proposals for an alternative, constitutional in his view, development of the standard.

    Legal and social developments from 2020

    In a judgment announced on February 26, 2020, the Federal Constitutional Court declared this ban unconstitutional and therefore null and void. According to the court, the general right of personality in connection with human dignity includes "as an expression of personal autonomy a right to self-determined death." It also includes the right to take one's own life. The prohibition in Section 217 of the Criminal Code makes it “de facto impossible for those willing to commit suicide to take advantage of the business-related suicide assistance they have chosen”, so “that the individual has in fact no room to exercise his constitutionally protected freedom.” Under strict conditions that the Legislators can determine, according to the court, business help should also be possible in the future.

    On the day the judgment was announced by the Federal Constitutional Court, FDP MP Katrin Helling-Plahr turned to the German Bundestag with a proposal for an advisory model . The legal politician presented a key issues paper for this. This provides for multi-stage counseling for people who want to commit suicide with the help of doctors or euthanasia associations - analogous to the procedure for abortions. Doctors and counseling centers would have to convince themselves whether the person who wanted to commit suicide has made a decision freely, independently and in full possession of his mental powers. A waiting period should be stipulated between the counseling and the assisted suicide.

    On April 15, 2020, Federal Health Minister Jens Spahn asked medical representatives, associations and churches for suggestions on key points of a possible new regulation of suicide assistance. Bills for a new regulation of suicide assistance have so far come from the Humanist Association of Germany (HVD) , the German Foundation for Patient Protection and an association of four scientists from medical law, medical ethics and palliative medicine.

    According to the proposal of the HVD of May 2, 2020, there should be neither a new paragraph 217 in the Criminal Code nor a new ban on assisted suicide for doctors, associations or non-medical euthanasia. Instead of psychiatric assessments and mandatory counseling, the association proposes voluntary offers for voluntary and open-ended discussions in so-called suicide (conflict) counseling centers. Commercial euthanasia remains prohibited in the proposed law and is to be punished with a prison sentence of up to two years or a fine. A particularly difficult case exists for the HVD when a predicament, crisis situation, weak will or lack of judgment is exploited due to a lack of knowledge about alternatives of a suicidal person. Then the prison sentence should not be less than two to five years.

    In its draft law presented on June 12, 2020, the German Foundation for Patient Protection aims at a new section 217 “Promotion of suicide” in the penal code in order to protect the right to self-determination of those willing to die. Commercial suicide assistance aimed at profit is to be punished with a prison sentence of up to five years. In the organized business-like euthanasia permitted by the Federal Constitutional Court , the foundation is guided by the judgment of the Karlsruhe judges. Accordingly, it must be guaranteed that the person willing to die is adequately informed about alternative courses of action and does not decide to commit suicide under pressure and coercion. A suicide helper must make sure of this and document it in writing. If he ignores the highest judicial standards, he should face a prison sentence of up to three years. According to the foundation's draft law, support from relatives of the suicidal person remains unpunished.

    The proposal by Gian Domenico Borasio and Ralf Jox, both palliative physicians at the University of Lausanne , the medical lawyer Jochen Taupitz and the Tübingen medical ethicist Urban Wiesing on June 22, 2020 provides for a form of suicide assistance largely determined by doctors. Relatives and people close to the person willing to die should be allowed to provide support for suicide assistance, but euthanasia associations continue to play no role. In the opinion of the medical professionals, because of their training, doctors are suitable for examining the responsibility for treatment requests, informing them about medical alternatives and finally also issuing the prescription for a killing agent. The decision must be made freely, permanently and informed. A second doctor must also be consulted for every decision. There should be at least ten days between the consultation with the doctor and the prescription of the deadly drug. In addition, no doctor should be forced to assist in suicide. The aim is to anchor the proposed law "Self-determination in dying - care for life" in both criminal law and medical law .

    Austria

    Active euthanasia is a criminal offense in Austria and falls under the criteria of murder (Section 75 StGB), killing on request (Section 77 StGB) or involvement in suicide (Section 78 StGB). On the other hand, passive euthanasia is not punishable, or the renouncement of life-prolonging measures when dying, if a patient currently wishes this or has expressed this wish in advance with a valid living will. Active indirect euthanasia is also permitted, which is understood to mean medical measures that alleviate a person's suffering using all possible means, even if this may shorten the dying process.

    In January 2014 an application was made to the Vienna Police Department to found the association “Last Help - Association for Self-Determined Dying” . The prohibition was made with reference to Section 78 StGB: "Anyone who induces another to kill himself, or helps him to do so, is punished with imprisonment from six months to five years." The astrophysicist Heinz Oberhummer and Eytan Reif, both of whom are still involved in the secular initiative Religion is a private matter, complained that the Vienna Administrative Court dealt with it on October 8, 2014, which announced a written decision.

    The proponents want to enable a "self-determined life and death in dignity" with the unapproved association. The association wants to come of age to those affected by incurably serious illness, disability or unbearable pain "to provide advice on suicide at their explicit request." The initiative wants to achieve a change in the legal situation and sees the state defaulting on the duty to protect citizens from dangers. The judge did not rule out the possibility of interrupting the proceedings in order to refer the matter to the Constitutional Court. Reif and Oberhummer also did not rule out going to the European Court of Human Rights ( ECHR ).

    At the beginning of June 2015, the Vienna Administrative Court dismissed the complaint. The complainants referred the matter to the Constitutional Court, which, in its decision of March 8, 2016, denied a violation of constitutionally guaranteed rights by not allowing the establishment of an association for euthanasia due to the pursuit of an illegal purpose.

    In 2019 the Austrian Society for a Humane End of Life (ÖGHL) was founded, which, among other things, submitted an application to the Austrian Constitutional Court for the decriminalization of euthanasia, in particular for the liberalization of Section 78 of the Criminal Code "Participation in suicide" (assisted suicide) and of Section 77 of the Criminal Code " Killing on demand ”(assisted suicide).

    Conversely, there are efforts to strengthen the ban on active euthanasia by raising it to constitutional status.

    On December 11, 2020, the Constitutional Court (VfGH) repealed the provision that makes assisting suicide a criminal offense. The phrase "or help him" in Section 78 of the Criminal Code (StGB) is unconstitutional. It violates the right to self-determination because this fact forbids any kind of assistance under any circumstances. The repeal of the previous version will come into effect at the end of December 31, 2021. On January 1, 2022, the Death Disposal Act and the new version of Section 78 of the Criminal Code come into force.

    Legal situation in Germany, Austria and Switzerland

    Country Active euthanasia Assisted suicide Passive euthanasia Indirect euthanasia
    GermanyGermany Germany noPunishable according to § 216 StGB (killing on request). Continuing effectiveness disputed by judgment of 02.26.2020, whereby a partial or complete unconstitutionality and thus ineffectiveness is assumed. Has never been heard before the Federal Constitutional Court. YesLegal with the entry into force of the Reich Criminal Code of 1871 (previously punishable in some countries, e.g. according to Section 208 of the Criminal Code of the Grand Duchy of Baden ).

    The "commercial promotion of suicide" was made a criminal offense in 2015 by Section 217 of the Criminal Code .

    With the judgment of the Federal Constitutional Court of February 26, 2020 (2 BvR 2347/15 et al.), § 217 was declared unconstitutional and the right to death recognized as an independent basic right derived directly from the guarantee of human dignity and the general freedom of action.

    Yes Legal if there is an expression of will by the person concerned or a valid living will Yes Legal if there is an expression of will by the person concerned or a valid living will
    AustriaAustria Austria noPunishable according to § 77 StGB-AT (killing on request) For formal reasons, the VfGH rejected an application in this regard on December 11, 2020 as inadmissible. Since the applicant did not attack the other killing offenses at the same time, he could not possibly achieve his goal only with the repeal of Section 77, since he would then be convicted according to these other offenses. “With the repeal the concerns of the applicants against § 77 StGB would not be dispelled; in this respect, the scope of the appeal was too narrow, ”said the court. YesLegal until 1934.

    noProhibited in 1934 with the abolition of the republic by National Socialist fascism or Austrofascism. Its self-image as an authoritarian corporate state also explains the religious concept of “suicide” instead of “suicide” (Section 139b of the Criminal Law; 1975 as Section 78 of the new Criminal Code).

    YesProhibition of criminal law due to its incompatibility with "the constitutionally guaranteed right to self-determination" unconstitutional according to the judgment of the Constitutional Court of December 11th, 2020 (G 139/2019). The previous version becomes null and void on December 31, 2021.

    Entry into force of the new Death Provision Act and the new version of Section 78 of the Criminal Code on January 1, 2022.

    Yes Legal if there is an expression of will by the person concerned or a valid living will Yes Legal
    SwitzerlandSwitzerland Switzerland noPunishable under Article 114 of the Swiss Criminal Code. (There is no constitutional jurisdiction in Switzerland) Yes Legal according to Art. 115 StGB-CH, as long as the helper has no “selfish motives”. Yes Legal Yes Legal

    Several associations are active in assisting suicide in Switzerland : the two independent Exit associations since 1982, Ex International since 1997, Dignitas since 1998, Life Circle since 2012 and Liberty Life since 2015.

    Other countries

    In Europe, until 2009, the Netherlands , Belgium and Luxembourg were the first countries to legally allow active and passive euthanasia to varying degrees. The Canadian Parliament passed a law legalizing assisted euthanasia in June 2016 (Bill C-14). This was preceded by a regulation in the province of Québec and a decision by the Supreme Court; who lifted the criminality of medical euthanasia. On March 18, 2021, Spain also approved the legalization of active euthanasia with a clear majority in parliament.

    In 2001, the Netherlands became the first country in the world to allow active euthanasia ( wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding - Law on the Control of Ending Life on Demand and Assistance in Suicide ). The law and its practice enable people to die at home and with loved ones. Formal procedures are designed to ensure that a patient is genuinely ready for voluntary death. Life-ending action takes place at home in around 90 percent of cases (in 2008 it was carried out by the family doctor in 2,083 of 2,331 cases ). Euthanasia for terminally ill babies has also been legal in the Netherlands since 2013.

    On October 13, 2016, it was announced that the government was planning a new bill. In 2015, 4.5 percent of all deaths in the Netherlands were due to active euthanasia; Doctors fulfilled around half of the requests for killing of the seriously ill.

    In 2002, the law on euthanasia came into force in Belgium , followed by the law on euthanasia and assisted suicide in the Grand Duchy of Luxembourg in 2009 . Both are similar to the Dutch Euthanasia Act. In February 2014, the Belgian parliament voted with a majority for a change in the law allowing active euthanasia for terminally ill children and young people under the age of 18 (e.g. minors with cancer). Doctors in Belgium expect around a dozen such cases per year.

    Over 2000 French doctors, nurses and carers publicly announced in March 2007 that they had helped suicide patients. This was seen as a cry for help to the public and legislators.

    In many European countries, for example in the Catholic countries Spain , France and Italy , a legal regulation on euthanasia has been or is controversially discussed.

    In the Anglo-Saxon legal system , medical assistance in the event of suicide was expressly permitted for the first time in 1995 in the Northern Territory of Australia - for a short time - by the Rights of the Terminally Ill Act . In the United States, several states have regulations that allow medical assistance in suicide: the Oregon Death with Dignity Act , which has existed since 1997 , the Washington Death with Dignity Act that came into force in 2009 , and the Vermont Patient Choice at End that came into force in 2013 of Life Act and the California End of Life Option Act , passed in 2016 . and the Colorado End-of-Life Options Act, in effect December 16, 2016. In addition, euthanasia is prohibited as a result of the Baxter v. Montana in the state of Montana de facto legal since December 31, 2009, similarly since 2014 in New Mexico . Most recently, the attempt to criminalize assisted suicide in Montana failed on March 2, 2021 when the Senate stopped a corresponding bill. On March 17, 2021, the New Mexico Senate approved the decriminalization of assisted suicide previously passed by the House of Commons.

    In Australia, five states have legalized assisted suicide, starting with the Voluntary Assisted Dying Act 2017 of November 29, 2017 in Victoria, followed by Western Australia with the Voluntary Assisted Dying Act 2019 of December 19, 2019 and March 23, 2021 adopted End of Life Choices Act in Tasmania. Legalization in the state of South Australia followed on June 24, 2021. On September 17, 2021 (entry into force: spring 2023), Queensland followed as the fifth state.

    Country Active euthanasia Assisted suicide Passive euthanasia Indirect euthanasia No legal form of euthanasia allowed / All forms of euthanasia are prohibited by law Unclear legal situation
    BelgiumBelgium Belgium YesLegal for adults (since 2002)
    YesLegal for children (since 2014)
    Yes Legal Yes Legal Yes Legal no no
    DenmarkDenmark Denmark no Forbidden no Forbidden Yes Legal not clear No details no no
    not clear Indirect euthanasia
    FinlandFinland Finland no Forbidden Yes Legal (No criminal offense, no professional ethics prohibition. Requirements set by jurisprudence) Yes Legal Yes Legal no no
    FranceFrance France no Prohibited (equated with negligent homicide, up to 5 years imprisonment) no Forbidden Yes Legal if there is an expression of will by the person concerned or a valid living will. Yes Legal if there is an expression of will by the person concerned or a valid living will. no no
    GreeceGreece Greece no Forbidden (equated with murder) no Forbidden not clear No details Yes Legal if there is an expression of will by the person concerned or a valid living will. no no
    not clear Passive euthanasia
    ItalyItaly Italy no Forbidden Yes Legal under certain conditions by judgment of the Constitutional Court (T-190 242) of November 27, 2019. Yes Legal by law of December 14, 2017. not clear Legally unclear no no
    not clear Indirect euthanasia
    IrelandIreland Ireland no Prohibited (up to 14 years imprisonment) no Prohibited (up to 14 years imprisonment) Yes Legal if there is an expression of will by the person concerned or a valid living will. Yes Legal when pain relief is the primary goal. no no
    CanadaCanada Canada YesLegal by Supreme Court judgment (Carter v. Canada 2015 SCC 5) of February 6, 2015 and by law of July 17, 2016. YesLegal by Supreme Court judgment (Carter v. Canada 2015 SCC 5) of February 6, 2015 and by law of July 17, 2016. Yes Legal by Supreme Court judgment (Rodriguez v. British Columbia 1993 3 SCR 519) of September 30, 1993. Yes Legal by Supreme Court judgment (Rodriguez v. British Columbia 1993 3 SCR 519) of September 30, 1993. no no
    ColombiaColombia Colombia YesLegal. Partial decriminalization by judgment of the Supreme Court (C-239) of May 20, 1997. Obligation to adopt legal guidelines by judgment of the Constitutional Court of February 19, 2015. Full legalization by adoption of guidelines by the Ministry of Health on April 29, 2015. Legalization for underage patients in 2018. With its judgment of July 22, 2021, the Constitutional Court revised its case law from 1997 by declaring the condition of an incurable disease to be unconstitutional and null and void. no Prohibited according to Article 107 of the Criminal Code. Yes Legal by law of September 8, 2014. not clear Legally unclear no no
    not clear Indirect euthanasia
    LuxembourgLuxembourg Luxembourg YesLegal for adults (since 2009). Is considered natural death due to the change in the law on February 11, 2021. YesLegal. Is considered natural death due to the change in the law on February 11, 2021. Yes Legal Yes Legal no no
    New ZealandNew Zealand New Zealand Yes Legal by law of 11/13/2019 (End of Life Choice Act), passed by referendum on 10/17/2020, with effect from 11/6/2021. Yes Legal by law of November 13, 2019 (End of Life Choice Act), passed by referendum on October 17, 2020, with effect from November 6, 2021. Yes Legal by Act of October 20, 1994 (Health and Disability Commissioner Act 1994). Yes Legal by judgment of the High Court (Seales v Attorney-General [2015] NZHC 1239) dated 06/04/2015. no no
    NetherlandsNetherlands Netherlands YesLegal for adults (since 2002)
    YesLegal for children aged 12 and over
    Yes Legal Yes Legal, is considered natural death Yes Legal, is considered natural death no no
    NorwayNorway Norway no Forbidden no Forbidden Yes Legal by law of July 2, 1999. Yes Legal if there is an expression of will by the person concerned or a valid living will. no no
    not clear Passive euthanasia
    PeruPeru Peru YesLegal by judgment of the Supreme Court of the Republic of Peru (00573-2020-0-1801-JR-DC-11) of February 25, 2021 through constitutional interpretation of Sections 112, 113 of the Criminal Code. Obligation of the Ministry of Health to issue a general euthanasia protocol that goes beyond the negotiated case. YesLegal by judgment of the Supreme Court of the Republic of Peru (00573-2020-0-1801-JR-DC-11) of February 25, 2021 through constitutional interpretation of Sections 112, 113 of the Criminal Code. Obligation of the Ministry of Health to issue a general euthanasia protocol that goes beyond the negotiated case. Yes Legal by judgment of the Supreme Court of the Republic of Peru (00573-2020-0-1801-JR-DC-11) of February 25, 2021 (As euthanasia would not be feasible without subsequent rescue attempts.) not clear Legally unclear no not clear Indirect euthanasia
    PolandPoland Poland no Forbidden no Forbidden no Forbidden no Forbidden Yes No legal form of euthanasia no Any form of euthanasia is prohibited by law.
    PortugalPortugal Portugal no Prohibited (up to 3 years imprisonment) no Prohibited (up to 3 years imprisonment) not clear No details not clear No details no The law only prohibits active euthanasia and assisted suicide.
    SwedenSweden Sweden no Forbidden Yes Legal if the helper is a private person. Yes Legal Yes Legal if there is an expression of will by the person concerned or a valid living will. no no
    SloveniaSlovenia Slovenia no Prohibited (at least 5 years imprisonment) no Prohibited (6 months to 5 years imprisonment) Yes Legal if there is an expression of will by the person concerned or a valid living will. not clear No details no no
    not clear Indirect euthanasia
    SpainSpain Spain YesLegal by law ( ley de la eutanasia ) of December 17, 2020 with entry into force on March 17, 2021. A constitutional complaint by the Vox party against this was rejected by the Constitutional Court on June 23, 2021. YesLegal by law ( ley de la eutanasia ) of December 17, 2020 with entry into force on March 17, 2021. A constitutional complaint by the Vox party against this was rejected by the Constitutional Court on June 23, 2021. not clear Legally unclear Yes Legal if it is done medically correctly. no no
    not clear Passive euthanasia
    HungaryHungary Hungary no Forbidden no Forbidden not clear Legally unclear Yes Legal if there is an expression of will by the person concerned or a valid living will. no no
    not clear Passive euthanasia
    United KingdomUnited Kingdom United Kingdom no Forbidden (equated with murder) no Prohibited (up to 14 years imprisonment) not clear Legally unclear Yes Legal no no
    not clear Passive euthanasia

    A distinction must be made between these cases of individual euthanasia and the killing of patients individually or partially in series by professional nurses (often called angel of death in the media ), who often cited "euthanasia" or "mercy" as a motive in the subsequent criminal proceedings . There was no long-standing trusting relationship between two people; In some cases, lower motives (in the legal sense) could be assumed or proven as the motive for the actions. A well-known case was the " Angel of Death von Lainz ".

    Comparative law

    The legal regulations on euthanasia differ from country to country. Below is a comparison of the various laws in the most important points. The countries in which both killing on demand and assisted suicide are permitted do not have different requirements. Therefore the table does not differentiate either. However, it is noted which of the two forms of euthanasia is regulated.

    Country basis Constitutional requirement? / Changeability? killing on demand Assisted suicide Emergence (actor) character No prerequisites Requirement:

    Free responsibility

    Citizenship or residence requirement Requirement:

    Formal age limit

    Requirement:

    Unbearable suffering

    Requirement:

    Fatal suffering within a foreseeable period of time

    The euthanasia must be a doctor or nurse Legal stipulation of the lethal agents used or special duty of care Prescribed control of the helper before or after (suicide)
    BelgiumBelgium Belgium Legal with the entry into force of the Loi relative à l'euthanasie law of 23.09.2002 no/ Yesby simple law Yes Regulated legally and under simple law Yes Regulated legally and under simple law Under simple law (parliament) Opening up the possibility, no claim no Yes Yes no (implicitly through free responsibility) Yes no Yes Yes Multiple eyes principle (before) and committee (after)
    GermanyGermany Germany Legal with the entry into force of the Constitution of the German Empire from April 16, 1871 (Kaiserreich)

    Legal with the entry into force of the Constitution of the German Empire of August 11, 1919 (Weimar Republic)

    Legal with the entry into force of the Basic Law for the Federal Republic of Germany from May 24, 1949

    Concretization of the prerequisites by judgment of the Federal Constitutional Court of February 26th, 2020 - 2 BvR 2347/15 et al.

    Yes/ noNecessary amendment of Art. 1 Abs. 1 S. 1 GG prohibited according to Art. 79 Abs. 3 GG not clear Constitutional conformity of the prohibition by judgment on § 217 STGB questionable. Yes Legal


    no No regulation

    Constitutional (Constitutional Court) Basic right of defense (non-prohibition) against the state no Yes no no (implicitly through free responsibility) no no no no no
    FinlandFinland Finland Legal by multitude of judgments no/ Yesby simple law no Forbidden Yes Legal


    no No regulation

    Simple legal omission Opening up the possibility, no claim no Yes no not clear Not clear not clear Not clear not clear Not clear no no no
    ItalyItaly Italy Legal by judgment of the Constitutional Court (T-190 242) of November 27, 2019. Yes/ Yesby constitutional amendment no Forbidden Yes Legal


    no No regulation

    Constitutional (Constitutional Court) Basic right of defense (non-prohibition) against the state no Yes not clear Not clear not clear Not clear Yes Yes not clear Not clear not clear Not clear Board (before)
    NetherlandsNetherlands Netherlands Legal with the entry into force of the wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding from April 12, 2001 no/ Yesby simple law Yes Regulated legally and under simple law Yes Regulated legally and under simple law Under simple law (parliament) Opening up the possibility, no claim no Yes Yes no (implicitly through free responsibility) Yes no Yes Yes Multiple eyes principle (before) and committee (after)
    CanadaCanada Canada Legal by Supreme Court judgment (Carter v. Canada 2015 SCC 5) of February 6, 2015 and

    by Law C-14 of July 17, 2016.

    Yes/ Yesby constitutional amendment Yes Regulated legally and under simple law YesRegulated legally and under simple law Constitutional (Constitutional Court) Fundamental right to claim (ensuring access) against the state no Yes Yes From 18 years Yes Yes/ no(Declared unconstitutional by judgment of 11.09.2019
    new regulation pending. Failure to do so will automatically result in nullity on 18.12.2020)
    Yes Yes Independent Adult Witness (Before)
    ColombiaColombia Colombia Legal by Supreme Court judgment (C-239) of May 20, 1997. Guidelines adopted by the Department of Health on April 29, 2015. Yes/ Yesby constitutional amendment YesLegally and regulated by ordinances no Prohibited according to Article 107 of the Criminal Code. Constitutional (Constitutional Court) Fundamental right to claim (ensuring access) against the state no Yes Yes From 12 years Yes no Yes no no
    LuxembourgLuxembourg Luxembourg Legal with the entry into force of the Loi sur l'euthanasie et l'assistance au suicide law of 03/12/2009 no/ Yesby simple law Yes Regulated legally and under simple law Yes Regulated legally and under simple law Under simple law (parliament) Right of entitlement (through compulsion to refer to a doctor if refused) no Yes Longer treatment period with a doctor with a Luxembourg license From 18 years Yes no Yes Yes Multiple eyes principle (before) and committee (after)
    New ZealandNew Zealand New Zealand Legal by the End of Life Choice Act of 11/13/2019,

    adopted by referendum on October 17, 2020,

    with entry into force on November 6th, 2021.

    no/ Yesby referendum Yes Regulated legally and under simple law Yes Regulated legally and under simple law Simple statute (referendum) Opening up the possibility, no claim no Yes Yes From 18 years Yes Yes Yes Yes Multiple eyes principle (before)
    SwedenSweden Sweden Legal by restricting the ban to non-relatives no/ Yesby simple law no Forbidden Yes Legal


    no No regulation

    Simple legal omission Opening up the possibility, no claim no Yes no not clear Not clear not clear Not clear not clear Not clear no no no
    SwitzerlandSwitzerland Switzerland Legal by limiting criminal liability to selfish motives (Art. 115 Criminal Code) no/ Yesby simple law no Forbidden Yes Legal

    no No regulation

    Under simple law (parliament) Opening up the possibility, no claim no Yes no From 18 years no no no no no

    The ethical discussion about euthanasia

    Euthanasia stands in the field of tension between

    The strongest conflicts exist with active euthanasia, and here especially in the different weighting of the will of a seriously suffering person. It should be noted here that not every example of active euthanasia discussed is also included here. Preparing for a suicide situation that the patient uses independently is, in Germany, aiding and abetting suicide with no punishment. (Example: A patient swallows an over-the-counter poison that someone asked for.)

    Euthanasia in conflict of opinions

    German history

    The German word "Euthanasia" as a synonym for euthanasia (also in the sense of killing on demand) is a new word formation published in the magazine The Monistic Century in 1913 , was criticized in 1914 as a "waste of language energy" by the linguist and philosopher Mauthner and had no later than 1915 Found its way into the legal language.

    Since the 17th century, medical doctors have increasingly had controversial discussions about active euthanasia. In the 19th century, Christoph Wilhelm Hufeland wrote : “To preserve people's lives and, where possible, to extend them, is the highest goal of the art of healing and every doctor has sworn not to do anything that could shorten a person's life [...]; Whether it is luck or misfortune, whether it is worth it or not, that is none of his business, and if he once presumes to include this consideration in his business, the consequences are incalculable, and the doctor becomes the most dangerous man in the world States. "

    The opponents of active euthanasia warned of the developments in Germany in the first half of the 20th century, which took away the initially serious discussion of the question of releasing terminally ill people from their suffering.

    In contrast, their advocates claim that, unlike back then, assisted dying is not about a decision by strangers about the life of individual people, but rather about a decision by a person willing to die, for whom he is looking for assistance.

    Fear of unbearable suffering

    The opponents of active euthanasia are of the opinion that people can take their sufferings, worries and fears of an agonizing transition from life to death with due care and the possibilities of modern medicine to such an extent that they do not have to despair of their living conditions. From the point of view of the constitutionally anchored protection of life and health, it is therefore the task of a humane community to make use of these possibilities, not to save them by enabling and helping the individual to end his own life to put.

    The proponents of euthanasia argue on the other hand: It is by no means possible in all cases to medically reduce unbearable pain and discomfort to a tolerable level. Furthermore: Reasons to wish for death are above all the emptying of meaning in life as a result of a natural erosion of life interests and goals; the desperate shame of the embarrassment that hurts one's self-esteem, no longer having one's most intimate needs under control and thus having to rely on the help of others with no prospect of change; the often very clearly perceived, depressing experience of seriously impairing the lives of others, especially relatives, with one's own frailty; finally the frustration that much of what was created and acquired in life and which was supposed to serve other purposes is now to be wasted in maintaining a life that no longer deserves this designation according to its evaluations. Palliative medicine does not help here and all human attention cannot ultimately help over this.

    Euthanasia as a questionable business

    Opponents of active euthanasia fear that official approval of euthanasia would lead to unacceptable deals with dying, since most people would find themselves dependent on euthanasia. A prominent example in Germany in 2008 was Roger Kusch .

    Doubtfulness of the wish to die

    The opponents of active euthanasia refer to the experiences of doctors, psychologists and pastors, who agree that the majority of people who have attempted suicide in vain find their way back to a normal life, often no longer understand their decision, retrospectively regret it and are glad that their attempt failed. Euthanasia would encourage these wrong decisions.

    Proponents of active euthanasia counter that people who have successfully committed suicide no longer have to quarrel with the question of whether this decision was the right one and perhaps do not have to regret what has been neglected, because they have found their peace in death. In addition, the argument of that “majority” itself admits the existence of conflicting cases. To prevent wrong decisions, education and advice centers or therapy offers would be the right measure, but not legal prohibitions based on the watering can principle .

    Illness of suicidal decisions

    The opponents of active euthanasia refer to scientific studies that have shown that suicides are often caused by depression. They are to be regarded as pathological and in the majority of cases can be treated by medical or therapeutic measures to such an extent that the energies of these people who are turned towards life can regain the upper hand. Euthanasia helps cut off such a development.

    Proponents of active euthanasia, on the other hand, point out that the increasing erosion of the will to live is a natural process, at least in the persistently ill, but especially in the elderly, which is often wrongly interpreted as pathological. But even if you see it as a disease, those affected are not insane because of it. If they preferred the option of dying to survival, that wish should be respected as well as the right to refuse medical or psychological treatment, even if they had a chance of success. Against this background, euthanasia is support for a concern that is to be recognized.

    Euthanasia as an imposition for the helpers

    The opponents of active euthanasia assert that euthanasia is a severe imposition, the more difficult the closer the person asked for help is to the person willing to die.

    Proponents of active euthanasia counter this by saying that once euthanasia is made possible, no one is forced to perform it. If there were orderly, even institutionalized forms of euthanasia, people who were particularly close to the person who wanted to die would not have to be used. But they could, taking part in the sufferings of those willing to die in a special way, have a human motivation to help them to end the tormenting state.

    Doubtful interests of relatives

    Opponents of active euthanasia see close relatives in particular as euthanasia in a problematic conflict of interests in which the well-meaning promotion of a wish to die can often be inextricably linked with the unspoken wish, freeing them from the demanding, costly and life-slowing burden of entertaining and caring for a seriously ill person to become.

    The proponents, on the other hand, believe that this undoubtedly not improbable case of conflict should not make a person's express wish to die unfulfilled. If close relatives are excluded from providing euthanasia, such help could still be provided by institutionally approved helpers who have no personal or material interest in the death of the person willing to die.

    The danger of an urge to die

    Some seriously ill people already feel urged to commit suicide in the sense of a moral pressure to relieve relatives or society, but the opponents of active euthanasia are also very concerned that the tolerated and enabled freedom to die could unexpectedly lead to expectations of society towards the individual mutate to make use of such freedom. Behind a decision that appears to be a virtue and made out of responsible insight lurks the danger of “bullying to death” of those members of society who become a nuisance to the community. Nobody should reach out to help with this.

    This concern is shared by advocates of active euthanasia. You point out, however, that such an urge is by no means ruled out, even under the currently prevailing conditions. It is the task of the state in the currently applicable law as well as in the law to be sought to protect the life of the individual from being accessed by others. Society must - as before - resolutely oppose all attempts to force people to die (a desolidarization of society in this regard would then be detrimental both to the state and to humanity as a whole). However, making it more difficult for people to die against their declared will so that they only have unsafe or cruel and possibly traumatizing third parties (e.g. train drivers) is not the task of the state.

    Medical standpoints on euthanasia and terminal care

    The German Medical Association sees the doctor's involvement in the suicide of a patient (in the context of an assisted suicide, for example as the last possible act of humanity, to avoid a suicide endangering third parties or to prevent unregulated and risky, non-institutionalized assisted suicide) as a fundamental contradiction to medical ethos and does not see such cooperation, which is not one of the doctor's core competencies and could endanger the doctor-patient relationship , as a medical task.

    The German Society for the Study of Pain (DGSS) and the German Society for Palliative Medicine (DGP) emphasize that in the discussion about active and passive euthanasia, the alternative of pain therapy and palliative medicine is often unnecessarily ignored.

    Both the DGSS and the DGP point out that there are methods for relieving the most severe pain. "We can almost always alleviate the pain and symptoms of dying patients and enable them to end their lives with dignity," said Rolf-Detlef Treede, President of the DGSS. Palliative medicine specialists would repeatedly experience that the desire to end life prematurely takes a back seat to the extent that, despite the existing limits of palliative medicine and hospice work, good palliative medicine treatment can also make the last lifetime bearable.

    Christian viewpoints on euthanasia

    The fifth of the ten commandments of the Bible demands: "You shall not murder (kill)" ( Ex 20.13  EU ). For this reason, some Christian churches also reject active euthanasia.

    In 1989 the Catholic and Protestant Churches in Germany rejected medical aid to suicide in a joint declaration .

    Roman Catholic position on active euthanasia

    The Roman Catholic Church rejects active euthanasia. The Catechism of the Catholic Church emphasizes the need to pay special attention to the sick and disabled. The direct active euthanasia, which puts an end to life, is referred to as an offense against human dignity, as murder . Further, bringing about death is seen as an attack against the Creator. Failure to result in death is also considered murder.

    The German Bishops' Conference also warns of the consequences that legalizing active euthanasia could have. The "internal and external pressure on all the elderly, seriously ill and those in need of care [could increase] to make use of such options." Human dignity follows from God's affirmation and is therefore not dependent on human performance or health. Life should therefore be protected until the end.

    The rejection of active euthanasia is not justified on the basis of the Bible's prohibition on killing. Church and theological positions point to the consequences of legalizing active euthanasia. This could lead to a "loss of trust in the medical nursing staff to want to do everything possible for a cure", and it could also build up "pressure from third parties on the seriously ill" to make use of active euthanasia.

    The Dutch Bishops' Conference protested against active euthanasia with a "Pastoral Handout" in which it stipulates:

    “The request for active euthanasia is the attempt to take the last course of life completely into one's own hands. This is not compatible with the handing over of oneself into the loving hand of God, as it is expressed in the sacraments of the Church [...]. "
    "Euthanasia is not a solution to suffering, but an annihilation of the suffering person."

    Roman Catholic position on passive euthanasia

    Indirect or passive euthanasia may be allowed under certain circumstances (unlike active euthanasia). The Congregation for the Doctrine of the Faith presented these exceptions as follows:

    "When death comes closer and can no longer be prevented by therapy, [...] but without neglecting the normal help that one owes a sick person in such cases. Then there is no reason for the doctor to have concerns [...]. "

    Pope John Paul II said on March 24, 2002, three years before his death, to doctors and health professionals from around the world:

    “When administering the necessary healing methods, the complexity of the human being demands that one not only consider his body, but also his mind. It would be presumptuous to rely on technology alone. And from this point of view, intensive care medicine would ultimately not only prove to be useless at any cost. Nor would she fully respect the sick man who has now reached his end. "

    Protestant statements on euthanasia

    Evangelical Church in Germany (EKD)

    “The starting point is the duty to enable everyone to die in dignity. [...] We should all support the dying in such a way that the desire to be killed or to kill oneself does not arise in the first place. ”(Bishop Wolfgang Huber, former council chairman of the Evangelical Church in Germany (EKD) : Between the right to self-determination and the duty to support life: accompaniment in death ). The Chairman of the Council of the EKD rejects active euthanasia and refers to the following alternatives:

    • Today everyone can make provisions for the shaping of their last lifetime. Since 1999, the churches have been issuing an advance directive with a power of attorney and care directive - the "Christian advance directive".
    • At the medical level, above all the further development and expansion of palliative medicine, which is dedicated to pain therapy and the alleviation of other symptoms of illness, is required. The training of doctors in palliative care and the corresponding equipment in hospitals should be improved.
    • For the overall area of ​​palliative care and support , the basic ideas and practical experiences of the hospice movement must be brought to bear more strongly. The concept of hospice aims at dying care in the hospital as well as in family and neighborly care and help.

    With regard to the landmark ruling of the Federal Court of Justice of June 25, 2010, the EKD declares:

    “The Evangelical Church in Germany (EKD) welcomes the fact that today's ruling by the Federal Court of Justice (BGH) strengthens the patient's right to implement his or her will. [...] According to Christian ethics, there is no human obligation to prolong life at any price, and there is also no ethical requirement to exhaust the therapeutic possibilities of medicine to the last. Letting a person die is not only justified, it is imperative, given the patient's will in advance. The finiteness of life also includes allowing death to approach when its time has come. ”“ In contrast, the targeted killing of a person in the last phase of life is and remains ethically unjustifiable from a Christian point of view, even if it is at his express request is done. Legal regulations and social conventions that pave the way for killing on request or assisted suicide are a wrong path, which the Christian churches resolutely reject. You will continue to work in the future to ensure that the existing legal regulations on killing on request are adhered to and that there is no relaxation. "

    In a position paper by Diakonie Deutschland (a work of the Evangelical Church in Germany) dated September 29, 2014, four positions on the current debate about assisted suicide (so-called assisted suicide) are listed:

    1. Suicide prevention
    2. Strengthening hospice and palliative care
    3. Prohibition of organized, not only for profit / commercial aiding and abetting of suicide
    4. Maintaining the ban on medical assistance in suicide

    Old Catholic position on active euthanasia

    The position of the old Catholic Church, which rejects active euthanasia, is exemplified by the Austrian Bishop Bernhard Heitz :

    “To be allowed to die by the hand and in the arm of the loved and trusted person is different from dying at the hand of a person. The Old Catholic Church thus resolutely rejects active euthanasia. Rather, being born and dying are human and natural basic conditions of life and as such are subject to human culture. A society that suppresses and denies death, that regards the dead as disposal cases, has lost some of its human solidarity. "

    Jewish standpoints on euthanasia

    The Torah represents God as the only one who brings about death and creates life (אני אמית ומחיה Deut. 32:39). The destruction of human life would therefore mean the destruction of something sacred. For this reason, the classical Jewish tradition rejects active euthanasia, but at the same time advocates the removal of an "obstacle to death". The dialectic between the inviolability of life (קדושת חיים) and the rejection of painful suffering (יסורים 'misery') may lead to not delaying the death of an incurably ill person and, in the case of insurmountable pain, empathy for the sick in the sense of mercy ( רחמים). Some contemporary Jewish voices advocate assisted suicide or even active euthanasia. However, there is no support for this in the previous halachic discourse.

    Non-religious-humanistic positions on euthanasia

    The focus of humanistic positions is on helping people to die independently, as formulated in 2014 in the “10 principles for self-determination until the end of life” of a civil society alliance coordinated by Ingrid Matthäus-Maier . Participated in this inter alia. Coordinating Council of Secular Organizations , Federation for Freedom of the Spirit Bavaria , Umbrella Association of Free Worldview Communities , German Society for Human Dying , Giordano Bruno Foundation , Humanist Union , Humanist Association of Germany , International Association of Non-Denominational and Atheists . What the humanistic currents have in common is to speak out against the criminalization of euthanasia. For example, several humanist organizations opposed Section 217 of the Criminal Code, which was introduced in 2015 and declared unconstitutional and null and void in 2020 .

    Position of the German Ethics Council

    In an ad hoc recommendation in 2014 , the German Ethics Council warned against making assisted suicide a “normal case”. In principle, he supported the position of the German Medical Association that euthanasia was not a medical activity arising from professional responsibility, whereby decisions of conscience in a trusting doctor-patient relationship had to be respected in exceptional situations. The patient should be able to rely on the fact that the doctors think “life-oriented”. The relationship between doctors and patients requires a special relationship of trust, which is why decisions of conscience can be accepted in exceptional cases.

    In addition, the Ethics Council spoke out in favor of expanding palliative medical and hospice services. Suicide prevention should also be promoted.

    See also

    literature

    Web links

    Wiktionary: Euthanasia  - explanations of meanings, word origins, synonyms, translations
    Commons : Euthanasia  - collection of pictures, videos and audio files

    Individual evidence

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