Gilli-WMA EoL Presentation Vatican-Nov2017

11/23/17
1
Practice and Challenges
Assisted Suicide in
Switzerland
Contents
• Figures
• Research, Evaluation
• Legal frameworks
• Swiss „right to die“-societies
• Guidelines for health professionals
• Summary
| WMA| Assisted Suicide | Yvonne Gilli | November 2017
There are good reasons for an in-depth
analysis
• Increase in assisted suicide
| WMA| Assisted Suicide | Yvonne Gilli | November 2017
Scientific aspects NFP 67
„The NRP 67 aims to contribute to a better understanding of
changes and newly emerging needs in the context of death and
dying. The research findings will identify gaps or problems in the
provision of care and provide affected persons and care
professionals with a useful basis for decision-making.
Proposals will be developed for the adaptation of legal
regulations, and ethical implications will be reflected upon.
Another aim is to acquire a better understanding of social
changes in perceptions of the end of life.“1
1http://www.nfp67.ch/en/the-nrp
| WMA| Assisted Suicide | Yvonne Gilli | November 2017
Comparison diseases reported
| WMA| Assisted Suicide | Yvonne Gilli | November 2017
Medical end-of-life decisions in comparison
Medical End-of-Life Practices in Switzerland: A Comparison of 2001 and 2013
Bosshard, Georg; Zellweger, Ueli; Bopp, Matthias; Schmid, Margareta; Hurst, Samia A; Puhan, Milo A; Faisst,
Karin, Zurich Open Repository and Archive University of Zurich
University of Zurich
2001
forgoing life-prolonging treatment
intensified alleviation of symptoms
physician-assisted death
2013
forgoing life-prolonging treatment
intensified alleviation of symptoms
physician-assisted death
| WMA| Assisted Suicide | Yvonne Gilli | November 2017
11/23/17
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Medical end-of-life decisions in comparison
Medical End-of-Life Practices in Switzerland: A Comparison of 2001 and 2013
Bosshard, Georg; Zellweger, Ueli; Bopp, Matthias; Schmid, Margareta; Hurst, Samia A; Puhan, Milo A; Faisst,
Karin, Zurich Open Repository and Archive University of Zurich
University of Zurich
| WMA| Assisted Suicide | Yvonne Gilli | November 2017
0
2
4
6
8
10
12
14
16
18
20
continous deep sedation
2013 2001
• Substantial increase of deep
sedation
• Specific guidelines since
2005
• Sedation is combined with
o foregoing life-prolonging
treatments (62%)
o alleviation of pain and
symptoms (28%)
o physician-assisted death
(3%)
Swiss academies of Arts and Sciences
Medical-ethical Guidelines
• „End-of-life care“
– Key principles
– Decisions and treatments that shorten the duration of life itself
– Broadly accepted
– Controversial
– Illegal
• Currently under revision
• Passed by the Senate of the Swiss academies: 1st November 2017,
Publication and start of the consultation procedure on 16th November 2017
https://www.samw.ch/en/Publications/Medical-ethical-Guidelines.html
| WMA| Assisted Suicide | Yvonne Gilli | November 2017
Legal situation (Swiss Criminal Code)
Paragraph 115
Inciting and assisting suicide
Any person who for selfish
motives incites or assists another
to commit or attempt to commit
suicide is, if that other person
thereafter commits or attempts to
commit suicide, liable to a
custodial sentence not exceeding
five years or to a monetary penalty
Paragraph 114
Homicide at the request of
the victim
Any person who for commendable
motives, and in particular out of
compassion for the victim, causes
the death of a person at that
person’s own genuine and
insistent request is liable to a
custodial sentence not exceeding
three years or to a monetary
penalty.
| WMA| Assisted Suicide | Yvonne Gilli | November 2017 | WMA| Assisted Suicide | Yvonne Gilli | November 2017
“End of life care“ guidelines under
revision
• Since 2004 Guidelines, approved by the Senate of the Swiss
Adademy of Medical Sciences
• Focus on „end of life care“
• Assisted suicide
o no physician can be ordered to assist suicide
o the decision-making process to assist suicide or to reject to
do so must be documented
o the death of a patient as a result of assisted suicide must be
reported to the examining authorities as an unnatural death
| WMA| Assisted Suicide | Yvonne Gilli | November 2017
The revised guidelines
• Content expanded
– Professional dialogue with the dying patient
– Decision-making and treatment options as a mediation process
between diverging interests and conflicts of interest
– Obligation to define the therapeutic objective
• Recommendations more specific
– Differentiation and definition of treatments that may shorten the
duration of life
o Guidelines for doctors concerning treatments that are
controversial
o Clearly illegal actions
| WMA| Assisted Suicide | Yvonne Gilli | November 2017
11/23/17
3
Summary 1
• The numbers of assisted suicides are increasing
• The use of deep sedation as a treatment method
in end-of-life-care has increased substantially in
recent years
• Statutory obligations and Criminal code remain
unaffected and are broadly accepted and effective
| WMA| Assisted Suicide | Yvonne Gilli | November 2017
Summary 2
• The revised guidelines of the Swiss Academy of Arts and
Medical Sciences have to fight
o any social pressure towards end-of-life-care with the
aim to shorten the life of chronically or critically ill
patients and elderly persons depending on care
o any pressure on physicians to assist or perform
assisted suicide
o the interpretation of human rights as guaranteed
unlimited self-determination of individuals concerning
their time of death in the context of end-of-life-care
| WMA| Assisted Suicide | Yvonne Gilli | November 2017
Summary 3
• The revised guidelines of the Swiss Academy of Arts and
Medical Sciences should give more specified
recommendations on palliative sedation
o Best possible control of the symptoms with as few side-
effects as possible
o Respite sedation for severe non-somatic suffering if there
are no alternative treatment options
o Limiting terminal deep sedation to the dying process
o Quality management
| WMA| Assisted Suicide | Yvonne Gilli | November 2017
Summary 4
• The revised guidelines of the Swiss Academy of Arts and
Medical sciences should give specified recommendations
on assisted suicide
o The physician has the right to refuse
o The physician respects the patient‘s human right of self-
determination and acts in dedication for the benefit of the patient
o It is the physician‘s responsibility to check the essential
prerequisites such as severe suffering, no alternative treatment
options, persistent desire to die, no indications of pressure from a
third party, free will, power of judgement…
| WMA| Assisted Suicide | Yvonne Gilli | November 2017
Thank you
| WMA| Assisted Suicide | Yvonne Gilli | November 2017