In Switzerland, it is legal to assist suicide for altruistic reasons. Doctors in this country are permitted to support patients for whom a cure is not available and whose suffering is unbearable. Opponents of assisted suicide fear that over time the threshold could be lowered and vulnerable people could even be forced to bring their life to an end in this way. Researchers led by Matthias Egger at the Institute of Social and Preventive Medicine at the University of Bern have now investigated whether these fears are supported by the data.
The right-to-die organisations Exit Deutsche Schweiz, Exit Suisse Romande and Dignitas provided the Swiss Federal Statistical Office with anonymised data on a total of 1,301 cases of assisted suicide provided by the organisations to Swiss residents between 2003 and 2008. The researchers linked the information to data from the Swiss National Cohort – a cohort study of the Swiss population that is based on anonymised census data. These links produced information including the place of residence of the people concerned, their level of education, whether they lived alone and whether they had children.
The study, which has just been published (*), showed that more women than men (740 women compared with 561 men) die from assisted suicide. The proportion of women is also higher when the fact that there are more older women than older men is taken into account. People living alone and those who are divorced are also more likely to seek an assisted suicide than married and socially integrated persons. Younger people with children seek out suicide assistance less frequently than those who have no children; although the existence of children appears not to offer any protection among older people. “The results indicate that there could well be vulnerable groups,” says Matthias Egger. “Social isolation and loneliness are known to be risk factors for suicide, and this might also be the case for assisted suicide.”
In wealthy residential areas
The study also shows that better-educated people living in urban locations and in wealthy residential areas are more likely to seek help in dying. “These findings are not consistent with the theory that pressure on socially weaker people leads to increased levels of assisted suicide,” says Egger. “On the other hand, educated people who are well-placed financially can of course also feel isolated and lonely.” Educated, wealthy people might also have easier access to assisted suicide, for financial reasons for example.
In 1,093 of the 1,301 cases of assisted suicide, the researchers had additional information from the death certificate on the people who had sought assisted suicide. In almost half of these cases the people concerned had been suffering from cancer. The proportion of people suffering from incurable degenerative diseases of the nervous system, such as multiple sclerosis, Parkinson’s disease or amyotrophic lateral sclerosis (ALS) was also high.
In around 200 of the 1,300 reported cases, the official death certificate failed to record the fatal illness from which the person concerned had been suffering at the time of assisted suicide. The researchers recommend that a register be created in which all assisted suicides are recorded anonymously. “Such a controversial topic demands careful oversight by the State,” says Egger.
(*) Nicole Steck, Christoph Junker, Maud Maessen, Thomas Reisch, Marcel Zwahlen, and Matthias Egger for the Swiss National Cohort (2014). Suicide assisted by Right-to-Die Associations: Population based cohort study. International Journal of Epidemiology online. doi: 10.1093/ije/dyu010
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Prof Matthias Egger
Institute of Social and Preventive Medicine
University of Bern
Phone: +41 79 239 97 17