Assisted suicide

When persons with capacity request medical professionals for support in bringing about their own death, this represents a highly challenging situation. A desire for death must be taken seriously and respected. At the same time, each physician must be able to decide freely whether or not they wish to perform assisted suicide. Anyone who decides to do so bears a substantial responsibility – from a medical and an ethical perspective. The SAMS guidelines offer medical-ethical guidance for those members of the medical profession who are in principle prepared to perform assisted suicide.

Since the late 1990s, there has been a marked increase in deaths by assisted suicide as a proportion of all deaths occurring in Switzerland – from 0.2% in 1999 to 2–3% today. This growing «normalisation» may lead to certain groups or individuals feeling under pressure to end their lives prematurely – for example, because they believe themselves to be a burden, or a drain on resources. The duty to care for and protect vulnerable persons involves an obligation to take appropriate measures to prevent them from feeling pressured into assisted suicide.

In Switzerland, there is no national law on assisted suicide. The legal framework is defined by the Swiss Criminal Code and the Narcotics Act. Assisted suicide is permissible in Switzerland provided that the person seeking suicide has capacity and performs the final act leading to death him/herself, and the person rendering assistance does not act from selfish motives. This means that assisted suicide is not prohibited even in the case of healthy individuals, or minors with capacity.

In practice, however, assisted suicide is subject to more stringent conditions, based on self‑regulation – on the one hand, the rules of the assisted suicide organisations (e.g. association by-laws) and, on the other, the SAMS guidelines on «Management of dying and death». These guidelines deal with medical-ethical aspects of assisted suicide and describe in general terms the duties of care associated with professional ethics. They form part of the Code of the Swiss Medical Association (FMH) and are binding for its members.

Both the above-mentioned association by-laws and the guidelines can be modified by the organisations in question. In the case of SAMS guidelines, this process is specified in the Regulations of the Central Ethics Committee (CEC) (available in French / German) and is subject to defined quality assurance and review procedures.

In Switzerland, assisted suicide is largely handled by private organisations in this field. In the vast majority of cases, it takes place outside of healthcare institutions. However, the medical profession is involved in two ways:

• Assisted suicide requires the administration of a lethal drug (phenobarbitone sodium, PBS), which can only be prescribed by a physician.
• The capacity of the person seeking suicide must be assessed, generally by a physician.

Physicians are thus inevitably involved in assisted suicide. If they are confronted with a request for assisted suicide, nuanced, case-by-case decision-making is called for. Guidance is provided by professional ethics – in particular, Section 6.2.1 («Assisted suicide») of the SAMS guidelines on «Management of dying and death».

The guidelines emphasis that a desire for death must be taken seriously. Physicians have a duty to listen and seek to identify the reasons underlying the desire for death. Their responsibilities include the alleviation of symptoms, provision of support for patients and discussion of alternatives to suicide. There is no duty to provide assisted suicide – physicians are not obliged either to perform it or to offer it proactively.

If patients ask physicians for assistance in ending their own lives, this poses a profound challenge to the medical professionals’ understanding of their role in terms of professional ethics. At issue is their autonomy in the exercise of their profession: individual physicians must be able to decide for themselves whether or not to perform assisted suicide. At the same time, empathy and compassion for the person wishing to die are also called for – attitudes which are likewise an integral part of the physician’s professional ethics.

Before performing assisted suicide or writing the necessary prescription, physicians must make sure that this decision is for the benefit of the person concerned. This requires a relationship of trust and respect, involving compassion and judgement. The physician’s action is based on careful reflection: on the one hand, autonomy and hence also the desire for a self-determined death are to be respected; at the same time, protection from abuse and prevention of coercion of particularly vulnerable individuals must always be assured. The aim is to arrive at a well-considered decision through a well-founded, respectful dialogue.

At the centre lies the dialogue with the person seeking suicide. The guidelines – other than in justified exceptional cases – require at least two detailed discussions to be conducted, separated by an interval of two weeks. If the desire for death persists in a person who has been carefully informed and assessed, assisted suicide is considered to be ethically justifiable according to the SAMS guidelines provided that all of the following four requirements are met.

1. Capacity: The person seeking suicide has capacity;
2. Self-determination: The person has an autonomous desire to die, which is well‑considered and not due to external pressure;
3. Severe suffering: The person is experiencing intolerable suffering. This involves medically definable severe symptoms of disease and/or functional impairments, and the expression of intolerability is comprehensible for the physician;
4. Consideration of alternatives: Possible alternatives have been explored and have proved inappropriate or been rejected by the person seeking suicide.

The first two requirements – capacity and self-determination – must additionally be confirmed by an independent third party, who need not be a physician.

In connection with assisted suicide, notification duties exist: the prescription of the lethal drug (PBS) must be reported to the relevant cantonal authorities within 30 days, and death as a result of assisted suicide must be immediately reported as an unnatural death.

Questions concerning the eligibility criteria for assisted suicide are continuously debated. The SAMS considers it essential that there should be a comprehensive discussion within society of how assisted suicide is to be understood and ethically evaluated. While the perspectives of the medical and other health professions provide central points of reference, they are not sufficient for a definitive assessment. It is a matter for society to determine whether, for example, assisted suicide should be accessible for healthy individuals or for minors, and what implications this would have for all concerned.

Also to be carefully considered is the question of what safeguards are required for vulnerable groups, so as to ensure that people do not feel pressured into assisted suicide. In addition, it must be discussed how self-determination is to be assured in each individual case and how possible abuses can be effectively prevented.

These questions are also a matter of political debate. As a member of the association of Academies, the SAMS has a responsibility to promote dialogue between scientists, policymakers and administrative bodies. One established forum for dialogue is Science et Politique à table!. Here, the Swiss Academies of Arts and Sciences invite parliamentarians from the National Council and the Council of States, as well as members of party secretariats, to discuss current topics with leading scientists. The event held on 4 March 2025 was concerned with assisted suicide. The documentation can be downloaded here.

• Presentations: Is assisted suicide adequately regulated in Switzerland? (4 March 2025) (available in French / German)
• Summary of the discussion: Is assisted suicide adequately regulated in Switzerland? (4 March 2025) (available in French / German)

In general, it is a physician who assesses whether the four requirements specified in the SAMS guidelines for assisted suicide are met (capacity, self-determination, intolerable suffering, consideration of alternatives – see above for details). The prescription for the lethal drug (PBS) can only be issued by a physician. In Switzerland, an assisted suicide organisation is usually responsible for coordination of the whole process.

A physician is not generally directly involved when assisted suicide takes place; instead, a volunteer from the assisted suicide organisation is present to provide support. The final action in the process leading to death must always be performed by the person wishing to die – i.e. they must drink the lethal preparation or initiate the infusion themselves.

Any death resulting from assisted suicide must be reported as an «unnatural death». The competent authorities arrange for the necessary investigations to be carried out.

This activity involves a high degree of responsibility. Discussions with the person seeking suicide are of crucial importance. Physicians must ensure that the person concerned (1) has capacity; (2) is aware of, and has been offered, alternatives; and that (3) their desire for death is self‑determined, well-considered and enduring, and not due to external pressure.

In the SAMS guidelines, prescription of the lethal drug (PBS) is subject to a fourth condition: (4) there must be medically definable severe symptoms of disease and/or functional impairments, causing intolerable suffering in the person concerned. This suffering and the person’s consequent wish to end their own life must be comprehensible for the physician. This comprehensibility is of central ethical importance: anyone prescribing a lethal substance must be certain, in each individual case, that this is a responsible action, since by issuing the prescription the physician is contributing directly to the ending of a life.

Medical participation in assisted suicide is ethically and professionally compatible with physicians’ understanding of their role if medically definable symptoms of disease and/or functional impairments are the reason for the suffering which is felt to be intolerable. Physicians are not, however, obliged to provide assisted suicide or to propose it as an option. Each physician will decide for themselves whether this activity is compatible with their own understanding of their professional role.

No. The term «end-of-life care» has a different meaning: this is what is provided on a daily basis by nurses, physicians and caring relatives supporting people who are approaching the end of their lives. End-of-life care in the sense of palliative care (available in French and in German) aims to provide comprehensive alleviation of distressing symptoms in people who are terminally ill. The focus is not on shortening life, but on preserving autonomy, dignity and quality of life right up to the end.

The term “end-of-life care” should therefore not be used for assisted suicide.

In Switzerland, the great majority of people who die with assisted suicide are aged over 64, with significantly more women than men. Around 40% are suffering from cancer, 10–15% from neurological diseases and the same proportion from cardiovascular disorders. A third have other conditions, including dementia and depression.

Assisted suicide almost always takes place at home, i.e. in a private apartment or care home. However, professionals working in hospitals and psychiatric clinics are also confronted with enquiries about assisted suicide. Some cantons have introduced binding regulations to ensure that assisted suicide can be performed in hospitals, psychiatric clinics and care/nursing homes. In other cantons, some healthcare facilities have their own internal guidelines: some prohibit assisted suicide on site, others tolerate it under certain conditions.

As the medical-ethical justifiability of assisted suicide according to the four criteria specified in the SAMS Guidelines (see above) is not restricted to particular diagnostic groups, it also applies to people with a mental disorder. It would be discriminatory to rule out the possibility of assisted suicide for this group solely on the basis of the diagnosis. It should be emphasised, however, that suicidality is a characteristic and treatable symptom of many mental disorders, and that the assessment of capacity in relation to assisted suicide in people with mental disorders poses particular professional and medical-ethical challenges.

A desire for death must always – i.e. also in the presence of a mental disorder – be taken seriously and discussed in depth. Addressing this topic is extremely demanding for both parties, but is indispensable in order to arrive at a decision that is coherent and justifiable both for the individual concerned and for the professional involved.

Given the implications of the decision, mental incapacity on the part of the person seeking assisted suicide must be particularly carefully excluded. Of relevance for the assessment are not only cognitive but also emotional, motivational and volitional factors. Physicians who are required to assess capacity can refer to the SAMS guidelines on «Assessment of capacity in medical practice». In addition to the exploratory discussions, these guidelines recommend the adoption of a standardised procedure for the evaluation of decision-making capacity and provide a tool U-Doc for this purpose.

Assisted suicide affects not only the person directly concerned but also the people close to them. Against this background, the SAMS guidelines recommend that individuals desiring suicide should be encouraged to discuss their wishes with their relatives at an early stage. Relatives who themselves wish, or are requested by the person concerned, to support the process face considerable emotional challenges – for example, when it comes to the “right” time for the assisted suicide appointment.

Physicians must therefore always bear in mind that those close to the person concerned also require attention and support in this stressful situation. Before, during and after the performance of assisted suicide, consideration should be given to the needs of relatives and, if appropriate, the interprofessional care team and others closely involved; any support which may be required is to be made available and documented.

In Switzerland, there is no specific federal law regulating the details of assisted suicide. At the federal level, assisted suicide is only explicitly mentioned in criminal law. The Swiss Criminal Code (CC) restricts assisted suicide in Art. 115, by prohibiting assistance in suicide if it is provided for selfish motives. It is also a legal requirement that the final act leading to death must be performed by the person concerned him/herself. Otherwise, this would be a case of homicide at the victim’s request, which is an offence under Art. 114 CC.

If assisted suicide is to be permissible, the person concerned must have capacity. Only then does it qualify as suicide. Involvement in the death of a person who lacks capacity could possibly be regarded as intentional homicide, which is prohibited under Art. 111 ff. CC.

Also applicable for physicians issuing a prescription for the lethal drug (PBS) are the provisions of the Federal Narcotics Act.

In summary, this means that assisted suicide is not an offence in Switzerland if the person wishing to die has capacity and performs the act him/herself, and if the person providing support is not acting from selfish motives. In practice, however, assisted suicide is subject to tighter standards, defined not by law but through self-regulation (the rules of the assisted suicide organisations and the SAMS guidelines).

Only a few cantons have specific legal regulations on assisted suicide. Such provisions have been enacted by the cantons of Geneva, Vaud, Neuchâtel and Valais. These relate to assisted suicide in public institutions such as hospitals, psychiatric clinics and care/nursing homes. The cantonal laws define material requirements which must be met. In terms of content, these are largely in agreement with the four criteria specified in the SAMS guidelines. In addition, the cantonal laws regulate the specific procedure and formulate binding duties of care.

The SAMS has been closely concerned with assisted suicide for many years. Over the last two decades, a notable development could be observed: in the guidelines on «Care of patients at the end of life» published in 2004, it was stated that assisted suicide could only be ethically justifiable «if the end of life is near». Through engagement with societal developments and in close consultation with the health professions concerned, medical-ethical reflection led to the revised guidelines.

The guidelines currently in force (2018, adapted in 2021) also discuss assisted suicide in relation to cases where death is not yet imminent. In these guidelines, assisted suicide is considered to be justifiable even when the end of life is not yet approaching but intolerable suffering is present. However, the wording used in the 2018 version gave rise to uncertainties in practice. The section on assisted suicide was therefore clarified in 2021. What was implicit in the 2018 version is now explicitly stated: under the guidelines, the performance of assisted suicide in persons who are healthy is not ethically justifiable. It may, however, be considered in cases where a person is experiencing intolerable suffering as a result of a medically defined severe disease or functional impairment, and treatment options have been exhausted or rejected.

• SÄZ/BMS: Forum contribution by Paul Hoff, Chair of the Central Ethics Committee of the SAMS. “Assisted suicide: not essentially a medical responsibility” (p. 22; available in French / German) (14 August 2024)
• SÄZ/BMS: Article by the FMH legal department. “Clarification of jurisprudence on assisted suicide” (pp. 36–37; available in French / German) (14 August 2024)
• SÄZ/BMS: Interview with Paul Hoff, Chair of the Central Ethics Committee of the SAMS. “We want to promote ethical sensitivity among physicians” (available in French / German) (17 August 2022)
• SAMS Newsletter: Guidance on end-of-life treatment and care (19 May 2022) (available in French / German)

Advance care planning (ACP)

ACP in retirement and nursing homes

Medical care in retirement and nursing homes (available in German and French)

Palliative care (available in German and French)

Dying and death

All SAMS guidelines